|
Chemo, IV Push, Addl Drug 96411
|
Facility
|
IP
|
$503.00
|
|
|
Service Code
|
CPT 96411
|
| Hospital Charge Code |
3595514
|
|
Hospital Revenue Code
|
330
|
| Min. Negotiated Rate |
$256.33 |
| Max. Negotiated Rate |
$481.27 |
| Rate for Payer: Aetna Commercial |
$470.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$449.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$277.25
|
| Rate for Payer: Cash Price |
$150.90
|
| Rate for Payer: Cigna Commercial |
$481.27
|
| Rate for Payer: Health EOS Commercial |
$465.58
|
| Rate for Payer: HFN Commercial |
$481.27
|
| Rate for Payer: Multiplan Commercial |
$418.50
|
| Rate for Payer: Preferred Network Access Commercial |
$481.27
|
| Rate for Payer: Quartz Beloit One Network |
$256.33
|
| Rate for Payer: Quartz Commercial |
$313.87
|
| Rate for Payer: WEA Trust Commercial |
$287.72
|
| Rate for Payer: WPS Commercial |
$387.46
|
|
|
Chemo, IV Push, Sngl Drug
|
Facility
|
IP
|
$697.00
|
|
|
Service Code
|
CPT 96409
|
| Hospital Charge Code |
3595513
|
|
Hospital Revenue Code
|
330
|
| Min. Negotiated Rate |
$355.19 |
| Max. Negotiated Rate |
$666.89 |
| Rate for Payer: Aetna Commercial |
$652.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$623.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$384.19
|
| Rate for Payer: Cash Price |
$209.10
|
| Rate for Payer: Cigna Commercial |
$666.89
|
| Rate for Payer: Health EOS Commercial |
$645.14
|
| Rate for Payer: HFN Commercial |
$666.89
|
| Rate for Payer: Multiplan Commercial |
$579.90
|
| Rate for Payer: Preferred Network Access Commercial |
$666.89
|
| Rate for Payer: Quartz Beloit One Network |
$355.19
|
| Rate for Payer: Quartz Commercial |
$434.93
|
| Rate for Payer: WEA Trust Commercial |
$398.68
|
| Rate for Payer: WPS Commercial |
$536.90
|
|
|
Chemo, IV Push, Sngl Drug
|
Facility
|
OP
|
$697.00
|
|
|
Service Code
|
CPT 96409
|
| Hospital Charge Code |
3595513
|
|
Hospital Revenue Code
|
330
|
| Min. Negotiated Rate |
$347.61 |
| Max. Negotiated Rate |
$1,390.44 |
| Rate for Payer: Aetna Commercial |
$652.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$623.40
|
| Rate for Payer: Aetna Managed Medicare |
$347.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$471.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$362.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$347.94
|
| Rate for Payer: Anthem Medicare Advantage |
$347.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$384.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$347.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$347.61
|
| Rate for Payer: Cash Price |
$209.10
|
| Rate for Payer: Cash Price |
$209.10
|
| Rate for Payer: Cigna Commercial |
$666.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$347.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$405.65
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$347.61
|
| Rate for Payer: Health EOS Commercial |
$645.14
|
| Rate for Payer: HFN Commercial |
$666.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,293.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$347.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$347.61
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$347.61
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$347.61
|
| Rate for Payer: Multiplan Commercial |
$579.90
|
| Rate for Payer: NAPHCARE Commercial |
$521.41
|
| Rate for Payer: Preferred Network Access Commercial |
$666.89
|
| Rate for Payer: Quartz Beloit One Network |
$355.19
|
| Rate for Payer: Quartz Commercial |
$471.17
|
| Rate for Payer: Quartz Medicare Advantage |
$347.61
|
| Rate for Payer: The Alliance Commercial |
$1,390.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$347.61
|
| Rate for Payer: United Healthcare PPO |
$543.66
|
| Rate for Payer: WEA Trust Commercial |
$398.68
|
| Rate for Payer: Wellcare Medicare |
$347.61
|
| Rate for Payer: WPS Commercial |
$536.90
|
|
|
CHEMO PORT INSERTION
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2959925
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$552.41 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$676.42
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
CHEMO PORT INSERTION
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2959925
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$315.66 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Aetna Managed Medicare |
$315.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$732.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$563.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$541.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$630.89
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.52
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: NAPHCARE Commercial |
$676.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$732.78
|
| Rate for Payer: Quartz Medicare Advantage |
$676.42
|
| Rate for Payer: The Alliance Commercial |
$563.68
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
CHEMOTHERAPY
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
EAPG 00803
|
| Min. Negotiated Rate |
$109.61 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Anthem Medicaid |
$109.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$109.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$109.61
|
| Rate for Payer: Dean Health Medicaid |
$109.61
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$109.61
|
| Rate for Payer: Managed Health Services Medicaid |
$114.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$109.61
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$109.61
|
| Rate for Payer: United Healthcare Medicaid |
$109.61
|
|
|
CHEMOTHERAPY FOR ACUTE LEUKEMIA
|
Facility
|
IP
|
$47,699.61
|
|
|
Service Code
|
APR-DRG 6954
|
| Min. Negotiated Rate |
$42,369.77 |
| Max. Negotiated Rate |
$47,699.61 |
| Rate for Payer: Anthem Medicaid |
$45,675.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$45,675.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$45,675.00
|
| Rate for Payer: Dean Health Medicaid |
$45,675.00
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$42,369.77
|
| Rate for Payer: Managed Health Services Medicaid |
$47,699.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$45,675.00
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$45,675.00
|
| Rate for Payer: United Healthcare Medicaid |
$45,675.00
|
|
|
CHEMOTHERAPY FOR ACUTE LEUKEMIA
|
Facility
|
IP
|
$12,100.27
|
|
|
Service Code
|
APR-DRG 6952
|
| Min. Negotiated Rate |
$10,748.21 |
| Max. Negotiated Rate |
$12,100.27 |
| Rate for Payer: Anthem Medicaid |
$11,586.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$11,586.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11,586.67
|
| Rate for Payer: Dean Health Medicaid |
$11,586.67
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$10,748.21
|
| Rate for Payer: Managed Health Services Medicaid |
$12,100.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,586.67
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11,586.67
|
| Rate for Payer: United Healthcare Medicaid |
$11,586.67
|
|
|
CHEMOTHERAPY FOR ACUTE LEUKEMIA
|
Facility
|
IP
|
$24,112.85
|
|
|
Service Code
|
APR-DRG 6953
|
| Min. Negotiated Rate |
$21,418.54 |
| Max. Negotiated Rate |
$24,112.85 |
| Rate for Payer: Anthem Medicaid |
$23,089.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$23,089.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$23,089.38
|
| Rate for Payer: Dean Health Medicaid |
$23,089.38
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$21,418.54
|
| Rate for Payer: Managed Health Services Medicaid |
$24,112.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$23,089.38
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$23,089.38
|
| Rate for Payer: United Healthcare Medicaid |
$23,089.38
|
|
|
CHEMOTHERAPY FOR ACUTE LEUKEMIA
|
Facility
|
IP
|
$7,540.75
|
|
|
Service Code
|
APR-DRG 6951
|
| Min. Negotiated Rate |
$6,698.16 |
| Max. Negotiated Rate |
$7,540.75 |
| Rate for Payer: Anthem Medicaid |
$7,220.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$7,220.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7,220.68
|
| Rate for Payer: Dean Health Medicaid |
$7,220.68
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6,698.16
|
| Rate for Payer: Managed Health Services Medicaid |
$7,540.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,220.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$7,220.68
|
| Rate for Payer: United Healthcare Medicaid |
$7,220.68
|
|
|
Chemotherapy Infusion > 8 hrs per portable pump
|
Facility
|
IP
|
$1,498.00
|
|
|
Service Code
|
CPT 96416
|
| Hospital Charge Code |
5220607
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$763.38 |
| Max. Negotiated Rate |
$1,433.29 |
| Rate for Payer: Aetna Commercial |
$1,402.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,339.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$825.70
|
| Rate for Payer: Cash Price |
$449.40
|
| Rate for Payer: Cigna Commercial |
$1,433.29
|
| Rate for Payer: Health EOS Commercial |
$1,386.55
|
| Rate for Payer: HFN Commercial |
$1,433.29
|
| Rate for Payer: Multiplan Commercial |
$1,246.34
|
| Rate for Payer: Preferred Network Access Commercial |
$1,433.29
|
| Rate for Payer: Quartz Beloit One Network |
$763.38
|
| Rate for Payer: Quartz Commercial |
$934.75
|
| Rate for Payer: WEA Trust Commercial |
$856.86
|
| Rate for Payer: WPS Commercial |
$1,153.91
|
|
|
Chemotherapy Infusion > 8 hrs per portable pump
|
Facility
|
OP
|
$1,498.00
|
|
|
Service Code
|
CPT 96416
|
| Hospital Charge Code |
5220607
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$347.61 |
| Max. Negotiated Rate |
$1,433.29 |
| Rate for Payer: Aetna Commercial |
$1,402.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,339.81
|
| Rate for Payer: Aetna Managed Medicare |
$347.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,012.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$778.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$747.80
|
| Rate for Payer: Anthem Medicare Advantage |
$347.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$825.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$347.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$347.61
|
| Rate for Payer: Cash Price |
$449.40
|
| Rate for Payer: Cash Price |
$449.40
|
| Rate for Payer: Cigna Commercial |
$1,433.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$347.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$871.84
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$347.61
|
| Rate for Payer: Health EOS Commercial |
$1,386.55
|
| Rate for Payer: HFN Commercial |
$1,433.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,293.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$347.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$347.61
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$347.61
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$347.61
|
| Rate for Payer: Multiplan Commercial |
$1,246.34
|
| Rate for Payer: NAPHCARE Commercial |
$521.41
|
| Rate for Payer: Preferred Network Access Commercial |
$1,433.29
|
| Rate for Payer: Quartz Beloit One Network |
$763.38
|
| Rate for Payer: Quartz Commercial |
$1,012.65
|
| Rate for Payer: Quartz Medicare Advantage |
$347.61
|
| Rate for Payer: The Alliance Commercial |
$1,390.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$347.61
|
| Rate for Payer: WEA Trust Commercial |
$856.86
|
| Rate for Payer: Wellcare Medicare |
$347.61
|
| Rate for Payer: WPS Commercial |
$1,153.91
|
|
|
Chemotherapy Infusion ea addl seq up to 1 hr
|
Facility
|
OP
|
$633.00
|
|
|
Service Code
|
CPT 96417
|
| Hospital Charge Code |
5216617
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$75.77 |
| Max. Negotiated Rate |
$605.65 |
| Rate for Payer: Aetna Commercial |
$592.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$566.16
|
| Rate for Payer: Aetna Managed Medicare |
$75.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$427.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$329.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$315.99
|
| Rate for Payer: Anthem Medicare Advantage |
$75.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$348.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$75.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$75.77
|
| Rate for Payer: Cash Price |
$189.90
|
| Rate for Payer: Cash Price |
$189.90
|
| Rate for Payer: Cigna Commercial |
$605.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$75.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$368.41
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$75.77
|
| Rate for Payer: Health EOS Commercial |
$585.90
|
| Rate for Payer: HFN Commercial |
$605.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$281.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$75.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$75.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$75.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$75.77
|
| Rate for Payer: Multiplan Commercial |
$526.66
|
| Rate for Payer: NAPHCARE Commercial |
$113.66
|
| Rate for Payer: Preferred Network Access Commercial |
$605.65
|
| Rate for Payer: Quartz Beloit One Network |
$322.58
|
| Rate for Payer: Quartz Commercial |
$427.91
|
| Rate for Payer: Quartz Medicare Advantage |
$75.77
|
| Rate for Payer: The Alliance Commercial |
$303.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$75.77
|
| Rate for Payer: WEA Trust Commercial |
$362.08
|
| Rate for Payer: Wellcare Medicare |
$75.77
|
| Rate for Payer: WPS Commercial |
$487.60
|
|
|
Chemotherapy Infusion ea addl seq up to 1 hr
|
Facility
|
IP
|
$633.00
|
|
|
Service Code
|
CPT 96417
|
| Hospital Charge Code |
5216617
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$322.58 |
| Max. Negotiated Rate |
$605.65 |
| Rate for Payer: Aetna Commercial |
$592.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$566.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$348.91
|
| Rate for Payer: Cash Price |
$189.90
|
| Rate for Payer: Cigna Commercial |
$605.65
|
| Rate for Payer: Health EOS Commercial |
$585.90
|
| Rate for Payer: HFN Commercial |
$605.65
|
| Rate for Payer: Multiplan Commercial |
$526.66
|
| Rate for Payer: Preferred Network Access Commercial |
$605.65
|
| Rate for Payer: Quartz Beloit One Network |
$322.58
|
| Rate for Payer: Quartz Commercial |
$394.99
|
| Rate for Payer: WEA Trust Commercial |
$362.08
|
| Rate for Payer: WPS Commercial |
$487.60
|
|
|
CHEMOTHERAPY, INTO CNS 96450
|
Professional
|
Both
|
$783.00
|
|
|
Service Code
|
CPT 96450
|
| Hospital Charge Code |
3015505
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$65.29 |
| Max. Negotiated Rate |
$773.60 |
| Rate for Payer: Aetna Commercial |
$773.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$700.32
|
| Rate for Payer: Aetna Managed Medicare |
$65.29
|
| Rate for Payer: Anthem Medicare Advantage |
$65.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$65.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$65.29
|
| Rate for Payer: Cash Price |
$234.90
|
| Rate for Payer: Cash Price |
$234.90
|
| Rate for Payer: Cash Price |
$234.90
|
| Rate for Payer: Cigna Commercial |
$773.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$136.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$65.29
|
| Rate for Payer: Health EOS Commercial |
$741.03
|
| Rate for Payer: HFN Commercial |
$773.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$631.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$631.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$65.29
|
| Rate for Payer: Multiplan Commercial |
$651.46
|
| Rate for Payer: NAPHCARE Commercial |
$97.94
|
| Rate for Payer: Preferred Network Access Commercial |
$773.60
|
| Rate for Payer: Quartz Beloit One Network |
$358.30
|
| Rate for Payer: Quartz Commercial |
$464.16
|
| Rate for Payer: Quartz Medicare Advantage |
$65.29
|
| Rate for Payer: The Alliance Commercial |
$163.23
|
| Rate for Payer: United Healthcare Medicaid |
$136.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$65.29
|
| Rate for Payer: WEA Trust Commercial |
$447.88
|
| Rate for Payer: WPS Commercial |
$261.16
|
|
|
CHEMOTHERAPY, INTRACAVITARY 96440
|
Professional
|
Both
|
$820.00
|
|
|
Service Code
|
CPT 96440
|
| Hospital Charge Code |
3015504
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$115.74 |
| Max. Negotiated Rate |
$3,419.95 |
| Rate for Payer: Aetna Commercial |
$810.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$733.41
|
| Rate for Payer: Aetna Managed Medicare |
$115.74
|
| Rate for Payer: Anthem Medicare Advantage |
$115.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$115.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$115.74
|
| Rate for Payer: Cash Price |
$246.00
|
| Rate for Payer: Cash Price |
$246.00
|
| Rate for Payer: Cash Price |
$246.00
|
| Rate for Payer: Cigna Commercial |
$810.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$136.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$115.74
|
| Rate for Payer: Health EOS Commercial |
$776.05
|
| Rate for Payer: HFN Commercial |
$810.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,419.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,419.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$115.74
|
| Rate for Payer: Multiplan Commercial |
$682.24
|
| Rate for Payer: NAPHCARE Commercial |
$173.61
|
| Rate for Payer: Preferred Network Access Commercial |
$810.16
|
| Rate for Payer: Quartz Beloit One Network |
$375.23
|
| Rate for Payer: Quartz Commercial |
$486.10
|
| Rate for Payer: Quartz Medicare Advantage |
$115.74
|
| Rate for Payer: The Alliance Commercial |
$289.35
|
| Rate for Payer: United Healthcare Medicaid |
$136.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$115.74
|
| Rate for Payer: WEA Trust Commercial |
$469.04
|
| Rate for Payer: WPS Commercial |
$462.97
|
|
|
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC
|
Facility
|
IP
|
$134,267.12
|
|
|
Service Code
|
MSDRG 837
|
| Min. Negotiated Rate |
$37,299.06 |
| Max. Negotiated Rate |
$134,267.12 |
| Rate for Payer: Aetna Managed Medicare |
$37,299.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$104,825.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$80,348.27
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$76,336.10
|
| Rate for Payer: Anthem Medicare Advantage |
$37,299.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$37,299.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$37,299.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$37,299.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$84,740.07
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$37,299.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$96,463.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$37,299.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$37,299.06
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$37,299.06
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$37,299.06
|
| Rate for Payer: NAPHCARE Commercial |
$55,948.59
|
| Rate for Payer: Quartz Medicare Advantage |
$37,299.06
|
| Rate for Payer: The Alliance Commercial |
$134,267.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37,299.06
|
| Rate for Payer: United Healthcare PPO |
$75,098.34
|
| Rate for Payer: Wellcare Medicare |
$37,299.06
|
|
|
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT
|
Facility
|
IP
|
$55,679.52
|
|
|
Service Code
|
MSDRG 838
|
| Min. Negotiated Rate |
$16,492.50 |
| Max. Negotiated Rate |
$55,679.52 |
| Rate for Payer: Aetna Managed Medicare |
$16,492.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45,545.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$34,910.18
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$33,166.95
|
| Rate for Payer: Anthem Medicare Advantage |
$16,492.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16,492.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16,492.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16,492.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36,818.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16,492.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39,594.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16,492.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16,492.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16,492.50
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16,492.50
|
| Rate for Payer: NAPHCARE Commercial |
$24,738.75
|
| Rate for Payer: Quartz Medicare Advantage |
$16,492.50
|
| Rate for Payer: The Alliance Commercial |
$55,679.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16,492.50
|
| Rate for Payer: United Healthcare PPO |
$30,824.96
|
| Rate for Payer: Wellcare Medicare |
$16,492.50
|
|
|
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC
|
Facility
|
IP
|
$36,363.60
|
|
|
Service Code
|
MSDRG 839
|
| Min. Negotiated Rate |
$11,564.45 |
| Max. Negotiated Rate |
$36,363.60 |
| Rate for Payer: Aetna Managed Medicare |
$11,564.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31,504.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24,148.13
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22,942.30
|
| Rate for Payer: Anthem Medicare Advantage |
$11,564.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,564.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,564.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,564.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25,468.06
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,564.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26,426.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,564.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,564.45
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,564.45
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,564.45
|
| Rate for Payer: NAPHCARE Commercial |
$17,346.67
|
| Rate for Payer: Quartz Medicare Advantage |
$11,564.45
|
| Rate for Payer: The Alliance Commercial |
$36,363.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,564.45
|
| Rate for Payer: United Healthcare PPO |
$20,573.65
|
| Rate for Payer: Wellcare Medicare |
$11,564.45
|
|
|
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC
|
Facility
|
IP
|
$33,861.36
|
|
|
Service Code
|
MSDRG 847
|
| Min. Negotiated Rate |
$10,525.23 |
| Max. Negotiated Rate |
$33,861.36 |
| Rate for Payer: Aetna Managed Medicare |
$10,525.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$28,543.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21,878.65
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20,786.15
|
| Rate for Payer: Anthem Medicare Advantage |
$10,525.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,525.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,525.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,525.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23,074.53
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,525.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24,591.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,525.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,525.23
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,525.23
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,525.23
|
| Rate for Payer: NAPHCARE Commercial |
$15,787.84
|
| Rate for Payer: Quartz Medicare Advantage |
$10,525.23
|
| Rate for Payer: The Alliance Commercial |
$33,861.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,525.23
|
| Rate for Payer: United Healthcare PPO |
$19,144.82
|
| Rate for Payer: Wellcare Medicare |
$10,525.23
|
|
|
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC
|
Facility
|
IP
|
$67,907.84
|
|
|
Service Code
|
MSDRG 846
|
| Min. Negotiated Rate |
$20,360.66 |
| Max. Negotiated Rate |
$67,907.84 |
| Rate for Payer: Aetna Managed Medicare |
$20,360.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56,566.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$43,357.59
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$41,192.54
|
| Rate for Payer: Anthem Medicare Advantage |
$20,360.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20,360.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20,360.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$20,360.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45,727.50
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$20,360.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49,564.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20,360.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20,360.66
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$20,360.66
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$20,360.66
|
| Rate for Payer: NAPHCARE Commercial |
$30,540.99
|
| Rate for Payer: Quartz Medicare Advantage |
$20,360.66
|
| Rate for Payer: The Alliance Commercial |
$67,907.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20,360.66
|
| Rate for Payer: United Healthcare PPO |
$38,586.45
|
| Rate for Payer: Wellcare Medicare |
$20,360.66
|
|
|
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC
|
Facility
|
IP
|
$23,454.08
|
|
|
Service Code
|
MSDRG 848
|
| Min. Negotiated Rate |
$7,011.65 |
| Max. Negotiated Rate |
$23,454.08 |
| Rate for Payer: Aetna Managed Medicare |
$7,011.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,533.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,205.57
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,496.22
|
| Rate for Payer: Anthem Medicare Advantage |
$7,011.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,011.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,011.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,011.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14,982.04
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,011.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,402.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,011.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,011.65
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,011.65
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,011.65
|
| Rate for Payer: NAPHCARE Commercial |
$10,517.47
|
| Rate for Payer: Quartz Medicare Advantage |
$7,011.65
|
| Rate for Payer: The Alliance Commercial |
$23,454.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,011.65
|
| Rate for Payer: United Healthcare PPO |
$11,991.17
|
| Rate for Payer: Wellcare Medicare |
$7,011.65
|
|
|
CHEST DRAIN ATRUIM EXPRESS ATS BLOOD RECOVERY 4050-100N
|
Facility
|
IP
|
$773.00
|
|
| Hospital Charge Code |
5179403
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$393.92 |
| Max. Negotiated Rate |
$739.61 |
| Rate for Payer: Aetna Commercial |
$723.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$691.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$426.08
|
| Rate for Payer: Cash Price |
$231.90
|
| Rate for Payer: Cigna Commercial |
$739.61
|
| Rate for Payer: Health EOS Commercial |
$715.49
|
| Rate for Payer: HFN Commercial |
$739.61
|
| Rate for Payer: Multiplan Commercial |
$643.14
|
| Rate for Payer: Preferred Network Access Commercial |
$739.61
|
| Rate for Payer: Quartz Beloit One Network |
$393.92
|
| Rate for Payer: Quartz Commercial |
$482.35
|
| Rate for Payer: WEA Trust Commercial |
$442.16
|
| Rate for Payer: WPS Commercial |
$595.44
|
|
|
CHEST DRAIN ATRUIM EXPRESS ATS BLOOD RECOVERY 4050-100N
|
Facility
|
OP
|
$773.00
|
|
| Hospital Charge Code |
5179403
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$225.10 |
| Max. Negotiated Rate |
$739.61 |
| Rate for Payer: Aetna Commercial |
$723.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$691.37
|
| Rate for Payer: Aetna Managed Medicare |
$225.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$522.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$401.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$385.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$426.08
|
| Rate for Payer: Cash Price |
$231.90
|
| Rate for Payer: Cigna Commercial |
$739.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$449.89
|
| Rate for Payer: Health EOS Commercial |
$715.49
|
| Rate for Payer: HFN Commercial |
$739.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$602.94
|
| Rate for Payer: Multiplan Commercial |
$643.14
|
| Rate for Payer: NAPHCARE Commercial |
$482.35
|
| Rate for Payer: Preferred Network Access Commercial |
$739.61
|
| Rate for Payer: Quartz Beloit One Network |
$393.92
|
| Rate for Payer: Quartz Commercial |
$522.55
|
| Rate for Payer: Quartz Medicare Advantage |
$482.35
|
| Rate for Payer: The Alliance Commercial |
$401.96
|
| Rate for Payer: WEA Trust Commercial |
$442.16
|
| Rate for Payer: WPS Commercial |
$595.44
|
|
|
CHEST DRAIN DUAL OASIS 3620-100
|
Facility
|
IP
|
$1,065.00
|
|
| Hospital Charge Code |
4020638
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$542.72 |
| Max. Negotiated Rate |
$1,018.99 |
| Rate for Payer: Aetna Commercial |
$996.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$952.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$587.03
|
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Cigna Commercial |
$1,018.99
|
| Rate for Payer: Health EOS Commercial |
$985.76
|
| Rate for Payer: HFN Commercial |
$1,018.99
|
| Rate for Payer: Multiplan Commercial |
$886.08
|
| Rate for Payer: Preferred Network Access Commercial |
$1,018.99
|
| Rate for Payer: Quartz Beloit One Network |
$542.72
|
| Rate for Payer: Quartz Commercial |
$664.56
|
| Rate for Payer: WEA Trust Commercial |
$609.18
|
| Rate for Payer: WPS Commercial |
$820.37
|
|
