|
Ado-Trastuzumab Emtansine
|
Facility
|
OP
|
$12,429.00
|
|
|
Service Code
|
HCPCS J9354
|
| Hospital Charge Code |
4065117
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.37 |
| Max. Negotiated Rate |
$11,434.68 |
| Rate for Payer: Aetna Commercial |
$11,186.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,688.94
|
| Rate for Payer: Aetna Managed Medicare |
$38.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$38.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$38.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$38.44
|
| Rate for Payer: Anthem Medicare Advantage |
$38.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,587.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$38.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$38.37
|
| Rate for Payer: Cash Price |
$3,728.70
|
| Rate for Payer: Cash Price |
$3,728.70
|
| Rate for Payer: Cigna Commercial |
$11,434.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$38.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50.85
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$38.37
|
| Rate for Payer: Health EOS Commercial |
$11,061.81
|
| Rate for Payer: HFN Commercial |
$11,434.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$142.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$38.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$38.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$38.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$38.37
|
| Rate for Payer: Multiplan Commercial |
$9,943.20
|
| Rate for Payer: NAPHCARE Commercial |
$57.55
|
| Rate for Payer: Preferred Network Access Commercial |
$11,434.68
|
| Rate for Payer: Quartz Beloit One Network |
$6,090.21
|
| Rate for Payer: Quartz Commercial |
$8,078.85
|
| Rate for Payer: Quartz Medicare Advantage |
$38.37
|
| Rate for Payer: The Alliance Commercial |
$153.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.37
|
| Rate for Payer: WEA Trust Commercial |
$6,835.95
|
| Rate for Payer: Wellcare Medicare |
$38.37
|
| Rate for Payer: WPS Commercial |
$96.10
|
|
|
Ado-Trastuzumab Emtansine
|
Professional
|
Both
|
$12,429.00
|
|
|
Service Code
|
HCPCS J9354
|
| Hospital Charge Code |
4065117
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.37 |
| Max. Negotiated Rate |
$11,807.55 |
| Rate for Payer: Aetna Commercial |
$11,807.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,688.94
|
| Rate for Payer: Cash Price |
$3,728.70
|
| Rate for Payer: Cash Price |
$3,728.70
|
| Rate for Payer: Cigna Commercial |
$11,807.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$38.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38.44
|
| Rate for Payer: Health EOS Commercial |
$11,310.39
|
| Rate for Payer: HFN Commercial |
$11,807.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$48.03
|
| Rate for Payer: Multiplan Commercial |
$9,943.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11,807.55
|
| Rate for Payer: Quartz Beloit One Network |
$5,468.76
|
| Rate for Payer: Quartz Commercial |
$7,084.53
|
| Rate for Payer: The Alliance Commercial |
$6,214.50
|
| Rate for Payer: United Healthcare Medicaid |
$38.37
|
| Rate for Payer: WEA Trust Commercial |
$6,835.95
|
| Rate for Payer: WPS Commercial |
$96.10
|
|
|
Ado-Trastuzumab Emtansine
|
Facility
|
IP
|
$12,429.00
|
|
|
Service Code
|
HCPCS J9354
|
| Hospital Charge Code |
4065117
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,090.21 |
| Max. Negotiated Rate |
$11,434.68 |
| Rate for Payer: Aetna Commercial |
$11,186.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,688.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,587.37
|
| Rate for Payer: Cash Price |
$3,728.70
|
| Rate for Payer: Cigna Commercial |
$11,434.68
|
| Rate for Payer: Health EOS Commercial |
$11,061.81
|
| Rate for Payer: HFN Commercial |
$11,434.68
|
| Rate for Payer: Multiplan Commercial |
$9,943.20
|
| Rate for Payer: NAPHCARE Commercial |
$7,457.40
|
| Rate for Payer: Preferred Network Access Commercial |
$11,434.68
|
| Rate for Payer: Quartz Beloit One Network |
$6,090.21
|
| Rate for Payer: Quartz Commercial |
$7,457.40
|
| Rate for Payer: WEA Trust Commercial |
$6,835.95
|
| Rate for Payer: WPS Commercial |
$9,206.16
|
|
|
ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$60,203.00
|
|
|
Service Code
|
MSDRG 614
|
| Min. Negotiated Rate |
$21,655.61 |
| Max. Negotiated Rate |
$60,203.00 |
| Rate for Payer: Aetna Managed Medicare |
$21,655.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$47,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36,182.25
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34,375.50
|
| Rate for Payer: Anthem Medicare Advantage |
$21,655.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21,655.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21,655.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$21,655.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38,159.96
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$21,655.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43,921.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21,655.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21,655.61
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$21,655.61
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$21,655.61
|
| Rate for Payer: NAPHCARE Commercial |
$32,483.42
|
| Rate for Payer: Quartz Medicare Advantage |
$21,655.61
|
| Rate for Payer: The Alliance Commercial |
$60,203.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21,655.61
|
| Rate for Payer: United Healthcare PPO |
$34,193.68
|
| Rate for Payer: Wellcare Medicare |
$21,655.61
|
|
|
ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$39,431.00
|
|
|
Service Code
|
MSDRG 615
|
| Min. Negotiated Rate |
$14,183.83 |
| Max. Negotiated Rate |
$39,431.00 |
| Rate for Payer: Aetna Managed Medicare |
$14,183.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30,840.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23,639.07
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22,458.66
|
| Rate for Payer: Anthem Medicare Advantage |
$14,183.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14,183.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14,183.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14,183.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24,931.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14,183.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28,686.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14,183.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14,183.83
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14,183.83
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14,183.83
|
| Rate for Payer: NAPHCARE Commercial |
$21,275.74
|
| Rate for Payer: Quartz Medicare Advantage |
$14,183.83
|
| Rate for Payer: The Alliance Commercial |
$39,431.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14,183.83
|
| Rate for Payer: United Healthcare PPO |
$22,332.77
|
| Rate for Payer: Wellcare Medicare |
$14,183.83
|
|
|
ADRENALECTOMY
|
Facility
|
IP
|
$7,912.00
|
|
| Hospital Charge Code |
2959782
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,876.88 |
| Max. Negotiated Rate |
$7,279.04 |
| Rate for Payer: Aetna Commercial |
$7,120.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,804.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,193.36
|
| Rate for Payer: Cash Price |
$2,373.60
|
| Rate for Payer: Cigna Commercial |
$7,279.04
|
| Rate for Payer: Health EOS Commercial |
$7,041.68
|
| Rate for Payer: HFN Commercial |
$7,279.04
|
| Rate for Payer: Multiplan Commercial |
$6,329.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,747.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,279.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,876.88
|
| Rate for Payer: Quartz Commercial |
$4,747.20
|
| Rate for Payer: WEA Trust Commercial |
$4,351.60
|
| Rate for Payer: WPS Commercial |
$5,860.42
|
|
|
ADRENALECTOMY
|
Facility
|
OP
|
$7,912.00
|
|
| Hospital Charge Code |
2959782
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,215.36 |
| Max. Negotiated Rate |
$31,648.00 |
| Rate for Payer: Aetna Commercial |
$7,120.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,804.32
|
| Rate for Payer: Aetna Managed Medicare |
$2,215.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,142.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,956.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,797.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,193.36
|
| Rate for Payer: Cash Price |
$2,373.60
|
| Rate for Payer: Cigna Commercial |
$7,279.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,427.56
|
| Rate for Payer: Health EOS Commercial |
$7,041.68
|
| Rate for Payer: HFN Commercial |
$7,279.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,934.00
|
| Rate for Payer: Multiplan Commercial |
$6,329.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,747.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,279.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,876.88
|
| Rate for Payer: Quartz Commercial |
$5,142.80
|
| Rate for Payer: Quartz Medicare Advantage |
$4,747.20
|
| Rate for Payer: The Alliance Commercial |
$31,648.00
|
| Rate for Payer: WEA Trust Commercial |
$4,351.60
|
| Rate for Payer: WPS Commercial |
$5,860.42
|
|
|
Adrenalin 0.1 mg Charge
|
Professional
|
Both
|
$6.00
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
2958828
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$5.70 |
| Rate for Payer: Aetna Commercial |
$5.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5.16
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$5.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$0.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.81
|
| Rate for Payer: Health EOS Commercial |
$5.46
|
| Rate for Payer: HFN Commercial |
$5.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1.23
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5.70
|
| Rate for Payer: Quartz Beloit One Network |
$2.64
|
| Rate for Payer: Quartz Commercial |
$3.42
|
| Rate for Payer: The Alliance Commercial |
$3.00
|
| Rate for Payer: United Healthcare Medicaid |
$0.75
|
| Rate for Payer: WEA Trust Commercial |
$3.30
|
| Rate for Payer: WPS Commercial |
$2.03
|
|
|
Adrenalin 0.1 mg Charge
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
2958828
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Aetna Commercial |
$5.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5.16
|
| Rate for Payer: Aetna Managed Medicare |
$1.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.18
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$5.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.07
|
| Rate for Payer: Health EOS Commercial |
$5.34
|
| Rate for Payer: HFN Commercial |
$5.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4.50
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
| Rate for Payer: NAPHCARE Commercial |
$3.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5.52
|
| Rate for Payer: Quartz Beloit One Network |
$2.94
|
| Rate for Payer: Quartz Commercial |
$3.90
|
| Rate for Payer: Quartz Medicare Advantage |
$3.60
|
| Rate for Payer: The Alliance Commercial |
$24.00
|
| Rate for Payer: WEA Trust Commercial |
$3.30
|
| Rate for Payer: WPS Commercial |
$2.03
|
|
|
Adrenalin 0.1 mg Charge
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
2958828
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$5.52 |
| Rate for Payer: Aetna Commercial |
$5.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.18
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$5.52
|
| Rate for Payer: Health EOS Commercial |
$5.34
|
| Rate for Payer: HFN Commercial |
$5.52
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
| Rate for Payer: NAPHCARE Commercial |
$3.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5.52
|
| Rate for Payer: Quartz Beloit One Network |
$2.94
|
| Rate for Payer: Quartz Commercial |
$3.60
|
| Rate for Payer: WEA Trust Commercial |
$3.30
|
| Rate for Payer: WPS Commercial |
$4.44
|
|
|
Adrenalin JW Waste Charge
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
HCPCS J0171 JW
|
| Hospital Charge Code |
5246656
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Aetna Commercial |
$0.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$0.86
|
| Rate for Payer: Aetna Managed Medicare |
$0.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$0.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$0.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$0.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$0.53
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna Commercial |
$0.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.56
|
| Rate for Payer: Health EOS Commercial |
$0.89
|
| Rate for Payer: HFN Commercial |
$0.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$0.75
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: NAPHCARE Commercial |
$0.60
|
| Rate for Payer: Preferred Network Access Commercial |
$0.92
|
| Rate for Payer: Quartz Beloit One Network |
$0.49
|
| Rate for Payer: Quartz Commercial |
$0.65
|
| Rate for Payer: Quartz Medicare Advantage |
$0.60
|
| Rate for Payer: The Alliance Commercial |
$4.00
|
| Rate for Payer: WEA Trust Commercial |
$0.55
|
| Rate for Payer: WPS Commercial |
$0.74
|
|
|
Adrenalin JW Waste Charge
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
HCPCS J0171 JW
|
| Hospital Charge Code |
5246656
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$0.92 |
| Rate for Payer: Aetna Commercial |
$0.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$0.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$0.53
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna Commercial |
$0.92
|
| Rate for Payer: Health EOS Commercial |
$0.89
|
| Rate for Payer: HFN Commercial |
$0.92
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: NAPHCARE Commercial |
$0.60
|
| Rate for Payer: Preferred Network Access Commercial |
$0.92
|
| Rate for Payer: Quartz Beloit One Network |
$0.49
|
| Rate for Payer: Quartz Commercial |
$0.60
|
| Rate for Payer: WEA Trust Commercial |
$0.55
|
| Rate for Payer: WPS Commercial |
$0.74
|
|
|
Adrenalin JW Waste Charge
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
HCPCS J0171 JW
|
| Hospital Charge Code |
5246656
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna Commercial |
$0.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$0.86
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna Commercial |
$0.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$0.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.60
|
| Rate for Payer: Health EOS Commercial |
$0.91
|
| Rate for Payer: HFN Commercial |
$0.95
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: Preferred Network Access Commercial |
$0.95
|
| Rate for Payer: Quartz Beloit One Network |
$0.44
|
| Rate for Payer: Quartz Commercial |
$0.57
|
| Rate for Payer: The Alliance Commercial |
$0.50
|
| Rate for Payer: WEA Trust Commercial |
$0.55
|
| Rate for Payer: WPS Commercial |
$0.74
|
|
|
Adrenocorticotropic Hormone
|
Professional
|
Both
|
$430.00
|
|
|
Service Code
|
CPT 82024
|
| Hospital Charge Code |
977772
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$136.33 |
| Max. Negotiated Rate |
$408.50 |
| Rate for Payer: Aetna Commercial |
$408.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$369.80
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$408.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$215.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$258.00
|
| Rate for Payer: Health EOS Commercial |
$391.30
|
| Rate for Payer: HFN Commercial |
$408.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$136.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$136.33
|
| Rate for Payer: Multiplan Commercial |
$344.00
|
| Rate for Payer: Preferred Network Access Commercial |
$408.50
|
| Rate for Payer: Quartz Beloit One Network |
$189.20
|
| Rate for Payer: Quartz Commercial |
$245.10
|
| Rate for Payer: The Alliance Commercial |
$215.00
|
| Rate for Payer: WEA Trust Commercial |
$236.50
|
| Rate for Payer: WPS Commercial |
$318.50
|
|
|
Adrenocorticotropic Hormone
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
CPT 82024
|
| Hospital Charge Code |
977772
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.62 |
| Max. Negotiated Rate |
$395.60 |
| Rate for Payer: Aetna Commercial |
$387.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$369.80
|
| Rate for Payer: Aetna Managed Medicare |
$38.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$144.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$67.58
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$64.11
|
| Rate for Payer: Anthem Medicaid |
$39.91
|
| Rate for Payer: Anthem Medicare Advantage |
$38.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$227.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$38.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$38.62
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$395.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$38.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$39.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$240.63
|
| Rate for Payer: Dean Health Medicaid |
$39.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$38.62
|
| Rate for Payer: Health EOS Commercial |
$382.70
|
| Rate for Payer: HFN Commercial |
$395.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$143.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$38.62
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$39.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$38.62
|
| Rate for Payer: Managed Health Services Medicaid |
$41.51
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$38.62
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$38.62
|
| Rate for Payer: Multiplan Commercial |
$344.00
|
| Rate for Payer: NAPHCARE Commercial |
$57.93
|
| Rate for Payer: Preferred Network Access Commercial |
$395.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$39.91
|
| Rate for Payer: Quartz Beloit One Network |
$210.70
|
| Rate for Payer: Quartz Commercial |
$279.50
|
| Rate for Payer: Quartz Medicare Advantage |
$38.62
|
| Rate for Payer: The Alliance Commercial |
$154.48
|
| Rate for Payer: United Healthcare Medicaid |
$39.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.62
|
| Rate for Payer: United Healthcare PPO |
$322.50
|
| Rate for Payer: WEA Trust Commercial |
$236.50
|
| Rate for Payer: Wellcare Medicare |
$38.62
|
| Rate for Payer: WMAP Medicaid |
$39.91
|
| Rate for Payer: WPS Commercial |
$318.50
|
|
|
Adrenocorticotropic Hormone
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
CPT 82024
|
| Hospital Charge Code |
977772
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$210.70 |
| Max. Negotiated Rate |
$395.60 |
| Rate for Payer: Aetna Commercial |
$387.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$369.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$227.90
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$395.60
|
| Rate for Payer: Health EOS Commercial |
$382.70
|
| Rate for Payer: HFN Commercial |
$395.60
|
| Rate for Payer: Multiplan Commercial |
$344.00
|
| Rate for Payer: NAPHCARE Commercial |
$258.00
|
| Rate for Payer: Preferred Network Access Commercial |
$395.60
|
| Rate for Payer: Quartz Beloit One Network |
$210.70
|
| Rate for Payer: Quartz Commercial |
$258.00
|
| Rate for Payer: WEA Trust Commercial |
$236.50
|
| Rate for Payer: WPS Commercial |
$318.50
|
|
|
Adriamycin 10 mg Charge
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
HCPCS J9000
|
| Hospital Charge Code |
2958978
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.82 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna Commercial |
$64.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$61.92
|
| Rate for Payer: Aetna Managed Medicare |
$20.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.16
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$66.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.82
|
| Rate for Payer: Health EOS Commercial |
$64.08
|
| Rate for Payer: HFN Commercial |
$66.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.00
|
| Rate for Payer: Multiplan Commercial |
$57.60
|
| Rate for Payer: NAPHCARE Commercial |
$43.20
|
| Rate for Payer: Preferred Network Access Commercial |
$66.24
|
| Rate for Payer: Quartz Beloit One Network |
$35.28
|
| Rate for Payer: Quartz Commercial |
$46.80
|
| Rate for Payer: Quartz Medicare Advantage |
$43.20
|
| Rate for Payer: The Alliance Commercial |
$288.00
|
| Rate for Payer: WEA Trust Commercial |
$39.60
|
| Rate for Payer: WPS Commercial |
$9.12
|
|
|
Adriamycin 10 mg Charge
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
HCPCS J9000
|
| Hospital Charge Code |
2958978
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.28 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$64.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$61.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.16
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$66.24
|
| Rate for Payer: Health EOS Commercial |
$64.08
|
| Rate for Payer: HFN Commercial |
$66.24
|
| Rate for Payer: Multiplan Commercial |
$57.60
|
| Rate for Payer: NAPHCARE Commercial |
$43.20
|
| Rate for Payer: Preferred Network Access Commercial |
$66.24
|
| Rate for Payer: Quartz Beloit One Network |
$35.28
|
| Rate for Payer: Quartz Commercial |
$43.20
|
| Rate for Payer: WEA Trust Commercial |
$39.60
|
| Rate for Payer: WPS Commercial |
$53.33
|
|
|
Adriamycin 10 mg Charge
|
Professional
|
Both
|
$72.00
|
|
|
Service Code
|
HCPCS J9000
|
| Hospital Charge Code |
2958978
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.28 |
| Max. Negotiated Rate |
$68.40 |
| Rate for Payer: Aetna Commercial |
$68.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$61.92
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$68.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.65
|
| Rate for Payer: Health EOS Commercial |
$65.52
|
| Rate for Payer: HFN Commercial |
$68.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3.88
|
| Rate for Payer: Multiplan Commercial |
$57.60
|
| Rate for Payer: Preferred Network Access Commercial |
$68.40
|
| Rate for Payer: Quartz Beloit One Network |
$31.68
|
| Rate for Payer: Quartz Commercial |
$41.04
|
| Rate for Payer: The Alliance Commercial |
$36.00
|
| Rate for Payer: United Healthcare Medicaid |
$3.28
|
| Rate for Payer: WEA Trust Commercial |
$39.60
|
| Rate for Payer: WPS Commercial |
$9.12
|
|
|
Adrucil 500 mg Charge
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
HCPCS J9190
|
| Hospital Charge Code |
2958948
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$88.00 |
| Rate for Payer: Aetna Commercial |
$19.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.92
|
| Rate for Payer: Aetna Managed Medicare |
$6.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.66
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cigna Commercial |
$20.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.90
|
| Rate for Payer: Health EOS Commercial |
$19.58
|
| Rate for Payer: HFN Commercial |
$20.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16.50
|
| Rate for Payer: Multiplan Commercial |
$17.60
|
| Rate for Payer: NAPHCARE Commercial |
$13.20
|
| Rate for Payer: Preferred Network Access Commercial |
$20.24
|
| Rate for Payer: Quartz Beloit One Network |
$10.78
|
| Rate for Payer: Quartz Commercial |
$14.30
|
| Rate for Payer: Quartz Medicare Advantage |
$13.20
|
| Rate for Payer: The Alliance Commercial |
$88.00
|
| Rate for Payer: WEA Trust Commercial |
$12.10
|
| Rate for Payer: WPS Commercial |
$7.38
|
|
|
Adrucil 500 mg Charge
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
HCPCS J9190
|
| Hospital Charge Code |
2958948
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.78 |
| Max. Negotiated Rate |
$20.24 |
| Rate for Payer: Aetna Commercial |
$19.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.66
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cigna Commercial |
$20.24
|
| Rate for Payer: Health EOS Commercial |
$19.58
|
| Rate for Payer: HFN Commercial |
$20.24
|
| Rate for Payer: Multiplan Commercial |
$17.60
|
| Rate for Payer: NAPHCARE Commercial |
$13.20
|
| Rate for Payer: Preferred Network Access Commercial |
$20.24
|
| Rate for Payer: Quartz Beloit One Network |
$10.78
|
| Rate for Payer: Quartz Commercial |
$13.20
|
| Rate for Payer: WEA Trust Commercial |
$12.10
|
| Rate for Payer: WPS Commercial |
$16.30
|
|
|
Adrucil 500 mg Charge
|
Professional
|
Both
|
$22.00
|
|
|
Service Code
|
HCPCS J9190
|
| Hospital Charge Code |
2958948
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.91 |
| Max. Negotiated Rate |
$20.90 |
| Rate for Payer: Aetna Commercial |
$20.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.92
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cigna Commercial |
$20.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.95
|
| Rate for Payer: Health EOS Commercial |
$20.02
|
| Rate for Payer: HFN Commercial |
$20.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2.91
|
| Rate for Payer: Multiplan Commercial |
$17.60
|
| Rate for Payer: Preferred Network Access Commercial |
$20.90
|
| Rate for Payer: Quartz Beloit One Network |
$9.68
|
| Rate for Payer: Quartz Commercial |
$12.54
|
| Rate for Payer: The Alliance Commercial |
$11.00
|
| Rate for Payer: United Healthcare Medicaid |
$2.95
|
| Rate for Payer: WEA Trust Commercial |
$12.10
|
| Rate for Payer: WPS Commercial |
$7.38
|
|
|
Adult Digital 02 Transducr D25
|
Facility
|
OP
|
$442.00
|
|
| Hospital Charge Code |
3101749
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$123.76 |
| Max. Negotiated Rate |
$1,768.00 |
| Rate for Payer: Aetna Commercial |
$397.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$380.12
|
| Rate for Payer: Aetna Managed Medicare |
$123.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$287.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$221.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$212.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$234.26
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cigna Commercial |
$406.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$247.34
|
| Rate for Payer: Health EOS Commercial |
$393.38
|
| Rate for Payer: HFN Commercial |
$406.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$331.50
|
| Rate for Payer: Multiplan Commercial |
$353.60
|
| Rate for Payer: NAPHCARE Commercial |
$265.20
|
| Rate for Payer: Preferred Network Access Commercial |
$406.64
|
| Rate for Payer: Quartz Beloit One Network |
$216.58
|
| Rate for Payer: Quartz Commercial |
$287.30
|
| Rate for Payer: Quartz Medicare Advantage |
$265.20
|
| Rate for Payer: The Alliance Commercial |
$1,768.00
|
| Rate for Payer: WEA Trust Commercial |
$243.10
|
| Rate for Payer: WPS Commercial |
$327.39
|
|
|
Adult Digital 02 Transducr D25
|
Facility
|
IP
|
$442.00
|
|
| Hospital Charge Code |
3101749
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$216.58 |
| Max. Negotiated Rate |
$406.64 |
| Rate for Payer: Aetna Commercial |
$397.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$234.26
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cigna Commercial |
$406.64
|
| Rate for Payer: Health EOS Commercial |
$393.38
|
| Rate for Payer: HFN Commercial |
$406.64
|
| Rate for Payer: Multiplan Commercial |
$353.60
|
| Rate for Payer: NAPHCARE Commercial |
$265.20
|
| Rate for Payer: Preferred Network Access Commercial |
$406.64
|
| Rate for Payer: Quartz Beloit One Network |
$216.58
|
| Rate for Payer: Quartz Commercial |
$265.20
|
| Rate for Payer: WEA Trust Commercial |
$243.10
|
| Rate for Payer: WPS Commercial |
$327.39
|
|
|
Adult Ezio
|
Facility
|
IP
|
$231.00
|
|
| Hospital Charge Code |
3040371
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$113.19 |
| Max. Negotiated Rate |
$212.52 |
| Rate for Payer: Aetna Commercial |
$207.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$198.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$122.43
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna Commercial |
$212.52
|
| Rate for Payer: Health EOS Commercial |
$205.59
|
| Rate for Payer: HFN Commercial |
$212.52
|
| Rate for Payer: Multiplan Commercial |
$184.80
|
| Rate for Payer: NAPHCARE Commercial |
$138.60
|
| Rate for Payer: Preferred Network Access Commercial |
$212.52
|
| Rate for Payer: Quartz Beloit One Network |
$113.19
|
| Rate for Payer: Quartz Commercial |
$138.60
|
| Rate for Payer: WEA Trust Commercial |
$127.05
|
| Rate for Payer: WPS Commercial |
$171.10
|
|
