|
Admin Pneumo Vaccine (Per Dialysis Medicare/MADV)
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
HCPCS G0009
|
| Hospital Charge Code |
5622233
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$26.50 |
| Max. Negotiated Rate |
$49.75 |
| Rate for Payer: Aetna Commercial |
$48.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.66
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$49.75
|
| Rate for Payer: Health EOS Commercial |
$48.13
|
| Rate for Payer: HFN Commercial |
$49.75
|
| Rate for Payer: Multiplan Commercial |
$43.26
|
| Rate for Payer: Preferred Network Access Commercial |
$49.75
|
| Rate for Payer: Quartz Beloit One Network |
$26.50
|
| Rate for Payer: Quartz Commercial |
$32.45
|
| Rate for Payer: WEA Trust Commercial |
$29.74
|
| Rate for Payer: WPS Commercial |
$40.06
|
|
|
Admin Pneum Vaccine (Dialysis Com Ins)
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
5622230
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$26.50 |
| Max. Negotiated Rate |
$49.75 |
| Rate for Payer: Aetna Commercial |
$48.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.66
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$49.75
|
| Rate for Payer: Health EOS Commercial |
$48.13
|
| Rate for Payer: HFN Commercial |
$49.75
|
| Rate for Payer: Multiplan Commercial |
$43.26
|
| Rate for Payer: Preferred Network Access Commercial |
$49.75
|
| Rate for Payer: Quartz Beloit One Network |
$26.50
|
| Rate for Payer: Quartz Commercial |
$32.45
|
| Rate for Payer: WEA Trust Commercial |
$29.74
|
| Rate for Payer: WPS Commercial |
$40.06
|
|
|
Admin Pneum Vaccine (Dialysis Com Ins)
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
5622230
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$25.96 |
| Max. Negotiated Rate |
$303.10 |
| Rate for Payer: Aetna Commercial |
$48.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.51
|
| Rate for Payer: Aetna Managed Medicare |
$75.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$35.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.96
|
| Rate for Payer: Anthem Medicare Advantage |
$75.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.66
|
| 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 |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$49.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$75.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$75.77
|
| Rate for Payer: Health EOS Commercial |
$48.13
|
| Rate for Payer: HFN Commercial |
$49.75
|
| 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 |
$43.26
|
| Rate for Payer: NAPHCARE Commercial |
$113.66
|
| Rate for Payer: Preferred Network Access Commercial |
$49.75
|
| Rate for Payer: Quartz Beloit One Network |
$26.50
|
| Rate for Payer: Quartz Commercial |
$35.15
|
| 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: United Healthcare PPO |
$40.56
|
| Rate for Payer: WEA Trust Commercial |
$29.74
|
| Rate for Payer: Wellcare Medicare |
$75.77
|
| Rate for Payer: WPS Commercial |
$40.06
|
|
|
Admin Pneum Vaccine (Dialysis Medicare/MADV)
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
HCPCS G0009
|
| Hospital Charge Code |
5622231
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$26.50 |
| Max. Negotiated Rate |
$49.75 |
| Rate for Payer: Aetna Commercial |
$48.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.66
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$49.75
|
| Rate for Payer: Health EOS Commercial |
$48.13
|
| Rate for Payer: HFN Commercial |
$49.75
|
| Rate for Payer: Multiplan Commercial |
$43.26
|
| Rate for Payer: Preferred Network Access Commercial |
$49.75
|
| Rate for Payer: Quartz Beloit One Network |
$26.50
|
| Rate for Payer: Quartz Commercial |
$32.45
|
| Rate for Payer: WEA Trust Commercial |
$29.74
|
| Rate for Payer: WPS Commercial |
$40.06
|
|
|
Admin Pneum Vaccine (Dialysis Medicare/MADV)
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
HCPCS G0009
|
| Hospital Charge Code |
5622231
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$25.96 |
| Max. Negotiated Rate |
$197.10 |
| Rate for Payer: Aetna Commercial |
$48.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.51
|
| Rate for Payer: Aetna Managed Medicare |
$49.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$35.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.96
|
| Rate for Payer: Anthem Medicare Advantage |
$49.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$49.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$49.28
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$49.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$49.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$49.28
|
| Rate for Payer: Health EOS Commercial |
$48.13
|
| Rate for Payer: HFN Commercial |
$49.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$183.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$49.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$49.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$49.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$49.28
|
| Rate for Payer: Multiplan Commercial |
$43.26
|
| Rate for Payer: NAPHCARE Commercial |
$73.91
|
| Rate for Payer: Preferred Network Access Commercial |
$49.75
|
| Rate for Payer: Quartz Beloit One Network |
$26.50
|
| Rate for Payer: Quartz Commercial |
$35.15
|
| Rate for Payer: Quartz Medicare Advantage |
$49.28
|
| Rate for Payer: The Alliance Commercial |
$197.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$49.28
|
| Rate for Payer: United Healthcare PPO |
$40.56
|
| Rate for Payer: WEA Trust Commercial |
$29.74
|
| Rate for Payer: Wellcare Medicare |
$49.28
|
| Rate for Payer: WPS Commercial |
$40.06
|
|
|
Ado-Trastuzumab Emtansine
|
Professional
|
Both
|
$12,429.00
|
|
|
Service Code
|
HCPCS J9354
|
| Hospital Charge Code |
4065117
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.98 |
| Max. Negotiated Rate |
$12,279.85 |
| Rate for Payer: Aetna Commercial |
$12,279.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,116.50
|
| Rate for Payer: Aetna Managed Medicare |
$43.88
|
| Rate for Payer: Anthem Medicare Advantage |
$43.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$43.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$43.88
|
| Rate for Payer: Cash Price |
$3,728.70
|
| Rate for Payer: Cash Price |
$3,728.70
|
| Rate for Payer: Cigna Commercial |
$12,279.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$43.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$39.98
|
| Rate for Payer: Health EOS Commercial |
$11,762.81
|
| Rate for Payer: HFN Commercial |
$12,279.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$49.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$43.88
|
| Rate for Payer: Multiplan Commercial |
$10,340.93
|
| Rate for Payer: NAPHCARE Commercial |
$65.82
|
| Rate for Payer: Preferred Network Access Commercial |
$12,279.85
|
| Rate for Payer: Quartz Beloit One Network |
$5,687.51
|
| Rate for Payer: Quartz Commercial |
$7,367.91
|
| Rate for Payer: Quartz Medicare Advantage |
$43.88
|
| Rate for Payer: The Alliance Commercial |
$120.66
|
| Rate for Payer: United Healthcare Medicaid |
$43.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.88
|
| Rate for Payer: WEA Trust Commercial |
$7,109.39
|
| Rate for Payer: WPS Commercial |
$99.94
|
|
|
Ado-Trastuzumab Emtansine
|
Facility
|
IP
|
$12,429.00
|
|
|
Service Code
|
HCPCS J9354
|
| Hospital Charge Code |
4065117
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,333.82 |
| Max. Negotiated Rate |
$11,892.07 |
| Rate for Payer: Aetna Commercial |
$11,633.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,116.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,850.86
|
| Rate for Payer: Cash Price |
$3,728.70
|
| Rate for Payer: Cigna Commercial |
$11,892.07
|
| Rate for Payer: Health EOS Commercial |
$11,504.28
|
| Rate for Payer: HFN Commercial |
$11,892.07
|
| Rate for Payer: Multiplan Commercial |
$10,340.93
|
| Rate for Payer: Preferred Network Access Commercial |
$11,892.07
|
| Rate for Payer: Quartz Beloit One Network |
$6,333.82
|
| Rate for Payer: Quartz Commercial |
$7,755.70
|
| Rate for Payer: WEA Trust Commercial |
$7,109.39
|
| Rate for Payer: WPS Commercial |
$9,574.06
|
|
|
Ado-Trastuzumab Emtansine
|
Facility
|
OP
|
$12,429.00
|
|
|
Service Code
|
HCPCS J9354
|
| Hospital Charge Code |
4065117
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.98 |
| Max. Negotiated Rate |
$11,892.07 |
| Rate for Payer: Aetna Commercial |
$11,633.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,116.50
|
| Rate for Payer: Aetna Managed Medicare |
$43.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$39.98
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$39.98
|
| Rate for Payer: Anthem Medicare Advantage |
$43.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,850.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$43.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$43.88
|
| Rate for Payer: Cash Price |
$3,728.70
|
| Rate for Payer: Cash Price |
$3,728.70
|
| Rate for Payer: Cigna Commercial |
$11,892.07
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$43.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$52.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$43.88
|
| Rate for Payer: Health EOS Commercial |
$11,504.28
|
| Rate for Payer: HFN Commercial |
$11,892.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$163.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$43.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$43.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$43.88
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$43.88
|
| Rate for Payer: Multiplan Commercial |
$10,340.93
|
| Rate for Payer: NAPHCARE Commercial |
$65.82
|
| Rate for Payer: Preferred Network Access Commercial |
$11,892.07
|
| Rate for Payer: Quartz Beloit One Network |
$6,333.82
|
| Rate for Payer: Quartz Commercial |
$8,402.00
|
| Rate for Payer: Quartz Medicare Advantage |
$43.88
|
| Rate for Payer: The Alliance Commercial |
$175.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.88
|
| Rate for Payer: WEA Trust Commercial |
$7,109.39
|
| Rate for Payer: Wellcare Medicare |
$43.88
|
| Rate for Payer: WPS Commercial |
$99.94
|
|
|
ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$62,611.12
|
|
|
Service Code
|
MSDRG 614
|
| Min. Negotiated Rate |
$17,292.02 |
| Max. Negotiated Rate |
$62,611.12 |
| Rate for Payer: Aetna Managed Medicare |
$17,292.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$47,823.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36,656.19
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34,825.77
|
| Rate for Payer: Anthem Medicare Advantage |
$17,292.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17,292.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17,292.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17,292.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38,659.80
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17,292.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45,678.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17,292.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17,292.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17,292.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17,292.02
|
| Rate for Payer: NAPHCARE Commercial |
$25,938.03
|
| Rate for Payer: Quartz Medicare Advantage |
$17,292.02
|
| Rate for Payer: The Alliance Commercial |
$62,611.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,292.02
|
| Rate for Payer: United Healthcare PPO |
$35,561.43
|
| Rate for Payer: Wellcare Medicare |
$17,292.02
|
|
|
ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$41,008.24
|
|
|
Service Code
|
MSDRG 615
|
| Min. Negotiated Rate |
$11,222.89 |
| Max. Negotiated Rate |
$41,008.24 |
| Rate for Payer: Aetna Managed Medicare |
$11,222.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30,531.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23,402.23
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22,233.65
|
| Rate for Payer: Anthem Medicare Advantage |
$11,222.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,222.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,222.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,222.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24,681.39
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,222.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29,833.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,222.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,222.89
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,222.89
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,222.89
|
| Rate for Payer: NAPHCARE Commercial |
$16,834.33
|
| Rate for Payer: Quartz Medicare Advantage |
$11,222.89
|
| Rate for Payer: The Alliance Commercial |
$41,008.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,222.89
|
| Rate for Payer: United Healthcare PPO |
$23,226.08
|
| Rate for Payer: Wellcare Medicare |
$11,222.89
|
|
|
ADRENALECTOMY
|
Facility
|
IP
|
$7,912.00
|
|
| Hospital Charge Code |
2959782
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,031.96 |
| Max. Negotiated Rate |
$7,570.20 |
| Rate for Payer: Aetna Commercial |
$7,405.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,076.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,361.09
|
| Rate for Payer: Cash Price |
$2,373.60
|
| Rate for Payer: Cigna Commercial |
$7,570.20
|
| Rate for Payer: Health EOS Commercial |
$7,323.35
|
| Rate for Payer: HFN Commercial |
$7,570.20
|
| Rate for Payer: Multiplan Commercial |
$6,582.78
|
| Rate for Payer: Preferred Network Access Commercial |
$7,570.20
|
| Rate for Payer: Quartz Beloit One Network |
$4,031.96
|
| Rate for Payer: Quartz Commercial |
$4,937.09
|
| Rate for Payer: WEA Trust Commercial |
$4,525.66
|
| Rate for Payer: WPS Commercial |
$6,094.61
|
|
|
ADRENALECTOMY
|
Facility
|
OP
|
$7,912.00
|
|
| Hospital Charge Code |
2959782
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,303.97 |
| Max. Negotiated Rate |
$7,570.20 |
| Rate for Payer: Aetna Commercial |
$7,405.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,076.49
|
| Rate for Payer: Aetna Managed Medicare |
$2,303.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,348.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,114.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,949.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,361.09
|
| Rate for Payer: Cash Price |
$2,373.60
|
| Rate for Payer: Cigna Commercial |
$7,570.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,604.78
|
| Rate for Payer: Health EOS Commercial |
$7,323.35
|
| Rate for Payer: HFN Commercial |
$7,570.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,171.36
|
| Rate for Payer: Multiplan Commercial |
$6,582.78
|
| Rate for Payer: NAPHCARE Commercial |
$4,937.09
|
| Rate for Payer: Preferred Network Access Commercial |
$7,570.20
|
| Rate for Payer: Quartz Beloit One Network |
$4,031.96
|
| Rate for Payer: Quartz Commercial |
$5,348.51
|
| Rate for Payer: Quartz Medicare Advantage |
$4,937.09
|
| Rate for Payer: The Alliance Commercial |
$4,114.24
|
| Rate for Payer: WEA Trust Commercial |
$4,525.66
|
| Rate for Payer: WPS Commercial |
$6,094.61
|
|
|
Adrenalin 0.1 mg Charge
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
2958828
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$5.74 |
| Rate for Payer: Aetna Commercial |
$5.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.31
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$5.74
|
| Rate for Payer: Health EOS Commercial |
$5.55
|
| Rate for Payer: HFN Commercial |
$5.74
|
| Rate for Payer: Multiplan Commercial |
$4.99
|
| Rate for Payer: Preferred Network Access Commercial |
$5.74
|
| Rate for Payer: Quartz Beloit One Network |
$3.06
|
| Rate for Payer: Quartz Commercial |
$3.74
|
| Rate for Payer: WEA Trust Commercial |
$3.43
|
| Rate for Payer: WPS Commercial |
$4.62
|
|
|
Adrenalin 0.1 mg Charge
|
Professional
|
Both
|
$6.00
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
2958828
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$5.93 |
| Rate for Payer: Aetna Commercial |
$5.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5.37
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$5.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.84
|
| Rate for Payer: Health EOS Commercial |
$5.68
|
| Rate for Payer: HFN Commercial |
$5.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1.28
|
| Rate for Payer: Multiplan Commercial |
$4.99
|
| Rate for Payer: Preferred Network Access Commercial |
$5.93
|
| Rate for Payer: Quartz Beloit One Network |
$2.75
|
| Rate for Payer: Quartz Commercial |
$3.56
|
| Rate for Payer: The Alliance Commercial |
$3.12
|
| Rate for Payer: WEA Trust Commercial |
$3.43
|
| Rate for Payer: WPS Commercial |
$2.11
|
|
|
Adrenalin 0.1 mg Charge
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
2958828
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$5.74 |
| Rate for Payer: Aetna Commercial |
$5.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5.37
|
| Rate for Payer: Aetna Managed Medicare |
$1.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.31
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$5.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.12
|
| Rate for Payer: Health EOS Commercial |
$5.55
|
| Rate for Payer: HFN Commercial |
$5.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4.68
|
| Rate for Payer: Multiplan Commercial |
$4.99
|
| Rate for Payer: NAPHCARE Commercial |
$3.74
|
| Rate for Payer: Preferred Network Access Commercial |
$5.74
|
| Rate for Payer: Quartz Beloit One Network |
$3.06
|
| Rate for Payer: Quartz Commercial |
$4.06
|
| Rate for Payer: Quartz Medicare Advantage |
$3.74
|
| Rate for Payer: The Alliance Commercial |
$3.12
|
| Rate for Payer: WEA Trust Commercial |
$3.43
|
| Rate for Payer: WPS Commercial |
$2.11
|
|
|
Adrenalin JW Waste Charge
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
HCPCS J0171 JW
|
| Hospital Charge Code |
5246656
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$2.11 |
| Rate for Payer: Aetna Commercial |
$0.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$0.89
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna Commercial |
$0.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$0.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.84
|
| Rate for Payer: Health EOS Commercial |
$0.95
|
| Rate for Payer: HFN Commercial |
$0.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1.28
|
| Rate for Payer: Multiplan Commercial |
$0.83
|
| Rate for Payer: Preferred Network Access Commercial |
$0.99
|
| Rate for Payer: Quartz Beloit One Network |
$0.46
|
| Rate for Payer: Quartz Commercial |
$0.59
|
| Rate for Payer: The Alliance Commercial |
$0.52
|
| Rate for Payer: WEA Trust Commercial |
$0.57
|
| Rate for Payer: WPS Commercial |
$2.11
|
|
|
Adrenalin JW Waste Charge
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
HCPCS J0171 JW
|
| Hospital Charge Code |
5246656
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Aetna Commercial |
$0.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$0.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$0.55
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna Commercial |
$0.96
|
| Rate for Payer: Health EOS Commercial |
$0.93
|
| Rate for Payer: HFN Commercial |
$0.96
|
| Rate for Payer: Multiplan Commercial |
$0.83
|
| Rate for Payer: Preferred Network Access Commercial |
$0.96
|
| Rate for Payer: Quartz Beloit One Network |
$0.51
|
| Rate for Payer: Quartz Commercial |
$0.62
|
| Rate for Payer: WEA Trust Commercial |
$0.57
|
| Rate for Payer: WPS Commercial |
$0.77
|
|
|
Adrenalin JW Waste Charge
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
HCPCS J0171 JW
|
| Hospital Charge Code |
5246656
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$2.11 |
| Rate for Payer: Aetna Commercial |
$0.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$0.89
|
| Rate for Payer: Aetna Managed Medicare |
$0.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$0.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$0.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$0.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$0.55
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna Commercial |
$0.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.12
|
| Rate for Payer: Health EOS Commercial |
$0.93
|
| Rate for Payer: HFN Commercial |
$0.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$0.78
|
| Rate for Payer: Multiplan Commercial |
$0.83
|
| Rate for Payer: NAPHCARE Commercial |
$0.62
|
| Rate for Payer: Preferred Network Access Commercial |
$0.96
|
| Rate for Payer: Quartz Beloit One Network |
$0.51
|
| Rate for Payer: Quartz Commercial |
$0.68
|
| Rate for Payer: Quartz Medicare Advantage |
$0.62
|
| Rate for Payer: The Alliance Commercial |
$0.52
|
| Rate for Payer: WEA Trust Commercial |
$0.57
|
| Rate for Payer: WPS Commercial |
$2.11
|
|
|
ADRENAL PROCEDURES
|
Facility
|
IP
|
$10,960.39
|
|
|
Service Code
|
APR-DRG 4011
|
| Min. Negotiated Rate |
$9,735.70 |
| Max. Negotiated Rate |
$10,960.39 |
| Rate for Payer: Anthem Medicaid |
$10,495.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$10,495.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10,495.17
|
| Rate for Payer: Dean Health Medicaid |
$10,495.17
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9,735.70
|
| Rate for Payer: Managed Health Services Medicaid |
$10,960.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,495.17
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$10,495.17
|
| Rate for Payer: United Healthcare Medicaid |
$10,495.17
|
|
|
ADRENAL PROCEDURES
|
Facility
|
IP
|
$27,883.23
|
|
|
Service Code
|
APR-DRG 4013
|
| Min. Negotiated Rate |
$24,767.62 |
| Max. Negotiated Rate |
$27,883.23 |
| Rate for Payer: Anthem Medicaid |
$26,699.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$26,699.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$26,699.73
|
| Rate for Payer: Dean Health Medicaid |
$26,699.73
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$24,767.62
|
| Rate for Payer: Managed Health Services Medicaid |
$27,883.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,699.73
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$26,699.73
|
| Rate for Payer: United Healthcare Medicaid |
$26,699.73
|
|
|
ADRENAL PROCEDURES
|
Facility
|
IP
|
$44,543.01
|
|
|
Service Code
|
APR-DRG 4014
|
| Min. Negotiated Rate |
$39,565.88 |
| Max. Negotiated Rate |
$44,543.01 |
| Rate for Payer: Anthem Medicaid |
$42,652.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$42,652.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$42,652.39
|
| Rate for Payer: Dean Health Medicaid |
$42,652.39
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$39,565.88
|
| Rate for Payer: Managed Health Services Medicaid |
$44,543.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$42,652.39
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$42,652.39
|
| Rate for Payer: United Healthcare Medicaid |
$42,652.39
|
|
|
ADRENAL PROCEDURES
|
Facility
|
IP
|
$14,993.81
|
|
|
Service Code
|
APR-DRG 4012
|
| Min. Negotiated Rate |
$13,318.44 |
| Max. Negotiated Rate |
$14,993.81 |
| Rate for Payer: Anthem Medicaid |
$14,357.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$14,357.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14,357.40
|
| Rate for Payer: Dean Health Medicaid |
$14,357.40
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13,318.44
|
| Rate for Payer: Managed Health Services Medicaid |
$14,993.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,357.40
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14,357.40
|
| Rate for Payer: United Healthcare Medicaid |
$14,357.40
|
|
|
Adrenocorticotropic Hormone
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
CPT 82024
|
| Hospital Charge Code |
977772
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.16 |
| Max. Negotiated Rate |
$411.42 |
| Rate for Payer: Aetna Commercial |
$402.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$384.59
|
| Rate for Payer: Aetna Managed Medicare |
$40.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$150.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$70.29
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$66.67
|
| Rate for Payer: Anthem Medicare Advantage |
$40.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$237.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$40.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$40.16
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$411.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$40.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$250.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$40.16
|
| Rate for Payer: Health EOS Commercial |
$398.01
|
| Rate for Payer: HFN Commercial |
$411.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$149.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$40.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$40.16
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$40.16
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$40.16
|
| Rate for Payer: Multiplan Commercial |
$357.76
|
| Rate for Payer: NAPHCARE Commercial |
$60.25
|
| Rate for Payer: Preferred Network Access Commercial |
$411.42
|
| Rate for Payer: Quartz Beloit One Network |
$219.13
|
| Rate for Payer: Quartz Commercial |
$290.68
|
| Rate for Payer: Quartz Medicare Advantage |
$40.16
|
| Rate for Payer: The Alliance Commercial |
$160.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$40.16
|
| Rate for Payer: United Healthcare PPO |
$335.40
|
| Rate for Payer: WEA Trust Commercial |
$245.96
|
| Rate for Payer: Wellcare Medicare |
$40.16
|
| Rate for Payer: WPS Commercial |
$331.23
|
|
|
Adrenocorticotropic Hormone
|
Professional
|
Both
|
$430.00
|
|
|
Service Code
|
CPT 82024
|
| Hospital Charge Code |
977772
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.16 |
| Max. Negotiated Rate |
$424.84 |
| Rate for Payer: Aetna Commercial |
$424.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$384.59
|
| Rate for Payer: Aetna Managed Medicare |
$40.16
|
| Rate for Payer: Anthem Medicare Advantage |
$40.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$40.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$40.16
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$424.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$223.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.16
|
| Rate for Payer: Health EOS Commercial |
$406.95
|
| Rate for Payer: HFN Commercial |
$424.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$141.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$141.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$40.16
|
| Rate for Payer: Multiplan Commercial |
$357.76
|
| Rate for Payer: NAPHCARE Commercial |
$60.25
|
| Rate for Payer: Preferred Network Access Commercial |
$424.84
|
| Rate for Payer: Quartz Beloit One Network |
$196.77
|
| Rate for Payer: Quartz Commercial |
$254.90
|
| Rate for Payer: Quartz Medicare Advantage |
$40.16
|
| Rate for Payer: The Alliance Commercial |
$158.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$40.16
|
| Rate for Payer: WEA Trust Commercial |
$245.96
|
| Rate for Payer: WPS Commercial |
$176.73
|
|
|
Adrenocorticotropic Hormone
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
CPT 82024
|
| Hospital Charge Code |
977772
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$219.13 |
| Max. Negotiated Rate |
$411.42 |
| Rate for Payer: Aetna Commercial |
$402.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$384.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$237.02
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$411.42
|
| Rate for Payer: Health EOS Commercial |
$398.01
|
| Rate for Payer: HFN Commercial |
$411.42
|
| Rate for Payer: Multiplan Commercial |
$357.76
|
| Rate for Payer: Preferred Network Access Commercial |
$411.42
|
| Rate for Payer: Quartz Beloit One Network |
$219.13
|
| Rate for Payer: Quartz Commercial |
$268.32
|
| Rate for Payer: WEA Trust Commercial |
$245.96
|
| Rate for Payer: WPS Commercial |
$331.23
|
|
