|
Declotting or Thrombolytic Agent of Implnted Vascular Access Device or Catheter 36593
|
Professional
|
Both
|
$108.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
1188958
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$24.80 |
| Max. Negotiated Rate |
$168.67 |
| Rate for Payer: Aetna Commercial |
$106.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$96.60
|
| Rate for Payer: Aetna Managed Medicare |
$37.48
|
| Rate for Payer: Anthem Medicare Advantage |
$37.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$37.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$37.48
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna Commercial |
$106.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37.48
|
| Rate for Payer: Health EOS Commercial |
$102.21
|
| Rate for Payer: HFN Commercial |
$106.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$114.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$114.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$37.48
|
| Rate for Payer: Multiplan Commercial |
$89.86
|
| Rate for Payer: NAPHCARE Commercial |
$56.22
|
| Rate for Payer: Preferred Network Access Commercial |
$106.70
|
| Rate for Payer: Quartz Beloit One Network |
$49.42
|
| Rate for Payer: Quartz Commercial |
$64.02
|
| Rate for Payer: Quartz Medicare Advantage |
$37.48
|
| Rate for Payer: The Alliance Commercial |
$159.30
|
| Rate for Payer: United Healthcare Medicaid |
$24.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.48
|
| Rate for Payer: WEA Trust Commercial |
$61.78
|
| Rate for Payer: WPS Commercial |
$168.67
|
|
|
DECOMPRESSION FASCIOTOMY, LEG; ANTERIOR AND/OR LATERAL COMPARTMENTS ONLY
|
Facility
|
OP
|
$13,773.68
|
|
|
Service Code
|
CPT 27600
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,443.42 |
| Max. Negotiated Rate |
$13,773.68 |
| Rate for Payer: Aetna Managed Medicare |
$3,443.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,443.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,443.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,443.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,443.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,443.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,809.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,443.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,443.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,443.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,443.42
|
| Rate for Payer: NAPHCARE Commercial |
$5,165.13
|
| Rate for Payer: Quartz Medicare Advantage |
$3,443.42
|
| Rate for Payer: The Alliance Commercial |
$13,773.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,443.42
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$3,443.42
|
|
|
DEEP LYMPH STRUCTURE PROCEDURES
|
Facility
|
OP
|
$1,027.28
|
|
|
Service Code
|
EAPG 00115
|
| Min. Negotiated Rate |
$987.76 |
| Max. Negotiated Rate |
$1,027.28 |
| Rate for Payer: Anthem Medicaid |
$987.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$987.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$987.76
|
| Rate for Payer: Dean Health Medicaid |
$987.76
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$987.76
|
| Rate for Payer: Managed Health Services Medicaid |
$1,027.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$987.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$987.76
|
| Rate for Payer: United Healthcare Medicaid |
$987.76
|
|
|
Deep Muscle Biopsy 20205
|
Professional
|
Both
|
$1,519.00
|
|
|
Service Code
|
CPT 20205
|
| Hospital Charge Code |
3404962
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$135.09 |
| Max. Negotiated Rate |
$1,500.77 |
| Rate for Payer: Aetna Commercial |
$1,500.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,358.59
|
| Rate for Payer: Aetna Managed Medicare |
$135.09
|
| Rate for Payer: Anthem Medicare Advantage |
$135.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$135.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$135.09
|
| Rate for Payer: Cash Price |
$455.70
|
| Rate for Payer: Cash Price |
$455.70
|
| Rate for Payer: Cash Price |
$455.70
|
| Rate for Payer: Cigna Commercial |
$1,500.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$156.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$135.09
|
| Rate for Payer: Health EOS Commercial |
$1,437.58
|
| Rate for Payer: HFN Commercial |
$1,500.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$514.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$514.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$135.09
|
| Rate for Payer: Multiplan Commercial |
$1,263.81
|
| Rate for Payer: NAPHCARE Commercial |
$202.63
|
| Rate for Payer: Preferred Network Access Commercial |
$1,500.77
|
| Rate for Payer: Quartz Beloit One Network |
$695.09
|
| Rate for Payer: Quartz Commercial |
$900.46
|
| Rate for Payer: Quartz Medicare Advantage |
$135.09
|
| Rate for Payer: The Alliance Commercial |
$574.11
|
| Rate for Payer: United Healthcare Medicaid |
$156.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$135.09
|
| Rate for Payer: WEA Trust Commercial |
$868.87
|
| Rate for Payer: WPS Commercial |
$607.89
|
|
|
DEEP SCROTAL RETRACTOR SYSTEM 72403867
|
Facility
|
IP
|
$4,733.00
|
|
| Hospital Charge Code |
5385021
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,411.94 |
| Max. Negotiated Rate |
$4,528.53 |
| Rate for Payer: Aetna Commercial |
$4,430.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,233.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,608.83
|
| Rate for Payer: Cash Price |
$1,419.90
|
| Rate for Payer: Cigna Commercial |
$4,528.53
|
| Rate for Payer: Health EOS Commercial |
$4,380.86
|
| Rate for Payer: HFN Commercial |
$4,528.53
|
| Rate for Payer: Multiplan Commercial |
$3,937.86
|
| Rate for Payer: Preferred Network Access Commercial |
$4,528.53
|
| Rate for Payer: Quartz Beloit One Network |
$2,411.94
|
| Rate for Payer: Quartz Commercial |
$2,953.39
|
| Rate for Payer: WEA Trust Commercial |
$2,707.28
|
| Rate for Payer: WPS Commercial |
$3,645.83
|
|
|
DEEP SCROTAL RETRACTOR SYSTEM 72403867
|
Facility
|
OP
|
$4,733.00
|
|
| Hospital Charge Code |
5385021
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,378.25 |
| Max. Negotiated Rate |
$4,528.53 |
| Rate for Payer: Aetna Commercial |
$4,430.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,233.20
|
| Rate for Payer: Aetna Managed Medicare |
$1,378.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,199.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,461.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,362.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,608.83
|
| Rate for Payer: Cash Price |
$1,419.90
|
| Rate for Payer: Cigna Commercial |
$4,528.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,754.61
|
| Rate for Payer: Health EOS Commercial |
$4,380.86
|
| Rate for Payer: HFN Commercial |
$4,528.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,691.74
|
| Rate for Payer: Multiplan Commercial |
$3,937.86
|
| Rate for Payer: NAPHCARE Commercial |
$2,953.39
|
| Rate for Payer: Preferred Network Access Commercial |
$4,528.53
|
| Rate for Payer: Quartz Beloit One Network |
$2,411.94
|
| Rate for Payer: Quartz Commercial |
$3,199.51
|
| Rate for Payer: Quartz Medicare Advantage |
$2,953.39
|
| Rate for Payer: The Alliance Commercial |
$2,461.16
|
| Rate for Payer: WEA Trust Commercial |
$2,707.28
|
| Rate for Payer: WPS Commercial |
$3,645.83
|
|
|
DEFIBRILLATOR IMPLANTS
|
Facility
|
IP
|
$34,722.51
|
|
|
Service Code
|
APR-DRG 1792
|
| Min. Negotiated Rate |
$30,842.70 |
| Max. Negotiated Rate |
$34,722.51 |
| Rate for Payer: Anthem Medicaid |
$33,248.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$33,248.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$33,248.71
|
| Rate for Payer: Dean Health Medicaid |
$33,248.71
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$30,842.70
|
| Rate for Payer: Managed Health Services Medicaid |
$34,722.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$33,248.71
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$33,248.71
|
| Rate for Payer: United Healthcare Medicaid |
$33,248.71
|
|
|
DEFIBRILLATOR IMPLANTS
|
Facility
|
IP
|
$29,373.84
|
|
|
Service Code
|
APR-DRG 1791
|
| Min. Negotiated Rate |
$26,091.68 |
| Max. Negotiated Rate |
$29,373.84 |
| Rate for Payer: Anthem Medicaid |
$28,127.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$28,127.07
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$28,127.07
|
| Rate for Payer: Dean Health Medicaid |
$28,127.07
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$26,091.68
|
| Rate for Payer: Managed Health Services Medicaid |
$29,373.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,127.07
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$28,127.07
|
| Rate for Payer: United Healthcare Medicaid |
$28,127.07
|
|
|
DEFIBRILLATOR IMPLANTS
|
Facility
|
IP
|
$42,087.89
|
|
|
Service Code
|
APR-DRG 1793
|
| Min. Negotiated Rate |
$37,385.09 |
| Max. Negotiated Rate |
$42,087.89 |
| Rate for Payer: Anthem Medicaid |
$40,301.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$40,301.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$40,301.47
|
| Rate for Payer: Dean Health Medicaid |
$40,301.47
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$37,385.09
|
| Rate for Payer: Managed Health Services Medicaid |
$42,087.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$40,301.47
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$40,301.47
|
| Rate for Payer: United Healthcare Medicaid |
$40,301.47
|
|
|
DEFIBRILLATOR IMPLANTS
|
Facility
|
IP
|
$55,240.35
|
|
|
Service Code
|
APR-DRG 1794
|
| Min. Negotiated Rate |
$49,067.93 |
| Max. Negotiated Rate |
$55,240.35 |
| Rate for Payer: Anthem Medicaid |
$52,895.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$52,895.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$52,895.68
|
| Rate for Payer: Dean Health Medicaid |
$52,895.68
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$49,067.93
|
| Rate for Payer: Managed Health Services Medicaid |
$55,240.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$52,895.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$52,895.68
|
| Rate for Payer: United Healthcare Medicaid |
$52,895.68
|
|
|
DEGENERATIVE NERVOUS SYSTEM DIAGNOSES EXC MULT SCLEROSIS
|
Facility
|
OP
|
$94.34
|
|
|
Service Code
|
EAPG 00522
|
| Min. Negotiated Rate |
$90.71 |
| Max. Negotiated Rate |
$94.34 |
| Rate for Payer: Anthem Medicaid |
$90.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$90.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$90.71
|
| Rate for Payer: Dean Health Medicaid |
$90.71
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$90.71
|
| Rate for Payer: Managed Health Services Medicaid |
$94.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$90.71
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$90.71
|
| Rate for Payer: United Healthcare Medicaid |
$90.71
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS
|
Facility
|
IP
|
$8,768.31
|
|
|
Service Code
|
APR-DRG 0422
|
| Min. Negotiated Rate |
$7,788.56 |
| Max. Negotiated Rate |
$8,768.31 |
| Rate for Payer: Anthem Medicaid |
$8,396.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$8,396.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8,396.14
|
| Rate for Payer: Dean Health Medicaid |
$8,396.14
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$7,788.56
|
| Rate for Payer: Managed Health Services Medicaid |
$8,768.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,396.14
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8,396.14
|
| Rate for Payer: United Healthcare Medicaid |
$8,396.14
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS
|
Facility
|
IP
|
$6,839.28
|
|
|
Service Code
|
APR-DRG 0421
|
| Min. Negotiated Rate |
$6,075.08 |
| Max. Negotiated Rate |
$6,839.28 |
| Rate for Payer: Anthem Medicaid |
$6,548.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$6,548.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,548.99
|
| Rate for Payer: Dean Health Medicaid |
$6,548.99
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6,075.08
|
| Rate for Payer: Managed Health Services Medicaid |
$6,839.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,548.99
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6,548.99
|
| Rate for Payer: United Healthcare Medicaid |
$6,548.99
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS
|
Facility
|
IP
|
$12,363.32
|
|
|
Service Code
|
APR-DRG 0423
|
| Min. Negotiated Rate |
$10,981.87 |
| Max. Negotiated Rate |
$12,363.32 |
| Rate for Payer: Anthem Medicaid |
$11,838.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$11,838.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11,838.56
|
| Rate for Payer: Dean Health Medicaid |
$11,838.56
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$10,981.87
|
| Rate for Payer: Managed Health Services Medicaid |
$12,363.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,838.56
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11,838.56
|
| Rate for Payer: United Healthcare Medicaid |
$11,838.56
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS EXCEPT MULTIPLE SCLEROSIS
|
Facility
|
IP
|
$22,797.61
|
|
|
Service Code
|
APR-DRG 0424
|
| Min. Negotiated Rate |
$20,250.26 |
| Max. Negotiated Rate |
$22,797.61 |
| Rate for Payer: Anthem Medicaid |
$21,829.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$21,829.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$21,829.96
|
| Rate for Payer: Dean Health Medicaid |
$21,829.96
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$20,250.26
|
| Rate for Payer: Managed Health Services Medicaid |
$22,797.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$21,829.96
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$21,829.96
|
| Rate for Payer: United Healthcare Medicaid |
$21,829.96
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC
|
Facility
|
IP
|
$66,525.68
|
|
|
Service Code
|
MSDRG 056
|
| Min. Negotiated Rate |
$18,297.54 |
| Max. Negotiated Rate |
$66,525.68 |
| Rate for Payer: Aetna Managed Medicare |
$18,297.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50,688.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$38,852.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$36,912.01
|
| Rate for Payer: Anthem Medicare Advantage |
$18,297.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18,297.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18,297.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18,297.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40,975.72
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18,297.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48,550.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18,297.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18,297.54
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18,297.54
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18,297.54
|
| Rate for Payer: NAPHCARE Commercial |
$27,446.31
|
| Rate for Payer: Quartz Medicare Advantage |
$18,297.54
|
| Rate for Payer: The Alliance Commercial |
$66,525.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18,297.54
|
| Rate for Payer: United Healthcare PPO |
$37,797.04
|
| Rate for Payer: Wellcare Medicare |
$18,297.54
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC
|
Facility
|
IP
|
$38,024.48
|
|
|
Service Code
|
MSDRG 057
|
| Min. Negotiated Rate |
$10,428.75 |
| Max. Negotiated Rate |
$38,024.48 |
| Rate for Payer: Aetna Managed Medicare |
$10,428.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$28,268.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21,667.93
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20,585.94
|
| Rate for Payer: Anthem Medicare Advantage |
$10,428.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,428.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,428.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,428.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22,852.29
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,428.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27,645.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,428.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,428.75
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,428.75
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,428.75
|
| Rate for Payer: NAPHCARE Commercial |
$15,643.12
|
| Rate for Payer: Quartz Medicare Advantage |
$10,428.75
|
| Rate for Payer: The Alliance Commercial |
$38,024.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,428.75
|
| Rate for Payer: United Healthcare PPO |
$21,522.53
|
| Rate for Payer: Wellcare Medicare |
$10,428.75
|
|
|
Deglyced RBC
|
Facility
|
IP
|
$723.00
|
|
|
Service Code
|
HCPCS P9054
|
| Hospital Charge Code |
5190719
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$368.44 |
| Max. Negotiated Rate |
$691.77 |
| Rate for Payer: Aetna Commercial |
$676.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$646.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$398.52
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Cigna Commercial |
$691.77
|
| Rate for Payer: Health EOS Commercial |
$669.21
|
| Rate for Payer: HFN Commercial |
$691.77
|
| Rate for Payer: Multiplan Commercial |
$601.54
|
| Rate for Payer: Preferred Network Access Commercial |
$691.77
|
| Rate for Payer: Quartz Beloit One Network |
$368.44
|
| Rate for Payer: Quartz Commercial |
$451.15
|
| Rate for Payer: WEA Trust Commercial |
$413.56
|
| Rate for Payer: WPS Commercial |
$556.93
|
|
|
Deglyced RBC
|
Facility
|
OP
|
$723.00
|
|
|
Service Code
|
HCPCS P9054
|
| Hospital Charge Code |
5190719
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$273.17 |
| Max. Negotiated Rate |
$1,092.67 |
| Rate for Payer: Aetna Commercial |
$676.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$646.65
|
| Rate for Payer: Aetna Managed Medicare |
$273.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$488.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$375.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$360.92
|
| Rate for Payer: Anthem Medicare Advantage |
$273.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$398.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$273.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$273.17
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Cigna Commercial |
$691.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$273.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$420.79
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$273.17
|
| Rate for Payer: Health EOS Commercial |
$669.21
|
| Rate for Payer: HFN Commercial |
$691.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,016.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$273.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$273.17
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$273.17
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$273.17
|
| Rate for Payer: Multiplan Commercial |
$601.54
|
| Rate for Payer: NAPHCARE Commercial |
$409.75
|
| Rate for Payer: Preferred Network Access Commercial |
$691.77
|
| Rate for Payer: Quartz Beloit One Network |
$368.44
|
| Rate for Payer: Quartz Commercial |
$488.75
|
| Rate for Payer: Quartz Medicare Advantage |
$273.17
|
| Rate for Payer: The Alliance Commercial |
$1,092.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$273.17
|
| Rate for Payer: United Healthcare PPO |
$563.94
|
| Rate for Payer: WEA Trust Commercial |
$413.56
|
| Rate for Payer: Wellcare Medicare |
$273.17
|
| Rate for Payer: WPS Commercial |
$556.93
|
|
|
Dehydroepiandrosterone
|
Professional
|
Both
|
$491.00
|
|
|
Service Code
|
CPT 82626
|
| Hospital Charge Code |
977924
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.28 |
| Max. Negotiated Rate |
$485.11 |
| Rate for Payer: Aetna Commercial |
$485.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$439.15
|
| Rate for Payer: Aetna Managed Medicare |
$26.28
|
| Rate for Payer: Anthem Medicare Advantage |
$26.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26.28
|
| Rate for Payer: Cash Price |
$147.30
|
| Rate for Payer: Cash Price |
$147.30
|
| Rate for Payer: Cigna Commercial |
$485.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$255.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.28
|
| Rate for Payer: Health EOS Commercial |
$464.68
|
| Rate for Payer: HFN Commercial |
$485.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$92.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$92.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26.28
|
| Rate for Payer: Multiplan Commercial |
$408.51
|
| Rate for Payer: NAPHCARE Commercial |
$39.42
|
| Rate for Payer: Preferred Network Access Commercial |
$485.11
|
| Rate for Payer: Quartz Beloit One Network |
$224.68
|
| Rate for Payer: Quartz Commercial |
$291.06
|
| Rate for Payer: Quartz Medicare Advantage |
$26.28
|
| Rate for Payer: The Alliance Commercial |
$103.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.28
|
| Rate for Payer: WEA Trust Commercial |
$280.85
|
| Rate for Payer: WPS Commercial |
$115.64
|
|
|
Dehydroepiandrosterone
|
Facility
|
OP
|
$491.00
|
|
|
Service Code
|
CPT 82626
|
| Hospital Charge Code |
977924
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.28 |
| Max. Negotiated Rate |
$469.79 |
| Rate for Payer: Aetna Commercial |
$459.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$439.15
|
| Rate for Payer: Aetna Managed Medicare |
$26.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$98.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$45.99
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$43.63
|
| Rate for Payer: Anthem Medicare Advantage |
$26.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$270.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26.28
|
| Rate for Payer: Cash Price |
$147.30
|
| Rate for Payer: Cash Price |
$147.30
|
| Rate for Payer: Cigna Commercial |
$469.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$26.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$285.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$26.28
|
| Rate for Payer: Health EOS Commercial |
$454.47
|
| Rate for Payer: HFN Commercial |
$469.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$97.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$26.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$26.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$26.28
|
| Rate for Payer: Multiplan Commercial |
$408.51
|
| Rate for Payer: NAPHCARE Commercial |
$39.42
|
| Rate for Payer: Preferred Network Access Commercial |
$469.79
|
| Rate for Payer: Quartz Beloit One Network |
$250.21
|
| Rate for Payer: Quartz Commercial |
$331.92
|
| Rate for Payer: Quartz Medicare Advantage |
$26.28
|
| Rate for Payer: The Alliance Commercial |
$105.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.28
|
| Rate for Payer: United Healthcare PPO |
$382.98
|
| Rate for Payer: WEA Trust Commercial |
$280.85
|
| Rate for Payer: Wellcare Medicare |
$26.28
|
| Rate for Payer: WPS Commercial |
$378.22
|
|
|
Dehydroepiandrosterone
|
Facility
|
IP
|
$491.00
|
|
|
Service Code
|
CPT 82626
|
| Hospital Charge Code |
977924
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$250.21 |
| Max. Negotiated Rate |
$469.79 |
| Rate for Payer: Aetna Commercial |
$459.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$439.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$270.64
|
| Rate for Payer: Cash Price |
$147.30
|
| Rate for Payer: Cigna Commercial |
$469.79
|
| Rate for Payer: Health EOS Commercial |
$454.47
|
| Rate for Payer: HFN Commercial |
$469.79
|
| Rate for Payer: Multiplan Commercial |
$408.51
|
| Rate for Payer: Preferred Network Access Commercial |
$469.79
|
| Rate for Payer: Quartz Beloit One Network |
$250.21
|
| Rate for Payer: Quartz Commercial |
$306.38
|
| Rate for Payer: WEA Trust Commercial |
$280.85
|
| Rate for Payer: WPS Commercial |
$378.22
|
|
|
Dehydroepiandrosterone Sulfate
|
Professional
|
Both
|
$174.00
|
|
|
Service Code
|
CPT 82627
|
| Hospital Charge Code |
977925
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.12 |
| Max. Negotiated Rate |
$171.91 |
| Rate for Payer: Aetna Commercial |
$171.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$155.63
|
| Rate for Payer: Aetna Managed Medicare |
$23.12
|
| Rate for Payer: Anthem Medicare Advantage |
$23.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23.12
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cigna Commercial |
$171.91
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$90.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23.12
|
| Rate for Payer: Health EOS Commercial |
$164.67
|
| Rate for Payer: HFN Commercial |
$171.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$81.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$81.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23.12
|
| Rate for Payer: Multiplan Commercial |
$144.77
|
| Rate for Payer: NAPHCARE Commercial |
$34.68
|
| Rate for Payer: Preferred Network Access Commercial |
$171.91
|
| Rate for Payer: Quartz Beloit One Network |
$79.62
|
| Rate for Payer: Quartz Commercial |
$103.15
|
| Rate for Payer: Quartz Medicare Advantage |
$23.12
|
| Rate for Payer: The Alliance Commercial |
$91.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.12
|
| Rate for Payer: WEA Trust Commercial |
$99.53
|
| Rate for Payer: WPS Commercial |
$101.72
|
|
|
Dehydroepiandrosterone Sulfate
|
Facility
|
IP
|
$174.00
|
|
|
Service Code
|
CPT 82627
|
| Hospital Charge Code |
977925
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$88.67 |
| Max. Negotiated Rate |
$166.48 |
| Rate for Payer: Aetna Commercial |
$162.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$155.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$95.91
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cigna Commercial |
$166.48
|
| Rate for Payer: Health EOS Commercial |
$161.05
|
| Rate for Payer: HFN Commercial |
$166.48
|
| Rate for Payer: Multiplan Commercial |
$144.77
|
| Rate for Payer: Preferred Network Access Commercial |
$166.48
|
| Rate for Payer: Quartz Beloit One Network |
$88.67
|
| Rate for Payer: Quartz Commercial |
$108.58
|
| Rate for Payer: WEA Trust Commercial |
$99.53
|
| Rate for Payer: WPS Commercial |
$134.03
|
|
|
Dehydroepiandrosterone Sulfate
|
Facility
|
OP
|
$174.00
|
|
|
Service Code
|
CPT 82627
|
| Hospital Charge Code |
977925
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.12 |
| Max. Negotiated Rate |
$166.48 |
| Rate for Payer: Aetna Commercial |
$162.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$155.63
|
| Rate for Payer: Aetna Managed Medicare |
$23.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$86.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$40.46
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$38.38
|
| Rate for Payer: Anthem Medicare Advantage |
$23.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$95.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23.12
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cigna Commercial |
$166.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$23.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$101.27
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$23.12
|
| Rate for Payer: Health EOS Commercial |
$161.05
|
| Rate for Payer: HFN Commercial |
$166.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$86.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$23.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$23.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$23.12
|
| Rate for Payer: Multiplan Commercial |
$144.77
|
| Rate for Payer: NAPHCARE Commercial |
$34.68
|
| Rate for Payer: Preferred Network Access Commercial |
$166.48
|
| Rate for Payer: Quartz Beloit One Network |
$88.67
|
| Rate for Payer: Quartz Commercial |
$117.62
|
| Rate for Payer: Quartz Medicare Advantage |
$23.12
|
| Rate for Payer: The Alliance Commercial |
$92.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.12
|
| Rate for Payer: United Healthcare PPO |
$135.72
|
| Rate for Payer: WEA Trust Commercial |
$99.53
|
| Rate for Payer: Wellcare Medicare |
$23.12
|
| Rate for Payer: WPS Commercial |
$134.03
|
|
