|
DEVICE VOYANT 5MM MARYLAND FUSION EB215
|
Facility
|
IP
|
$3,197.00
|
|
| Hospital Charge Code |
6153653
|
|
Hospital Revenue Code
|
372
|
| Min. Negotiated Rate |
$1,629.19 |
| Max. Negotiated Rate |
$3,058.89 |
| Rate for Payer: Aetna Commercial |
$2,992.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,859.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,762.19
|
| Rate for Payer: Cash Price |
$959.10
|
| Rate for Payer: Cigna Commercial |
$3,058.89
|
| Rate for Payer: Health EOS Commercial |
$2,959.14
|
| Rate for Payer: HFN Commercial |
$3,058.89
|
| Rate for Payer: Multiplan Commercial |
$2,659.90
|
| Rate for Payer: Preferred Network Access Commercial |
$3,058.89
|
| Rate for Payer: Quartz Beloit One Network |
$1,629.19
|
| Rate for Payer: Quartz Commercial |
$1,994.93
|
| Rate for Payer: WEA Trust Commercial |
$1,828.68
|
| Rate for Payer: WPS Commercial |
$2,462.65
|
|
|
DEVICE VOYANT 5MM MARYLAND FUSION EB215
|
Facility
|
OP
|
$3,197.00
|
|
| Hospital Charge Code |
6153653
|
|
Hospital Revenue Code
|
372
|
| Min. Negotiated Rate |
$930.97 |
| Max. Negotiated Rate |
$3,058.89 |
| Rate for Payer: Aetna Commercial |
$2,992.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,859.40
|
| Rate for Payer: Aetna Managed Medicare |
$930.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,161.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,662.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,595.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,762.19
|
| Rate for Payer: Cash Price |
$959.10
|
| Rate for Payer: Cigna Commercial |
$3,058.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,860.65
|
| Rate for Payer: Health EOS Commercial |
$2,959.14
|
| Rate for Payer: HFN Commercial |
$3,058.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,493.66
|
| Rate for Payer: Multiplan Commercial |
$2,659.90
|
| Rate for Payer: NAPHCARE Commercial |
$1,994.93
|
| Rate for Payer: Preferred Network Access Commercial |
$3,058.89
|
| Rate for Payer: Quartz Beloit One Network |
$1,629.19
|
| Rate for Payer: Quartz Commercial |
$2,161.17
|
| Rate for Payer: Quartz Medicare Advantage |
$1,994.93
|
| Rate for Payer: The Alliance Commercial |
$1,662.44
|
| Rate for Payer: WEA Trust Commercial |
$1,828.68
|
| Rate for Payer: WPS Commercial |
$2,462.65
|
|
|
DEVICE VOYANT 5MM MARYLAND SINGLE-STEP EB212
|
Facility
|
IP
|
$3,074.00
|
|
| Hospital Charge Code |
6178283
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,566.51 |
| Max. Negotiated Rate |
$2,941.20 |
| Rate for Payer: Aetna Commercial |
$2,877.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,749.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,694.39
|
| Rate for Payer: Cash Price |
$922.20
|
| Rate for Payer: Cigna Commercial |
$2,941.20
|
| Rate for Payer: Health EOS Commercial |
$2,845.29
|
| Rate for Payer: HFN Commercial |
$2,941.20
|
| Rate for Payer: Multiplan Commercial |
$2,557.57
|
| Rate for Payer: Preferred Network Access Commercial |
$2,941.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,566.51
|
| Rate for Payer: Quartz Commercial |
$1,918.18
|
| Rate for Payer: WEA Trust Commercial |
$1,758.33
|
| Rate for Payer: WPS Commercial |
$2,367.90
|
|
|
DEVICE VOYANT 5MM MARYLAND SINGLE-STEP EB212
|
Facility
|
OP
|
$3,074.00
|
|
| Hospital Charge Code |
6178283
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$895.15 |
| Max. Negotiated Rate |
$2,941.20 |
| Rate for Payer: Aetna Commercial |
$2,877.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,749.39
|
| Rate for Payer: Aetna Managed Medicare |
$895.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,078.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,598.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,534.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,694.39
|
| Rate for Payer: Cash Price |
$922.20
|
| Rate for Payer: Cigna Commercial |
$2,941.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,789.07
|
| Rate for Payer: Health EOS Commercial |
$2,845.29
|
| Rate for Payer: HFN Commercial |
$2,941.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,397.72
|
| Rate for Payer: Multiplan Commercial |
$2,557.57
|
| Rate for Payer: NAPHCARE Commercial |
$1,918.18
|
| Rate for Payer: Preferred Network Access Commercial |
$2,941.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,566.51
|
| Rate for Payer: Quartz Commercial |
$2,078.02
|
| Rate for Payer: Quartz Medicare Advantage |
$1,918.18
|
| Rate for Payer: The Alliance Commercial |
$1,598.48
|
| Rate for Payer: WEA Trust Commercial |
$1,758.33
|
| Rate for Payer: WPS Commercial |
$2,367.90
|
|
|
DEVICE VOYANT FINE FUSION EB230
|
Facility
|
IP
|
$3,197.00
|
|
| Hospital Charge Code |
6153655
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,629.19 |
| Max. Negotiated Rate |
$3,058.89 |
| Rate for Payer: Aetna Commercial |
$2,992.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,859.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,762.19
|
| Rate for Payer: Cash Price |
$959.10
|
| Rate for Payer: Cigna Commercial |
$3,058.89
|
| Rate for Payer: Health EOS Commercial |
$2,959.14
|
| Rate for Payer: HFN Commercial |
$3,058.89
|
| Rate for Payer: Multiplan Commercial |
$2,659.90
|
| Rate for Payer: Preferred Network Access Commercial |
$3,058.89
|
| Rate for Payer: Quartz Beloit One Network |
$1,629.19
|
| Rate for Payer: Quartz Commercial |
$1,994.93
|
| Rate for Payer: WEA Trust Commercial |
$1,828.68
|
| Rate for Payer: WPS Commercial |
$2,462.65
|
|
|
DEVICE VOYANT FINE FUSION EB230
|
Facility
|
OP
|
$3,197.00
|
|
| Hospital Charge Code |
6153655
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$930.97 |
| Max. Negotiated Rate |
$3,058.89 |
| Rate for Payer: Aetna Commercial |
$2,992.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,859.40
|
| Rate for Payer: Aetna Managed Medicare |
$930.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,161.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,662.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,595.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,762.19
|
| Rate for Payer: Cash Price |
$959.10
|
| Rate for Payer: Cigna Commercial |
$3,058.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,860.65
|
| Rate for Payer: Health EOS Commercial |
$2,959.14
|
| Rate for Payer: HFN Commercial |
$3,058.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,493.66
|
| Rate for Payer: Multiplan Commercial |
$2,659.90
|
| Rate for Payer: NAPHCARE Commercial |
$1,994.93
|
| Rate for Payer: Preferred Network Access Commercial |
$3,058.89
|
| Rate for Payer: Quartz Beloit One Network |
$1,629.19
|
| Rate for Payer: Quartz Commercial |
$2,161.17
|
| Rate for Payer: Quartz Medicare Advantage |
$1,994.93
|
| Rate for Payer: The Alliance Commercial |
$1,662.44
|
| Rate for Payer: WEA Trust Commercial |
$1,828.68
|
| Rate for Payer: WPS Commercial |
$2,462.65
|
|
|
DEVICE VOYANT OPEN FUSION EB240
|
Facility
|
OP
|
$3,197.00
|
|
| Hospital Charge Code |
6153656
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$930.97 |
| Max. Negotiated Rate |
$3,058.89 |
| Rate for Payer: Aetna Commercial |
$2,992.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,859.40
|
| Rate for Payer: Aetna Managed Medicare |
$930.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,161.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,662.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,595.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,762.19
|
| Rate for Payer: Cash Price |
$959.10
|
| Rate for Payer: Cigna Commercial |
$3,058.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,860.65
|
| Rate for Payer: Health EOS Commercial |
$2,959.14
|
| Rate for Payer: HFN Commercial |
$3,058.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,493.66
|
| Rate for Payer: Multiplan Commercial |
$2,659.90
|
| Rate for Payer: NAPHCARE Commercial |
$1,994.93
|
| Rate for Payer: Preferred Network Access Commercial |
$3,058.89
|
| Rate for Payer: Quartz Beloit One Network |
$1,629.19
|
| Rate for Payer: Quartz Commercial |
$2,161.17
|
| Rate for Payer: Quartz Medicare Advantage |
$1,994.93
|
| Rate for Payer: The Alliance Commercial |
$1,662.44
|
| Rate for Payer: WEA Trust Commercial |
$1,828.68
|
| Rate for Payer: WPS Commercial |
$2,462.65
|
|
|
DEVICE VOYANT OPEN FUSION EB240
|
Facility
|
IP
|
$3,197.00
|
|
| Hospital Charge Code |
6153656
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,629.19 |
| Max. Negotiated Rate |
$3,058.89 |
| Rate for Payer: Aetna Commercial |
$2,992.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,859.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,762.19
|
| Rate for Payer: Cash Price |
$959.10
|
| Rate for Payer: Cigna Commercial |
$3,058.89
|
| Rate for Payer: Health EOS Commercial |
$2,959.14
|
| Rate for Payer: HFN Commercial |
$3,058.89
|
| Rate for Payer: Multiplan Commercial |
$2,659.90
|
| Rate for Payer: Preferred Network Access Commercial |
$3,058.89
|
| Rate for Payer: Quartz Beloit One Network |
$1,629.19
|
| Rate for Payer: Quartz Commercial |
$1,994.93
|
| Rate for Payer: WEA Trust Commercial |
$1,828.68
|
| Rate for Payer: WPS Commercial |
$2,462.65
|
|
|
Dexamethasone 10mg/1ml (1ml VIA) [MED]
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
3031080
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$24.88 |
| Rate for Payer: Aetna Commercial |
$24.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$23.25
|
| Rate for Payer: Aetna Managed Medicare |
$7.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.33
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cigna Commercial |
$24.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.16
|
| Rate for Payer: Health EOS Commercial |
$24.07
|
| Rate for Payer: HFN Commercial |
$24.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.28
|
| Rate for Payer: Multiplan Commercial |
$21.63
|
| Rate for Payer: NAPHCARE Commercial |
$16.22
|
| Rate for Payer: Preferred Network Access Commercial |
$24.88
|
| Rate for Payer: Quartz Beloit One Network |
$13.25
|
| Rate for Payer: Quartz Commercial |
$17.58
|
| Rate for Payer: Quartz Medicare Advantage |
$16.22
|
| Rate for Payer: The Alliance Commercial |
$0.46
|
| Rate for Payer: WEA Trust Commercial |
$14.87
|
| Rate for Payer: WPS Commercial |
$0.30
|
|
|
Dexamethasone 10mg/1ml (1ml VIA) [MED]
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
3031080
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$24.88 |
| Rate for Payer: Aetna Commercial |
$24.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$23.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.33
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cigna Commercial |
$24.88
|
| Rate for Payer: Health EOS Commercial |
$24.07
|
| Rate for Payer: HFN Commercial |
$24.88
|
| Rate for Payer: Multiplan Commercial |
$21.63
|
| Rate for Payer: Preferred Network Access Commercial |
$24.88
|
| Rate for Payer: Quartz Beloit One Network |
$13.25
|
| Rate for Payer: Quartz Commercial |
$16.22
|
| Rate for Payer: WEA Trust Commercial |
$14.87
|
| Rate for Payer: WPS Commercial |
$20.03
|
|
|
dexamethasone 1 mg Charge
|
Professional
|
Both
|
$2.00
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
2958971
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$1.98 |
| Rate for Payer: Aetna Commercial |
$1.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1.79
|
| Rate for Payer: Aetna Managed Medicare |
$0.11
|
| Rate for Payer: Anthem Medicare Advantage |
$0.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$0.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$0.11
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$0.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.12
|
| Rate for Payer: Health EOS Commercial |
$1.89
|
| Rate for Payer: HFN Commercial |
$1.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$0.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$0.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: NAPHCARE Commercial |
$0.17
|
| Rate for Payer: Preferred Network Access Commercial |
$1.98
|
| Rate for Payer: Quartz Beloit One Network |
$0.92
|
| Rate for Payer: Quartz Commercial |
$1.19
|
| Rate for Payer: Quartz Medicare Advantage |
$0.11
|
| Rate for Payer: The Alliance Commercial |
$0.31
|
| Rate for Payer: United Healthcare Medicaid |
$0.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.11
|
| Rate for Payer: WEA Trust Commercial |
$1.14
|
| Rate for Payer: WPS Commercial |
$0.30
|
|
|
dexamethasone 1 mg Charge
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
2958971
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Aetna Commercial |
$1.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.10
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.91
|
| Rate for Payer: Health EOS Commercial |
$1.85
|
| Rate for Payer: HFN Commercial |
$1.91
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: Preferred Network Access Commercial |
$1.91
|
| Rate for Payer: Quartz Beloit One Network |
$1.02
|
| Rate for Payer: Quartz Commercial |
$1.25
|
| Rate for Payer: WEA Trust Commercial |
$1.14
|
| Rate for Payer: WPS Commercial |
$1.54
|
|
|
dexamethasone 1 mg Charge
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
2958971
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Aetna Commercial |
$1.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1.79
|
| Rate for Payer: Aetna Managed Medicare |
$0.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.10
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.16
|
| Rate for Payer: Health EOS Commercial |
$1.85
|
| Rate for Payer: HFN Commercial |
$1.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1.56
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: NAPHCARE Commercial |
$1.25
|
| Rate for Payer: Preferred Network Access Commercial |
$1.91
|
| Rate for Payer: Quartz Beloit One Network |
$1.02
|
| Rate for Payer: Quartz Commercial |
$1.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1.25
|
| Rate for Payer: The Alliance Commercial |
$0.46
|
| Rate for Payer: WEA Trust Commercial |
$1.14
|
| Rate for Payer: WPS Commercial |
$0.30
|
|
|
Dexamethasone 4mg/1ml vial [Med]
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
2974928
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$10.52 |
| Rate for Payer: Aetna Commercial |
$10.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6.06
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cigna Commercial |
$10.52
|
| Rate for Payer: Health EOS Commercial |
$10.18
|
| Rate for Payer: HFN Commercial |
$10.52
|
| Rate for Payer: Multiplan Commercial |
$9.15
|
| Rate for Payer: Preferred Network Access Commercial |
$10.52
|
| Rate for Payer: Quartz Beloit One Network |
$5.61
|
| Rate for Payer: Quartz Commercial |
$6.86
|
| Rate for Payer: WEA Trust Commercial |
$6.29
|
| Rate for Payer: WPS Commercial |
$8.47
|
|
|
Dexamethasone 4mg/1ml vial [Med]
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
2974928
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$10.52 |
| Rate for Payer: Aetna Commercial |
$10.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9.84
|
| Rate for Payer: Aetna Managed Medicare |
$3.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6.06
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cigna Commercial |
$10.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.16
|
| Rate for Payer: Health EOS Commercial |
$10.18
|
| Rate for Payer: HFN Commercial |
$10.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8.58
|
| Rate for Payer: Multiplan Commercial |
$9.15
|
| Rate for Payer: NAPHCARE Commercial |
$6.86
|
| Rate for Payer: Preferred Network Access Commercial |
$10.52
|
| Rate for Payer: Quartz Beloit One Network |
$5.61
|
| Rate for Payer: Quartz Commercial |
$7.44
|
| Rate for Payer: Quartz Medicare Advantage |
$6.86
|
| Rate for Payer: The Alliance Commercial |
$0.46
|
| Rate for Payer: WEA Trust Commercial |
$6.29
|
| Rate for Payer: WPS Commercial |
$0.30
|
|
|
Dexamethasone JW Waste Charge
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
HCPCS J1100 JW
|
| Hospital Charge Code |
5246654
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Aetna Commercial |
$1.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.10
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.91
|
| Rate for Payer: Health EOS Commercial |
$1.85
|
| Rate for Payer: HFN Commercial |
$1.91
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: Preferred Network Access Commercial |
$1.91
|
| Rate for Payer: Quartz Beloit One Network |
$1.02
|
| Rate for Payer: Quartz Commercial |
$1.25
|
| Rate for Payer: WEA Trust Commercial |
$1.14
|
| Rate for Payer: WPS Commercial |
$1.54
|
|
|
Dexamethasone JW Waste Charge
|
Professional
|
Both
|
$2.00
|
|
|
Service Code
|
HCPCS J1100 JW
|
| Hospital Charge Code |
5246654
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$1.98 |
| Rate for Payer: Aetna Commercial |
$1.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1.79
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$0.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.12
|
| Rate for Payer: Health EOS Commercial |
$1.89
|
| Rate for Payer: HFN Commercial |
$1.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$0.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: Preferred Network Access Commercial |
$1.98
|
| Rate for Payer: Quartz Beloit One Network |
$0.92
|
| Rate for Payer: Quartz Commercial |
$1.19
|
| Rate for Payer: The Alliance Commercial |
$1.04
|
| Rate for Payer: United Healthcare Medicaid |
$0.11
|
| Rate for Payer: WEA Trust Commercial |
$1.14
|
| Rate for Payer: WPS Commercial |
$0.30
|
|
|
Dexamethasone JW Waste Charge
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
HCPCS J1100 JW
|
| Hospital Charge Code |
5246654
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Aetna Commercial |
$1.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1.79
|
| Rate for Payer: Aetna Managed Medicare |
$0.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.10
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.16
|
| Rate for Payer: Health EOS Commercial |
$1.85
|
| Rate for Payer: HFN Commercial |
$1.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1.56
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: NAPHCARE Commercial |
$1.25
|
| Rate for Payer: Preferred Network Access Commercial |
$1.91
|
| Rate for Payer: Quartz Beloit One Network |
$1.02
|
| Rate for Payer: Quartz Commercial |
$1.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1.25
|
| Rate for Payer: The Alliance Commercial |
$1.04
|
| Rate for Payer: WEA Trust Commercial |
$1.14
|
| Rate for Payer: WPS Commercial |
$0.30
|
|
|
Dexamethasone Level
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
3256226
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.39 |
| Max. Negotiated Rate |
$139.69 |
| Rate for Payer: Aetna Commercial |
$136.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$130.58
|
| Rate for Payer: Aetna Managed Medicare |
$19.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$72.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.18
|
| Rate for Payer: Anthem Medicare Advantage |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.39
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cigna Commercial |
$139.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$84.97
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.39
|
| Rate for Payer: Health EOS Commercial |
$135.14
|
| Rate for Payer: HFN Commercial |
$139.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.39
|
| Rate for Payer: Multiplan Commercial |
$121.47
|
| Rate for Payer: NAPHCARE Commercial |
$29.08
|
| Rate for Payer: Preferred Network Access Commercial |
$139.69
|
| Rate for Payer: Quartz Beloit One Network |
$74.40
|
| Rate for Payer: Quartz Commercial |
$98.70
|
| Rate for Payer: Quartz Medicare Advantage |
$19.39
|
| Rate for Payer: The Alliance Commercial |
$77.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.39
|
| Rate for Payer: United Healthcare PPO |
$113.88
|
| Rate for Payer: WEA Trust Commercial |
$83.51
|
| Rate for Payer: Wellcare Medicare |
$19.39
|
| Rate for Payer: WPS Commercial |
$112.46
|
|
|
Dexamethasone Level
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
3256226
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$74.40 |
| Max. Negotiated Rate |
$139.69 |
| Rate for Payer: Aetna Commercial |
$136.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$130.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.48
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cigna Commercial |
$139.69
|
| Rate for Payer: Health EOS Commercial |
$135.14
|
| Rate for Payer: HFN Commercial |
$139.69
|
| Rate for Payer: Multiplan Commercial |
$121.47
|
| Rate for Payer: Preferred Network Access Commercial |
$139.69
|
| Rate for Payer: Quartz Beloit One Network |
$74.40
|
| Rate for Payer: Quartz Commercial |
$91.10
|
| Rate for Payer: WEA Trust Commercial |
$83.51
|
| Rate for Payer: WPS Commercial |
$112.46
|
|
|
Dexamethasone Level
|
Professional
|
Both
|
$146.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
3256226
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.39 |
| Max. Negotiated Rate |
$144.25 |
| Rate for Payer: Aetna Commercial |
$144.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$130.58
|
| Rate for Payer: Aetna Managed Medicare |
$19.39
|
| Rate for Payer: Anthem Medicare Advantage |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.39
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cigna Commercial |
$144.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$75.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.39
|
| Rate for Payer: Health EOS Commercial |
$138.17
|
| Rate for Payer: HFN Commercial |
$144.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$68.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.39
|
| Rate for Payer: Multiplan Commercial |
$121.47
|
| Rate for Payer: NAPHCARE Commercial |
$29.08
|
| Rate for Payer: Preferred Network Access Commercial |
$144.25
|
| Rate for Payer: Quartz Beloit One Network |
$66.81
|
| Rate for Payer: Quartz Commercial |
$86.55
|
| Rate for Payer: Quartz Medicare Advantage |
$19.39
|
| Rate for Payer: The Alliance Commercial |
$76.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.39
|
| Rate for Payer: WEA Trust Commercial |
$83.51
|
| Rate for Payer: WPS Commercial |
$85.30
|
|
|
Dexamethasone sodium phos 1 mg J1100
|
Professional
|
Both
|
$3.00
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
3376948
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$2.96 |
| Rate for Payer: Aetna Commercial |
$2.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2.68
|
| Rate for Payer: Aetna Managed Medicare |
$0.11
|
| Rate for Payer: Anthem Medicare Advantage |
$0.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$0.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$0.11
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna Commercial |
$2.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$0.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.12
|
| Rate for Payer: Health EOS Commercial |
$2.84
|
| Rate for Payer: HFN Commercial |
$2.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$0.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$0.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$2.50
|
| Rate for Payer: NAPHCARE Commercial |
$0.17
|
| Rate for Payer: Preferred Network Access Commercial |
$2.96
|
| Rate for Payer: Quartz Beloit One Network |
$1.37
|
| Rate for Payer: Quartz Commercial |
$1.78
|
| Rate for Payer: Quartz Medicare Advantage |
$0.11
|
| Rate for Payer: The Alliance Commercial |
$0.31
|
| Rate for Payer: United Healthcare Medicaid |
$0.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.11
|
| Rate for Payer: WEA Trust Commercial |
$1.72
|
| Rate for Payer: WPS Commercial |
$0.30
|
|
|
Dexamethasone sodium phos 1 mg J1100
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
3376948
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Aetna Commercial |
$2.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2.68
|
| Rate for Payer: Aetna Managed Medicare |
$0.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.65
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna Commercial |
$2.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.16
|
| Rate for Payer: Health EOS Commercial |
$2.78
|
| Rate for Payer: HFN Commercial |
$2.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2.34
|
| Rate for Payer: Multiplan Commercial |
$2.50
|
| Rate for Payer: NAPHCARE Commercial |
$1.87
|
| Rate for Payer: Preferred Network Access Commercial |
$2.87
|
| Rate for Payer: Quartz Beloit One Network |
$1.53
|
| Rate for Payer: Quartz Commercial |
$2.03
|
| Rate for Payer: Quartz Medicare Advantage |
$1.87
|
| Rate for Payer: The Alliance Commercial |
$0.46
|
| Rate for Payer: WEA Trust Commercial |
$1.72
|
| Rate for Payer: WPS Commercial |
$0.30
|
|
|
Dexamethasone sodium phos 1 mg J1100
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
3376948
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Aetna Commercial |
$2.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.65
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna Commercial |
$2.87
|
| Rate for Payer: Health EOS Commercial |
$2.78
|
| Rate for Payer: HFN Commercial |
$2.87
|
| Rate for Payer: Multiplan Commercial |
$2.50
|
| Rate for Payer: Preferred Network Access Commercial |
$2.87
|
| Rate for Payer: Quartz Beloit One Network |
$1.53
|
| Rate for Payer: Quartz Commercial |
$1.87
|
| Rate for Payer: WEA Trust Commercial |
$1.72
|
| Rate for Payer: WPS Commercial |
$2.31
|
|
|
Dexamethasone Suppression Test
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
1038965
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.67 |
| Max. Negotiated Rate |
$66.98 |
| Rate for Payer: Aetna Commercial |
$65.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$62.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.58
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$66.98
|
| Rate for Payer: Health EOS Commercial |
$64.79
|
| Rate for Payer: HFN Commercial |
$66.98
|
| Rate for Payer: Multiplan Commercial |
$58.24
|
| Rate for Payer: Preferred Network Access Commercial |
$66.98
|
| Rate for Payer: Quartz Beloit One Network |
$35.67
|
| Rate for Payer: Quartz Commercial |
$43.68
|
| Rate for Payer: WEA Trust Commercial |
$40.04
|
| Rate for Payer: WPS Commercial |
$53.92
|
|
