|
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 |
$0.37
|
| Rate for Payer: WEA Trust Commercial |
$1.14
|
| Rate for Payer: WPS Commercial |
$0.30
|
|
|
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 |
$0.37
|
| Rate for Payer: WEA Trust Commercial |
$6.29
|
| 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 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 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 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 |
$0.09 |
| 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 |
$0.09
|
| Rate for Payer: Anthem Medicare Advantage |
$0.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$0.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$0.09
|
| 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 |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$2.50
|
| Rate for Payer: NAPHCARE Commercial |
$0.14
|
| 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 |
$0.09
|
| Rate for Payer: The Alliance Commercial |
$0.26
|
| Rate for Payer: United Healthcare Medicaid |
$0.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.09
|
| 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 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 |
$0.37
|
| Rate for Payer: WEA Trust Commercial |
$1.72
|
| Rate for Payer: WPS Commercial |
$0.30
|
|
|
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
|
|
|
Dexamethasone Suppression Test
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
1038965
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.95 |
| Max. Negotiated Rate |
$74.59 |
| Rate for Payer: Aetna Commercial |
$69.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$62.61
|
| Rate for Payer: Aetna Managed Medicare |
$16.95
|
| Rate for Payer: Anthem Medicare Advantage |
$16.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.95
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$69.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$36.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.95
|
| Rate for Payer: Health EOS Commercial |
$66.25
|
| Rate for Payer: HFN Commercial |
$69.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$59.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.95
|
| Rate for Payer: Multiplan Commercial |
$58.24
|
| Rate for Payer: NAPHCARE Commercial |
$25.43
|
| Rate for Payer: Preferred Network Access Commercial |
$69.16
|
| Rate for Payer: Quartz Beloit One Network |
$32.03
|
| Rate for Payer: Quartz Commercial |
$41.50
|
| Rate for Payer: Quartz Medicare Advantage |
$16.95
|
| Rate for Payer: The Alliance Commercial |
$66.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.95
|
| Rate for Payer: WEA Trust Commercial |
$40.04
|
| Rate for Payer: WPS Commercial |
$74.59
|
|
|
Dexamethasone Suppression Test
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
1038965
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.95 |
| Max. Negotiated Rate |
$67.81 |
| Rate for Payer: Aetna Commercial |
$65.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$62.61
|
| Rate for Payer: Aetna Managed Medicare |
$16.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29.67
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.14
|
| Rate for Payer: Anthem Medicare Advantage |
$16.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.95
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$66.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.74
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.95
|
| Rate for Payer: Health EOS Commercial |
$64.79
|
| Rate for Payer: HFN Commercial |
$66.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.95
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.95
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.95
|
| Rate for Payer: Multiplan Commercial |
$58.24
|
| Rate for Payer: NAPHCARE Commercial |
$25.43
|
| Rate for Payer: Preferred Network Access Commercial |
$66.98
|
| Rate for Payer: Quartz Beloit One Network |
$35.67
|
| Rate for Payer: Quartz Commercial |
$47.32
|
| Rate for Payer: Quartz Medicare Advantage |
$16.95
|
| Rate for Payer: The Alliance Commercial |
$67.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.95
|
| Rate for Payer: United Healthcare PPO |
$54.60
|
| Rate for Payer: WEA Trust Commercial |
$40.04
|
| Rate for Payer: Wellcare Medicare |
$16.95
|
| Rate for Payer: WPS Commercial |
$53.92
|
|
|
DIABETES
|
Facility
|
IP
|
$5,874.77
|
|
|
Service Code
|
APR-DRG 4202
|
| Min. Negotiated Rate |
$5,218.34 |
| Max. Negotiated Rate |
$5,874.77 |
| Rate for Payer: Anthem Medicaid |
$5,625.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$5,625.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,625.41
|
| Rate for Payer: Dean Health Medicaid |
$5,625.41
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5,218.34
|
| Rate for Payer: Managed Health Services Medicaid |
$5,874.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,625.41
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5,625.41
|
| Rate for Payer: United Healthcare Medicaid |
$5,625.41
|
|
|
DIABETES
|
Facility
|
IP
|
$4,471.84
|
|
|
Service Code
|
APR-DRG 4201
|
| Min. Negotiated Rate |
$3,972.17 |
| Max. Negotiated Rate |
$4,471.84 |
| Rate for Payer: Anthem Medicaid |
$4,282.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$4,282.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,282.03
|
| Rate for Payer: Dean Health Medicaid |
$4,282.03
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$3,972.17
|
| Rate for Payer: Managed Health Services Medicaid |
$4,471.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,282.03
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4,282.03
|
| Rate for Payer: United Healthcare Medicaid |
$4,282.03
|
|
|
DIABETES
|
Facility
|
IP
|
$8,943.68
|
|
|
Service Code
|
APR-DRG 4203
|
| Min. Negotiated Rate |
$7,944.33 |
| Max. Negotiated Rate |
$8,943.68 |
| Rate for Payer: Anthem Medicaid |
$8,564.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$8,564.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8,564.06
|
| Rate for Payer: Dean Health Medicaid |
$8,564.06
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$7,944.33
|
| Rate for Payer: Managed Health Services Medicaid |
$8,943.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,564.06
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8,564.06
|
| Rate for Payer: United Healthcare Medicaid |
$8,564.06
|
|
|
DIABETES
|
Facility
|
IP
|
$16,747.47
|
|
|
Service Code
|
APR-DRG 4204
|
| Min. Negotiated Rate |
$14,876.15 |
| Max. Negotiated Rate |
$16,747.47 |
| Rate for Payer: Anthem Medicaid |
$16,036.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$16,036.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16,036.63
|
| Rate for Payer: Dean Health Medicaid |
$16,036.63
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14,876.15
|
| Rate for Payer: Managed Health Services Medicaid |
$16,747.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$16,036.63
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$16,036.63
|
| Rate for Payer: United Healthcare Medicaid |
$16,036.63
|
|
|
DIABETES WITH CC
|
Facility
|
IP
|
$25,201.28
|
|
|
Service Code
|
MSDRG 638
|
| Min. Negotiated Rate |
$7,370.05 |
| Max. Negotiated Rate |
$25,201.28 |
| Rate for Payer: Aetna Managed Medicare |
$7,370.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,554.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,988.26
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14,239.83
|
| Rate for Payer: Anthem Medicare Advantage |
$7,370.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,370.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,370.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,370.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15,807.52
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,370.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18,239.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,370.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,370.05
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,370.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,370.05
|
| Rate for Payer: NAPHCARE Commercial |
$11,055.08
|
| Rate for Payer: Quartz Medicare Advantage |
$7,370.05
|
| Rate for Payer: The Alliance Commercial |
$25,201.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,370.05
|
| Rate for Payer: United Healthcare PPO |
$14,199.94
|
| Rate for Payer: Wellcare Medicare |
$7,370.05
|
|
|
DIABETES WITH MCC
|
Facility
|
IP
|
$40,405.04
|
|
|
Service Code
|
MSDRG 637
|
| Min. Negotiated Rate |
$11,509.31 |
| Max. Negotiated Rate |
$40,405.04 |
| Rate for Payer: Aetna Managed Medicare |
$11,509.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31,347.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24,027.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22,827.90
|
| Rate for Payer: Anthem Medicare Advantage |
$11,509.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,509.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,509.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,509.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25,341.06
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,509.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29,391.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,509.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,509.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,509.31
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,509.31
|
| Rate for Payer: NAPHCARE Commercial |
$17,263.96
|
| Rate for Payer: Quartz Medicare Advantage |
$11,509.31
|
| Rate for Payer: The Alliance Commercial |
$40,405.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,509.31
|
| Rate for Payer: United Healthcare PPO |
$22,881.89
|
| Rate for Payer: Wellcare Medicare |
$11,509.31
|
|
|
DIABETES WITH NEUROLOGIC MANIFESTATIONS
|
Facility
|
OP
|
$27.37
|
|
|
Service Code
|
EAPG 00712
|
| Min. Negotiated Rate |
$26.32 |
| Max. Negotiated Rate |
$27.37 |
| Rate for Payer: Anthem Medicaid |
$26.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$26.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$26.32
|
| Rate for Payer: Dean Health Medicaid |
$26.32
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$26.32
|
| Rate for Payer: Managed Health Services Medicaid |
$27.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.32
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$26.32
|
| Rate for Payer: United Healthcare Medicaid |
$26.32
|
|
|
DIABETES WITH OPHTHALMIC MANIFESTATIONS
|
Facility
|
OP
|
$39.50
|
|
|
Service Code
|
EAPG 00710
|
| Min. Negotiated Rate |
$37.98 |
| Max. Negotiated Rate |
$39.50 |
| Rate for Payer: Anthem Medicaid |
$37.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$37.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$37.98
|
| Rate for Payer: Dean Health Medicaid |
$37.98
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$37.98
|
| Rate for Payer: Managed Health Services Medicaid |
$39.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$37.98
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$37.98
|
| Rate for Payer: United Healthcare Medicaid |
$37.98
|
|
|
DIABETES WITH OTHER MANIFESTATIONS & COMPLICATIONS
|
Facility
|
OP
|
$34.98
|
|
|
Service Code
|
EAPG 00711
|
| Min. Negotiated Rate |
$33.64 |
| Max. Negotiated Rate |
$34.98 |
| Rate for Payer: Anthem Medicaid |
$33.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$33.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$33.64
|
| Rate for Payer: Dean Health Medicaid |
$33.64
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$33.64
|
| Rate for Payer: Managed Health Services Medicaid |
$34.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$33.64
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$33.64
|
| Rate for Payer: United Healthcare Medicaid |
$33.64
|
|
