|
heparin 1000units/ml [MED]
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
3072322
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.82 |
| Max. Negotiated Rate |
$31.57 |
| Rate for Payer: Aetna Commercial |
$30.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$29.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$18.19
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cigna Commercial |
$31.57
|
| Rate for Payer: Health EOS Commercial |
$30.54
|
| Rate for Payer: HFN Commercial |
$31.57
|
| Rate for Payer: Multiplan Commercial |
$27.46
|
| Rate for Payer: Preferred Network Access Commercial |
$31.57
|
| Rate for Payer: Quartz Beloit One Network |
$16.82
|
| Rate for Payer: Quartz Commercial |
$20.59
|
| Rate for Payer: WEA Trust Commercial |
$18.88
|
| Rate for Payer: WPS Commercial |
$25.42
|
|
|
heparin 1000units/ml [MED]
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
3072322
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$31.57 |
| Rate for Payer: Aetna Commercial |
$30.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$29.52
|
| Rate for Payer: Aetna Managed Medicare |
$9.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$18.19
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cigna Commercial |
$31.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.38
|
| Rate for Payer: Health EOS Commercial |
$30.54
|
| Rate for Payer: HFN Commercial |
$31.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25.74
|
| Rate for Payer: Multiplan Commercial |
$27.46
|
| Rate for Payer: NAPHCARE Commercial |
$20.59
|
| Rate for Payer: Preferred Network Access Commercial |
$31.57
|
| Rate for Payer: Quartz Beloit One Network |
$16.82
|
| Rate for Payer: Quartz Commercial |
$22.31
|
| Rate for Payer: Quartz Medicare Advantage |
$20.59
|
| Rate for Payer: The Alliance Commercial |
$0.75
|
| Rate for Payer: WEA Trust Commercial |
$18.88
|
| Rate for Payer: WPS Commercial |
$0.71
|
|
|
Heparin 50,000units/5ml (Med)
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
5415008
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$76.54 |
| Rate for Payer: Aetna Commercial |
$74.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.55
|
| Rate for Payer: Aetna Managed Medicare |
$23.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$54.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$41.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$39.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.10
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$76.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.38
|
| Rate for Payer: Health EOS Commercial |
$74.05
|
| Rate for Payer: HFN Commercial |
$76.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.40
|
| Rate for Payer: Multiplan Commercial |
$66.56
|
| Rate for Payer: NAPHCARE Commercial |
$49.92
|
| Rate for Payer: Preferred Network Access Commercial |
$76.54
|
| Rate for Payer: Quartz Beloit One Network |
$40.77
|
| Rate for Payer: Quartz Commercial |
$54.08
|
| Rate for Payer: Quartz Medicare Advantage |
$49.92
|
| Rate for Payer: The Alliance Commercial |
$0.75
|
| Rate for Payer: WEA Trust Commercial |
$45.76
|
| Rate for Payer: WPS Commercial |
$0.71
|
|
|
Heparin 50,000units/5ml (Med)
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
5415008
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.77 |
| Max. Negotiated Rate |
$76.54 |
| Rate for Payer: Aetna Commercial |
$74.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.10
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$76.54
|
| Rate for Payer: Health EOS Commercial |
$74.05
|
| Rate for Payer: HFN Commercial |
$76.54
|
| Rate for Payer: Multiplan Commercial |
$66.56
|
| Rate for Payer: Preferred Network Access Commercial |
$76.54
|
| Rate for Payer: Quartz Beloit One Network |
$40.77
|
| Rate for Payer: Quartz Commercial |
$49.92
|
| Rate for Payer: WEA Trust Commercial |
$45.76
|
| Rate for Payer: WPS Commercial |
$61.62
|
|
|
Heparin 5000units/1ml vial [Med]
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
2974945
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.19 |
| Max. Negotiated Rate |
$19.14 |
| Rate for Payer: Aetna Commercial |
$18.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.02
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cigna Commercial |
$19.14
|
| Rate for Payer: Health EOS Commercial |
$18.51
|
| Rate for Payer: HFN Commercial |
$19.14
|
| Rate for Payer: Multiplan Commercial |
$16.64
|
| Rate for Payer: Preferred Network Access Commercial |
$19.14
|
| Rate for Payer: Quartz Beloit One Network |
$10.19
|
| Rate for Payer: Quartz Commercial |
$12.48
|
| Rate for Payer: WEA Trust Commercial |
$11.44
|
| Rate for Payer: WPS Commercial |
$15.41
|
|
|
Heparin 5000units/1ml vial [Med]
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
2974945
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$19.14 |
| Rate for Payer: Aetna Commercial |
$18.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17.89
|
| Rate for Payer: Aetna Managed Medicare |
$5.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.02
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cigna Commercial |
$19.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.38
|
| Rate for Payer: Health EOS Commercial |
$18.51
|
| Rate for Payer: HFN Commercial |
$19.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.60
|
| Rate for Payer: Multiplan Commercial |
$16.64
|
| Rate for Payer: NAPHCARE Commercial |
$12.48
|
| Rate for Payer: Preferred Network Access Commercial |
$19.14
|
| Rate for Payer: Quartz Beloit One Network |
$10.19
|
| Rate for Payer: Quartz Commercial |
$13.52
|
| Rate for Payer: Quartz Medicare Advantage |
$12.48
|
| Rate for Payer: The Alliance Commercial |
$0.75
|
| Rate for Payer: WEA Trust Commercial |
$11.44
|
| Rate for Payer: WPS Commercial |
$0.71
|
|
|
Heparin Flush 100units/ml syringe 10ml [Med]
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS J1642
|
| Hospital Charge Code |
2974946
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Aetna Commercial |
$7.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.41
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.65
|
| Rate for Payer: Health EOS Commercial |
$7.40
|
| Rate for Payer: HFN Commercial |
$7.65
|
| Rate for Payer: Multiplan Commercial |
$6.66
|
| Rate for Payer: Preferred Network Access Commercial |
$7.65
|
| Rate for Payer: Quartz Beloit One Network |
$4.08
|
| Rate for Payer: Quartz Commercial |
$4.99
|
| Rate for Payer: WEA Trust Commercial |
$4.58
|
| Rate for Payer: WPS Commercial |
$6.16
|
|
|
Heparin Flush 100units/ml syringe 10ml [Med]
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS J1642
|
| Hospital Charge Code |
2974946
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Aetna Commercial |
$7.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7.16
|
| Rate for Payer: Aetna Managed Medicare |
$2.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.41
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.02
|
| Rate for Payer: Health EOS Commercial |
$7.40
|
| Rate for Payer: HFN Commercial |
$7.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6.24
|
| Rate for Payer: Multiplan Commercial |
$6.66
|
| Rate for Payer: NAPHCARE Commercial |
$4.99
|
| Rate for Payer: Preferred Network Access Commercial |
$7.65
|
| Rate for Payer: Quartz Beloit One Network |
$4.08
|
| Rate for Payer: Quartz Commercial |
$5.41
|
| Rate for Payer: Quartz Medicare Advantage |
$4.99
|
| Rate for Payer: The Alliance Commercial |
$0.08
|
| Rate for Payer: WEA Trust Commercial |
$4.58
|
| Rate for Payer: WPS Commercial |
$0.04
|
|
|
Heparin Induced Platelet Antibody
|
Facility
|
OP
|
$656.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
979849
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.10 |
| Max. Negotiated Rate |
$627.66 |
| Rate for Payer: Aetna Commercial |
$614.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$586.73
|
| Rate for Payer: Aetna Managed Medicare |
$19.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$71.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.71
|
| Rate for Payer: Anthem Medicare Advantage |
$19.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$361.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.10
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cigna Commercial |
$627.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$381.79
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.10
|
| Rate for Payer: Health EOS Commercial |
$607.19
|
| Rate for Payer: HFN Commercial |
$627.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$71.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.10
|
| Rate for Payer: Multiplan Commercial |
$545.79
|
| Rate for Payer: NAPHCARE Commercial |
$28.66
|
| Rate for Payer: Preferred Network Access Commercial |
$627.66
|
| Rate for Payer: Quartz Beloit One Network |
$334.30
|
| Rate for Payer: Quartz Commercial |
$443.46
|
| Rate for Payer: Quartz Medicare Advantage |
$19.10
|
| Rate for Payer: The Alliance Commercial |
$76.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.10
|
| Rate for Payer: United Healthcare PPO |
$511.68
|
| Rate for Payer: WEA Trust Commercial |
$375.23
|
| Rate for Payer: Wellcare Medicare |
$19.10
|
| Rate for Payer: WPS Commercial |
$505.32
|
|
|
Heparin Induced Platelet Antibody
|
Professional
|
Both
|
$656.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
979849
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.10 |
| Max. Negotiated Rate |
$648.13 |
| Rate for Payer: Aetna Commercial |
$648.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$586.73
|
| Rate for Payer: Aetna Managed Medicare |
$19.10
|
| Rate for Payer: Anthem Medicare Advantage |
$19.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.10
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cigna Commercial |
$648.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$341.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.10
|
| Rate for Payer: Health EOS Commercial |
$620.84
|
| Rate for Payer: HFN Commercial |
$648.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$67.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$67.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.10
|
| Rate for Payer: Multiplan Commercial |
$545.79
|
| Rate for Payer: NAPHCARE Commercial |
$28.66
|
| Rate for Payer: Preferred Network Access Commercial |
$648.13
|
| Rate for Payer: Quartz Beloit One Network |
$300.19
|
| Rate for Payer: Quartz Commercial |
$388.88
|
| Rate for Payer: Quartz Medicare Advantage |
$19.10
|
| Rate for Payer: The Alliance Commercial |
$75.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.10
|
| Rate for Payer: WEA Trust Commercial |
$375.23
|
| Rate for Payer: WPS Commercial |
$84.06
|
|
|
Heparin Induced Platelet Antibody
|
Facility
|
IP
|
$656.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
979849
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$334.30 |
| Max. Negotiated Rate |
$627.66 |
| Rate for Payer: Aetna Commercial |
$614.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$586.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$361.59
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cigna Commercial |
$627.66
|
| Rate for Payer: Health EOS Commercial |
$607.19
|
| Rate for Payer: HFN Commercial |
$627.66
|
| Rate for Payer: Multiplan Commercial |
$545.79
|
| Rate for Payer: Preferred Network Access Commercial |
$627.66
|
| Rate for Payer: Quartz Beloit One Network |
$334.30
|
| Rate for Payer: Quartz Commercial |
$409.34
|
| Rate for Payer: WEA Trust Commercial |
$375.23
|
| Rate for Payer: WPS Commercial |
$505.32
|
|
|
Heparin JW Waste Charge per 1000 u
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
HCPCS J1644 JW
|
| Hospital Charge Code |
5266700
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.38 |
| 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 |
$0.38
|
| 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 |
$1.56
|
| Rate for Payer: WEA Trust Commercial |
$1.72
|
| Rate for Payer: WPS Commercial |
$0.71
|
|
|
Heparin JW Waste Charge per 1000 u
|
Professional
|
Both
|
$3.00
|
|
|
Service Code
|
HCPCS J1644 JW
|
| Hospital Charge Code |
5266700
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$2.96 |
| Rate for Payer: Aetna Commercial |
$2.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2.68
|
| 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 |
$0.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.28
|
| Rate for Payer: Health EOS Commercial |
$2.84
|
| Rate for Payer: HFN Commercial |
$2.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$0.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$2.50
|
| 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: The Alliance Commercial |
$1.56
|
| Rate for Payer: United Healthcare Medicaid |
$0.19
|
| Rate for Payer: WEA Trust Commercial |
$1.72
|
| Rate for Payer: WPS Commercial |
$0.71
|
|
|
Heparin JW Waste Charge per 1000 u
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
HCPCS J1644 JW
|
| Hospital Charge Code |
5266700
|
|
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
|
|
|
HEPATIC COMA AND OTHER MAJOR ACUTE LIVER DISORDERS
|
Facility
|
IP
|
$11,311.12
|
|
|
Service Code
|
APR-DRG 2793
|
| Min. Negotiated Rate |
$10,047.24 |
| Max. Negotiated Rate |
$11,311.12 |
| Rate for Payer: Anthem Medicaid |
$10,831.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$10,831.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10,831.02
|
| Rate for Payer: Dean Health Medicaid |
$10,831.02
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$10,047.24
|
| Rate for Payer: Managed Health Services Medicaid |
$11,311.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,831.02
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$10,831.02
|
| Rate for Payer: United Healthcare Medicaid |
$10,831.02
|
|
|
HEPATIC COMA AND OTHER MAJOR ACUTE LIVER DISORDERS
|
Facility
|
IP
|
$6,576.23
|
|
|
Service Code
|
APR-DRG 2792
|
| Min. Negotiated Rate |
$5,841.42 |
| Max. Negotiated Rate |
$6,576.23 |
| Rate for Payer: Anthem Medicaid |
$6,297.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$6,297.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,297.10
|
| Rate for Payer: Dean Health Medicaid |
$6,297.10
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5,841.42
|
| Rate for Payer: Managed Health Services Medicaid |
$6,576.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,297.10
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6,297.10
|
| Rate for Payer: United Healthcare Medicaid |
$6,297.10
|
|
|
HEPATIC COMA AND OTHER MAJOR ACUTE LIVER DISORDERS
|
Facility
|
IP
|
$4,559.52
|
|
|
Service Code
|
APR-DRG 2791
|
| Min. Negotiated Rate |
$4,050.05 |
| Max. Negotiated Rate |
$4,559.52 |
| Rate for Payer: Anthem Medicaid |
$4,365.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$4,365.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,365.99
|
| Rate for Payer: Dean Health Medicaid |
$4,365.99
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4,050.05
|
| Rate for Payer: Managed Health Services Medicaid |
$4,559.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,365.99
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4,365.99
|
| Rate for Payer: United Healthcare Medicaid |
$4,365.99
|
|
|
HEPATIC COMA AND OTHER MAJOR ACUTE LIVER DISORDERS
|
Facility
|
IP
|
$21,570.04
|
|
|
Service Code
|
APR-DRG 2794
|
| Min. Negotiated Rate |
$19,159.86 |
| Max. Negotiated Rate |
$21,570.04 |
| Rate for Payer: Anthem Medicaid |
$20,654.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$20,654.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$20,654.50
|
| Rate for Payer: Dean Health Medicaid |
$20,654.50
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19,159.86
|
| Rate for Payer: Managed Health Services Medicaid |
$21,570.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$20,654.50
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$20,654.50
|
| Rate for Payer: United Healthcare Medicaid |
$20,654.50
|
|
|
Hepatitis A Antibody IgG + IgM
|
Facility
|
OP
|
$286.00
|
|
|
Service Code
|
CPT 86708
|
| Hospital Charge Code |
633745
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.89 |
| Max. Negotiated Rate |
$273.64 |
| Rate for Payer: Aetna Commercial |
$267.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$255.80
|
| Rate for Payer: Aetna Managed Medicare |
$12.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.55
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.39
|
| Rate for Payer: Anthem Medicare Advantage |
$12.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$157.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.89
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cigna Commercial |
$273.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$166.45
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.89
|
| Rate for Payer: Health EOS Commercial |
$264.72
|
| Rate for Payer: HFN Commercial |
$273.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.89
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.89
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.89
|
| Rate for Payer: Multiplan Commercial |
$237.95
|
| Rate for Payer: NAPHCARE Commercial |
$19.33
|
| Rate for Payer: Preferred Network Access Commercial |
$273.64
|
| Rate for Payer: Quartz Beloit One Network |
$145.75
|
| Rate for Payer: Quartz Commercial |
$193.34
|
| Rate for Payer: Quartz Medicare Advantage |
$12.89
|
| Rate for Payer: The Alliance Commercial |
$51.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.89
|
| Rate for Payer: United Healthcare PPO |
$223.08
|
| Rate for Payer: WEA Trust Commercial |
$163.59
|
| Rate for Payer: Wellcare Medicare |
$12.89
|
| Rate for Payer: WPS Commercial |
$220.31
|
|
|
Hepatitis A Antibody IgG + IgM
|
Facility
|
IP
|
$286.00
|
|
|
Service Code
|
CPT 86708
|
| Hospital Charge Code |
633745
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$145.75 |
| Max. Negotiated Rate |
$273.64 |
| Rate for Payer: Aetna Commercial |
$267.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$255.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$157.64
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cigna Commercial |
$273.64
|
| Rate for Payer: Health EOS Commercial |
$264.72
|
| Rate for Payer: HFN Commercial |
$273.64
|
| Rate for Payer: Multiplan Commercial |
$237.95
|
| Rate for Payer: Preferred Network Access Commercial |
$273.64
|
| Rate for Payer: Quartz Beloit One Network |
$145.75
|
| Rate for Payer: Quartz Commercial |
$178.46
|
| Rate for Payer: WEA Trust Commercial |
$163.59
|
| Rate for Payer: WPS Commercial |
$220.31
|
|
|
Hepatitis A Antibody IgG + IgM
|
Professional
|
Both
|
$286.00
|
|
|
Service Code
|
CPT 86708
|
| Hospital Charge Code |
633745
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.89 |
| Max. Negotiated Rate |
$282.57 |
| Rate for Payer: Aetna Commercial |
$282.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$255.80
|
| Rate for Payer: Aetna Managed Medicare |
$12.89
|
| Rate for Payer: Anthem Medicare Advantage |
$12.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.89
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cigna Commercial |
$282.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$148.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.89
|
| Rate for Payer: Health EOS Commercial |
$270.67
|
| Rate for Payer: HFN Commercial |
$282.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$45.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.89
|
| Rate for Payer: Multiplan Commercial |
$237.95
|
| Rate for Payer: NAPHCARE Commercial |
$19.33
|
| Rate for Payer: Preferred Network Access Commercial |
$282.57
|
| Rate for Payer: Quartz Beloit One Network |
$130.87
|
| Rate for Payer: Quartz Commercial |
$169.54
|
| Rate for Payer: Quartz Medicare Advantage |
$12.89
|
| Rate for Payer: The Alliance Commercial |
$50.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.89
|
| Rate for Payer: WEA Trust Commercial |
$163.59
|
| Rate for Payer: WPS Commercial |
$56.70
|
|
|
Hepatitis A Antibody IgM Acute Titer
|
Professional
|
Both
|
$386.00
|
|
|
Service Code
|
CPT 86709
|
| Hospital Charge Code |
633747
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.71 |
| Max. Negotiated Rate |
$381.37 |
| Rate for Payer: Aetna Commercial |
$381.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$345.24
|
| Rate for Payer: Aetna Managed Medicare |
$11.71
|
| Rate for Payer: Anthem Medicare Advantage |
$11.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.71
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cigna Commercial |
$381.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$200.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.71
|
| Rate for Payer: Health EOS Commercial |
$365.31
|
| Rate for Payer: HFN Commercial |
$381.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$41.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$41.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.71
|
| Rate for Payer: Multiplan Commercial |
$321.15
|
| Rate for Payer: NAPHCARE Commercial |
$17.57
|
| Rate for Payer: Preferred Network Access Commercial |
$381.37
|
| Rate for Payer: Quartz Beloit One Network |
$176.63
|
| Rate for Payer: Quartz Commercial |
$228.82
|
| Rate for Payer: Quartz Medicare Advantage |
$11.71
|
| Rate for Payer: The Alliance Commercial |
$46.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.71
|
| Rate for Payer: WEA Trust Commercial |
$220.79
|
| Rate for Payer: WPS Commercial |
$51.53
|
|
|
Hepatitis A Antibody IgM Acute Titer
|
Facility
|
OP
|
$386.00
|
|
|
Service Code
|
CPT 86709
|
| Hospital Charge Code |
633747
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.71 |
| Max. Negotiated Rate |
$369.32 |
| Rate for Payer: Aetna Commercial |
$361.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$345.24
|
| Rate for Payer: Aetna Managed Medicare |
$11.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$43.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.49
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.44
|
| Rate for Payer: Anthem Medicare Advantage |
$11.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$212.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.71
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cigna Commercial |
$369.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$224.65
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.71
|
| Rate for Payer: Health EOS Commercial |
$357.28
|
| Rate for Payer: HFN Commercial |
$369.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.71
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.71
|
| Rate for Payer: Multiplan Commercial |
$321.15
|
| Rate for Payer: NAPHCARE Commercial |
$17.57
|
| Rate for Payer: Preferred Network Access Commercial |
$369.32
|
| Rate for Payer: Quartz Beloit One Network |
$196.71
|
| Rate for Payer: Quartz Commercial |
$260.94
|
| Rate for Payer: Quartz Medicare Advantage |
$11.71
|
| Rate for Payer: The Alliance Commercial |
$46.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.71
|
| Rate for Payer: United Healthcare PPO |
$301.08
|
| Rate for Payer: WEA Trust Commercial |
$220.79
|
| Rate for Payer: Wellcare Medicare |
$11.71
|
| Rate for Payer: WPS Commercial |
$297.34
|
|
|
Hepatitis A Antibody IgM Acute Titer
|
Facility
|
IP
|
$386.00
|
|
|
Service Code
|
CPT 86709
|
| Hospital Charge Code |
633747
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$196.71 |
| Max. Negotiated Rate |
$369.32 |
| Rate for Payer: Aetna Commercial |
$361.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$345.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$212.76
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cigna Commercial |
$369.32
|
| Rate for Payer: Health EOS Commercial |
$357.28
|
| Rate for Payer: HFN Commercial |
$369.32
|
| Rate for Payer: Multiplan Commercial |
$321.15
|
| Rate for Payer: Preferred Network Access Commercial |
$369.32
|
| Rate for Payer: Quartz Beloit One Network |
$196.71
|
| Rate for Payer: Quartz Commercial |
$240.86
|
| Rate for Payer: WEA Trust Commercial |
$220.79
|
| Rate for Payer: WPS Commercial |
$297.34
|
|
|
Hepatitis A Antibody Total w/ Reflex IgM
|
Professional
|
Both
|
$129.00
|
|
|
Service Code
|
CPT 86708
|
| Hospital Charge Code |
1039129
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.89 |
| Max. Negotiated Rate |
$127.45 |
| Rate for Payer: Aetna Commercial |
$127.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$115.38
|
| Rate for Payer: Aetna Managed Medicare |
$12.89
|
| Rate for Payer: Anthem Medicare Advantage |
$12.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.89
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cigna Commercial |
$127.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$67.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.89
|
| Rate for Payer: Health EOS Commercial |
$122.09
|
| Rate for Payer: HFN Commercial |
$127.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$45.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.89
|
| Rate for Payer: Multiplan Commercial |
$107.33
|
| Rate for Payer: NAPHCARE Commercial |
$19.33
|
| Rate for Payer: Preferred Network Access Commercial |
$127.45
|
| Rate for Payer: Quartz Beloit One Network |
$59.03
|
| Rate for Payer: Quartz Commercial |
$76.47
|
| Rate for Payer: Quartz Medicare Advantage |
$12.89
|
| Rate for Payer: The Alliance Commercial |
$50.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.89
|
| Rate for Payer: WEA Trust Commercial |
$73.79
|
| Rate for Payer: WPS Commercial |
$56.70
|
|
