|
HUMIDIFIER DISPOSABLE
|
Facility
|
IP
|
$53.00
|
|
| Hospital Charge Code |
2974649
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.01 |
| Max. Negotiated Rate |
$50.71 |
| Rate for Payer: Aetna Commercial |
$49.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.21
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$50.71
|
| Rate for Payer: Health EOS Commercial |
$49.06
|
| Rate for Payer: HFN Commercial |
$50.71
|
| Rate for Payer: Multiplan Commercial |
$44.10
|
| Rate for Payer: Preferred Network Access Commercial |
$50.71
|
| Rate for Payer: Quartz Beloit One Network |
$27.01
|
| Rate for Payer: Quartz Commercial |
$33.07
|
| Rate for Payer: WEA Trust Commercial |
$30.32
|
| Rate for Payer: WPS Commercial |
$40.83
|
|
|
HUMIDIFIER DISPOSABLE
|
Facility
|
OP
|
$53.00
|
|
| Hospital Charge Code |
2974649
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.43 |
| Max. Negotiated Rate |
$50.71 |
| Rate for Payer: Aetna Commercial |
$49.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47.40
|
| Rate for Payer: Aetna Managed Medicare |
$15.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$35.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.21
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$50.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.85
|
| Rate for Payer: Health EOS Commercial |
$49.06
|
| Rate for Payer: HFN Commercial |
$50.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$41.34
|
| Rate for Payer: Multiplan Commercial |
$44.10
|
| Rate for Payer: NAPHCARE Commercial |
$33.07
|
| Rate for Payer: Preferred Network Access Commercial |
$50.71
|
| Rate for Payer: Quartz Beloit One Network |
$27.01
|
| Rate for Payer: Quartz Commercial |
$35.83
|
| Rate for Payer: Quartz Medicare Advantage |
$33.07
|
| Rate for Payer: The Alliance Commercial |
$27.56
|
| Rate for Payer: WEA Trust Commercial |
$30.32
|
| Rate for Payer: WPS Commercial |
$40.83
|
|
|
Humid-Vent Portex
|
Facility
|
IP
|
$73.00
|
|
| Hospital Charge Code |
3101737
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$69.85 |
| Rate for Payer: Aetna Commercial |
$68.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$65.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.24
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cigna Commercial |
$69.85
|
| Rate for Payer: Health EOS Commercial |
$67.57
|
| Rate for Payer: HFN Commercial |
$69.85
|
| Rate for Payer: Multiplan Commercial |
$60.74
|
| Rate for Payer: Preferred Network Access Commercial |
$69.85
|
| Rate for Payer: Quartz Beloit One Network |
$37.20
|
| Rate for Payer: Quartz Commercial |
$45.55
|
| Rate for Payer: WEA Trust Commercial |
$41.76
|
| Rate for Payer: WPS Commercial |
$56.23
|
|
|
Humid-Vent Portex
|
Facility
|
OP
|
$73.00
|
|
| Hospital Charge Code |
3101737
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$21.26 |
| Max. Negotiated Rate |
$69.85 |
| Rate for Payer: Aetna Commercial |
$68.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$65.29
|
| Rate for Payer: Aetna Managed Medicare |
$21.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$49.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$37.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$36.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.24
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cigna Commercial |
$69.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$42.49
|
| Rate for Payer: Health EOS Commercial |
$67.57
|
| Rate for Payer: HFN Commercial |
$69.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.94
|
| Rate for Payer: Multiplan Commercial |
$60.74
|
| Rate for Payer: NAPHCARE Commercial |
$45.55
|
| Rate for Payer: Preferred Network Access Commercial |
$69.85
|
| Rate for Payer: Quartz Beloit One Network |
$37.20
|
| Rate for Payer: Quartz Commercial |
$49.35
|
| Rate for Payer: Quartz Medicare Advantage |
$45.55
|
| Rate for Payer: The Alliance Commercial |
$37.96
|
| Rate for Payer: WEA Trust Commercial |
$41.76
|
| Rate for Payer: WPS Commercial |
$56.23
|
|
|
Huntington Disease Mutation Analysis
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
1039266
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$142.48 |
| Max. Negotiated Rate |
$741.00 |
| Rate for Payer: Aetna Commercial |
$741.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$670.80
|
| Rate for Payer: Aetna Managed Medicare |
$142.48
|
| Rate for Payer: Anthem Medicare Advantage |
$142.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$142.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$142.48
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$741.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$390.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$142.48
|
| Rate for Payer: Health EOS Commercial |
$709.80
|
| Rate for Payer: HFN Commercial |
$741.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$502.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$502.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$142.48
|
| Rate for Payer: Multiplan Commercial |
$624.00
|
| Rate for Payer: NAPHCARE Commercial |
$213.72
|
| Rate for Payer: Preferred Network Access Commercial |
$741.00
|
| Rate for Payer: Quartz Beloit One Network |
$343.20
|
| Rate for Payer: Quartz Commercial |
$444.60
|
| Rate for Payer: Quartz Medicare Advantage |
$142.48
|
| Rate for Payer: The Alliance Commercial |
$562.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$142.48
|
| Rate for Payer: WEA Trust Commercial |
$429.00
|
| Rate for Payer: WPS Commercial |
$626.91
|
|
|
Huntington Disease Mutation Analysis
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
1039266
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$142.48 |
| Max. Negotiated Rate |
$717.60 |
| Rate for Payer: Aetna Commercial |
$702.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$670.80
|
| Rate for Payer: Aetna Managed Medicare |
$142.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$534.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$249.34
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$236.52
|
| Rate for Payer: Anthem Medicare Advantage |
$142.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$413.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$142.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$142.48
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$717.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$142.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$436.50
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$142.48
|
| Rate for Payer: Health EOS Commercial |
$694.20
|
| Rate for Payer: HFN Commercial |
$717.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$530.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$142.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$142.48
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$142.48
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$142.48
|
| Rate for Payer: Multiplan Commercial |
$624.00
|
| Rate for Payer: NAPHCARE Commercial |
$213.72
|
| Rate for Payer: Preferred Network Access Commercial |
$717.60
|
| Rate for Payer: Quartz Beloit One Network |
$382.20
|
| Rate for Payer: Quartz Commercial |
$507.00
|
| Rate for Payer: Quartz Medicare Advantage |
$142.48
|
| Rate for Payer: The Alliance Commercial |
$569.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$142.48
|
| Rate for Payer: United Healthcare PPO |
$585.00
|
| Rate for Payer: WEA Trust Commercial |
$429.00
|
| Rate for Payer: Wellcare Medicare |
$142.48
|
| Rate for Payer: WPS Commercial |
$577.73
|
|
|
Huntington Disease Mutation Analysis
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
1039266
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$382.20 |
| Max. Negotiated Rate |
$717.60 |
| Rate for Payer: Aetna Commercial |
$702.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$670.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$413.40
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$717.60
|
| Rate for Payer: Health EOS Commercial |
$694.20
|
| Rate for Payer: HFN Commercial |
$717.60
|
| Rate for Payer: Multiplan Commercial |
$624.00
|
| Rate for Payer: Preferred Network Access Commercial |
$717.60
|
| Rate for Payer: Quartz Beloit One Network |
$382.20
|
| Rate for Payer: Quartz Commercial |
$468.00
|
| Rate for Payer: WEA Trust Commercial |
$429.00
|
| Rate for Payer: WPS Commercial |
$577.73
|
|
|
Hyalgan/Supartz 1 Unit Charge
|
Facility
|
IP
|
$540.00
|
|
|
Service Code
|
HCPCS J7321
|
| Hospital Charge Code |
2958959
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$275.18 |
| Max. Negotiated Rate |
$516.67 |
| Rate for Payer: Aetna Commercial |
$505.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$482.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$297.65
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cigna Commercial |
$516.67
|
| Rate for Payer: Health EOS Commercial |
$499.82
|
| Rate for Payer: HFN Commercial |
$516.67
|
| Rate for Payer: Multiplan Commercial |
$449.28
|
| Rate for Payer: Preferred Network Access Commercial |
$516.67
|
| Rate for Payer: Quartz Beloit One Network |
$275.18
|
| Rate for Payer: Quartz Commercial |
$336.96
|
| Rate for Payer: WEA Trust Commercial |
$308.88
|
| Rate for Payer: WPS Commercial |
$415.96
|
|
|
Hyalgan/Supartz 1 Unit Charge
|
Facility
|
OP
|
$540.00
|
|
|
Service Code
|
HCPCS J7321
|
| Hospital Charge Code |
2958959
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$100.60 |
| Max. Negotiated Rate |
$516.67 |
| Rate for Payer: Aetna Commercial |
$505.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$482.98
|
| Rate for Payer: Aetna Managed Medicare |
$157.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$365.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$280.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$269.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$297.65
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cigna Commercial |
$516.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$100.60
|
| Rate for Payer: Health EOS Commercial |
$499.82
|
| Rate for Payer: HFN Commercial |
$516.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$421.20
|
| Rate for Payer: Multiplan Commercial |
$449.28
|
| Rate for Payer: NAPHCARE Commercial |
$336.96
|
| Rate for Payer: Preferred Network Access Commercial |
$516.67
|
| Rate for Payer: Quartz Beloit One Network |
$275.18
|
| Rate for Payer: Quartz Commercial |
$365.04
|
| Rate for Payer: Quartz Medicare Advantage |
$336.96
|
| Rate for Payer: The Alliance Commercial |
$303.56
|
| Rate for Payer: WEA Trust Commercial |
$308.88
|
| Rate for Payer: WPS Commercial |
$190.11
|
|
|
Hyalgan/Supartz 1 Unit Charge
|
Professional
|
Both
|
$540.00
|
|
|
Service Code
|
HCPCS J7321
|
| Hospital Charge Code |
2958959
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$75.89 |
| Max. Negotiated Rate |
$533.52 |
| Rate for Payer: Aetna Commercial |
$533.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$482.98
|
| Rate for Payer: Aetna Managed Medicare |
$75.89
|
| Rate for Payer: Anthem Medicare Advantage |
$75.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$75.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$75.89
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cigna Commercial |
$533.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$75.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$76.04
|
| Rate for Payer: Health EOS Commercial |
$511.06
|
| Rate for Payer: HFN Commercial |
$533.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$115.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$115.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$75.89
|
| Rate for Payer: Multiplan Commercial |
$449.28
|
| Rate for Payer: NAPHCARE Commercial |
$113.83
|
| Rate for Payer: Preferred Network Access Commercial |
$533.52
|
| Rate for Payer: Quartz Beloit One Network |
$247.10
|
| Rate for Payer: Quartz Commercial |
$320.11
|
| Rate for Payer: Quartz Medicare Advantage |
$75.89
|
| Rate for Payer: The Alliance Commercial |
$208.69
|
| Rate for Payer: United Healthcare Medicaid |
$75.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$75.89
|
| Rate for Payer: WEA Trust Commercial |
$308.88
|
| Rate for Payer: WPS Commercial |
$190.11
|
|
|
Hyalgan/supartz inj per dose J7321 man
|
Professional
|
Both
|
$551.00
|
|
|
Service Code
|
HCPCS J7321
|
| Hospital Charge Code |
3373517
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$75.89 |
| Max. Negotiated Rate |
$544.39 |
| Rate for Payer: Aetna Commercial |
$544.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$492.81
|
| Rate for Payer: Aetna Managed Medicare |
$75.89
|
| Rate for Payer: Anthem Medicare Advantage |
$75.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$75.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$75.89
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cigna Commercial |
$544.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$75.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$76.04
|
| Rate for Payer: Health EOS Commercial |
$521.47
|
| Rate for Payer: HFN Commercial |
$544.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$115.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$115.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$75.89
|
| Rate for Payer: Multiplan Commercial |
$458.43
|
| Rate for Payer: NAPHCARE Commercial |
$113.83
|
| Rate for Payer: Preferred Network Access Commercial |
$544.39
|
| Rate for Payer: Quartz Beloit One Network |
$252.14
|
| Rate for Payer: Quartz Commercial |
$326.63
|
| Rate for Payer: Quartz Medicare Advantage |
$75.89
|
| Rate for Payer: The Alliance Commercial |
$208.69
|
| Rate for Payer: United Healthcare Medicaid |
$75.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$75.89
|
| Rate for Payer: WEA Trust Commercial |
$315.17
|
| Rate for Payer: WPS Commercial |
$190.11
|
|
|
Hyalgan/supartz inj per dose J7321 man
|
Facility
|
IP
|
$551.00
|
|
|
Service Code
|
HCPCS J7321
|
| Hospital Charge Code |
3373517
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$280.79 |
| Max. Negotiated Rate |
$527.20 |
| Rate for Payer: Aetna Commercial |
$515.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$492.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$303.71
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cigna Commercial |
$527.20
|
| Rate for Payer: Health EOS Commercial |
$510.01
|
| Rate for Payer: HFN Commercial |
$527.20
|
| Rate for Payer: Multiplan Commercial |
$458.43
|
| Rate for Payer: Preferred Network Access Commercial |
$527.20
|
| Rate for Payer: Quartz Beloit One Network |
$280.79
|
| Rate for Payer: Quartz Commercial |
$343.82
|
| Rate for Payer: WEA Trust Commercial |
$315.17
|
| Rate for Payer: WPS Commercial |
$424.44
|
|
|
Hyalgan/supartz inj per dose J7321 man
|
Facility
|
OP
|
$551.00
|
|
|
Service Code
|
HCPCS J7321
|
| Hospital Charge Code |
3373517
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$100.60 |
| Max. Negotiated Rate |
$527.20 |
| Rate for Payer: Aetna Commercial |
$515.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$492.81
|
| Rate for Payer: Aetna Managed Medicare |
$160.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$372.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$286.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$275.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$303.71
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cigna Commercial |
$527.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$100.60
|
| Rate for Payer: Health EOS Commercial |
$510.01
|
| Rate for Payer: HFN Commercial |
$527.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$429.78
|
| Rate for Payer: Multiplan Commercial |
$458.43
|
| Rate for Payer: NAPHCARE Commercial |
$343.82
|
| Rate for Payer: Preferred Network Access Commercial |
$527.20
|
| Rate for Payer: Quartz Beloit One Network |
$280.79
|
| Rate for Payer: Quartz Commercial |
$372.48
|
| Rate for Payer: Quartz Medicare Advantage |
$343.82
|
| Rate for Payer: The Alliance Commercial |
$303.56
|
| Rate for Payer: WEA Trust Commercial |
$315.17
|
| Rate for Payer: WPS Commercial |
$190.11
|
|
|
Hycamtin 0.1 mg Charge
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS J9351
|
| Hospital Charge Code |
2958866
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$19.76 |
| Rate for Payer: Aetna Commercial |
$19.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17.89
|
| Rate for Payer: Aetna Managed Medicare |
$1.30
|
| Rate for Payer: Anthem Medicare Advantage |
$1.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1.30
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cigna Commercial |
$19.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.22
|
| Rate for Payer: Health EOS Commercial |
$18.93
|
| Rate for Payer: HFN Commercial |
$19.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1.30
|
| Rate for Payer: Multiplan Commercial |
$16.64
|
| Rate for Payer: NAPHCARE Commercial |
$1.95
|
| Rate for Payer: Preferred Network Access Commercial |
$19.76
|
| Rate for Payer: Quartz Beloit One Network |
$9.15
|
| Rate for Payer: Quartz Commercial |
$11.86
|
| Rate for Payer: Quartz Medicare Advantage |
$1.30
|
| Rate for Payer: The Alliance Commercial |
$3.58
|
| Rate for Payer: United Healthcare Medicaid |
$1.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.30
|
| Rate for Payer: WEA Trust Commercial |
$11.44
|
| Rate for Payer: WPS Commercial |
$3.04
|
|
|
Hycamtin 0.1 mg Charge
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
HCPCS J9351
|
| Hospital Charge Code |
2958866
|
|
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
|
|
|
Hycamtin 0.1 mg Charge
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
HCPCS J9351
|
| Hospital Charge Code |
2958866
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.61 |
| 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 |
$1.61
|
| 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 |
$5.20
|
| Rate for Payer: WEA Trust Commercial |
$11.44
|
| Rate for Payer: WPS Commercial |
$3.04
|
|
|
Hydralazine 20mg Inj J0360
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
HCPCS J0360
|
| Hospital Charge Code |
4514807
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$63.70 |
| Max. Negotiated Rate |
$119.60 |
| Rate for Payer: Aetna Commercial |
$117.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$111.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$68.90
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$119.60
|
| Rate for Payer: Health EOS Commercial |
$115.70
|
| Rate for Payer: HFN Commercial |
$119.60
|
| Rate for Payer: Multiplan Commercial |
$104.00
|
| Rate for Payer: Preferred Network Access Commercial |
$119.60
|
| Rate for Payer: Quartz Beloit One Network |
$63.70
|
| Rate for Payer: Quartz Commercial |
$78.00
|
| Rate for Payer: WEA Trust Commercial |
$71.50
|
| Rate for Payer: WPS Commercial |
$96.29
|
|
|
Hydralazine 20mg Inj J0360
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS J0360
|
| Hospital Charge Code |
4514807
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$123.50 |
| Rate for Payer: Aetna Commercial |
$123.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$111.80
|
| Rate for Payer: Aetna Managed Medicare |
$4.57
|
| Rate for Payer: Anthem Medicare Advantage |
$4.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.57
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$123.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.78
|
| Rate for Payer: Health EOS Commercial |
$118.30
|
| Rate for Payer: HFN Commercial |
$123.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.57
|
| Rate for Payer: Multiplan Commercial |
$104.00
|
| Rate for Payer: NAPHCARE Commercial |
$6.85
|
| Rate for Payer: Preferred Network Access Commercial |
$123.50
|
| Rate for Payer: Quartz Beloit One Network |
$57.20
|
| Rate for Payer: Quartz Commercial |
$74.10
|
| Rate for Payer: Quartz Medicare Advantage |
$4.57
|
| Rate for Payer: The Alliance Commercial |
$12.56
|
| Rate for Payer: United Healthcare Medicaid |
$4.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.57
|
| Rate for Payer: WEA Trust Commercial |
$71.50
|
| Rate for Payer: WPS Commercial |
$14.45
|
|
|
Hydralazine 20mg Inj J0360
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
HCPCS J0360
|
| Hospital Charge Code |
4514807
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.64 |
| Max. Negotiated Rate |
$119.60 |
| Rate for Payer: Aetna Commercial |
$117.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$111.80
|
| Rate for Payer: Aetna Managed Medicare |
$36.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$84.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$65.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$62.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$68.90
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$119.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7.64
|
| Rate for Payer: Health EOS Commercial |
$115.70
|
| Rate for Payer: HFN Commercial |
$119.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$97.50
|
| Rate for Payer: Multiplan Commercial |
$104.00
|
| Rate for Payer: NAPHCARE Commercial |
$78.00
|
| Rate for Payer: Preferred Network Access Commercial |
$119.60
|
| Rate for Payer: Quartz Beloit One Network |
$63.70
|
| Rate for Payer: Quartz Commercial |
$84.50
|
| Rate for Payer: Quartz Medicare Advantage |
$78.00
|
| Rate for Payer: The Alliance Commercial |
$18.26
|
| Rate for Payer: WEA Trust Commercial |
$71.50
|
| Rate for Payer: WPS Commercial |
$14.45
|
|
|
HYDRATOME RX44 CANNULATING M00583040
|
Facility
|
IP
|
$5,182.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2973558
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,640.75 |
| Max. Negotiated Rate |
$4,958.14 |
| Rate for Payer: Aetna Commercial |
$4,850.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,634.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,856.32
|
| Rate for Payer: Cash Price |
$1,554.60
|
| Rate for Payer: Cigna Commercial |
$4,958.14
|
| Rate for Payer: Health EOS Commercial |
$4,796.46
|
| Rate for Payer: HFN Commercial |
$4,958.14
|
| Rate for Payer: Multiplan Commercial |
$4,311.42
|
| Rate for Payer: Preferred Network Access Commercial |
$4,958.14
|
| Rate for Payer: Quartz Beloit One Network |
$2,640.75
|
| Rate for Payer: Quartz Commercial |
$3,233.57
|
| Rate for Payer: WEA Trust Commercial |
$2,964.10
|
| Rate for Payer: WPS Commercial |
$3,991.69
|
|
|
HYDRATOME RX44 CANNULATING M00583040
|
Facility
|
OP
|
$5,182.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2973558
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,509.00 |
| Max. Negotiated Rate |
$4,958.14 |
| Rate for Payer: Aetna Commercial |
$4,850.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,634.78
|
| Rate for Payer: Aetna Managed Medicare |
$1,509.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,503.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,694.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,586.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,856.32
|
| Rate for Payer: Cash Price |
$1,554.60
|
| Rate for Payer: Cigna Commercial |
$4,958.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,015.92
|
| Rate for Payer: Health EOS Commercial |
$4,796.46
|
| Rate for Payer: HFN Commercial |
$4,958.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,041.96
|
| Rate for Payer: Multiplan Commercial |
$4,311.42
|
| Rate for Payer: NAPHCARE Commercial |
$3,233.57
|
| Rate for Payer: Preferred Network Access Commercial |
$4,958.14
|
| Rate for Payer: Quartz Beloit One Network |
$2,640.75
|
| Rate for Payer: Quartz Commercial |
$3,503.03
|
| Rate for Payer: Quartz Medicare Advantage |
$3,233.57
|
| Rate for Payer: The Alliance Commercial |
$2,694.64
|
| Rate for Payer: WEA Trust Commercial |
$2,964.10
|
| Rate for Payer: WPS Commercial |
$3,991.69
|
|
|
HYDRATOME RX49 CANNULATING M00583000
|
Facility
|
OP
|
$4,991.00
|
|
| Hospital Charge Code |
2973557
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,453.38 |
| Max. Negotiated Rate |
$4,775.39 |
| Rate for Payer: Aetna Commercial |
$4,671.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,463.95
|
| Rate for Payer: Aetna Managed Medicare |
$1,453.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,373.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,595.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,491.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,751.04
|
| Rate for Payer: Cash Price |
$1,497.30
|
| Rate for Payer: Cigna Commercial |
$4,775.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,904.76
|
| Rate for Payer: Health EOS Commercial |
$4,619.67
|
| Rate for Payer: HFN Commercial |
$4,775.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,892.98
|
| Rate for Payer: Multiplan Commercial |
$4,152.51
|
| Rate for Payer: NAPHCARE Commercial |
$3,114.38
|
| Rate for Payer: Preferred Network Access Commercial |
$4,775.39
|
| Rate for Payer: Quartz Beloit One Network |
$2,543.41
|
| Rate for Payer: Quartz Commercial |
$3,373.92
|
| Rate for Payer: Quartz Medicare Advantage |
$3,114.38
|
| Rate for Payer: The Alliance Commercial |
$2,595.32
|
| Rate for Payer: WEA Trust Commercial |
$2,854.85
|
| Rate for Payer: WPS Commercial |
$3,844.57
|
|
|
HYDRATOME RX49 CANNULATING M00583000
|
Facility
|
IP
|
$4,991.00
|
|
| Hospital Charge Code |
2973557
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,543.41 |
| Max. Negotiated Rate |
$4,775.39 |
| Rate for Payer: Aetna Commercial |
$4,671.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,463.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,751.04
|
| Rate for Payer: Cash Price |
$1,497.30
|
| Rate for Payer: Cigna Commercial |
$4,775.39
|
| Rate for Payer: Health EOS Commercial |
$4,619.67
|
| Rate for Payer: HFN Commercial |
$4,775.39
|
| Rate for Payer: Multiplan Commercial |
$4,152.51
|
| Rate for Payer: Preferred Network Access Commercial |
$4,775.39
|
| Rate for Payer: Quartz Beloit One Network |
$2,543.41
|
| Rate for Payer: Quartz Commercial |
$3,114.38
|
| Rate for Payer: WEA Trust Commercial |
$2,854.85
|
| Rate for Payer: WPS Commercial |
$3,844.57
|
|
|
HYDROCELECTOMY, PEDIATRIC
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2950480
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$292.95 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Aetna Managed Medicare |
$292.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$680.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$523.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$502.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$585.49
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.68
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: NAPHCARE Commercial |
$627.74
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$680.06
|
| Rate for Payer: Quartz Medicare Advantage |
$627.74
|
| Rate for Payer: The Alliance Commercial |
$523.12
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
HYDROCELECTOMY, PEDIATRIC
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2950480
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$512.66 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$627.74
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
