|
HUMIDIFIER AQUA
|
Facility
|
IP
|
$75.00
|
|
| Hospital Charge Code |
2974555
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$69.00 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$64.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.75
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$69.00
|
| Rate for Payer: Health EOS Commercial |
$66.75
|
| Rate for Payer: HFN Commercial |
$69.00
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: NAPHCARE Commercial |
$45.00
|
| Rate for Payer: Preferred Network Access Commercial |
$69.00
|
| Rate for Payer: Quartz Beloit One Network |
$36.75
|
| Rate for Payer: Quartz Commercial |
$45.00
|
| Rate for Payer: WEA Trust Commercial |
$41.25
|
| Rate for Payer: WPS Commercial |
$55.55
|
|
|
HUMIDIFIER AQUA FLEX #1570
|
Facility
|
OP
|
$60.00
|
|
| Hospital Charge Code |
2974547
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna Commercial |
$54.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$51.60
|
| Rate for Payer: Aetna Managed Medicare |
$16.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.80
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$55.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.58
|
| Rate for Payer: Health EOS Commercial |
$53.40
|
| Rate for Payer: HFN Commercial |
$55.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.00
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: NAPHCARE Commercial |
$36.00
|
| Rate for Payer: Preferred Network Access Commercial |
$55.20
|
| Rate for Payer: Quartz Beloit One Network |
$29.40
|
| Rate for Payer: Quartz Commercial |
$39.00
|
| Rate for Payer: Quartz Medicare Advantage |
$36.00
|
| Rate for Payer: The Alliance Commercial |
$240.00
|
| Rate for Payer: WEA Trust Commercial |
$33.00
|
| Rate for Payer: WPS Commercial |
$44.44
|
|
|
HUMIDIFIER AQUA FLEX #1570
|
Facility
|
IP
|
$60.00
|
|
| Hospital Charge Code |
2974547
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.40 |
| Max. Negotiated Rate |
$55.20 |
| Rate for Payer: Aetna Commercial |
$54.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$51.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.80
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$55.20
|
| Rate for Payer: Health EOS Commercial |
$53.40
|
| Rate for Payer: HFN Commercial |
$55.20
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: NAPHCARE Commercial |
$36.00
|
| Rate for Payer: Preferred Network Access Commercial |
$55.20
|
| Rate for Payer: Quartz Beloit One Network |
$29.40
|
| Rate for Payer: Quartz Commercial |
$36.00
|
| Rate for Payer: WEA Trust Commercial |
$33.00
|
| Rate for Payer: WPS Commercial |
$44.44
|
|
|
HUMIDIFIER DISPOSABLE
|
Facility
|
IP
|
$53.00
|
|
| Hospital Charge Code |
2974649
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.97 |
| Max. Negotiated Rate |
$48.76 |
| Rate for Payer: Aetna Commercial |
$47.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$45.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.09
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$48.76
|
| Rate for Payer: Health EOS Commercial |
$47.17
|
| Rate for Payer: HFN Commercial |
$48.76
|
| Rate for Payer: Multiplan Commercial |
$42.40
|
| Rate for Payer: NAPHCARE Commercial |
$31.80
|
| Rate for Payer: Preferred Network Access Commercial |
$48.76
|
| Rate for Payer: Quartz Beloit One Network |
$25.97
|
| Rate for Payer: Quartz Commercial |
$31.80
|
| Rate for Payer: WEA Trust Commercial |
$29.15
|
| Rate for Payer: WPS Commercial |
$39.26
|
|
|
HUMIDIFIER DISPOSABLE
|
Facility
|
OP
|
$53.00
|
|
| Hospital Charge Code |
2974649
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.84 |
| Max. Negotiated Rate |
$212.00 |
| Rate for Payer: Aetna Commercial |
$47.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$45.58
|
| Rate for Payer: Aetna Managed Medicare |
$14.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$34.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.09
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$48.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.66
|
| Rate for Payer: Health EOS Commercial |
$47.17
|
| Rate for Payer: HFN Commercial |
$48.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39.75
|
| Rate for Payer: Multiplan Commercial |
$42.40
|
| Rate for Payer: NAPHCARE Commercial |
$31.80
|
| Rate for Payer: Preferred Network Access Commercial |
$48.76
|
| Rate for Payer: Quartz Beloit One Network |
$25.97
|
| Rate for Payer: Quartz Commercial |
$34.45
|
| Rate for Payer: Quartz Medicare Advantage |
$31.80
|
| Rate for Payer: The Alliance Commercial |
$212.00
|
| Rate for Payer: WEA Trust Commercial |
$29.15
|
| Rate for Payer: WPS Commercial |
$39.26
|
|
|
Humid-Vent Portex
|
Facility
|
OP
|
$73.00
|
|
| Hospital Charge Code |
3101737
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$20.44 |
| Max. Negotiated Rate |
$292.00 |
| Rate for Payer: Aetna Commercial |
$65.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$62.78
|
| Rate for Payer: Aetna Managed Medicare |
$20.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$47.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.69
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cigna Commercial |
$67.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.85
|
| Rate for Payer: Health EOS Commercial |
$64.97
|
| Rate for Payer: HFN Commercial |
$67.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.75
|
| Rate for Payer: Multiplan Commercial |
$58.40
|
| Rate for Payer: NAPHCARE Commercial |
$43.80
|
| Rate for Payer: Preferred Network Access Commercial |
$67.16
|
| Rate for Payer: Quartz Beloit One Network |
$35.77
|
| Rate for Payer: Quartz Commercial |
$47.45
|
| Rate for Payer: Quartz Medicare Advantage |
$43.80
|
| Rate for Payer: The Alliance Commercial |
$292.00
|
| Rate for Payer: WEA Trust Commercial |
$40.15
|
| Rate for Payer: WPS Commercial |
$54.07
|
|
|
Humid-Vent Portex
|
Facility
|
IP
|
$73.00
|
|
| Hospital Charge Code |
3101737
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$35.77 |
| Max. Negotiated Rate |
$67.16 |
| Rate for Payer: Aetna Commercial |
$65.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$62.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.69
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cigna Commercial |
$67.16
|
| Rate for Payer: Health EOS Commercial |
$64.97
|
| Rate for Payer: HFN Commercial |
$67.16
|
| Rate for Payer: Multiplan Commercial |
$58.40
|
| Rate for Payer: NAPHCARE Commercial |
$43.80
|
| Rate for Payer: Preferred Network Access Commercial |
$67.16
|
| Rate for Payer: Quartz Beloit One Network |
$35.77
|
| Rate for Payer: Quartz Commercial |
$43.80
|
| Rate for Payer: WEA Trust Commercial |
$40.15
|
| Rate for Payer: WPS Commercial |
$54.07
|
|
|
Huntington Disease Mutation Analysis
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
1039266
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$367.50 |
| Max. Negotiated Rate |
$690.00 |
| Rate for Payer: Aetna Commercial |
$675.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$645.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$397.50
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$690.00
|
| Rate for Payer: Health EOS Commercial |
$667.50
|
| Rate for Payer: HFN Commercial |
$690.00
|
| Rate for Payer: Multiplan Commercial |
$600.00
|
| Rate for Payer: NAPHCARE Commercial |
$450.00
|
| Rate for Payer: Preferred Network Access Commercial |
$690.00
|
| Rate for Payer: Quartz Beloit One Network |
$367.50
|
| Rate for Payer: Quartz Commercial |
$450.00
|
| Rate for Payer: WEA Trust Commercial |
$412.50
|
| Rate for Payer: WPS Commercial |
$555.52
|
|
|
Huntington Disease Mutation Analysis
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
1039266
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$137.00 |
| Max. Negotiated Rate |
$690.00 |
| Rate for Payer: Aetna Commercial |
$675.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$645.00
|
| Rate for Payer: Aetna Managed Medicare |
$137.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$513.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$239.75
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$227.42
|
| Rate for Payer: Anthem Medicaid |
$137.00
|
| Rate for Payer: Anthem Medicare Advantage |
$137.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$397.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$137.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$137.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$690.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$137.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$137.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$419.70
|
| Rate for Payer: Dean Health Medicaid |
$137.00
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$137.00
|
| Rate for Payer: Health EOS Commercial |
$667.50
|
| Rate for Payer: HFN Commercial |
$690.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$509.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$137.00
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$137.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$137.00
|
| Rate for Payer: Managed Health Services Medicaid |
$142.48
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$137.00
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$137.00
|
| Rate for Payer: Multiplan Commercial |
$600.00
|
| Rate for Payer: NAPHCARE Commercial |
$205.50
|
| Rate for Payer: Preferred Network Access Commercial |
$690.00
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$137.00
|
| Rate for Payer: Quartz Beloit One Network |
$367.50
|
| Rate for Payer: Quartz Commercial |
$487.50
|
| Rate for Payer: Quartz Medicare Advantage |
$137.00
|
| Rate for Payer: The Alliance Commercial |
$548.00
|
| Rate for Payer: United Healthcare Medicaid |
$137.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$137.00
|
| Rate for Payer: United Healthcare PPO |
$562.50
|
| Rate for Payer: WEA Trust Commercial |
$412.50
|
| Rate for Payer: Wellcare Medicare |
$137.00
|
| Rate for Payer: WMAP Medicaid |
$137.00
|
| Rate for Payer: WPS Commercial |
$555.52
|
|
|
Huntington Disease Mutation Analysis
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
1039266
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$330.00 |
| Max. Negotiated Rate |
$712.50 |
| Rate for Payer: Aetna Commercial |
$712.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$645.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$712.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$375.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$450.00
|
| Rate for Payer: Health EOS Commercial |
$682.50
|
| Rate for Payer: HFN Commercial |
$712.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$483.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$483.61
|
| Rate for Payer: Multiplan Commercial |
$600.00
|
| Rate for Payer: Preferred Network Access Commercial |
$712.50
|
| Rate for Payer: Quartz Beloit One Network |
$330.00
|
| Rate for Payer: Quartz Commercial |
$427.50
|
| Rate for Payer: The Alliance Commercial |
$375.00
|
| Rate for Payer: WEA Trust Commercial |
$412.50
|
| Rate for Payer: WPS Commercial |
$555.52
|
|
|
Hyalgan/Supartz 1 Unit Charge
|
Professional
|
Both
|
$540.00
|
|
|
Service Code
|
HCPCS J7321
|
| Hospital Charge Code |
2958959
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.10 |
| Max. Negotiated Rate |
$513.00 |
| Rate for Payer: Aetna Commercial |
$513.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$464.40
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cigna Commercial |
$513.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$73.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$73.12
|
| Rate for Payer: Health EOS Commercial |
$491.40
|
| Rate for Payer: HFN Commercial |
$513.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$110.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$110.99
|
| Rate for Payer: Multiplan Commercial |
$432.00
|
| Rate for Payer: Preferred Network Access Commercial |
$513.00
|
| Rate for Payer: Quartz Beloit One Network |
$237.60
|
| Rate for Payer: Quartz Commercial |
$307.80
|
| Rate for Payer: The Alliance Commercial |
$270.00
|
| Rate for Payer: United Healthcare Medicaid |
$73.10
|
| Rate for Payer: WEA Trust Commercial |
$297.00
|
| Rate for Payer: WPS Commercial |
$182.80
|
|
|
Hyalgan/Supartz 1 Unit Charge
|
Facility
|
OP
|
$540.00
|
|
|
Service Code
|
HCPCS J7321
|
| Hospital Charge Code |
2958959
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$96.74 |
| Max. Negotiated Rate |
$2,160.00 |
| Rate for Payer: Aetna Commercial |
$486.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$464.40
|
| Rate for Payer: Aetna Managed Medicare |
$151.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$351.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$270.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$259.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$286.20
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cigna Commercial |
$496.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$96.74
|
| Rate for Payer: Health EOS Commercial |
$480.60
|
| Rate for Payer: HFN Commercial |
$496.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$405.00
|
| Rate for Payer: Multiplan Commercial |
$432.00
|
| Rate for Payer: NAPHCARE Commercial |
$324.00
|
| Rate for Payer: Preferred Network Access Commercial |
$496.80
|
| Rate for Payer: Quartz Beloit One Network |
$264.60
|
| Rate for Payer: Quartz Commercial |
$351.00
|
| Rate for Payer: Quartz Medicare Advantage |
$324.00
|
| Rate for Payer: The Alliance Commercial |
$2,160.00
|
| Rate for Payer: WEA Trust Commercial |
$297.00
|
| Rate for Payer: WPS Commercial |
$182.80
|
|
|
Hyalgan/Supartz 1 Unit Charge
|
Facility
|
IP
|
$540.00
|
|
|
Service Code
|
HCPCS J7321
|
| Hospital Charge Code |
2958959
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$264.60 |
| Max. Negotiated Rate |
$496.80 |
| Rate for Payer: Aetna Commercial |
$486.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$464.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$286.20
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cigna Commercial |
$496.80
|
| Rate for Payer: Health EOS Commercial |
$480.60
|
| Rate for Payer: HFN Commercial |
$496.80
|
| Rate for Payer: Multiplan Commercial |
$432.00
|
| Rate for Payer: NAPHCARE Commercial |
$324.00
|
| Rate for Payer: Preferred Network Access Commercial |
$496.80
|
| Rate for Payer: Quartz Beloit One Network |
$264.60
|
| Rate for Payer: Quartz Commercial |
$324.00
|
| Rate for Payer: WEA Trust Commercial |
$297.00
|
| Rate for Payer: WPS Commercial |
$399.98
|
|
|
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 |
$269.99 |
| Max. Negotiated Rate |
$506.92 |
| Rate for Payer: Aetna Commercial |
$495.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$473.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$292.03
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cigna Commercial |
$506.92
|
| Rate for Payer: Health EOS Commercial |
$490.39
|
| Rate for Payer: HFN Commercial |
$506.92
|
| Rate for Payer: Multiplan Commercial |
$440.80
|
| Rate for Payer: NAPHCARE Commercial |
$330.60
|
| Rate for Payer: Preferred Network Access Commercial |
$506.92
|
| Rate for Payer: Quartz Beloit One Network |
$269.99
|
| Rate for Payer: Quartz Commercial |
$330.60
|
| Rate for Payer: WEA Trust Commercial |
$303.05
|
| Rate for Payer: WPS Commercial |
$408.13
|
|
|
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 |
$73.10 |
| Max. Negotiated Rate |
$523.45 |
| Rate for Payer: Aetna Commercial |
$523.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$473.86
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cigna Commercial |
$523.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$73.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$73.12
|
| Rate for Payer: Health EOS Commercial |
$501.41
|
| Rate for Payer: HFN Commercial |
$523.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$110.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$110.99
|
| Rate for Payer: Multiplan Commercial |
$440.80
|
| Rate for Payer: Preferred Network Access Commercial |
$523.45
|
| Rate for Payer: Quartz Beloit One Network |
$242.44
|
| Rate for Payer: Quartz Commercial |
$314.07
|
| Rate for Payer: The Alliance Commercial |
$275.50
|
| Rate for Payer: United Healthcare Medicaid |
$73.10
|
| Rate for Payer: WEA Trust Commercial |
$303.05
|
| Rate for Payer: WPS Commercial |
$182.80
|
|
|
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 |
$96.74 |
| Max. Negotiated Rate |
$2,204.00 |
| Rate for Payer: Aetna Commercial |
$495.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$473.86
|
| Rate for Payer: Aetna Managed Medicare |
$154.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$358.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$275.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$264.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$292.03
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cigna Commercial |
$506.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$96.74
|
| Rate for Payer: Health EOS Commercial |
$490.39
|
| Rate for Payer: HFN Commercial |
$506.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$413.25
|
| Rate for Payer: Multiplan Commercial |
$440.80
|
| Rate for Payer: NAPHCARE Commercial |
$330.60
|
| Rate for Payer: Preferred Network Access Commercial |
$506.92
|
| Rate for Payer: Quartz Beloit One Network |
$269.99
|
| Rate for Payer: Quartz Commercial |
$358.15
|
| Rate for Payer: Quartz Medicare Advantage |
$330.60
|
| Rate for Payer: The Alliance Commercial |
$2,204.00
|
| Rate for Payer: WEA Trust Commercial |
$303.05
|
| Rate for Payer: WPS Commercial |
$182.80
|
|
|
Hycamtin 0.1 mg Charge
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
HCPCS J9351
|
| Hospital Charge Code |
2958866
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.55 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: Aetna Commercial |
$18.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17.20
|
| Rate for Payer: Aetna Managed Medicare |
$5.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10.60
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cigna Commercial |
$18.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.55
|
| Rate for Payer: Health EOS Commercial |
$17.80
|
| Rate for Payer: HFN Commercial |
$18.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.00
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: NAPHCARE Commercial |
$12.00
|
| Rate for Payer: Preferred Network Access Commercial |
$18.40
|
| Rate for Payer: Quartz Beloit One Network |
$9.80
|
| Rate for Payer: Quartz Commercial |
$13.00
|
| Rate for Payer: Quartz Medicare Advantage |
$12.00
|
| Rate for Payer: The Alliance Commercial |
$80.00
|
| Rate for Payer: WEA Trust Commercial |
$11.00
|
| Rate for Payer: WPS Commercial |
$2.92
|
|
|
Hycamtin 0.1 mg Charge
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS J9351
|
| Hospital Charge Code |
2958866
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$19.00 |
| Rate for Payer: Aetna Commercial |
$19.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17.20
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cigna Commercial |
$19.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$0.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.17
|
| Rate for Payer: Health EOS Commercial |
$18.20
|
| Rate for Payer: HFN Commercial |
$19.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1.71
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: Preferred Network Access Commercial |
$19.00
|
| Rate for Payer: Quartz Beloit One Network |
$8.80
|
| Rate for Payer: Quartz Commercial |
$11.40
|
| Rate for Payer: The Alliance Commercial |
$10.00
|
| Rate for Payer: United Healthcare Medicaid |
$0.78
|
| Rate for Payer: WEA Trust Commercial |
$11.00
|
| Rate for Payer: WPS Commercial |
$2.92
|
|
|
Hycamtin 0.1 mg Charge
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
HCPCS J9351
|
| Hospital Charge Code |
2958866
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$18.40 |
| Rate for Payer: Aetna Commercial |
$18.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10.60
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cigna Commercial |
$18.40
|
| Rate for Payer: Health EOS Commercial |
$17.80
|
| Rate for Payer: HFN Commercial |
$18.40
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: NAPHCARE Commercial |
$12.00
|
| Rate for Payer: Preferred Network Access Commercial |
$18.40
|
| Rate for Payer: Quartz Beloit One Network |
$9.80
|
| Rate for Payer: Quartz Commercial |
$12.00
|
| Rate for Payer: WEA Trust Commercial |
$11.00
|
| Rate for Payer: WPS Commercial |
$14.81
|
|
|
Hydralazine 20mg Inj J0360
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
HCPCS J0360
|
| Hospital Charge Code |
4514807
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.25 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Aetna Commercial |
$112.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$107.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.25
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$115.00
|
| Rate for Payer: Health EOS Commercial |
$111.25
|
| Rate for Payer: HFN Commercial |
$115.00
|
| Rate for Payer: Multiplan Commercial |
$100.00
|
| Rate for Payer: NAPHCARE Commercial |
$75.00
|
| Rate for Payer: Preferred Network Access Commercial |
$115.00
|
| Rate for Payer: Quartz Beloit One Network |
$61.25
|
| Rate for Payer: Quartz Commercial |
$75.00
|
| Rate for Payer: WEA Trust Commercial |
$68.75
|
| Rate for Payer: WPS Commercial |
$92.59
|
|
|
Hydralazine 20mg Inj J0360
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
HCPCS J0360
|
| Hospital Charge Code |
4514807
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.35 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna Commercial |
$112.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$107.50
|
| Rate for Payer: Aetna Managed Medicare |
$35.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$81.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$62.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$60.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.25
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$115.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7.35
|
| Rate for Payer: Health EOS Commercial |
$111.25
|
| Rate for Payer: HFN Commercial |
$115.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$93.75
|
| Rate for Payer: Multiplan Commercial |
$100.00
|
| Rate for Payer: NAPHCARE Commercial |
$75.00
|
| Rate for Payer: Preferred Network Access Commercial |
$115.00
|
| Rate for Payer: Quartz Beloit One Network |
$61.25
|
| Rate for Payer: Quartz Commercial |
$81.25
|
| Rate for Payer: Quartz Medicare Advantage |
$75.00
|
| Rate for Payer: The Alliance Commercial |
$500.00
|
| Rate for Payer: WEA Trust Commercial |
$68.75
|
| Rate for Payer: WPS Commercial |
$13.89
|
|
|
Hydralazine 20mg Inj J0360
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS J0360
|
| Hospital Charge Code |
4514807
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.56 |
| Max. Negotiated Rate |
$118.75 |
| Rate for Payer: Aetna Commercial |
$118.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$107.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$118.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.56
|
| Rate for Payer: Health EOS Commercial |
$113.75
|
| Rate for Payer: HFN Commercial |
$118.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7.11
|
| Rate for Payer: Multiplan Commercial |
$100.00
|
| Rate for Payer: Preferred Network Access Commercial |
$118.75
|
| Rate for Payer: Quartz Beloit One Network |
$55.00
|
| Rate for Payer: Quartz Commercial |
$71.25
|
| Rate for Payer: The Alliance Commercial |
$62.50
|
| Rate for Payer: United Healthcare Medicaid |
$5.56
|
| Rate for Payer: WEA Trust Commercial |
$68.75
|
| Rate for Payer: WPS Commercial |
$13.89
|
|
|
HYDRATOME RX44 CANNULATING M00583040
|
Facility
|
IP
|
$5,182.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2973558
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,539.18 |
| Max. Negotiated Rate |
$4,767.44 |
| Rate for Payer: Aetna Commercial |
$4,663.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,456.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,746.46
|
| Rate for Payer: Cash Price |
$1,554.60
|
| Rate for Payer: Cigna Commercial |
$4,767.44
|
| Rate for Payer: Health EOS Commercial |
$4,611.98
|
| Rate for Payer: HFN Commercial |
$4,767.44
|
| Rate for Payer: Multiplan Commercial |
$4,145.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,109.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,767.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,539.18
|
| Rate for Payer: Quartz Commercial |
$3,109.20
|
| Rate for Payer: WEA Trust Commercial |
$2,850.10
|
| Rate for Payer: WPS Commercial |
$3,838.31
|
|
|
HYDRATOME RX44 CANNULATING M00583040
|
Facility
|
OP
|
$5,182.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2973558
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,450.96 |
| Max. Negotiated Rate |
$20,728.00 |
| Rate for Payer: Aetna Commercial |
$4,663.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,456.52
|
| Rate for Payer: Aetna Managed Medicare |
$1,450.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,368.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,591.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,487.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,746.46
|
| Rate for Payer: Cash Price |
$1,554.60
|
| Rate for Payer: Cigna Commercial |
$4,767.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,899.85
|
| Rate for Payer: Health EOS Commercial |
$4,611.98
|
| Rate for Payer: HFN Commercial |
$4,767.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,886.50
|
| Rate for Payer: Multiplan Commercial |
$4,145.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,109.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,767.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,539.18
|
| Rate for Payer: Quartz Commercial |
$3,368.30
|
| Rate for Payer: Quartz Medicare Advantage |
$3,109.20
|
| Rate for Payer: The Alliance Commercial |
$20,728.00
|
| Rate for Payer: WEA Trust Commercial |
$2,850.10
|
| Rate for Payer: WPS Commercial |
$3,838.31
|
|
|
HYDRATOME RX49 CANNULATING M00583000
|
Facility
|
OP
|
$4,991.00
|
|
| Hospital Charge Code |
2973557
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,397.48 |
| Max. Negotiated Rate |
$19,964.00 |
| Rate for Payer: Aetna Commercial |
$4,491.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,292.26
|
| Rate for Payer: Aetna Managed Medicare |
$1,397.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,244.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,495.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,395.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,645.23
|
| Rate for Payer: Cash Price |
$1,497.30
|
| Rate for Payer: Cigna Commercial |
$4,591.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,792.96
|
| Rate for Payer: Health EOS Commercial |
$4,441.99
|
| Rate for Payer: HFN Commercial |
$4,591.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,743.25
|
| Rate for Payer: Multiplan Commercial |
$3,992.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,994.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,591.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,445.59
|
| Rate for Payer: Quartz Commercial |
$3,244.15
|
| Rate for Payer: Quartz Medicare Advantage |
$2,994.60
|
| Rate for Payer: The Alliance Commercial |
$19,964.00
|
| Rate for Payer: WEA Trust Commercial |
$2,745.05
|
| Rate for Payer: WPS Commercial |
$3,696.83
|
|
