|
Hymovis Injection 1 mg J7322
|
Professional
|
Both
|
$1,006.00
|
|
|
Service Code
|
HCPCS J7322
|
| Hospital Charge Code |
5166612
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.21 |
| Max. Negotiated Rate |
$993.93 |
| Rate for Payer: Aetna Commercial |
$993.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Aetna Managed Medicare |
$18.35
|
| Rate for Payer: Anthem Medicare Advantage |
$18.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.35
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$993.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.21
|
| Rate for Payer: Health EOS Commercial |
$952.08
|
| Rate for Payer: HFN Commercial |
$993.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.35
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: NAPHCARE Commercial |
$27.52
|
| Rate for Payer: Preferred Network Access Commercial |
$993.93
|
| Rate for Payer: Quartz Beloit One Network |
$460.35
|
| Rate for Payer: Quartz Commercial |
$596.36
|
| Rate for Payer: Quartz Medicare Advantage |
$18.35
|
| Rate for Payer: The Alliance Commercial |
$50.45
|
| Rate for Payer: United Healthcare Medicaid |
$18.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.35
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$45.52
|
|
|
Hymovis Injection 1 mg J7322
|
Facility
|
OP
|
$1,006.00
|
|
|
Service Code
|
HCPCS J7322
|
| Hospital Charge Code |
5166612
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.35 |
| 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 |
$18.35
|
| 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: Anthem Medicare Advantage |
$18.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.35
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24.09
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.35
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.35
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.35
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.35
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: NAPHCARE Commercial |
$27.52
|
| 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 |
$18.35
|
| Rate for Payer: The Alliance Commercial |
$73.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.35
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: Wellcare Medicare |
$18.35
|
| Rate for Payer: WPS Commercial |
$45.52
|
|
|
Hypersensitivity Pneumonitis Screen
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
CPT 86606
|
| Hospital Charge Code |
1042939
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.65 |
| Max. Negotiated Rate |
$117.69 |
| Rate for Payer: Aetna Commercial |
$115.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.01
|
| Rate for Payer: Aetna Managed Medicare |
$15.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$58.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27.39
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.98
|
| Rate for Payer: Anthem Medicare Advantage |
$15.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$67.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.65
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna Commercial |
$117.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$71.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.65
|
| Rate for Payer: Health EOS Commercial |
$113.85
|
| Rate for Payer: HFN Commercial |
$117.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.65
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.65
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.65
|
| Rate for Payer: Multiplan Commercial |
$102.34
|
| Rate for Payer: NAPHCARE Commercial |
$23.48
|
| Rate for Payer: Preferred Network Access Commercial |
$117.69
|
| Rate for Payer: Quartz Beloit One Network |
$62.68
|
| Rate for Payer: Quartz Commercial |
$83.15
|
| Rate for Payer: Quartz Medicare Advantage |
$15.65
|
| Rate for Payer: The Alliance Commercial |
$62.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.65
|
| Rate for Payer: United Healthcare PPO |
$95.94
|
| Rate for Payer: WEA Trust Commercial |
$70.36
|
| Rate for Payer: Wellcare Medicare |
$15.65
|
| Rate for Payer: WPS Commercial |
$94.75
|
|
|
Hypersensitivity Pneumonitis Screen
|
Professional
|
Both
|
$123.00
|
|
|
Service Code
|
CPT 86606
|
| Hospital Charge Code |
1042939
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.65 |
| Max. Negotiated Rate |
$121.52 |
| Rate for Payer: Aetna Commercial |
$121.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.01
|
| Rate for Payer: Aetna Managed Medicare |
$15.65
|
| Rate for Payer: Anthem Medicare Advantage |
$15.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.65
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna Commercial |
$121.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$63.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.65
|
| Rate for Payer: Health EOS Commercial |
$116.41
|
| Rate for Payer: HFN Commercial |
$121.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$55.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.65
|
| Rate for Payer: Multiplan Commercial |
$102.34
|
| Rate for Payer: NAPHCARE Commercial |
$23.48
|
| Rate for Payer: Preferred Network Access Commercial |
$121.52
|
| Rate for Payer: Quartz Beloit One Network |
$56.28
|
| Rate for Payer: Quartz Commercial |
$72.91
|
| Rate for Payer: Quartz Medicare Advantage |
$15.65
|
| Rate for Payer: The Alliance Commercial |
$61.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.65
|
| Rate for Payer: WEA Trust Commercial |
$70.36
|
| Rate for Payer: WPS Commercial |
$68.87
|
|
|
Hypersensitivity Pneumonitis Screen
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
CPT 86606
|
| Hospital Charge Code |
1042939
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$62.68 |
| Max. Negotiated Rate |
$117.69 |
| Rate for Payer: Aetna Commercial |
$115.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$67.80
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna Commercial |
$117.69
|
| Rate for Payer: Health EOS Commercial |
$113.85
|
| Rate for Payer: HFN Commercial |
$117.69
|
| Rate for Payer: Multiplan Commercial |
$102.34
|
| Rate for Payer: Preferred Network Access Commercial |
$117.69
|
| Rate for Payer: Quartz Beloit One Network |
$62.68
|
| Rate for Payer: Quartz Commercial |
$76.75
|
| Rate for Payer: WEA Trust Commercial |
$70.36
|
| Rate for Payer: WPS Commercial |
$94.75
|
|
|
HYPERTENSION
|
Facility
|
IP
|
$6,050.13
|
|
|
Service Code
|
APR-DRG 1992
|
| Min. Negotiated Rate |
$5,374.11 |
| Max. Negotiated Rate |
$6,050.13 |
| Rate for Payer: Anthem Medicaid |
$5,793.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$5,793.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,793.34
|
| Rate for Payer: Dean Health Medicaid |
$5,793.34
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5,374.11
|
| Rate for Payer: Managed Health Services Medicaid |
$6,050.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,793.34
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5,793.34
|
| Rate for Payer: United Healthcare Medicaid |
$5,793.34
|
|
|
HYPERTENSION
|
Facility
|
IP
|
$17,098.20
|
|
|
Service Code
|
APR-DRG 1994
|
| Min. Negotiated Rate |
$15,187.69 |
| Max. Negotiated Rate |
$17,098.20 |
| Rate for Payer: Anthem Medicaid |
$16,372.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$16,372.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16,372.47
|
| Rate for Payer: Dean Health Medicaid |
$16,372.47
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15,187.69
|
| Rate for Payer: Managed Health Services Medicaid |
$17,098.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$16,372.47
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$16,372.47
|
| Rate for Payer: United Healthcare Medicaid |
$16,372.47
|
|
|
HYPERTENSION
|
Facility
|
IP
|
$9,119.04
|
|
|
Service Code
|
APR-DRG 1993
|
| Min. Negotiated Rate |
$8,100.10 |
| Max. Negotiated Rate |
$9,119.04 |
| Rate for Payer: Anthem Medicaid |
$8,731.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$8,731.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8,731.99
|
| Rate for Payer: Dean Health Medicaid |
$8,731.99
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8,100.10
|
| Rate for Payer: Managed Health Services Medicaid |
$9,119.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,731.99
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8,731.99
|
| Rate for Payer: United Healthcare Medicaid |
$8,731.99
|
|
|
HYPERTENSION
|
Facility
|
IP
|
$5,173.30
|
|
|
Service Code
|
APR-DRG 1991
|
| Min. Negotiated Rate |
$4,595.25 |
| Max. Negotiated Rate |
$5,173.30 |
| Rate for Payer: Anthem Medicaid |
$4,953.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$4,953.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,953.72
|
| Rate for Payer: Dean Health Medicaid |
$4,953.72
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4,595.25
|
| Rate for Payer: Managed Health Services Medicaid |
$5,173.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,953.72
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4,953.72
|
| Rate for Payer: United Healthcare Medicaid |
$4,953.72
|
|
|
HYPERTENSION
|
Facility
|
OP
|
$85.17
|
|
|
Service Code
|
EAPG 00599
|
| Min. Negotiated Rate |
$81.89 |
| Max. Negotiated Rate |
$85.17 |
| Rate for Payer: Anthem Medicaid |
$81.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$81.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$81.89
|
| Rate for Payer: Dean Health Medicaid |
$81.89
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$81.89
|
| Rate for Payer: Managed Health Services Medicaid |
$85.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$81.89
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$81.89
|
| Rate for Payer: United Healthcare Medicaid |
$81.89
|
|
|
HYPERTENSION WITH MCC
|
Facility
|
IP
|
$32,102.72
|
|
|
Service Code
|
MSDRG 304
|
| Min. Negotiated Rate |
$9,620.03 |
| Max. Negotiated Rate |
$32,102.72 |
| Rate for Payer: Aetna Managed Medicare |
$9,620.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25,964.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,901.85
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18,908.05
|
| Rate for Payer: Anthem Medicare Advantage |
$9,620.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,620.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,620.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,620.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20,989.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,620.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23,301.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,620.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9,620.03
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9,620.03
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,620.03
|
| Rate for Payer: NAPHCARE Commercial |
$14,430.05
|
| Rate for Payer: Quartz Medicare Advantage |
$9,620.03
|
| Rate for Payer: The Alliance Commercial |
$32,102.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,620.03
|
| Rate for Payer: United Healthcare PPO |
$18,140.69
|
| Rate for Payer: Wellcare Medicare |
$9,620.03
|
|
|
HYPERTENSION WITHOUT MCC
|
Facility
|
IP
|
$21,167.12
|
|
|
Service Code
|
MSDRG 305
|
| Min. Negotiated Rate |
$6,289.48 |
| Max. Negotiated Rate |
$21,167.12 |
| Rate for Payer: Aetna Managed Medicare |
$6,289.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,475.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,628.47
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,997.87
|
| Rate for Payer: Anthem Medicare Advantage |
$6,289.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,289.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,289.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,289.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13,318.74
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,289.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,280.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,289.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,289.48
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,289.48
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,289.48
|
| Rate for Payer: NAPHCARE Commercial |
$9,434.22
|
| Rate for Payer: Quartz Medicare Advantage |
$6,289.48
|
| Rate for Payer: The Alliance Commercial |
$21,167.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,289.48
|
| Rate for Payer: United Healthcare PPO |
$11,896.44
|
| Rate for Payer: Wellcare Medicare |
$6,289.48
|
|
|
Hypertrophic Cardiomyopathy Multi-Gene Panel
|
Facility
|
IP
|
$4,713.00
|
|
|
Service Code
|
CPT 81439
|
| Hospital Charge Code |
6171717
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2,401.74 |
| Max. Negotiated Rate |
$4,509.40 |
| Rate for Payer: Aetna Commercial |
$4,411.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,215.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,597.81
|
| Rate for Payer: Cash Price |
$1,413.90
|
| Rate for Payer: Cigna Commercial |
$4,509.40
|
| Rate for Payer: Health EOS Commercial |
$4,362.35
|
| Rate for Payer: HFN Commercial |
$4,509.40
|
| Rate for Payer: Multiplan Commercial |
$3,921.22
|
| Rate for Payer: Preferred Network Access Commercial |
$4,509.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,401.74
|
| Rate for Payer: Quartz Commercial |
$2,940.91
|
| Rate for Payer: WEA Trust Commercial |
$2,695.84
|
| Rate for Payer: WPS Commercial |
$3,630.42
|
|
|
Hypertrophic Cardiomyopathy Multi-Gene Panel
|
Facility
|
OP
|
$4,713.00
|
|
|
Service Code
|
CPT 81439
|
| Hospital Charge Code |
6171717
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$608.30 |
| Max. Negotiated Rate |
$4,509.40 |
| Rate for Payer: Aetna Commercial |
$4,411.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,215.31
|
| Rate for Payer: Aetna Managed Medicare |
$608.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,281.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,064.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,009.77
|
| Rate for Payer: Anthem Medicare Advantage |
$608.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,597.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$608.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$608.30
|
| Rate for Payer: Cash Price |
$1,413.90
|
| Rate for Payer: Cash Price |
$1,413.90
|
| Rate for Payer: Cigna Commercial |
$4,509.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$608.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,742.97
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$608.30
|
| Rate for Payer: Health EOS Commercial |
$4,362.35
|
| Rate for Payer: HFN Commercial |
$4,509.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,262.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$608.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$608.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$608.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$608.30
|
| Rate for Payer: Multiplan Commercial |
$3,921.22
|
| Rate for Payer: NAPHCARE Commercial |
$912.44
|
| Rate for Payer: Preferred Network Access Commercial |
$4,509.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,401.74
|
| Rate for Payer: Quartz Commercial |
$3,185.99
|
| Rate for Payer: Quartz Medicare Advantage |
$608.30
|
| Rate for Payer: The Alliance Commercial |
$2,433.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$608.30
|
| Rate for Payer: United Healthcare PPO |
$3,676.14
|
| Rate for Payer: WEA Trust Commercial |
$2,695.84
|
| Rate for Payer: Wellcare Medicare |
$608.30
|
| Rate for Payer: WPS Commercial |
$3,630.42
|
|
|
Hypertrophic Cardiomyopathy Multi-Gene Panel
|
Professional
|
Both
|
$4,713.00
|
|
|
Service Code
|
CPT 81439
|
| Hospital Charge Code |
6171717
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$608.30 |
| Max. Negotiated Rate |
$4,656.44 |
| Rate for Payer: Aetna Commercial |
$4,656.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,215.31
|
| Rate for Payer: Aetna Managed Medicare |
$608.30
|
| Rate for Payer: Anthem Medicare Advantage |
$608.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$608.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$608.30
|
| Rate for Payer: Cash Price |
$1,413.90
|
| Rate for Payer: Cash Price |
$1,413.90
|
| Rate for Payer: Cigna Commercial |
$4,656.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,450.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$608.30
|
| Rate for Payer: Health EOS Commercial |
$4,460.38
|
| Rate for Payer: HFN Commercial |
$4,656.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,147.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,147.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$608.30
|
| Rate for Payer: Multiplan Commercial |
$3,921.22
|
| Rate for Payer: NAPHCARE Commercial |
$912.44
|
| Rate for Payer: Preferred Network Access Commercial |
$4,656.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,156.67
|
| Rate for Payer: Quartz Commercial |
$2,793.87
|
| Rate for Payer: Quartz Medicare Advantage |
$608.30
|
| Rate for Payer: The Alliance Commercial |
$2,402.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$608.30
|
| Rate for Payer: WEA Trust Commercial |
$2,695.84
|
| Rate for Payer: WPS Commercial |
$2,676.50
|
|
|
Hypoglycemic Panel, Qual
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
3256232
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$127.91 |
| Max. Negotiated Rate |
$240.16 |
| Rate for Payer: Aetna Commercial |
$234.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$224.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$138.35
|
| Rate for Payer: Cash Price |
$75.30
|
| Rate for Payer: Cigna Commercial |
$240.16
|
| Rate for Payer: Health EOS Commercial |
$232.33
|
| Rate for Payer: HFN Commercial |
$240.16
|
| Rate for Payer: Multiplan Commercial |
$208.83
|
| Rate for Payer: Preferred Network Access Commercial |
$240.16
|
| Rate for Payer: Quartz Beloit One Network |
$127.91
|
| Rate for Payer: Quartz Commercial |
$156.62
|
| Rate for Payer: WEA Trust Commercial |
$143.57
|
| Rate for Payer: WPS Commercial |
$193.35
|
|
|
Hypoglycemic Panel, Qual
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
3256232
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.39 |
| Max. Negotiated Rate |
$240.16 |
| Rate for Payer: Aetna Commercial |
$234.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$224.49
|
| Rate for Payer: Aetna Managed Medicare |
$19.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$72.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.18
|
| Rate for Payer: Anthem Medicare Advantage |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$138.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.39
|
| Rate for Payer: Cash Price |
$75.30
|
| Rate for Payer: Cash Price |
$75.30
|
| Rate for Payer: Cigna Commercial |
$240.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$146.08
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.39
|
| Rate for Payer: Health EOS Commercial |
$232.33
|
| Rate for Payer: HFN Commercial |
$240.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.39
|
| Rate for Payer: Multiplan Commercial |
$208.83
|
| Rate for Payer: NAPHCARE Commercial |
$29.08
|
| Rate for Payer: Preferred Network Access Commercial |
$240.16
|
| Rate for Payer: Quartz Beloit One Network |
$127.91
|
| Rate for Payer: Quartz Commercial |
$169.68
|
| Rate for Payer: Quartz Medicare Advantage |
$19.39
|
| Rate for Payer: The Alliance Commercial |
$77.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.39
|
| Rate for Payer: United Healthcare PPO |
$195.78
|
| Rate for Payer: WEA Trust Commercial |
$143.57
|
| Rate for Payer: Wellcare Medicare |
$19.39
|
| Rate for Payer: WPS Commercial |
$193.35
|
|
|
Hypoglycemic Panel, Qual
|
Professional
|
Both
|
$251.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
3256232
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.39 |
| Max. Negotiated Rate |
$247.99 |
| Rate for Payer: Aetna Commercial |
$247.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$224.49
|
| Rate for Payer: Aetna Managed Medicare |
$19.39
|
| Rate for Payer: Anthem Medicare Advantage |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.39
|
| Rate for Payer: Cash Price |
$75.30
|
| Rate for Payer: Cash Price |
$75.30
|
| Rate for Payer: Cigna Commercial |
$247.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$130.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.39
|
| Rate for Payer: Health EOS Commercial |
$237.55
|
| Rate for Payer: HFN Commercial |
$247.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$68.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.39
|
| Rate for Payer: Multiplan Commercial |
$208.83
|
| Rate for Payer: NAPHCARE Commercial |
$29.08
|
| Rate for Payer: Preferred Network Access Commercial |
$247.99
|
| Rate for Payer: Quartz Beloit One Network |
$114.86
|
| Rate for Payer: Quartz Commercial |
$148.79
|
| Rate for Payer: Quartz Medicare Advantage |
$19.39
|
| Rate for Payer: The Alliance Commercial |
$76.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.39
|
| Rate for Payer: WEA Trust Commercial |
$143.57
|
| Rate for Payer: WPS Commercial |
$85.30
|
|
|
HYPOSPADIAS DEFORMITY REPAIR
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960127
|
|
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
|
|
|
HYPOSPADIAS DEFORMITY REPAIR
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960127
|
|
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
|
|
|
Hypothermia protocol - CCC - Cooling Measures
|
Facility
|
OP
|
$11,636.00
|
|
| Hospital Charge Code |
3034560
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$3,388.40 |
| Max. Negotiated Rate |
$11,133.32 |
| Rate for Payer: Aetna Commercial |
$10,891.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,407.24
|
| Rate for Payer: Aetna Managed Medicare |
$3,388.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,865.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,050.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,808.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,413.76
|
| Rate for Payer: Cash Price |
$3,490.80
|
| Rate for Payer: Cigna Commercial |
$11,133.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,772.15
|
| Rate for Payer: Health EOS Commercial |
$10,770.28
|
| Rate for Payer: HFN Commercial |
$11,133.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,076.08
|
| Rate for Payer: Multiplan Commercial |
$9,681.15
|
| Rate for Payer: NAPHCARE Commercial |
$7,260.86
|
| Rate for Payer: Preferred Network Access Commercial |
$11,133.32
|
| Rate for Payer: Quartz Beloit One Network |
$5,929.71
|
| Rate for Payer: Quartz Commercial |
$7,865.94
|
| Rate for Payer: Quartz Medicare Advantage |
$7,260.86
|
| Rate for Payer: The Alliance Commercial |
$6,050.72
|
| Rate for Payer: WEA Trust Commercial |
$6,655.79
|
| Rate for Payer: WPS Commercial |
$8,963.21
|
|
|
Hypothermia protocol - CCC - Cooling Measures
|
Facility
|
IP
|
$11,636.00
|
|
| Hospital Charge Code |
3034560
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$5,929.71 |
| Max. Negotiated Rate |
$11,133.32 |
| Rate for Payer: Aetna Commercial |
$10,891.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,407.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,413.76
|
| Rate for Payer: Cash Price |
$3,490.80
|
| Rate for Payer: Cigna Commercial |
$11,133.32
|
| Rate for Payer: Health EOS Commercial |
$10,770.28
|
| Rate for Payer: HFN Commercial |
$11,133.32
|
| Rate for Payer: Multiplan Commercial |
$9,681.15
|
| Rate for Payer: Preferred Network Access Commercial |
$11,133.32
|
| Rate for Payer: Quartz Beloit One Network |
$5,929.71
|
| Rate for Payer: Quartz Commercial |
$7,260.86
|
| Rate for Payer: WEA Trust Commercial |
$6,655.79
|
| Rate for Payer: WPS Commercial |
$8,963.21
|
|
|
HYPOVOLEMIA AND RELATED ELECTROLYTE DISORDERS
|
Facility
|
IP
|
$3,858.06
|
|
|
Service Code
|
APR-DRG 4221
|
| Min. Negotiated Rate |
$3,426.97 |
| Max. Negotiated Rate |
$3,858.06 |
| Rate for Payer: Anthem Medicaid |
$3,694.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$3,694.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,694.30
|
| Rate for Payer: Dean Health Medicaid |
$3,694.30
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$3,426.97
|
| Rate for Payer: Managed Health Services Medicaid |
$3,858.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,694.30
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$3,694.30
|
| Rate for Payer: United Healthcare Medicaid |
$3,694.30
|
|
|
HYPOVOLEMIA AND RELATED ELECTROLYTE DISORDERS
|
Facility
|
IP
|
$12,275.63
|
|
|
Service Code
|
APR-DRG 4224
|
| Min. Negotiated Rate |
$10,903.98 |
| Max. Negotiated Rate |
$12,275.63 |
| Rate for Payer: Anthem Medicaid |
$11,754.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$11,754.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11,754.60
|
| Rate for Payer: Dean Health Medicaid |
$11,754.60
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$10,903.98
|
| Rate for Payer: Managed Health Services Medicaid |
$12,275.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,754.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11,754.60
|
| Rate for Payer: United Healthcare Medicaid |
$11,754.60
|
|
|
HYPOVOLEMIA AND RELATED ELECTROLYTE DISORDERS
|
Facility
|
IP
|
$5,173.30
|
|
|
Service Code
|
APR-DRG 4222
|
| Min. Negotiated Rate |
$4,595.25 |
| Max. Negotiated Rate |
$5,173.30 |
| Rate for Payer: Anthem Medicaid |
$4,953.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$4,953.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,953.72
|
| Rate for Payer: Dean Health Medicaid |
$4,953.72
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4,595.25
|
| Rate for Payer: Managed Health Services Medicaid |
$5,173.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,953.72
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4,953.72
|
| Rate for Payer: United Healthcare Medicaid |
$4,953.72
|
|
