|
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$138,561.28
|
|
|
Service Code
|
MSDRG 853
|
| Min. Negotiated Rate |
$38,327.56 |
| Max. Negotiated Rate |
$138,561.28 |
| Rate for Payer: Aetna Managed Medicare |
$38,327.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$107,756.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$82,594.33
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$78,470.01
|
| Rate for Payer: Anthem Medicare Advantage |
$38,327.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$38,327.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$38,327.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$38,327.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$87,108.90
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$38,327.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$101,385.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$38,327.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$38,327.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$38,327.56
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$38,327.56
|
| Rate for Payer: NAPHCARE Commercial |
$57,491.34
|
| Rate for Payer: Quartz Medicare Advantage |
$38,327.56
|
| Rate for Payer: The Alliance Commercial |
$138,561.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38,327.56
|
| Rate for Payer: United Healthcare PPO |
$78,930.14
|
| Rate for Payer: Wellcare Medicare |
$38,327.56
|
|
|
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$47,386.56
|
|
|
Service Code
|
MSDRG 855
|
| Min. Negotiated Rate |
$11,972.64 |
| Max. Negotiated Rate |
$47,386.56 |
| Rate for Payer: Aetna Managed Medicare |
$11,972.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32,667.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25,039.53
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23,789.19
|
| Rate for Payer: Anthem Medicare Advantage |
$11,972.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,972.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,972.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,972.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26,408.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,972.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34,512.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,972.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,972.64
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,972.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,972.64
|
| Rate for Payer: NAPHCARE Commercial |
$17,958.95
|
| Rate for Payer: Quartz Medicare Advantage |
$11,972.64
|
| Rate for Payer: The Alliance Commercial |
$47,386.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,972.64
|
| Rate for Payer: United Healthcare PPO |
$26,868.43
|
| Rate for Payer: Wellcare Medicare |
$11,972.64
|
|
|
Infed 50mg Charge
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
HCPCS J1750
|
| Hospital Charge Code |
2983479
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.57 |
| Max. Negotiated Rate |
$106.20 |
| Rate for Payer: Aetna Commercial |
$103.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.18
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$106.20
|
| Rate for Payer: Health EOS Commercial |
$102.74
|
| Rate for Payer: HFN Commercial |
$106.20
|
| Rate for Payer: Multiplan Commercial |
$92.35
|
| Rate for Payer: Preferred Network Access Commercial |
$106.20
|
| Rate for Payer: Quartz Beloit One Network |
$56.57
|
| Rate for Payer: Quartz Commercial |
$69.26
|
| Rate for Payer: WEA Trust Commercial |
$63.49
|
| Rate for Payer: WPS Commercial |
$85.50
|
|
|
Infed 50mg Charge
|
Professional
|
Both
|
$111.00
|
|
|
Service Code
|
HCPCS J1750
|
| Hospital Charge Code |
2983479
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.01 |
| Max. Negotiated Rate |
$109.67 |
| Rate for Payer: Aetna Commercial |
$109.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.28
|
| Rate for Payer: Aetna Managed Medicare |
$18.80
|
| Rate for Payer: Anthem Medicare Advantage |
$18.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.80
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$109.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.01
|
| Rate for Payer: Health EOS Commercial |
$105.05
|
| Rate for Payer: HFN Commercial |
$109.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.80
|
| Rate for Payer: Multiplan Commercial |
$92.35
|
| Rate for Payer: NAPHCARE Commercial |
$28.20
|
| Rate for Payer: Preferred Network Access Commercial |
$109.67
|
| Rate for Payer: Quartz Beloit One Network |
$50.79
|
| Rate for Payer: Quartz Commercial |
$65.80
|
| Rate for Payer: Quartz Medicare Advantage |
$18.80
|
| Rate for Payer: The Alliance Commercial |
$51.71
|
| Rate for Payer: United Healthcare Medicaid |
$18.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.80
|
| Rate for Payer: WEA Trust Commercial |
$63.49
|
| Rate for Payer: WPS Commercial |
$45.02
|
|
|
Infed 50mg Charge
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
HCPCS J1750
|
| Hospital Charge Code |
2983479
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.01 |
| Max. Negotiated Rate |
$106.20 |
| Rate for Payer: Aetna Commercial |
$103.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.28
|
| Rate for Payer: Aetna Managed Medicare |
$18.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18.01
|
| Rate for Payer: Anthem Medicare Advantage |
$18.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.80
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$106.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23.82
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.80
|
| Rate for Payer: Health EOS Commercial |
$102.74
|
| Rate for Payer: HFN Commercial |
$106.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.80
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.80
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.80
|
| Rate for Payer: Multiplan Commercial |
$92.35
|
| Rate for Payer: NAPHCARE Commercial |
$28.20
|
| Rate for Payer: Preferred Network Access Commercial |
$106.20
|
| Rate for Payer: Quartz Beloit One Network |
$56.57
|
| Rate for Payer: Quartz Commercial |
$75.04
|
| Rate for Payer: Quartz Medicare Advantage |
$18.80
|
| Rate for Payer: The Alliance Commercial |
$75.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.80
|
| Rate for Payer: WEA Trust Commercial |
$63.49
|
| Rate for Payer: Wellcare Medicare |
$18.80
|
| Rate for Payer: WPS Commercial |
$45.02
|
|
|
INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC
|
Facility
|
IP
|
$45,152.64
|
|
|
Service Code
|
MSDRG 727
|
| Min. Negotiated Rate |
$11,863.11 |
| Max. Negotiated Rate |
$45,152.64 |
| Rate for Payer: Aetna Managed Medicare |
$11,863.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32,355.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24,800.38
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23,561.98
|
| Rate for Payer: Anthem Medicare Advantage |
$11,863.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,863.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,863.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,863.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26,155.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,863.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32,873.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,863.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,863.11
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,863.11
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,863.11
|
| Rate for Payer: NAPHCARE Commercial |
$17,794.67
|
| Rate for Payer: Quartz Medicare Advantage |
$11,863.11
|
| Rate for Payer: The Alliance Commercial |
$45,152.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,863.11
|
| Rate for Payer: United Healthcare PPO |
$25,592.74
|
| Rate for Payer: Wellcare Medicare |
$11,863.11
|
|
|
INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC
|
Facility
|
IP
|
$22,455.68
|
|
|
Service Code
|
MSDRG 728
|
| Min. Negotiated Rate |
$6,719.12 |
| Max. Negotiated Rate |
$22,455.68 |
| Rate for Payer: Aetna Managed Medicare |
$6,719.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17,699.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,566.70
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,889.25
|
| Rate for Payer: Anthem Medicare Advantage |
$6,719.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,719.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,719.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,719.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14,308.25
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,719.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16,226.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,719.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,719.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,719.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,719.12
|
| Rate for Payer: NAPHCARE Commercial |
$10,078.68
|
| Rate for Payer: Quartz Medicare Advantage |
$6,719.12
|
| Rate for Payer: The Alliance Commercial |
$22,455.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,719.12
|
| Rate for Payer: United Healthcare PPO |
$12,632.17
|
| Rate for Payer: Wellcare Medicare |
$6,719.12
|
|
|
INFLAMMATORY BOWEL DISEASE
|
Facility
|
IP
|
$5,260.99
|
|
|
Service Code
|
APR-DRG 2451
|
| Min. Negotiated Rate |
$4,673.14 |
| Max. Negotiated Rate |
$5,260.99 |
| Rate for Payer: Anthem Medicaid |
$5,037.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$5,037.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,037.68
|
| Rate for Payer: Dean Health Medicaid |
$5,037.68
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4,673.14
|
| Rate for Payer: Managed Health Services Medicaid |
$5,260.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,037.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5,037.68
|
| Rate for Payer: United Healthcare Medicaid |
$5,037.68
|
|
|
INFLAMMATORY BOWEL DISEASE
|
Facility
|
IP
|
$18,764.18
|
|
|
Service Code
|
APR-DRG 2454
|
| Min. Negotiated Rate |
$16,667.52 |
| Max. Negotiated Rate |
$18,764.18 |
| Rate for Payer: Anthem Medicaid |
$17,967.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$17,967.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17,967.74
|
| Rate for Payer: Dean Health Medicaid |
$17,967.74
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$16,667.52
|
| Rate for Payer: Managed Health Services Medicaid |
$18,764.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$17,967.74
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17,967.74
|
| Rate for Payer: United Healthcare Medicaid |
$17,967.74
|
|
|
INFLAMMATORY BOWEL DISEASE
|
Facility
|
OP
|
$81.24
|
|
|
Service Code
|
EAPG 00626
|
| Min. Negotiated Rate |
$78.11 |
| Max. Negotiated Rate |
$81.24 |
| Rate for Payer: Anthem Medicaid |
$78.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$78.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$78.11
|
| Rate for Payer: Dean Health Medicaid |
$78.11
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$78.11
|
| Rate for Payer: Managed Health Services Medicaid |
$81.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$78.11
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$78.11
|
| Rate for Payer: United Healthcare Medicaid |
$78.11
|
|
|
INFLAMMATORY BOWEL DISEASE
|
Facility
|
IP
|
$7,102.33
|
|
|
Service Code
|
APR-DRG 2452
|
| Min. Negotiated Rate |
$6,308.73 |
| Max. Negotiated Rate |
$7,102.33 |
| Rate for Payer: Anthem Medicaid |
$6,800.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$6,800.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,800.87
|
| Rate for Payer: Dean Health Medicaid |
$6,800.87
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6,308.73
|
| Rate for Payer: Managed Health Services Medicaid |
$7,102.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,800.87
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6,800.87
|
| Rate for Payer: United Healthcare Medicaid |
$6,800.87
|
|
|
INFLAMMATORY BOWEL DISEASE
|
Facility
|
IP
|
$10,960.39
|
|
|
Service Code
|
APR-DRG 2453
|
| Min. Negotiated Rate |
$9,735.70 |
| Max. Negotiated Rate |
$10,960.39 |
| Rate for Payer: Anthem Medicaid |
$10,495.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$10,495.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10,495.17
|
| Rate for Payer: Dean Health Medicaid |
$10,495.17
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9,735.70
|
| Rate for Payer: Managed Health Services Medicaid |
$10,960.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,495.17
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$10,495.17
|
| Rate for Payer: United Healthcare Medicaid |
$10,495.17
|
|
|
Inflammatory Bowel Disease Panel
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 86021
|
| Hospital Charge Code |
5438801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.65 |
| Max. Negotiated Rate |
$114.82 |
| Rate for Payer: Aetna Commercial |
$112.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$107.33
|
| 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 |
$66.14
|
| 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 |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$114.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$69.84
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.65
|
| Rate for Payer: Health EOS Commercial |
$111.07
|
| Rate for Payer: HFN Commercial |
$114.82
|
| 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 |
$99.84
|
| Rate for Payer: NAPHCARE Commercial |
$23.48
|
| Rate for Payer: Preferred Network Access Commercial |
$114.82
|
| Rate for Payer: Quartz Beloit One Network |
$61.15
|
| Rate for Payer: Quartz Commercial |
$81.12
|
| 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 |
$93.60
|
| Rate for Payer: WEA Trust Commercial |
$68.64
|
| Rate for Payer: Wellcare Medicare |
$15.65
|
| Rate for Payer: WPS Commercial |
$92.44
|
|
|
Inflammatory Bowel Disease Panel
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 86021
|
| Hospital Charge Code |
5438801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$61.15 |
| Max. Negotiated Rate |
$114.82 |
| Rate for Payer: Aetna Commercial |
$112.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$107.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.14
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$114.82
|
| Rate for Payer: Health EOS Commercial |
$111.07
|
| Rate for Payer: HFN Commercial |
$114.82
|
| Rate for Payer: Multiplan Commercial |
$99.84
|
| Rate for Payer: Preferred Network Access Commercial |
$114.82
|
| Rate for Payer: Quartz Beloit One Network |
$61.15
|
| Rate for Payer: Quartz Commercial |
$74.88
|
| Rate for Payer: WEA Trust Commercial |
$68.64
|
| Rate for Payer: WPS Commercial |
$92.44
|
|
|
Inflammatory Bowel Disease Panel
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
CPT 86021
|
| Hospital Charge Code |
5438801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.65 |
| Max. Negotiated Rate |
$118.56 |
| Rate for Payer: Aetna Commercial |
$118.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$107.33
|
| 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 |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$118.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$62.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.65
|
| Rate for Payer: Health EOS Commercial |
$113.57
|
| Rate for Payer: HFN Commercial |
$118.56
|
| 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 |
$99.84
|
| Rate for Payer: NAPHCARE Commercial |
$23.48
|
| Rate for Payer: Preferred Network Access Commercial |
$118.56
|
| Rate for Payer: Quartz Beloit One Network |
$54.91
|
| Rate for Payer: Quartz Commercial |
$71.14
|
| 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 |
$68.64
|
| Rate for Payer: WPS Commercial |
$68.87
|
|
|
INFLAMMATORY BOWEL DISEASE WITH CC
|
Facility
|
IP
|
$27,197.04
|
|
|
Service Code
|
MSDRG 386
|
| Min. Negotiated Rate |
$7,983.48 |
| Max. Negotiated Rate |
$27,197.04 |
| Rate for Payer: Aetna Managed Medicare |
$7,983.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21,302.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,327.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,512.55
|
| Rate for Payer: Anthem Medicare Advantage |
$7,983.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,983.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,983.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,983.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17,220.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,983.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19,704.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,983.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,983.48
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,983.48
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,983.48
|
| Rate for Payer: NAPHCARE Commercial |
$11,975.22
|
| Rate for Payer: Quartz Medicare Advantage |
$7,983.48
|
| Rate for Payer: The Alliance Commercial |
$27,197.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,983.48
|
| Rate for Payer: United Healthcare PPO |
$15,339.85
|
| Rate for Payer: Wellcare Medicare |
$7,983.48
|
|
|
INFLAMMATORY BOWEL DISEASE WITH MCC
|
Facility
|
IP
|
$43,657.12
|
|
|
Service Code
|
MSDRG 385
|
| Min. Negotiated Rate |
$12,624.35 |
| Max. Negotiated Rate |
$43,657.12 |
| Rate for Payer: Aetna Managed Medicare |
$12,624.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$34,524.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26,462.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25,141.35
|
| Rate for Payer: Anthem Medicare Advantage |
$12,624.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12,624.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12,624.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12,624.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27,909.21
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12,624.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31,776.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12,624.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12,624.35
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12,624.35
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12,624.35
|
| Rate for Payer: NAPHCARE Commercial |
$18,936.53
|
| Rate for Payer: Quartz Medicare Advantage |
$12,624.35
|
| Rate for Payer: The Alliance Commercial |
$43,657.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,624.35
|
| Rate for Payer: United Healthcare PPO |
$24,738.59
|
| Rate for Payer: Wellcare Medicare |
$12,624.35
|
|
|
INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC
|
Facility
|
IP
|
$19,248.32
|
|
|
Service Code
|
MSDRG 387
|
| Min. Negotiated Rate |
$5,724.31 |
| Max. Negotiated Rate |
$19,248.32 |
| Rate for Payer: Aetna Managed Medicare |
$5,724.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14,865.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,394.22
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,825.26
|
| Rate for Payer: Anthem Medicare Advantage |
$5,724.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,724.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,724.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,724.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,017.03
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,724.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,873.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,724.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,724.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,724.31
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,724.31
|
| Rate for Payer: NAPHCARE Commercial |
$8,586.46
|
| Rate for Payer: Quartz Medicare Advantage |
$5,724.31
|
| Rate for Payer: The Alliance Commercial |
$19,248.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,724.31
|
| Rate for Payer: United Healthcare PPO |
$10,800.73
|
| Rate for Payer: Wellcare Medicare |
$5,724.31
|
|
|
INFLATION DEVICE EAGLE 30ATM BURST PRESSURE 20CC 325130
|
Facility
|
IP
|
$1,151.00
|
|
| Hospital Charge Code |
5520930
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$586.55 |
| Max. Negotiated Rate |
$1,101.28 |
| Rate for Payer: Aetna Commercial |
$1,077.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,029.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$634.43
|
| Rate for Payer: Cash Price |
$345.30
|
| Rate for Payer: Cigna Commercial |
$1,101.28
|
| Rate for Payer: Health EOS Commercial |
$1,065.37
|
| Rate for Payer: HFN Commercial |
$1,101.28
|
| Rate for Payer: Multiplan Commercial |
$957.63
|
| Rate for Payer: Preferred Network Access Commercial |
$1,101.28
|
| Rate for Payer: Quartz Beloit One Network |
$586.55
|
| Rate for Payer: Quartz Commercial |
$718.22
|
| Rate for Payer: WEA Trust Commercial |
$658.37
|
| Rate for Payer: WPS Commercial |
$886.62
|
|
|
INFLATION DEVICE EAGLE 30ATM BURST PRESSURE 20CC 325130
|
Facility
|
OP
|
$1,151.00
|
|
| Hospital Charge Code |
5520930
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$335.17 |
| Max. Negotiated Rate |
$1,101.28 |
| Rate for Payer: Aetna Commercial |
$1,077.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,029.45
|
| Rate for Payer: Aetna Managed Medicare |
$335.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$778.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$598.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$574.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$634.43
|
| Rate for Payer: Cash Price |
$345.30
|
| Rate for Payer: Cigna Commercial |
$1,101.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$669.88
|
| Rate for Payer: Health EOS Commercial |
$1,065.37
|
| Rate for Payer: HFN Commercial |
$1,101.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$897.78
|
| Rate for Payer: Multiplan Commercial |
$957.63
|
| Rate for Payer: NAPHCARE Commercial |
$718.22
|
| Rate for Payer: Preferred Network Access Commercial |
$1,101.28
|
| Rate for Payer: Quartz Beloit One Network |
$586.55
|
| Rate for Payer: Quartz Commercial |
$778.08
|
| Rate for Payer: Quartz Medicare Advantage |
$718.22
|
| Rate for Payer: The Alliance Commercial |
$598.52
|
| Rate for Payer: WEA Trust Commercial |
$658.37
|
| Rate for Payer: WPS Commercial |
$886.62
|
|
|
INFLATION DEVICE ENCORE 26 04526-01
|
Facility
|
IP
|
$983.00
|
|
| Hospital Charge Code |
2971788
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$500.94 |
| Max. Negotiated Rate |
$940.53 |
| Rate for Payer: Aetna Commercial |
$920.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$879.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$541.83
|
| Rate for Payer: Cash Price |
$294.90
|
| Rate for Payer: Cigna Commercial |
$940.53
|
| Rate for Payer: Health EOS Commercial |
$909.86
|
| Rate for Payer: HFN Commercial |
$940.53
|
| Rate for Payer: Multiplan Commercial |
$817.86
|
| Rate for Payer: Preferred Network Access Commercial |
$940.53
|
| Rate for Payer: Quartz Beloit One Network |
$500.94
|
| Rate for Payer: Quartz Commercial |
$613.39
|
| Rate for Payer: WEA Trust Commercial |
$562.28
|
| Rate for Payer: WPS Commercial |
$757.20
|
|
|
INFLATION DEVICE ENCORE 26 04526-01
|
Facility
|
OP
|
$983.00
|
|
| Hospital Charge Code |
2971788
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$286.25 |
| Max. Negotiated Rate |
$940.53 |
| Rate for Payer: Aetna Commercial |
$920.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$879.20
|
| Rate for Payer: Aetna Managed Medicare |
$286.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$664.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$511.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$490.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$541.83
|
| Rate for Payer: Cash Price |
$294.90
|
| Rate for Payer: Cigna Commercial |
$940.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$572.11
|
| Rate for Payer: Health EOS Commercial |
$909.86
|
| Rate for Payer: HFN Commercial |
$940.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$766.74
|
| Rate for Payer: Multiplan Commercial |
$817.86
|
| Rate for Payer: NAPHCARE Commercial |
$613.39
|
| Rate for Payer: Preferred Network Access Commercial |
$940.53
|
| Rate for Payer: Quartz Beloit One Network |
$500.94
|
| Rate for Payer: Quartz Commercial |
$664.51
|
| Rate for Payer: Quartz Medicare Advantage |
$613.39
|
| Rate for Payer: The Alliance Commercial |
$511.16
|
| Rate for Payer: WEA Trust Commercial |
$562.28
|
| Rate for Payer: WPS Commercial |
$757.20
|
|
|
INFLATION DEVICE ENCORE 26 20ML - OR INV - M0067101140
|
Facility
|
IP
|
$1,206.00
|
|
| Hospital Charge Code |
4595198
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$614.58 |
| Max. Negotiated Rate |
$1,153.90 |
| Rate for Payer: Aetna Commercial |
$1,128.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,078.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$664.75
|
| Rate for Payer: Cash Price |
$361.80
|
| Rate for Payer: Cigna Commercial |
$1,153.90
|
| Rate for Payer: Health EOS Commercial |
$1,116.27
|
| Rate for Payer: HFN Commercial |
$1,153.90
|
| Rate for Payer: Multiplan Commercial |
$1,003.39
|
| Rate for Payer: Preferred Network Access Commercial |
$1,153.90
|
| Rate for Payer: Quartz Beloit One Network |
$614.58
|
| Rate for Payer: Quartz Commercial |
$752.54
|
| Rate for Payer: WEA Trust Commercial |
$689.83
|
| Rate for Payer: WPS Commercial |
$928.98
|
|
|
INFLATION DEVICE ENCORE 26 20ML - OR INV - M0067101140
|
Facility
|
OP
|
$1,206.00
|
|
| Hospital Charge Code |
4595198
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$351.19 |
| Max. Negotiated Rate |
$1,153.90 |
| Rate for Payer: Aetna Commercial |
$1,128.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,078.65
|
| Rate for Payer: Aetna Managed Medicare |
$351.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$815.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$627.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$602.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$664.75
|
| Rate for Payer: Cash Price |
$361.80
|
| Rate for Payer: Cigna Commercial |
$1,153.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$701.89
|
| Rate for Payer: Health EOS Commercial |
$1,116.27
|
| Rate for Payer: HFN Commercial |
$1,153.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$940.68
|
| Rate for Payer: Multiplan Commercial |
$1,003.39
|
| Rate for Payer: NAPHCARE Commercial |
$752.54
|
| Rate for Payer: Preferred Network Access Commercial |
$1,153.90
|
| Rate for Payer: Quartz Beloit One Network |
$614.58
|
| Rate for Payer: Quartz Commercial |
$815.26
|
| Rate for Payer: Quartz Medicare Advantage |
$752.54
|
| Rate for Payer: The Alliance Commercial |
$627.12
|
| Rate for Payer: WEA Trust Commercial |
$689.83
|
| Rate for Payer: WPS Commercial |
$928.98
|
|
|
INFLATION DEVICE SE ACCLARENT SEID
|
Facility
|
OP
|
$1,314.00
|
|
| Hospital Charge Code |
5178631
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$382.64 |
| Max. Negotiated Rate |
$1,257.24 |
| Rate for Payer: Aetna Commercial |
$1,229.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,175.24
|
| Rate for Payer: Aetna Managed Medicare |
$382.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$888.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$683.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$655.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$724.28
|
| Rate for Payer: Cash Price |
$394.20
|
| Rate for Payer: Cigna Commercial |
$1,257.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$764.75
|
| Rate for Payer: Health EOS Commercial |
$1,216.24
|
| Rate for Payer: HFN Commercial |
$1,257.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,024.92
|
| Rate for Payer: Multiplan Commercial |
$1,093.25
|
| Rate for Payer: NAPHCARE Commercial |
$819.94
|
| Rate for Payer: Preferred Network Access Commercial |
$1,257.24
|
| Rate for Payer: Quartz Beloit One Network |
$669.61
|
| Rate for Payer: Quartz Commercial |
$888.26
|
| Rate for Payer: Quartz Medicare Advantage |
$819.94
|
| Rate for Payer: The Alliance Commercial |
$683.28
|
| Rate for Payer: WEA Trust Commercial |
$751.61
|
| Rate for Payer: WPS Commercial |
$1,012.17
|
|
