|
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$133,232.00
|
|
|
Service Code
|
MSDRG 853
|
| Min. Negotiated Rate |
$47,925.05 |
| Max. Negotiated Rate |
$133,232.00 |
| Rate for Payer: Aetna Managed Medicare |
$47,925.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$104,900.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$80,405.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$76,390.00
|
| Rate for Payer: Anthem Medicare Advantage |
$47,925.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$47,925.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$47,925.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$47,925.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$84,799.90
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$47,925.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$97,486.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47,925.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$47,925.05
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$47,925.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$47,925.05
|
| Rate for Payer: NAPHCARE Commercial |
$71,887.58
|
| Rate for Payer: Quartz Medicare Advantage |
$47,925.05
|
| Rate for Payer: The Alliance Commercial |
$133,232.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47,925.05
|
| Rate for Payer: United Healthcare PPO |
$75,894.37
|
| Rate for Payer: Wellcare Medicare |
$47,925.05
|
|
|
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$45,564.00
|
|
|
Service Code
|
MSDRG 855
|
| Min. Negotiated Rate |
$16,390.08 |
| Max. Negotiated Rate |
$45,564.00 |
| Rate for Payer: Aetna Managed Medicare |
$16,390.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$35,666.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27,337.70
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25,972.60
|
| Rate for Payer: Anthem Medicare Advantage |
$16,390.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16,390.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16,390.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16,390.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28,831.97
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16,390.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33,185.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16,390.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16,390.08
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16,390.08
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16,390.08
|
| Rate for Payer: NAPHCARE Commercial |
$24,585.12
|
| Rate for Payer: Quartz Medicare Advantage |
$16,390.08
|
| Rate for Payer: The Alliance Commercial |
$45,564.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16,390.08
|
| Rate for Payer: United Healthcare PPO |
$25,835.03
|
| Rate for Payer: Wellcare Medicare |
$16,390.08
|
|
|
Infed 50mg Charge
|
Professional
|
Both
|
$111.00
|
|
|
Service Code
|
HCPCS J1750
|
| Hospital Charge Code |
2983479
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.31 |
| Max. Negotiated Rate |
$105.45 |
| Rate for Payer: Aetna Commercial |
$105.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.46
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$105.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.31
|
| Rate for Payer: Health EOS Commercial |
$101.01
|
| Rate for Payer: HFN Commercial |
$105.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22.00
|
| Rate for Payer: Multiplan Commercial |
$88.80
|
| Rate for Payer: Preferred Network Access Commercial |
$105.45
|
| Rate for Payer: Quartz Beloit One Network |
$48.84
|
| Rate for Payer: Quartz Commercial |
$63.27
|
| Rate for Payer: The Alliance Commercial |
$55.50
|
| Rate for Payer: United Healthcare Medicaid |
$17.31
|
| Rate for Payer: WEA Trust Commercial |
$61.05
|
| Rate for Payer: WPS Commercial |
$43.28
|
|
|
Infed 50mg Charge
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
HCPCS J1750
|
| Hospital Charge Code |
2983479
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.39 |
| Max. Negotiated Rate |
$102.12 |
| Rate for Payer: Aetna Commercial |
$99.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.83
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$102.12
|
| Rate for Payer: Health EOS Commercial |
$98.79
|
| Rate for Payer: HFN Commercial |
$102.12
|
| Rate for Payer: Multiplan Commercial |
$88.80
|
| Rate for Payer: NAPHCARE Commercial |
$66.60
|
| Rate for Payer: Preferred Network Access Commercial |
$102.12
|
| Rate for Payer: Quartz Beloit One Network |
$54.39
|
| Rate for Payer: Quartz Commercial |
$66.60
|
| Rate for Payer: WEA Trust Commercial |
$61.05
|
| Rate for Payer: WPS Commercial |
$82.22
|
|
|
Infed 50mg Charge
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
HCPCS J1750
|
| Hospital Charge Code |
2983479
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.31 |
| Max. Negotiated Rate |
$102.12 |
| Rate for Payer: Aetna Commercial |
$99.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.46
|
| Rate for Payer: Aetna Managed Medicare |
$17.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17.31
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17.31
|
| Rate for Payer: Anthem Medicare Advantage |
$17.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.32
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$102.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.32
|
| Rate for Payer: Health EOS Commercial |
$98.79
|
| Rate for Payer: HFN Commercial |
$102.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.32
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.32
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.32
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.32
|
| Rate for Payer: Multiplan Commercial |
$88.80
|
| Rate for Payer: NAPHCARE Commercial |
$25.99
|
| Rate for Payer: Preferred Network Access Commercial |
$102.12
|
| Rate for Payer: Quartz Beloit One Network |
$54.39
|
| Rate for Payer: Quartz Commercial |
$72.15
|
| Rate for Payer: Quartz Medicare Advantage |
$17.32
|
| Rate for Payer: The Alliance Commercial |
$69.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.32
|
| Rate for Payer: WEA Trust Commercial |
$61.05
|
| Rate for Payer: Wellcare Medicare |
$17.32
|
| Rate for Payer: WPS Commercial |
$43.28
|
|
|
INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC
|
Facility
|
IP
|
$43,416.00
|
|
|
Service Code
|
MSDRG 727
|
| Min. Negotiated Rate |
$15,617.37 |
| Max. Negotiated Rate |
$43,416.00 |
| Rate for Payer: Aetna Managed Medicare |
$15,617.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33,987.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26,051.22
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24,750.36
|
| Rate for Payer: Anthem Medicare Advantage |
$15,617.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15,617.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15,617.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15,617.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27,475.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15,617.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31,609.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15,617.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15,617.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15,617.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15,617.37
|
| Rate for Payer: NAPHCARE Commercial |
$23,426.06
|
| Rate for Payer: Quartz Medicare Advantage |
$15,617.37
|
| Rate for Payer: The Alliance Commercial |
$43,416.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15,617.37
|
| Rate for Payer: United Healthcare PPO |
$24,608.40
|
| Rate for Payer: Wellcare Medicare |
$15,617.37
|
|
|
INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC
|
Facility
|
IP
|
$21,592.00
|
|
|
Service Code
|
MSDRG 728
|
| Min. Negotiated Rate |
$7,766.86 |
| Max. Negotiated Rate |
$21,592.00 |
| Rate for Payer: Aetna Managed Medicare |
$7,766.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,784.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,864.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,222.40
|
| Rate for Payer: Anthem Medicare Advantage |
$7,766.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,766.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,766.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,766.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13,567.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,766.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,601.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,766.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,766.86
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,766.86
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,766.86
|
| Rate for Payer: NAPHCARE Commercial |
$11,650.29
|
| Rate for Payer: Quartz Medicare Advantage |
$7,766.86
|
| Rate for Payer: The Alliance Commercial |
$21,592.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,766.86
|
| Rate for Payer: United Healthcare PPO |
$12,146.32
|
| Rate for Payer: Wellcare Medicare |
$7,766.86
|
|
|
Inflammatory Bowel Disease Panel
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 86021
|
| Hospital Charge Code |
5438801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$110.40 |
| Rate for Payer: Aetna Commercial |
$108.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$103.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.60
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$110.40
|
| Rate for Payer: Health EOS Commercial |
$106.80
|
| Rate for Payer: HFN Commercial |
$110.40
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: NAPHCARE Commercial |
$72.00
|
| Rate for Payer: Preferred Network Access Commercial |
$110.40
|
| Rate for Payer: Quartz Beloit One Network |
$58.80
|
| Rate for Payer: Quartz Commercial |
$72.00
|
| Rate for Payer: WEA Trust Commercial |
$66.00
|
| Rate for Payer: WPS Commercial |
$88.88
|
|
|
Inflammatory Bowel Disease Panel
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 86021
|
| Hospital Charge Code |
5438801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.05 |
| Max. Negotiated Rate |
$110.40 |
| Rate for Payer: Aetna Commercial |
$108.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$103.20
|
| Rate for Payer: Aetna Managed Medicare |
$15.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.34
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.98
|
| Rate for Payer: Anthem Medicaid |
$15.55
|
| Rate for Payer: Anthem Medicare Advantage |
$15.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.05
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$110.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$67.15
|
| Rate for Payer: Dean Health Medicaid |
$15.55
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.05
|
| Rate for Payer: Health EOS Commercial |
$106.80
|
| Rate for Payer: HFN Commercial |
$110.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.05
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.05
|
| Rate for Payer: Managed Health Services Medicaid |
$16.17
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.05
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: NAPHCARE Commercial |
$22.58
|
| Rate for Payer: Preferred Network Access Commercial |
$110.40
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$15.55
|
| Rate for Payer: Quartz Beloit One Network |
$58.80
|
| Rate for Payer: Quartz Commercial |
$78.00
|
| Rate for Payer: Quartz Medicare Advantage |
$15.05
|
| Rate for Payer: The Alliance Commercial |
$60.20
|
| Rate for Payer: United Healthcare Medicaid |
$15.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.05
|
| Rate for Payer: United Healthcare PPO |
$90.00
|
| Rate for Payer: WEA Trust Commercial |
$66.00
|
| Rate for Payer: Wellcare Medicare |
$15.05
|
| Rate for Payer: WMAP Medicaid |
$15.55
|
| Rate for Payer: WPS Commercial |
$88.88
|
|
|
Inflammatory Bowel Disease Panel
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
CPT 86021
|
| Hospital Charge Code |
5438801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$114.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$103.20
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$114.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$60.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$72.00
|
| Rate for Payer: Health EOS Commercial |
$109.20
|
| Rate for Payer: HFN Commercial |
$114.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$53.13
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Preferred Network Access Commercial |
$114.00
|
| Rate for Payer: Quartz Beloit One Network |
$52.80
|
| Rate for Payer: Quartz Commercial |
$68.40
|
| Rate for Payer: The Alliance Commercial |
$60.00
|
| Rate for Payer: WEA Trust Commercial |
$66.00
|
| Rate for Payer: WPS Commercial |
$88.88
|
|
|
INFLAMMATORY BOWEL DISEASE WITH CC
|
Facility
|
IP
|
$26,151.00
|
|
|
Service Code
|
MSDRG 386
|
| Min. Negotiated Rate |
$9,406.97 |
| Max. Negotiated Rate |
$26,151.00 |
| Rate for Payer: Aetna Managed Medicare |
$9,406.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20,350.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15,598.57
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14,819.66
|
| Rate for Payer: Anthem Medicare Advantage |
$9,406.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,406.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,406.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,406.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16,451.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,406.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18,946.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,406.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9,406.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9,406.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,406.97
|
| Rate for Payer: NAPHCARE Commercial |
$14,110.46
|
| Rate for Payer: Quartz Medicare Advantage |
$9,406.97
|
| Rate for Payer: The Alliance Commercial |
$26,151.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,406.97
|
| Rate for Payer: United Healthcare PPO |
$14,749.86
|
| Rate for Payer: Wellcare Medicare |
$9,406.97
|
|
|
INFLAMMATORY BOWEL DISEASE WITH MCC
|
Facility
|
IP
|
$41,978.00
|
|
|
Service Code
|
MSDRG 385
|
| Min. Negotiated Rate |
$15,100.00 |
| Max. Negotiated Rate |
$41,978.00 |
| Rate for Payer: Aetna Managed Medicare |
$15,100.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32,938.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25,247.17
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23,986.46
|
| Rate for Payer: Anthem Medicare Advantage |
$15,100.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15,100.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15,100.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15,100.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26,627.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15,100.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30,554.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15,100.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15,100.00
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15,100.00
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15,100.00
|
| Rate for Payer: NAPHCARE Commercial |
$22,650.00
|
| Rate for Payer: Quartz Medicare Advantage |
$15,100.00
|
| Rate for Payer: The Alliance Commercial |
$41,978.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15,100.00
|
| Rate for Payer: United Healthcare PPO |
$23,787.11
|
| Rate for Payer: Wellcare Medicare |
$15,100.00
|
|
|
INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC
|
Facility
|
IP
|
$18,508.00
|
|
|
Service Code
|
MSDRG 387
|
| Min. Negotiated Rate |
$6,657.51 |
| Max. Negotiated Rate |
$18,508.00 |
| Rate for Payer: Aetna Managed Medicare |
$6,657.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14,266.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,935.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,389.04
|
| Rate for Payer: Anthem Medicare Advantage |
$6,657.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,657.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,657.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,657.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,532.79
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,657.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,339.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,657.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,657.51
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,657.51
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,657.51
|
| Rate for Payer: NAPHCARE Commercial |
$9,986.26
|
| Rate for Payer: Quartz Medicare Advantage |
$6,657.51
|
| Rate for Payer: The Alliance Commercial |
$18,508.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,657.51
|
| Rate for Payer: United Healthcare PPO |
$10,385.32
|
| Rate for Payer: Wellcare Medicare |
$6,657.51
|
|
|
INFLATION DEVICE EAGLE 30ATM BURST PRESSURE 20CC 325130
|
Facility
|
OP
|
$1,151.00
|
|
| Hospital Charge Code |
5520930
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$322.28 |
| Max. Negotiated Rate |
$4,604.00 |
| Rate for Payer: Aetna Commercial |
$1,035.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$989.86
|
| Rate for Payer: Aetna Managed Medicare |
$322.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$748.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$575.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$552.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$610.03
|
| Rate for Payer: Cash Price |
$345.30
|
| Rate for Payer: Cigna Commercial |
$1,058.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$644.10
|
| Rate for Payer: Health EOS Commercial |
$1,024.39
|
| Rate for Payer: HFN Commercial |
$1,058.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$863.25
|
| Rate for Payer: Multiplan Commercial |
$920.80
|
| Rate for Payer: NAPHCARE Commercial |
$690.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,058.92
|
| Rate for Payer: Quartz Beloit One Network |
$563.99
|
| Rate for Payer: Quartz Commercial |
$748.15
|
| Rate for Payer: Quartz Medicare Advantage |
$690.60
|
| Rate for Payer: The Alliance Commercial |
$4,604.00
|
| Rate for Payer: WEA Trust Commercial |
$633.05
|
| Rate for Payer: WPS Commercial |
$852.55
|
|
|
INFLATION DEVICE EAGLE 30ATM BURST PRESSURE 20CC 325130
|
Facility
|
IP
|
$1,151.00
|
|
| Hospital Charge Code |
5520930
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$563.99 |
| Max. Negotiated Rate |
$1,058.92 |
| Rate for Payer: Aetna Commercial |
$1,035.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$989.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$610.03
|
| Rate for Payer: Cash Price |
$345.30
|
| Rate for Payer: Cigna Commercial |
$1,058.92
|
| Rate for Payer: Health EOS Commercial |
$1,024.39
|
| Rate for Payer: HFN Commercial |
$1,058.92
|
| Rate for Payer: Multiplan Commercial |
$920.80
|
| Rate for Payer: NAPHCARE Commercial |
$690.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,058.92
|
| Rate for Payer: Quartz Beloit One Network |
$563.99
|
| Rate for Payer: Quartz Commercial |
$690.60
|
| Rate for Payer: WEA Trust Commercial |
$633.05
|
| Rate for Payer: WPS Commercial |
$852.55
|
|
|
INFLATION DEVICE ENCORE 26 04526-01
|
Facility
|
OP
|
$983.00
|
|
| Hospital Charge Code |
2971788
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$275.24 |
| Max. Negotiated Rate |
$3,932.00 |
| Rate for Payer: Aetna Commercial |
$884.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$845.38
|
| Rate for Payer: Aetna Managed Medicare |
$275.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$638.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$491.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$471.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$520.99
|
| Rate for Payer: Cash Price |
$294.90
|
| Rate for Payer: Cigna Commercial |
$904.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$550.09
|
| Rate for Payer: Health EOS Commercial |
$874.87
|
| Rate for Payer: HFN Commercial |
$904.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$737.25
|
| Rate for Payer: Multiplan Commercial |
$786.40
|
| Rate for Payer: NAPHCARE Commercial |
$589.80
|
| Rate for Payer: Preferred Network Access Commercial |
$904.36
|
| Rate for Payer: Quartz Beloit One Network |
$481.67
|
| Rate for Payer: Quartz Commercial |
$638.95
|
| Rate for Payer: Quartz Medicare Advantage |
$589.80
|
| Rate for Payer: The Alliance Commercial |
$3,932.00
|
| Rate for Payer: WEA Trust Commercial |
$540.65
|
| Rate for Payer: WPS Commercial |
$728.11
|
|
|
INFLATION DEVICE ENCORE 26 04526-01
|
Facility
|
IP
|
$983.00
|
|
| Hospital Charge Code |
2971788
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$481.67 |
| Max. Negotiated Rate |
$904.36 |
| Rate for Payer: Aetna Commercial |
$884.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$845.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$520.99
|
| Rate for Payer: Cash Price |
$294.90
|
| Rate for Payer: Cigna Commercial |
$904.36
|
| Rate for Payer: Health EOS Commercial |
$874.87
|
| Rate for Payer: HFN Commercial |
$904.36
|
| Rate for Payer: Multiplan Commercial |
$786.40
|
| Rate for Payer: NAPHCARE Commercial |
$589.80
|
| Rate for Payer: Preferred Network Access Commercial |
$904.36
|
| Rate for Payer: Quartz Beloit One Network |
$481.67
|
| Rate for Payer: Quartz Commercial |
$589.80
|
| Rate for Payer: WEA Trust Commercial |
$540.65
|
| Rate for Payer: WPS Commercial |
$728.11
|
|
|
INFLATION DEVICE ENCORE 26 20ML - OR INV - M0067101140
|
Facility
|
OP
|
$1,206.00
|
|
| Hospital Charge Code |
4595198
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$337.68 |
| Max. Negotiated Rate |
$4,824.00 |
| Rate for Payer: Aetna Commercial |
$1,085.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,037.16
|
| Rate for Payer: Aetna Managed Medicare |
$337.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$783.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$603.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$578.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$639.18
|
| Rate for Payer: Cash Price |
$361.80
|
| Rate for Payer: Cigna Commercial |
$1,109.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$674.88
|
| Rate for Payer: Health EOS Commercial |
$1,073.34
|
| Rate for Payer: HFN Commercial |
$1,109.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$904.50
|
| Rate for Payer: Multiplan Commercial |
$964.80
|
| Rate for Payer: NAPHCARE Commercial |
$723.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,109.52
|
| Rate for Payer: Quartz Beloit One Network |
$590.94
|
| Rate for Payer: Quartz Commercial |
$783.90
|
| Rate for Payer: Quartz Medicare Advantage |
$723.60
|
| Rate for Payer: The Alliance Commercial |
$4,824.00
|
| Rate for Payer: WEA Trust Commercial |
$663.30
|
| Rate for Payer: WPS Commercial |
$893.28
|
|
|
INFLATION DEVICE ENCORE 26 20ML - OR INV - M0067101140
|
Facility
|
IP
|
$1,206.00
|
|
| Hospital Charge Code |
4595198
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$590.94 |
| Max. Negotiated Rate |
$1,109.52 |
| Rate for Payer: Aetna Commercial |
$1,085.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,037.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$639.18
|
| Rate for Payer: Cash Price |
$361.80
|
| Rate for Payer: Cigna Commercial |
$1,109.52
|
| Rate for Payer: Health EOS Commercial |
$1,073.34
|
| Rate for Payer: HFN Commercial |
$1,109.52
|
| Rate for Payer: Multiplan Commercial |
$964.80
|
| Rate for Payer: NAPHCARE Commercial |
$723.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,109.52
|
| Rate for Payer: Quartz Beloit One Network |
$590.94
|
| Rate for Payer: Quartz Commercial |
$723.60
|
| Rate for Payer: WEA Trust Commercial |
$663.30
|
| Rate for Payer: WPS Commercial |
$893.28
|
|
|
INFLATION DEVICE SE ACCLARENT SEID
|
Facility
|
IP
|
$1,314.00
|
|
| Hospital Charge Code |
5178631
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$643.86 |
| Max. Negotiated Rate |
$1,208.88 |
| Rate for Payer: Aetna Commercial |
$1,182.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,130.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$696.42
|
| Rate for Payer: Cash Price |
$394.20
|
| Rate for Payer: Cigna Commercial |
$1,208.88
|
| Rate for Payer: Health EOS Commercial |
$1,169.46
|
| Rate for Payer: HFN Commercial |
$1,208.88
|
| Rate for Payer: Multiplan Commercial |
$1,051.20
|
| Rate for Payer: NAPHCARE Commercial |
$788.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,208.88
|
| Rate for Payer: Quartz Beloit One Network |
$643.86
|
| Rate for Payer: Quartz Commercial |
$788.40
|
| Rate for Payer: WEA Trust Commercial |
$722.70
|
| Rate for Payer: WPS Commercial |
$973.28
|
|
|
INFLATION DEVICE SE ACCLARENT SEID
|
Facility
|
OP
|
$1,314.00
|
|
| Hospital Charge Code |
5178631
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$367.92 |
| Max. Negotiated Rate |
$5,256.00 |
| Rate for Payer: Aetna Commercial |
$1,182.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,130.04
|
| Rate for Payer: Aetna Managed Medicare |
$367.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$854.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$657.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$630.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$696.42
|
| Rate for Payer: Cash Price |
$394.20
|
| Rate for Payer: Cigna Commercial |
$1,208.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$735.31
|
| Rate for Payer: Health EOS Commercial |
$1,169.46
|
| Rate for Payer: HFN Commercial |
$1,208.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$985.50
|
| Rate for Payer: Multiplan Commercial |
$1,051.20
|
| Rate for Payer: NAPHCARE Commercial |
$788.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,208.88
|
| Rate for Payer: Quartz Beloit One Network |
$643.86
|
| Rate for Payer: Quartz Commercial |
$854.10
|
| Rate for Payer: Quartz Medicare Advantage |
$788.40
|
| Rate for Payer: The Alliance Commercial |
$5,256.00
|
| Rate for Payer: WEA Trust Commercial |
$722.70
|
| Rate for Payer: WPS Commercial |
$973.28
|
|
|
INFLATION SYSTEM TTS BALLOON M00550601
|
Facility
|
IP
|
$667.00
|
|
| Hospital Charge Code |
2972923
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$326.83 |
| Max. Negotiated Rate |
$613.64 |
| Rate for Payer: Aetna Commercial |
$600.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$573.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$353.51
|
| Rate for Payer: Cash Price |
$200.10
|
| Rate for Payer: Cigna Commercial |
$613.64
|
| Rate for Payer: Health EOS Commercial |
$593.63
|
| Rate for Payer: HFN Commercial |
$613.64
|
| Rate for Payer: Multiplan Commercial |
$533.60
|
| Rate for Payer: NAPHCARE Commercial |
$400.20
|
| Rate for Payer: Preferred Network Access Commercial |
$613.64
|
| Rate for Payer: Quartz Beloit One Network |
$326.83
|
| Rate for Payer: Quartz Commercial |
$400.20
|
| Rate for Payer: WEA Trust Commercial |
$366.85
|
| Rate for Payer: WPS Commercial |
$494.05
|
|
|
INFLATION SYSTEM TTS BALLOON M00550601
|
Facility
|
OP
|
$667.00
|
|
| Hospital Charge Code |
2972923
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$186.76 |
| Max. Negotiated Rate |
$2,668.00 |
| Rate for Payer: Aetna Commercial |
$600.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$573.62
|
| Rate for Payer: Aetna Managed Medicare |
$186.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$433.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$333.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$320.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$353.51
|
| Rate for Payer: Cash Price |
$200.10
|
| Rate for Payer: Cigna Commercial |
$613.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$373.25
|
| Rate for Payer: Health EOS Commercial |
$593.63
|
| Rate for Payer: HFN Commercial |
$613.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$500.25
|
| Rate for Payer: Multiplan Commercial |
$533.60
|
| Rate for Payer: NAPHCARE Commercial |
$400.20
|
| Rate for Payer: Preferred Network Access Commercial |
$613.64
|
| Rate for Payer: Quartz Beloit One Network |
$326.83
|
| Rate for Payer: Quartz Commercial |
$433.55
|
| Rate for Payer: Quartz Medicare Advantage |
$400.20
|
| Rate for Payer: The Alliance Commercial |
$2,668.00
|
| Rate for Payer: WEA Trust Commercial |
$366.85
|
| Rate for Payer: WPS Commercial |
$494.05
|
|
|
Infliximab Activity
|
Professional
|
Both
|
$556.00
|
|
|
Service Code
|
CPT 86352
|
| Hospital Charge Code |
3609523
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$244.64 |
| Max. Negotiated Rate |
$528.20 |
| Rate for Payer: Aetna Commercial |
$528.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$478.16
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$528.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$278.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$333.60
|
| Rate for Payer: Health EOS Commercial |
$505.96
|
| Rate for Payer: HFN Commercial |
$528.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$479.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$479.59
|
| Rate for Payer: Multiplan Commercial |
$444.80
|
| Rate for Payer: Preferred Network Access Commercial |
$528.20
|
| Rate for Payer: Quartz Beloit One Network |
$244.64
|
| Rate for Payer: Quartz Commercial |
$316.92
|
| Rate for Payer: The Alliance Commercial |
$278.00
|
| Rate for Payer: WEA Trust Commercial |
$305.80
|
| Rate for Payer: WPS Commercial |
$411.83
|
|
|
Infliximab Activity
|
Facility
|
IP
|
$556.00
|
|
|
Service Code
|
CPT 86352
|
| Hospital Charge Code |
3609523
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$272.44 |
| Max. Negotiated Rate |
$511.52 |
| Rate for Payer: Aetna Commercial |
$500.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$478.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$294.68
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$511.52
|
| Rate for Payer: Health EOS Commercial |
$494.84
|
| Rate for Payer: HFN Commercial |
$511.52
|
| Rate for Payer: Multiplan Commercial |
$444.80
|
| Rate for Payer: NAPHCARE Commercial |
$333.60
|
| Rate for Payer: Preferred Network Access Commercial |
$511.52
|
| Rate for Payer: Quartz Beloit One Network |
$272.44
|
| Rate for Payer: Quartz Commercial |
$333.60
|
| Rate for Payer: WEA Trust Commercial |
$305.80
|
| Rate for Payer: WPS Commercial |
$411.83
|
|
