|
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
|
$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
|
Facility
|
OP
|
$28.66
|
|
|
Service Code
|
EAPG 00626
|
| Min. Negotiated Rate |
$27.56 |
| Max. Negotiated Rate |
$28.66 |
| Rate for Payer: Anthem Medicaid |
$27.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$27.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$27.56
|
| Rate for Payer: Dean Health Medicaid |
$27.56
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$27.56
|
| Rate for Payer: Managed Health Services Medicaid |
$28.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.56
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$27.56
|
| Rate for Payer: United Healthcare Medicaid |
$27.56
|
|
|
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
|
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 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
|
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 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 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
|
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 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 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 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 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
|
|
|
INFLATION DEVICE SE ACCLARENT SEID
|
Facility
|
IP
|
$1,314.00
|
|
| Hospital Charge Code |
5178631
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$669.61 |
| 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: 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: Health EOS Commercial |
$1,216.24
|
| Rate for Payer: HFN Commercial |
$1,257.24
|
| Rate for Payer: Multiplan Commercial |
$1,093.25
|
| Rate for Payer: Preferred Network Access Commercial |
$1,257.24
|
| Rate for Payer: Quartz Beloit One Network |
$669.61
|
| Rate for Payer: Quartz Commercial |
$819.94
|
| Rate for Payer: WEA Trust Commercial |
$751.61
|
| Rate for Payer: WPS Commercial |
$1,012.17
|
|
|
INFLATION SYSTEM TTS BALLOON M00550601
|
Facility
|
OP
|
$667.00
|
|
| Hospital Charge Code |
2972923
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$194.23 |
| Max. Negotiated Rate |
$638.19 |
| Rate for Payer: Aetna Commercial |
$624.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$596.56
|
| Rate for Payer: Aetna Managed Medicare |
$194.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$450.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$346.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$332.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$367.65
|
| Rate for Payer: Cash Price |
$200.10
|
| Rate for Payer: Cigna Commercial |
$638.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$388.19
|
| Rate for Payer: Health EOS Commercial |
$617.38
|
| Rate for Payer: HFN Commercial |
$638.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$520.26
|
| Rate for Payer: Multiplan Commercial |
$554.94
|
| Rate for Payer: NAPHCARE Commercial |
$416.21
|
| Rate for Payer: Preferred Network Access Commercial |
$638.19
|
| Rate for Payer: Quartz Beloit One Network |
$339.90
|
| Rate for Payer: Quartz Commercial |
$450.89
|
| Rate for Payer: Quartz Medicare Advantage |
$416.21
|
| Rate for Payer: The Alliance Commercial |
$346.84
|
| Rate for Payer: WEA Trust Commercial |
$381.52
|
| Rate for Payer: WPS Commercial |
$513.79
|
|
|
INFLATION SYSTEM TTS BALLOON M00550601
|
Facility
|
IP
|
$667.00
|
|
| Hospital Charge Code |
2972923
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$339.90 |
| Max. Negotiated Rate |
$638.19 |
| Rate for Payer: Aetna Commercial |
$624.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$596.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$367.65
|
| Rate for Payer: Cash Price |
$200.10
|
| Rate for Payer: Cigna Commercial |
$638.19
|
| Rate for Payer: Health EOS Commercial |
$617.38
|
| Rate for Payer: HFN Commercial |
$638.19
|
| Rate for Payer: Multiplan Commercial |
$554.94
|
| Rate for Payer: Preferred Network Access Commercial |
$638.19
|
| Rate for Payer: Quartz Beloit One Network |
$339.90
|
| Rate for Payer: Quartz Commercial |
$416.21
|
| Rate for Payer: WEA Trust Commercial |
$381.52
|
| Rate for Payer: WPS Commercial |
$513.79
|
|
|
Infliximab Activity
|
Facility
|
OP
|
$556.00
|
|
|
Service Code
|
CPT 86352
|
| Hospital Charge Code |
3609523
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$141.29 |
| Max. Negotiated Rate |
$565.18 |
| Rate for Payer: Aetna Commercial |
$520.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$497.29
|
| Rate for Payer: Aetna Managed Medicare |
$141.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$529.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$247.27
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$234.55
|
| Rate for Payer: Anthem Medicare Advantage |
$141.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$306.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$141.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$141.29
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$531.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$141.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$323.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$141.29
|
| Rate for Payer: Health EOS Commercial |
$514.63
|
| Rate for Payer: HFN Commercial |
$531.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$525.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$141.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$141.29
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$141.29
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$141.29
|
| Rate for Payer: Multiplan Commercial |
$462.59
|
| Rate for Payer: NAPHCARE Commercial |
$211.94
|
| Rate for Payer: Preferred Network Access Commercial |
$531.98
|
| Rate for Payer: Quartz Beloit One Network |
$283.34
|
| Rate for Payer: Quartz Commercial |
$375.86
|
| Rate for Payer: Quartz Medicare Advantage |
$141.29
|
| Rate for Payer: The Alliance Commercial |
$565.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$141.29
|
| Rate for Payer: United Healthcare PPO |
$433.68
|
| Rate for Payer: WEA Trust Commercial |
$318.03
|
| Rate for Payer: Wellcare Medicare |
$141.29
|
| Rate for Payer: WPS Commercial |
$428.29
|
|
|
Infliximab Activity
|
Professional
|
Both
|
$556.00
|
|
|
Service Code
|
CPT 86352
|
| Hospital Charge Code |
3609523
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$141.29 |
| Max. Negotiated Rate |
$621.70 |
| Rate for Payer: Aetna Commercial |
$549.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$497.29
|
| Rate for Payer: Aetna Managed Medicare |
$141.29
|
| Rate for Payer: Anthem Medicare Advantage |
$141.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$141.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$141.29
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$549.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$289.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$141.29
|
| Rate for Payer: Health EOS Commercial |
$526.20
|
| Rate for Payer: HFN Commercial |
$549.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$498.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$498.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$141.29
|
| Rate for Payer: Multiplan Commercial |
$462.59
|
| Rate for Payer: NAPHCARE Commercial |
$211.94
|
| Rate for Payer: Preferred Network Access Commercial |
$549.33
|
| Rate for Payer: Quartz Beloit One Network |
$254.43
|
| Rate for Payer: Quartz Commercial |
$329.60
|
| Rate for Payer: Quartz Medicare Advantage |
$141.29
|
| Rate for Payer: The Alliance Commercial |
$558.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$141.29
|
| Rate for Payer: WEA Trust Commercial |
$318.03
|
| Rate for Payer: WPS Commercial |
$621.70
|
|
|
Infliximab Activity
|
Facility
|
IP
|
$556.00
|
|
|
Service Code
|
CPT 86352
|
| Hospital Charge Code |
3609523
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$283.34 |
| Max. Negotiated Rate |
$531.98 |
| Rate for Payer: Aetna Commercial |
$520.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$497.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$306.47
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$531.98
|
| Rate for Payer: Health EOS Commercial |
$514.63
|
| Rate for Payer: HFN Commercial |
$531.98
|
| Rate for Payer: Multiplan Commercial |
$462.59
|
| Rate for Payer: Preferred Network Access Commercial |
$531.98
|
| Rate for Payer: Quartz Beloit One Network |
$283.34
|
| Rate for Payer: Quartz Commercial |
$346.94
|
| Rate for Payer: WEA Trust Commercial |
$318.03
|
| Rate for Payer: WPS Commercial |
$428.29
|
|
