|
Irradiation Fee
|
Professional
|
Both
|
$181.00
|
|
|
Service Code
|
CPT 86945
|
| Hospital Charge Code |
2949312
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$82.83 |
| Max. Negotiated Rate |
$178.83 |
| Rate for Payer: Aetna Commercial |
$178.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$161.89
|
| Rate for Payer: Cash Price |
$54.30
|
| Rate for Payer: Cash Price |
$54.30
|
| Rate for Payer: Cigna Commercial |
$178.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$94.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$112.94
|
| Rate for Payer: Health EOS Commercial |
$171.30
|
| Rate for Payer: HFN Commercial |
$178.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$105.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$105.00
|
| Rate for Payer: Multiplan Commercial |
$150.59
|
| Rate for Payer: Preferred Network Access Commercial |
$178.83
|
| Rate for Payer: Quartz Beloit One Network |
$82.83
|
| Rate for Payer: Quartz Commercial |
$107.30
|
| Rate for Payer: The Alliance Commercial |
$94.12
|
| Rate for Payer: WEA Trust Commercial |
$103.53
|
| Rate for Payer: WPS Commercial |
$139.42
|
|
|
Irradiation Fee
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 86945
|
| Hospital Charge Code |
2949312
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.31 |
| Max. Negotiated Rate |
$173.18 |
| Rate for Payer: Aetna Commercial |
$169.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$161.89
|
| Rate for Payer: Aetna Managed Medicare |
$39.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$154.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$72.14
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$68.43
|
| Rate for Payer: Anthem Medicare Advantage |
$39.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$99.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.31
|
| Rate for Payer: Cash Price |
$54.30
|
| Rate for Payer: Cash Price |
$54.30
|
| Rate for Payer: Cigna Commercial |
$173.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$39.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$105.34
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$39.31
|
| Rate for Payer: Health EOS Commercial |
$167.53
|
| Rate for Payer: HFN Commercial |
$173.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$146.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$39.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$39.31
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$39.31
|
| Rate for Payer: Multiplan Commercial |
$150.59
|
| Rate for Payer: NAPHCARE Commercial |
$58.97
|
| Rate for Payer: Preferred Network Access Commercial |
$173.18
|
| Rate for Payer: Quartz Beloit One Network |
$92.24
|
| Rate for Payer: Quartz Commercial |
$122.36
|
| Rate for Payer: Quartz Medicare Advantage |
$39.31
|
| Rate for Payer: The Alliance Commercial |
$157.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.31
|
| Rate for Payer: United Healthcare PPO |
$141.18
|
| Rate for Payer: WEA Trust Commercial |
$103.53
|
| Rate for Payer: Wellcare Medicare |
$39.31
|
| Rate for Payer: WPS Commercial |
$139.42
|
|
|
IRRIGATING SLEEVE FOR PM2 58PM2SLV
|
Facility
|
OP
|
$5,632.00
|
|
| Hospital Charge Code |
6220208
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,640.04 |
| Max. Negotiated Rate |
$5,388.70 |
| Rate for Payer: Aetna Commercial |
$5,271.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,037.26
|
| Rate for Payer: Aetna Managed Medicare |
$1,640.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,807.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,928.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,811.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,104.36
|
| Rate for Payer: Cash Price |
$1,689.60
|
| Rate for Payer: Cigna Commercial |
$5,388.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,277.82
|
| Rate for Payer: Health EOS Commercial |
$5,212.98
|
| Rate for Payer: HFN Commercial |
$5,388.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,392.96
|
| Rate for Payer: Multiplan Commercial |
$4,685.82
|
| Rate for Payer: NAPHCARE Commercial |
$3,514.37
|
| Rate for Payer: Preferred Network Access Commercial |
$5,388.70
|
| Rate for Payer: Quartz Beloit One Network |
$2,870.07
|
| Rate for Payer: Quartz Commercial |
$3,807.23
|
| Rate for Payer: Quartz Medicare Advantage |
$3,514.37
|
| Rate for Payer: The Alliance Commercial |
$2,928.64
|
| Rate for Payer: WEA Trust Commercial |
$3,221.50
|
| Rate for Payer: WPS Commercial |
$4,338.33
|
|
|
IRRIGATING SLEEVE FOR PM2 58PM2SLV
|
Facility
|
IP
|
$5,632.00
|
|
| Hospital Charge Code |
6220208
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,870.07 |
| Max. Negotiated Rate |
$5,388.70 |
| Rate for Payer: Aetna Commercial |
$5,271.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,037.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,104.36
|
| Rate for Payer: Cash Price |
$1,689.60
|
| Rate for Payer: Cigna Commercial |
$5,388.70
|
| Rate for Payer: Health EOS Commercial |
$5,212.98
|
| Rate for Payer: HFN Commercial |
$5,388.70
|
| Rate for Payer: Multiplan Commercial |
$4,685.82
|
| Rate for Payer: Preferred Network Access Commercial |
$5,388.70
|
| Rate for Payer: Quartz Beloit One Network |
$2,870.07
|
| Rate for Payer: Quartz Commercial |
$3,514.37
|
| Rate for Payer: WEA Trust Commercial |
$3,221.50
|
| Rate for Payer: WPS Commercial |
$4,338.33
|
|
|
IRRIGATION, MAXILLARY SINUS 31000
|
Professional
|
Both
|
$359.00
|
|
|
Service Code
|
CPT 31000
|
| Hospital Charge Code |
3014367
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$71.25 |
| Max. Negotiated Rate |
$449.65 |
| Rate for Payer: Aetna Commercial |
$354.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$321.09
|
| Rate for Payer: Aetna Managed Medicare |
$99.92
|
| Rate for Payer: Anthem Medicare Advantage |
$99.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$99.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$99.92
|
| Rate for Payer: Cash Price |
$107.70
|
| Rate for Payer: Cash Price |
$107.70
|
| Rate for Payer: Cash Price |
$107.70
|
| Rate for Payer: Cigna Commercial |
$354.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$71.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$99.92
|
| Rate for Payer: Health EOS Commercial |
$339.76
|
| Rate for Payer: HFN Commercial |
$354.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$372.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$372.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$99.92
|
| Rate for Payer: Multiplan Commercial |
$298.69
|
| Rate for Payer: NAPHCARE Commercial |
$149.88
|
| Rate for Payer: Preferred Network Access Commercial |
$354.69
|
| Rate for Payer: Quartz Beloit One Network |
$164.28
|
| Rate for Payer: Quartz Commercial |
$212.82
|
| Rate for Payer: Quartz Medicare Advantage |
$99.92
|
| Rate for Payer: The Alliance Commercial |
$424.67
|
| Rate for Payer: United Healthcare Medicaid |
$71.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$99.92
|
| Rate for Payer: WEA Trust Commercial |
$205.35
|
| Rate for Payer: WPS Commercial |
$449.65
|
|
|
IRRIGATION NEZHAT-DORSEY 5102710
|
Facility
|
OP
|
$952.00
|
|
| Hospital Charge Code |
2962952
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$277.22 |
| Max. Negotiated Rate |
$910.87 |
| Rate for Payer: Aetna Commercial |
$891.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$851.47
|
| Rate for Payer: Aetna Managed Medicare |
$277.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$643.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$495.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$475.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$524.74
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cigna Commercial |
$910.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$554.06
|
| Rate for Payer: Health EOS Commercial |
$881.17
|
| Rate for Payer: HFN Commercial |
$910.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$742.56
|
| Rate for Payer: Multiplan Commercial |
$792.06
|
| Rate for Payer: NAPHCARE Commercial |
$594.05
|
| Rate for Payer: Preferred Network Access Commercial |
$910.87
|
| Rate for Payer: Quartz Beloit One Network |
$485.14
|
| Rate for Payer: Quartz Commercial |
$643.55
|
| Rate for Payer: Quartz Medicare Advantage |
$594.05
|
| Rate for Payer: The Alliance Commercial |
$495.04
|
| Rate for Payer: WEA Trust Commercial |
$544.54
|
| Rate for Payer: WPS Commercial |
$733.33
|
|
|
IRRIGATION NEZHAT-DORSEY 5102710
|
Facility
|
IP
|
$952.00
|
|
| Hospital Charge Code |
2962952
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$485.14 |
| Max. Negotiated Rate |
$910.87 |
| Rate for Payer: Aetna Commercial |
$891.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$851.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$524.74
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cigna Commercial |
$910.87
|
| Rate for Payer: Health EOS Commercial |
$881.17
|
| Rate for Payer: HFN Commercial |
$910.87
|
| Rate for Payer: Multiplan Commercial |
$792.06
|
| Rate for Payer: Preferred Network Access Commercial |
$910.87
|
| Rate for Payer: Quartz Beloit One Network |
$485.14
|
| Rate for Payer: Quartz Commercial |
$594.05
|
| Rate for Payer: WEA Trust Commercial |
$544.54
|
| Rate for Payer: WPS Commercial |
$733.33
|
|
|
Irrigation of Bladder 51700PP
|
Professional
|
Both
|
$420.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
3850017
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$19.24 |
| Max. Negotiated Rate |
$414.96 |
| Rate for Payer: Aetna Commercial |
$414.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$375.65
|
| Rate for Payer: Aetna Managed Medicare |
$25.24
|
| Rate for Payer: Anthem Medicare Advantage |
$25.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.24
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna Commercial |
$414.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25.24
|
| Rate for Payer: Health EOS Commercial |
$397.49
|
| Rate for Payer: HFN Commercial |
$414.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$105.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$105.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.24
|
| Rate for Payer: Multiplan Commercial |
$349.44
|
| Rate for Payer: NAPHCARE Commercial |
$37.86
|
| Rate for Payer: Preferred Network Access Commercial |
$414.96
|
| Rate for Payer: Quartz Beloit One Network |
$192.19
|
| Rate for Payer: Quartz Commercial |
$248.98
|
| Rate for Payer: Quartz Medicare Advantage |
$25.24
|
| Rate for Payer: The Alliance Commercial |
$107.27
|
| Rate for Payer: United Healthcare Medicaid |
$19.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.24
|
| Rate for Payer: WEA Trust Commercial |
$240.24
|
| Rate for Payer: WPS Commercial |
$113.58
|
|
|
Irrigation of Implanted Venous Access Device for Drug Delivery
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
3451575
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$101.92 |
| Max. Negotiated Rate |
$191.36 |
| Rate for Payer: Aetna Commercial |
$187.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$178.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$110.24
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$191.36
|
| Rate for Payer: Health EOS Commercial |
$185.12
|
| Rate for Payer: HFN Commercial |
$191.36
|
| Rate for Payer: Multiplan Commercial |
$166.40
|
| Rate for Payer: Preferred Network Access Commercial |
$191.36
|
| Rate for Payer: Quartz Beloit One Network |
$101.92
|
| Rate for Payer: Quartz Commercial |
$124.80
|
| Rate for Payer: WEA Trust Commercial |
$114.40
|
| Rate for Payer: WPS Commercial |
$154.06
|
|
|
Irrigation of Implanted Venous Access Device for Drug Delivery
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
3451575
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$62.09 |
| Max. Negotiated Rate |
$248.35 |
| Rate for Payer: Aetna Commercial |
$187.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$178.88
|
| Rate for Payer: Aetna Managed Medicare |
$62.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$135.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$104.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$99.84
|
| Rate for Payer: Anthem Medicare Advantage |
$62.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$110.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$62.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$62.09
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$191.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$62.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$116.40
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$62.09
|
| Rate for Payer: Health EOS Commercial |
$185.12
|
| Rate for Payer: HFN Commercial |
$191.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$230.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$62.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$62.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$62.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$62.09
|
| Rate for Payer: Multiplan Commercial |
$166.40
|
| Rate for Payer: NAPHCARE Commercial |
$93.13
|
| Rate for Payer: Preferred Network Access Commercial |
$191.36
|
| Rate for Payer: Quartz Beloit One Network |
$101.92
|
| Rate for Payer: Quartz Commercial |
$135.20
|
| Rate for Payer: Quartz Medicare Advantage |
$62.09
|
| Rate for Payer: The Alliance Commercial |
$248.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$62.09
|
| Rate for Payer: United Healthcare PPO |
$156.00
|
| Rate for Payer: WEA Trust Commercial |
$114.40
|
| Rate for Payer: Wellcare Medicare |
$62.09
|
| Rate for Payer: WPS Commercial |
$154.06
|
|
|
IRRIGATOR HYDRO-SURG PLUS NEZHAT-DORSEY 0026870
|
Facility
|
OP
|
$839.00
|
|
| Hospital Charge Code |
5178939
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$244.32 |
| Max. Negotiated Rate |
$802.76 |
| Rate for Payer: Aetna Commercial |
$785.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$750.40
|
| Rate for Payer: Aetna Managed Medicare |
$244.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$567.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$436.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$418.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$462.46
|
| Rate for Payer: Cash Price |
$251.70
|
| Rate for Payer: Cigna Commercial |
$802.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$488.30
|
| Rate for Payer: Health EOS Commercial |
$776.58
|
| Rate for Payer: HFN Commercial |
$802.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$654.42
|
| Rate for Payer: Multiplan Commercial |
$698.05
|
| Rate for Payer: NAPHCARE Commercial |
$523.54
|
| Rate for Payer: Preferred Network Access Commercial |
$802.76
|
| Rate for Payer: Quartz Beloit One Network |
$427.55
|
| Rate for Payer: Quartz Commercial |
$567.16
|
| Rate for Payer: Quartz Medicare Advantage |
$523.54
|
| Rate for Payer: The Alliance Commercial |
$436.28
|
| Rate for Payer: WEA Trust Commercial |
$479.91
|
| Rate for Payer: WPS Commercial |
$646.28
|
|
|
IRRIGATOR HYDRO-SURG PLUS NEZHAT-DORSEY 0026870
|
Facility
|
IP
|
$839.00
|
|
| Hospital Charge Code |
5178939
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$427.55 |
| Max. Negotiated Rate |
$802.76 |
| Rate for Payer: Aetna Commercial |
$785.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$750.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$462.46
|
| Rate for Payer: Cash Price |
$251.70
|
| Rate for Payer: Cigna Commercial |
$802.76
|
| Rate for Payer: Health EOS Commercial |
$776.58
|
| Rate for Payer: HFN Commercial |
$802.76
|
| Rate for Payer: Multiplan Commercial |
$698.05
|
| Rate for Payer: Preferred Network Access Commercial |
$802.76
|
| Rate for Payer: Quartz Beloit One Network |
$427.55
|
| Rate for Payer: Quartz Commercial |
$523.54
|
| Rate for Payer: WEA Trust Commercial |
$479.91
|
| Rate for Payer: WPS Commercial |
$646.28
|
|
|
IRRITABLE BOWEL SYNDROME
|
Facility
|
OP
|
$24.55
|
|
|
Service Code
|
EAPG 00632
|
| Min. Negotiated Rate |
$23.60 |
| Max. Negotiated Rate |
$24.55 |
| Rate for Payer: Anthem Medicaid |
$23.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$23.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$23.60
|
| Rate for Payer: Dean Health Medicaid |
$23.60
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$23.60
|
| Rate for Payer: Managed Health Services Medicaid |
$24.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$23.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$23.60
|
| Rate for Payer: United Healthcare Medicaid |
$23.60
|
|
|
Isavuconazole Level
|
Facility
|
IP
|
$634.00
|
|
|
Service Code
|
CPT 80375
|
| Hospital Charge Code |
5412826
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$323.09 |
| Max. Negotiated Rate |
$606.61 |
| Rate for Payer: Aetna Commercial |
$593.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$567.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$349.46
|
| Rate for Payer: Cash Price |
$190.20
|
| Rate for Payer: Cigna Commercial |
$606.61
|
| Rate for Payer: Health EOS Commercial |
$586.83
|
| Rate for Payer: HFN Commercial |
$606.61
|
| Rate for Payer: Multiplan Commercial |
$527.49
|
| Rate for Payer: Preferred Network Access Commercial |
$606.61
|
| Rate for Payer: Quartz Beloit One Network |
$323.09
|
| Rate for Payer: Quartz Commercial |
$395.62
|
| Rate for Payer: WEA Trust Commercial |
$362.65
|
| Rate for Payer: WPS Commercial |
$488.37
|
|
|
Isavuconazole Level
|
Professional
|
Both
|
$634.00
|
|
|
Service Code
|
CPT 80375
|
| Hospital Charge Code |
5412826
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.26 |
| Max. Negotiated Rate |
$626.39 |
| Rate for Payer: Aetna Commercial |
$626.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$567.05
|
| Rate for Payer: Cash Price |
$190.20
|
| Rate for Payer: Cash Price |
$190.20
|
| Rate for Payer: Cigna Commercial |
$626.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$329.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$395.62
|
| Rate for Payer: Health EOS Commercial |
$600.02
|
| Rate for Payer: HFN Commercial |
$626.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$83.26
|
| Rate for Payer: Multiplan Commercial |
$527.49
|
| Rate for Payer: Preferred Network Access Commercial |
$626.39
|
| Rate for Payer: Quartz Beloit One Network |
$290.12
|
| Rate for Payer: Quartz Commercial |
$375.84
|
| Rate for Payer: The Alliance Commercial |
$329.68
|
| Rate for Payer: WEA Trust Commercial |
$362.65
|
| Rate for Payer: WPS Commercial |
$488.37
|
|
|
Isavuconazole Level
|
Facility
|
OP
|
$634.00
|
|
|
Service Code
|
CPT 80375
|
| Hospital Charge Code |
5412826
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$184.62 |
| Max. Negotiated Rate |
$606.61 |
| Rate for Payer: Aetna Commercial |
$593.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$567.05
|
| Rate for Payer: Aetna Managed Medicare |
$184.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$428.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$329.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$316.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$349.46
|
| Rate for Payer: Cash Price |
$190.20
|
| Rate for Payer: Cigna Commercial |
$606.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$368.99
|
| Rate for Payer: Health EOS Commercial |
$586.83
|
| Rate for Payer: HFN Commercial |
$606.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$494.52
|
| Rate for Payer: Multiplan Commercial |
$527.49
|
| Rate for Payer: NAPHCARE Commercial |
$395.62
|
| Rate for Payer: Preferred Network Access Commercial |
$606.61
|
| Rate for Payer: Quartz Beloit One Network |
$323.09
|
| Rate for Payer: Quartz Commercial |
$428.58
|
| Rate for Payer: Quartz Medicare Advantage |
$395.62
|
| Rate for Payer: The Alliance Commercial |
$329.68
|
| Rate for Payer: United Healthcare PPO |
$494.52
|
| Rate for Payer: WEA Trust Commercial |
$362.65
|
| Rate for Payer: WPS Commercial |
$488.37
|
|
|
ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC
|
Facility
|
IP
|
$52,084.24
|
|
|
Service Code
|
MSDRG 062
|
| Min. Negotiated Rate |
$13,963.76 |
| Max. Negotiated Rate |
$52,084.24 |
| Rate for Payer: Aetna Managed Medicare |
$13,963.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$38,340.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29,387.83
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27,920.36
|
| Rate for Payer: Anthem Medicare Advantage |
$13,963.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,963.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,963.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,963.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30,994.16
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,963.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37,958.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,963.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,963.76
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,963.76
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,963.76
|
| Rate for Payer: NAPHCARE Commercial |
$20,945.64
|
| Rate for Payer: Quartz Medicare Advantage |
$13,963.76
|
| Rate for Payer: The Alliance Commercial |
$52,084.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,963.76
|
| Rate for Payer: United Healthcare PPO |
$29,550.85
|
| Rate for Payer: Wellcare Medicare |
$13,963.76
|
|
|
ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC
|
Facility
|
IP
|
$77,829.44
|
|
|
Service Code
|
MSDRG 061
|
| Min. Negotiated Rate |
$21,621.20 |
| Max. Negotiated Rate |
$77,829.44 |
| Rate for Payer: Aetna Managed Medicare |
$21,621.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$60,157.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$46,110.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$43,807.89
|
| Rate for Payer: Anthem Medicare Advantage |
$21,621.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21,621.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21,621.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$21,621.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48,630.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$21,621.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56,840.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21,621.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21,621.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$21,621.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$21,621.20
|
| Rate for Payer: NAPHCARE Commercial |
$32,431.81
|
| Rate for Payer: Quartz Medicare Advantage |
$21,621.20
|
| Rate for Payer: The Alliance Commercial |
$77,829.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21,621.20
|
| Rate for Payer: United Healthcare PPO |
$44,251.28
|
| Rate for Payer: Wellcare Medicare |
$21,621.20
|
|
|
ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC
|
Facility
|
IP
|
$41,441.92
|
|
|
Service Code
|
MSDRG 063
|
| Min. Negotiated Rate |
$11,257.38 |
| Max. Negotiated Rate |
$41,441.92 |
| Rate for Payer: Aetna Managed Medicare |
$11,257.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30,629.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23,477.49
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22,305.15
|
| Rate for Payer: Anthem Medicare Advantage |
$11,257.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,257.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,257.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,257.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24,760.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,257.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30,152.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,257.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,257.38
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,257.38
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,257.38
|
| Rate for Payer: NAPHCARE Commercial |
$16,886.06
|
| Rate for Payer: Quartz Medicare Advantage |
$11,257.38
|
| Rate for Payer: The Alliance Commercial |
$41,441.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,257.38
|
| Rate for Payer: United Healthcare PPO |
$23,473.95
|
| Rate for Payer: Wellcare Medicare |
$11,257.38
|
|
|
ISLAND PEDICLE FLAP GRAFT 15740
|
Professional
|
Both
|
$5,349.00
|
|
|
Service Code
|
CPT 15740
|
| Hospital Charge Code |
3013648
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$705.09 |
| Max. Negotiated Rate |
$5,284.81 |
| Rate for Payer: Aetna Commercial |
$5,284.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,784.15
|
| Rate for Payer: Aetna Managed Medicare |
$723.67
|
| Rate for Payer: Anthem Medicare Advantage |
$723.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$723.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$723.67
|
| Rate for Payer: Cash Price |
$1,604.70
|
| Rate for Payer: Cash Price |
$1,604.70
|
| Rate for Payer: Cash Price |
$1,604.70
|
| Rate for Payer: Cigna Commercial |
$5,284.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$705.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$723.67
|
| Rate for Payer: Health EOS Commercial |
$5,062.29
|
| Rate for Payer: HFN Commercial |
$5,284.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,886.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,886.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$723.67
|
| Rate for Payer: Multiplan Commercial |
$4,450.37
|
| Rate for Payer: NAPHCARE Commercial |
$1,085.51
|
| Rate for Payer: Preferred Network Access Commercial |
$5,284.81
|
| Rate for Payer: Quartz Beloit One Network |
$2,447.70
|
| Rate for Payer: Quartz Commercial |
$3,170.89
|
| Rate for Payer: Quartz Medicare Advantage |
$723.67
|
| Rate for Payer: The Alliance Commercial |
$3,075.61
|
| Rate for Payer: United Healthcare Medicaid |
$705.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$723.67
|
| Rate for Payer: WEA Trust Commercial |
$3,059.63
|
| Rate for Payer: WPS Commercial |
$3,256.53
|
|
|
Islet Cell Antibody
|
Facility
|
OP
|
$244.00
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
978000
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.51 |
| Max. Negotiated Rate |
$233.46 |
| Rate for Payer: Aetna Commercial |
$228.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$218.23
|
| Rate for Payer: Aetna Managed Medicare |
$24.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$91.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42.90
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$40.69
|
| Rate for Payer: Anthem Medicare Advantage |
$24.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$134.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24.51
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$233.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$24.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$142.01
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$24.51
|
| Rate for Payer: Health EOS Commercial |
$225.85
|
| Rate for Payer: HFN Commercial |
$233.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$91.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$24.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24.51
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$24.51
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$24.51
|
| Rate for Payer: Multiplan Commercial |
$203.01
|
| Rate for Payer: NAPHCARE Commercial |
$36.77
|
| Rate for Payer: Preferred Network Access Commercial |
$233.46
|
| Rate for Payer: Quartz Beloit One Network |
$124.34
|
| Rate for Payer: Quartz Commercial |
$164.94
|
| Rate for Payer: Quartz Medicare Advantage |
$24.51
|
| Rate for Payer: The Alliance Commercial |
$98.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.51
|
| Rate for Payer: United Healthcare PPO |
$190.32
|
| Rate for Payer: WEA Trust Commercial |
$139.57
|
| Rate for Payer: Wellcare Medicare |
$24.51
|
| Rate for Payer: WPS Commercial |
$187.95
|
|
|
Islet Cell Antibody
|
Professional
|
Both
|
$244.00
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
978000
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.51 |
| Max. Negotiated Rate |
$241.07 |
| Rate for Payer: Aetna Commercial |
$241.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$218.23
|
| Rate for Payer: Aetna Managed Medicare |
$24.51
|
| Rate for Payer: Anthem Medicare Advantage |
$24.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24.51
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$241.07
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$126.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24.51
|
| Rate for Payer: Health EOS Commercial |
$230.92
|
| Rate for Payer: HFN Commercial |
$241.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$86.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$86.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24.51
|
| Rate for Payer: Multiplan Commercial |
$203.01
|
| Rate for Payer: NAPHCARE Commercial |
$36.77
|
| Rate for Payer: Preferred Network Access Commercial |
$241.07
|
| Rate for Payer: Quartz Beloit One Network |
$111.65
|
| Rate for Payer: Quartz Commercial |
$144.64
|
| Rate for Payer: Quartz Medicare Advantage |
$24.51
|
| Rate for Payer: The Alliance Commercial |
$96.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.51
|
| Rate for Payer: WEA Trust Commercial |
$139.57
|
| Rate for Payer: WPS Commercial |
$107.86
|
|
|
Islet Cell Antibody
|
Facility
|
IP
|
$244.00
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
978000
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$233.46 |
| Rate for Payer: Aetna Commercial |
$228.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$218.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$134.49
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$233.46
|
| Rate for Payer: Health EOS Commercial |
$225.85
|
| Rate for Payer: HFN Commercial |
$233.46
|
| Rate for Payer: Multiplan Commercial |
$203.01
|
| Rate for Payer: Preferred Network Access Commercial |
$233.46
|
| Rate for Payer: Quartz Beloit One Network |
$124.34
|
| Rate for Payer: Quartz Commercial |
$152.26
|
| Rate for Payer: WEA Trust Commercial |
$139.57
|
| Rate for Payer: WPS Commercial |
$187.95
|
|
|
Islet Cell Antibody Titer
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
3856694
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.83 |
| Max. Negotiated Rate |
$82.28 |
| Rate for Payer: Aetna Commercial |
$80.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.40
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$82.28
|
| Rate for Payer: Health EOS Commercial |
$79.60
|
| Rate for Payer: HFN Commercial |
$82.28
|
| Rate for Payer: Multiplan Commercial |
$71.55
|
| Rate for Payer: Preferred Network Access Commercial |
$82.28
|
| Rate for Payer: Quartz Beloit One Network |
$43.83
|
| Rate for Payer: Quartz Commercial |
$53.66
|
| Rate for Payer: WEA Trust Commercial |
$49.19
|
| Rate for Payer: WPS Commercial |
$66.25
|
|
|
Islet Cell Antibody Titer
|
Professional
|
Both
|
$86.00
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
3856694
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.51 |
| Max. Negotiated Rate |
$107.86 |
| Rate for Payer: Aetna Commercial |
$84.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.92
|
| Rate for Payer: Aetna Managed Medicare |
$24.51
|
| Rate for Payer: Anthem Medicare Advantage |
$24.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24.51
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$84.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$44.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24.51
|
| Rate for Payer: Health EOS Commercial |
$81.39
|
| Rate for Payer: HFN Commercial |
$84.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$86.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$86.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24.51
|
| Rate for Payer: Multiplan Commercial |
$71.55
|
| Rate for Payer: NAPHCARE Commercial |
$36.77
|
| Rate for Payer: Preferred Network Access Commercial |
$84.97
|
| Rate for Payer: Quartz Beloit One Network |
$39.35
|
| Rate for Payer: Quartz Commercial |
$50.98
|
| Rate for Payer: Quartz Medicare Advantage |
$24.51
|
| Rate for Payer: The Alliance Commercial |
$96.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.51
|
| Rate for Payer: WEA Trust Commercial |
$49.19
|
| Rate for Payer: WPS Commercial |
$107.86
|
|
