|
Kenalog 10mg Charge
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
4524852
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.29 |
| Max. Negotiated Rate |
$28.70 |
| Rate for Payer: Aetna Commercial |
$28.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.54
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$28.70
|
| Rate for Payer: Health EOS Commercial |
$27.77
|
| Rate for Payer: HFN Commercial |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$24.96
|
| Rate for Payer: Preferred Network Access Commercial |
$28.70
|
| Rate for Payer: Quartz Beloit One Network |
$15.29
|
| Rate for Payer: Quartz Commercial |
$18.72
|
| Rate for Payer: WEA Trust Commercial |
$17.16
|
| Rate for Payer: WPS Commercial |
$23.11
|
|
|
Kenalog JW Waste Charge
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
HCPCS J3301 JW
|
| Hospital Charge Code |
5246655
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$72.72 |
| Rate for Payer: Aetna Commercial |
$71.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.97
|
| Rate for Payer: Aetna Managed Medicare |
$22.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$51.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$39.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$37.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.89
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$72.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.49
|
| Rate for Payer: Health EOS Commercial |
$70.35
|
| Rate for Payer: HFN Commercial |
$72.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.28
|
| Rate for Payer: Multiplan Commercial |
$63.23
|
| Rate for Payer: NAPHCARE Commercial |
$47.42
|
| Rate for Payer: Preferred Network Access Commercial |
$72.72
|
| Rate for Payer: Quartz Beloit One Network |
$38.73
|
| Rate for Payer: Quartz Commercial |
$51.38
|
| Rate for Payer: Quartz Medicare Advantage |
$47.42
|
| Rate for Payer: The Alliance Commercial |
$39.52
|
| Rate for Payer: WEA Trust Commercial |
$43.47
|
| Rate for Payer: WPS Commercial |
$2.82
|
|
|
Kenalog JW Waste Charge
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
HCPCS J3301 JW
|
| Hospital Charge Code |
5246655
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.73 |
| Max. Negotiated Rate |
$72.72 |
| Rate for Payer: Aetna Commercial |
$71.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.89
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$72.72
|
| Rate for Payer: Health EOS Commercial |
$70.35
|
| Rate for Payer: HFN Commercial |
$72.72
|
| Rate for Payer: Multiplan Commercial |
$63.23
|
| Rate for Payer: Preferred Network Access Commercial |
$72.72
|
| Rate for Payer: Quartz Beloit One Network |
$38.73
|
| Rate for Payer: Quartz Commercial |
$47.42
|
| Rate for Payer: WEA Trust Commercial |
$43.47
|
| Rate for Payer: WPS Commercial |
$58.54
|
|
|
Kenalog JW Waste Charge
|
Professional
|
Both
|
$76.00
|
|
|
Service Code
|
HCPCS J3301 JW
|
| Hospital Charge Code |
5246655
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$75.09 |
| Rate for Payer: Aetna Commercial |
$75.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.97
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$75.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$0.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.13
|
| Rate for Payer: Health EOS Commercial |
$71.93
|
| Rate for Payer: HFN Commercial |
$75.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1.96
|
| Rate for Payer: Multiplan Commercial |
$63.23
|
| Rate for Payer: Preferred Network Access Commercial |
$75.09
|
| Rate for Payer: Quartz Beloit One Network |
$34.78
|
| Rate for Payer: Quartz Commercial |
$45.05
|
| Rate for Payer: The Alliance Commercial |
$39.52
|
| Rate for Payer: United Healthcare Medicaid |
$0.77
|
| Rate for Payer: WEA Trust Commercial |
$43.47
|
| Rate for Payer: WPS Commercial |
$2.82
|
|
|
Ketorolac tromethamine inj 15 mg J1885 man
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
3373575
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$6.70 |
| Rate for Payer: Aetna Commercial |
$6.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.26
|
| Rate for Payer: Aetna Managed Medicare |
$0.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.49
|
| Rate for Payer: Anthem Medicare Advantage |
$0.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$0.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$0.30
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$0.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.97
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$0.30
|
| Rate for Payer: Health EOS Commercial |
$6.48
|
| Rate for Payer: HFN Commercial |
$6.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$0.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$0.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$0.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$0.30
|
| Rate for Payer: Multiplan Commercial |
$5.82
|
| Rate for Payer: NAPHCARE Commercial |
$0.45
|
| Rate for Payer: Preferred Network Access Commercial |
$6.70
|
| Rate for Payer: Quartz Beloit One Network |
$3.57
|
| Rate for Payer: Quartz Commercial |
$4.73
|
| Rate for Payer: Quartz Medicare Advantage |
$0.30
|
| Rate for Payer: The Alliance Commercial |
$1.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.30
|
| Rate for Payer: WEA Trust Commercial |
$4.00
|
| Rate for Payer: Wellcare Medicare |
$0.30
|
| Rate for Payer: WPS Commercial |
$1.83
|
|
|
Ketorolac tromethamine inj 15 mg J1885 man
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
3373575
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.57 |
| Max. Negotiated Rate |
$6.70 |
| Rate for Payer: Aetna Commercial |
$6.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.86
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.70
|
| Rate for Payer: Health EOS Commercial |
$6.48
|
| Rate for Payer: HFN Commercial |
$6.70
|
| Rate for Payer: Multiplan Commercial |
$5.82
|
| Rate for Payer: Preferred Network Access Commercial |
$6.70
|
| Rate for Payer: Quartz Beloit One Network |
$3.57
|
| Rate for Payer: Quartz Commercial |
$4.37
|
| Rate for Payer: WEA Trust Commercial |
$4.00
|
| Rate for Payer: WPS Commercial |
$5.39
|
|
|
Ketorolac tromethamine inj 15 mg J1885 man
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
3373575
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$6.92 |
| Rate for Payer: Aetna Commercial |
$6.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.26
|
| Rate for Payer: Aetna Managed Medicare |
$0.30
|
| Rate for Payer: Anthem Medicare Advantage |
$0.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$0.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$0.30
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$0.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.73
|
| Rate for Payer: Health EOS Commercial |
$6.62
|
| Rate for Payer: HFN Commercial |
$6.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$0.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$0.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$0.30
|
| Rate for Payer: Multiplan Commercial |
$5.82
|
| Rate for Payer: NAPHCARE Commercial |
$0.45
|
| Rate for Payer: Preferred Network Access Commercial |
$6.92
|
| Rate for Payer: Quartz Beloit One Network |
$3.20
|
| Rate for Payer: Quartz Commercial |
$4.15
|
| Rate for Payer: Quartz Medicare Advantage |
$0.30
|
| Rate for Payer: The Alliance Commercial |
$0.83
|
| Rate for Payer: United Healthcare Medicaid |
$0.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.30
|
| Rate for Payer: WEA Trust Commercial |
$4.00
|
| Rate for Payer: WPS Commercial |
$1.83
|
|
|
Ketorolac Tromethamine Ophth Solution [Med]
|
Facility
|
IP
|
$26.00
|
|
| Hospital Charge Code |
2974952
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$24.88 |
| Rate for Payer: Aetna Commercial |
$24.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$23.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.33
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cigna Commercial |
$24.88
|
| Rate for Payer: Health EOS Commercial |
$24.07
|
| Rate for Payer: HFN Commercial |
$24.88
|
| Rate for Payer: Multiplan Commercial |
$21.63
|
| Rate for Payer: Preferred Network Access Commercial |
$24.88
|
| Rate for Payer: Quartz Beloit One Network |
$13.25
|
| Rate for Payer: Quartz Commercial |
$16.22
|
| Rate for Payer: WEA Trust Commercial |
$14.87
|
| Rate for Payer: WPS Commercial |
$20.03
|
|
|
Ketorolac Tromethamine Ophth Solution [Med]
|
Facility
|
OP
|
$26.00
|
|
| Hospital Charge Code |
2974952
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.57 |
| Max. Negotiated Rate |
$24.88 |
| Rate for Payer: Aetna Commercial |
$24.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$23.25
|
| Rate for Payer: Aetna Managed Medicare |
$7.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.33
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cigna Commercial |
$24.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.13
|
| Rate for Payer: Health EOS Commercial |
$24.07
|
| Rate for Payer: HFN Commercial |
$24.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.28
|
| Rate for Payer: Multiplan Commercial |
$21.63
|
| Rate for Payer: NAPHCARE Commercial |
$16.22
|
| Rate for Payer: Preferred Network Access Commercial |
$24.88
|
| Rate for Payer: Quartz Beloit One Network |
$13.25
|
| Rate for Payer: Quartz Commercial |
$17.58
|
| Rate for Payer: Quartz Medicare Advantage |
$16.22
|
| Rate for Payer: The Alliance Commercial |
$13.52
|
| Rate for Payer: WEA Trust Commercial |
$14.87
|
| Rate for Payer: WPS Commercial |
$20.03
|
|
|
KEY TRANSONIC KEY314-5
|
Facility
|
OP
|
$2,616.00
|
|
| Hospital Charge Code |
4048790
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$761.78 |
| Max. Negotiated Rate |
$2,502.99 |
| Rate for Payer: Aetna Commercial |
$2,448.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,339.75
|
| Rate for Payer: Aetna Managed Medicare |
$761.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,768.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,360.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,305.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,441.94
|
| Rate for Payer: Cash Price |
$784.80
|
| Rate for Payer: Cigna Commercial |
$2,502.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,522.51
|
| Rate for Payer: Health EOS Commercial |
$2,421.37
|
| Rate for Payer: HFN Commercial |
$2,502.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,040.48
|
| Rate for Payer: Multiplan Commercial |
$2,176.51
|
| Rate for Payer: NAPHCARE Commercial |
$1,632.38
|
| Rate for Payer: Preferred Network Access Commercial |
$2,502.99
|
| Rate for Payer: Quartz Beloit One Network |
$1,333.11
|
| Rate for Payer: Quartz Commercial |
$1,768.42
|
| Rate for Payer: Quartz Medicare Advantage |
$1,632.38
|
| Rate for Payer: The Alliance Commercial |
$1,360.32
|
| Rate for Payer: WEA Trust Commercial |
$1,496.35
|
| Rate for Payer: WPS Commercial |
$2,015.10
|
|
|
KEY TRANSONIC KEY314-5
|
Facility
|
IP
|
$2,616.00
|
|
| Hospital Charge Code |
4048790
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,333.11 |
| Max. Negotiated Rate |
$2,502.99 |
| Rate for Payer: Aetna Commercial |
$2,448.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,339.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,441.94
|
| Rate for Payer: Cash Price |
$784.80
|
| Rate for Payer: Cigna Commercial |
$2,502.99
|
| Rate for Payer: Health EOS Commercial |
$2,421.37
|
| Rate for Payer: HFN Commercial |
$2,502.99
|
| Rate for Payer: Multiplan Commercial |
$2,176.51
|
| Rate for Payer: Preferred Network Access Commercial |
$2,502.99
|
| Rate for Payer: Quartz Beloit One Network |
$1,333.11
|
| Rate for Payer: Quartz Commercial |
$1,632.38
|
| Rate for Payer: WEA Trust Commercial |
$1,496.35
|
| Rate for Payer: WPS Commercial |
$2,015.10
|
|
|
KIDNER PROCEDURE
|
Facility
|
IP
|
$1,632.00
|
|
| Hospital Charge Code |
2960164
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$831.67 |
| Max. Negotiated Rate |
$1,561.50 |
| Rate for Payer: Aetna Commercial |
$1,527.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,459.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$899.56
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cigna Commercial |
$1,561.50
|
| Rate for Payer: Health EOS Commercial |
$1,510.58
|
| Rate for Payer: HFN Commercial |
$1,561.50
|
| Rate for Payer: Multiplan Commercial |
$1,357.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,561.50
|
| Rate for Payer: Quartz Beloit One Network |
$831.67
|
| Rate for Payer: Quartz Commercial |
$1,018.37
|
| Rate for Payer: WEA Trust Commercial |
$933.50
|
| Rate for Payer: WPS Commercial |
$1,257.13
|
|
|
KIDNER PROCEDURE
|
Facility
|
OP
|
$1,632.00
|
|
| Hospital Charge Code |
2960164
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$475.24 |
| Max. Negotiated Rate |
$1,561.50 |
| Rate for Payer: Aetna Commercial |
$1,527.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,459.66
|
| Rate for Payer: Aetna Managed Medicare |
$475.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,103.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$848.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$814.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$899.56
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cigna Commercial |
$1,561.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$949.82
|
| Rate for Payer: Health EOS Commercial |
$1,510.58
|
| Rate for Payer: HFN Commercial |
$1,561.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,272.96
|
| Rate for Payer: Multiplan Commercial |
$1,357.82
|
| Rate for Payer: NAPHCARE Commercial |
$1,018.37
|
| Rate for Payer: Preferred Network Access Commercial |
$1,561.50
|
| Rate for Payer: Quartz Beloit One Network |
$831.67
|
| Rate for Payer: Quartz Commercial |
$1,103.23
|
| Rate for Payer: Quartz Medicare Advantage |
$1,018.37
|
| Rate for Payer: The Alliance Commercial |
$848.64
|
| Rate for Payer: WEA Trust Commercial |
$933.50
|
| Rate for Payer: WPS Commercial |
$1,257.13
|
|
|
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC
|
Facility
|
IP
|
$51,324.00
|
|
|
Service Code
|
MSDRG 657
|
| Min. Negotiated Rate |
$14,521.28 |
| Max. Negotiated Rate |
$51,324.00 |
| Rate for Payer: Aetna Managed Medicare |
$14,521.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39,929.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30,605.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29,077.09
|
| Rate for Payer: Anthem Medicare Advantage |
$14,521.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14,521.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14,521.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14,521.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32,278.24
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14,521.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37,400.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14,521.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14,521.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14,521.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14,521.28
|
| Rate for Payer: NAPHCARE Commercial |
$21,781.92
|
| Rate for Payer: Quartz Medicare Advantage |
$14,521.28
|
| Rate for Payer: The Alliance Commercial |
$51,324.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14,521.28
|
| Rate for Payer: United Healthcare PPO |
$29,116.67
|
| Rate for Payer: Wellcare Medicare |
$14,521.28
|
|
|
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC
|
Facility
|
IP
|
$87,086.48
|
|
|
Service Code
|
MSDRG 656
|
| Min. Negotiated Rate |
$24,888.95 |
| Max. Negotiated Rate |
$87,086.48 |
| Rate for Payer: Aetna Managed Medicare |
$24,888.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$69,467.97
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$53,246.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$50,587.78
|
| Rate for Payer: Anthem Medicare Advantage |
$24,888.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24,888.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24,888.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$24,888.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$56,157.07
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$24,888.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63,630.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$24,888.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24,888.95
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$24,888.95
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$24,888.95
|
| Rate for Payer: NAPHCARE Commercial |
$37,333.42
|
| Rate for Payer: Quartz Medicare Advantage |
$24,888.95
|
| Rate for Payer: The Alliance Commercial |
$87,086.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24,888.95
|
| Rate for Payer: United Healthcare PPO |
$49,537.19
|
| Rate for Payer: Wellcare Medicare |
$24,888.95
|
|
|
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC
|
Facility
|
IP
|
$41,265.12
|
|
|
Service Code
|
MSDRG 658
|
| Min. Negotiated Rate |
$12,390.78 |
| Max. Negotiated Rate |
$41,265.12 |
| Rate for Payer: Aetna Managed Medicare |
$12,390.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33,859.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25,952.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24,656.74
|
| Rate for Payer: Anthem Medicare Advantage |
$12,390.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12,390.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12,390.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12,390.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27,371.24
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12,390.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30,022.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12,390.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12,390.78
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12,390.78
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12,390.78
|
| Rate for Payer: NAPHCARE Commercial |
$18,586.17
|
| Rate for Payer: Quartz Medicare Advantage |
$12,390.78
|
| Rate for Payer: The Alliance Commercial |
$41,265.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,390.78
|
| Rate for Payer: United Healthcare PPO |
$23,372.91
|
| Rate for Payer: Wellcare Medicare |
$12,390.78
|
|
|
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC
|
Facility
|
IP
|
$37,546.08
|
|
|
Service Code
|
MSDRG 660
|
| Min. Negotiated Rate |
$10,628.61 |
| Max. Negotiated Rate |
$37,546.08 |
| Rate for Payer: Aetna Managed Medicare |
$10,628.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$28,838.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22,104.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21,000.65
|
| Rate for Payer: Anthem Medicare Advantage |
$10,628.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,628.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,628.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,628.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23,312.65
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,628.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27,294.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,628.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,628.61
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,628.61
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,628.61
|
| Rate for Payer: NAPHCARE Commercial |
$15,942.92
|
| Rate for Payer: Quartz Medicare Advantage |
$10,628.61
|
| Rate for Payer: The Alliance Commercial |
$37,546.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,628.61
|
| Rate for Payer: United Healthcare PPO |
$21,249.39
|
| Rate for Payer: Wellcare Medicare |
$10,628.61
|
|
|
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC
|
Facility
|
IP
|
$71,914.96
|
|
|
Service Code
|
MSDRG 659
|
| Min. Negotiated Rate |
$19,965.49 |
| Max. Negotiated Rate |
$71,914.96 |
| Rate for Payer: Aetna Managed Medicare |
$19,965.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$55,440.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42,494.62
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$40,372.67
|
| Rate for Payer: Anthem Medicare Advantage |
$19,965.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19,965.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19,965.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19,965.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44,817.36
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19,965.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$52,502.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19,965.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19,965.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19,965.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19,965.49
|
| Rate for Payer: NAPHCARE Commercial |
$29,948.24
|
| Rate for Payer: Quartz Medicare Advantage |
$19,965.49
|
| Rate for Payer: The Alliance Commercial |
$71,914.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19,965.49
|
| Rate for Payer: United Healthcare PPO |
$40,874.17
|
| Rate for Payer: Wellcare Medicare |
$19,965.49
|
|
|
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC
|
Facility
|
IP
|
$29,320.72
|
|
|
Service Code
|
MSDRG 661
|
| Min. Negotiated Rate |
$8,436.08 |
| Max. Negotiated Rate |
$29,320.72 |
| Rate for Payer: Aetna Managed Medicare |
$8,436.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22,591.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17,316.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16,451.59
|
| Rate for Payer: Anthem Medicare Advantage |
$8,436.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,436.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,436.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,436.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18,262.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,436.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21,261.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,436.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,436.08
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,436.08
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,436.08
|
| Rate for Payer: NAPHCARE Commercial |
$12,654.13
|
| Rate for Payer: Quartz Medicare Advantage |
$8,436.08
|
| Rate for Payer: The Alliance Commercial |
$29,320.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,436.08
|
| Rate for Payer: United Healthcare PPO |
$16,552.39
|
| Rate for Payer: Wellcare Medicare |
$8,436.08
|
|
|
KIDNEY AND URINARY TRACT INFECTIONS
|
Facility
|
IP
|
$5,787.08
|
|
|
Service Code
|
APR-DRG 4632
|
| Min. Negotiated Rate |
$5,140.45 |
| Max. Negotiated Rate |
$5,787.08 |
| Rate for Payer: Anthem Medicaid |
$5,541.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$5,541.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,541.45
|
| Rate for Payer: Dean Health Medicaid |
$5,541.45
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5,140.45
|
| Rate for Payer: Managed Health Services Medicaid |
$5,787.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,541.45
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5,541.45
|
| Rate for Payer: United Healthcare Medicaid |
$5,541.45
|
|
|
KIDNEY AND URINARY TRACT INFECTIONS
|
Facility
|
IP
|
$13,240.15
|
|
|
Service Code
|
APR-DRG 4634
|
| Min. Negotiated Rate |
$11,760.73 |
| Max. Negotiated Rate |
$13,240.15 |
| Rate for Payer: Anthem Medicaid |
$12,678.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$12,678.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12,678.17
|
| Rate for Payer: Dean Health Medicaid |
$12,678.17
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11,760.73
|
| Rate for Payer: Managed Health Services Medicaid |
$13,240.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,678.17
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12,678.17
|
| Rate for Payer: United Healthcare Medicaid |
$12,678.17
|
|
|
KIDNEY AND URINARY TRACT INFECTIONS
|
Facility
|
IP
|
$7,979.16
|
|
|
Service Code
|
APR-DRG 4633
|
| Min. Negotiated Rate |
$7,087.59 |
| Max. Negotiated Rate |
$7,979.16 |
| Rate for Payer: Anthem Medicaid |
$7,640.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$7,640.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7,640.49
|
| Rate for Payer: Dean Health Medicaid |
$7,640.49
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$7,087.59
|
| Rate for Payer: Managed Health Services Medicaid |
$7,979.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,640.49
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$7,640.49
|
| Rate for Payer: United Healthcare Medicaid |
$7,640.49
|
|
|
KIDNEY AND URINARY TRACT INFECTIONS
|
Facility
|
IP
|
$4,559.52
|
|
|
Service Code
|
APR-DRG 4631
|
| Min. Negotiated Rate |
$4,050.05 |
| Max. Negotiated Rate |
$4,559.52 |
| Rate for Payer: Anthem Medicaid |
$4,365.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$4,365.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,365.99
|
| Rate for Payer: Dean Health Medicaid |
$4,365.99
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4,050.05
|
| Rate for Payer: Managed Health Services Medicaid |
$4,559.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,365.99
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4,365.99
|
| Rate for Payer: United Healthcare Medicaid |
$4,365.99
|
|
|
KIDNEY AND URINARY TRACT INFECTIONS WITH MCC
|
Facility
|
IP
|
$32,804.72
|
|
|
Service Code
|
MSDRG 689
|
| Min. Negotiated Rate |
$9,392.59 |
| Max. Negotiated Rate |
$32,804.72 |
| Rate for Payer: Aetna Managed Medicare |
$9,392.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25,316.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,405.14
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18,436.15
|
| Rate for Payer: Anthem Medicare Advantage |
$9,392.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,392.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,392.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,392.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20,465.81
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,392.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23,816.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,392.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9,392.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9,392.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,392.59
|
| Rate for Payer: NAPHCARE Commercial |
$14,088.89
|
| Rate for Payer: Quartz Medicare Advantage |
$9,392.59
|
| Rate for Payer: The Alliance Commercial |
$32,804.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,392.59
|
| Rate for Payer: United Healthcare PPO |
$18,541.71
|
| Rate for Payer: Wellcare Medicare |
$9,392.59
|
|
|
KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC
|
Facility
|
IP
|
$22,643.92
|
|
|
Service Code
|
MSDRG 690
|
| Min. Negotiated Rate |
$6,706.10 |
| Max. Negotiated Rate |
$22,643.92 |
| Rate for Payer: Aetna Managed Medicare |
$6,706.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17,662.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,538.27
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,862.24
|
| Rate for Payer: Anthem Medicare Advantage |
$6,706.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,706.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,706.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,706.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14,278.27
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,706.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16,363.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,706.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,706.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,706.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,706.10
|
| Rate for Payer: NAPHCARE Commercial |
$10,059.15
|
| Rate for Payer: Quartz Medicare Advantage |
$6,706.10
|
| Rate for Payer: The Alliance Commercial |
$22,643.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,706.10
|
| Rate for Payer: United Healthcare PPO |
$12,739.53
|
| Rate for Payer: Wellcare Medicare |
$6,706.10
|
|
