|
Multihance 10 ml
|
Professional
|
Both
|
$258.00
|
|
| Hospital Charge Code |
1486806
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$118.06 |
| Max. Negotiated Rate |
$254.90 |
| Rate for Payer: Aetna Commercial |
$254.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$230.76
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna Commercial |
$254.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$134.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$160.99
|
| Rate for Payer: Health EOS Commercial |
$244.17
|
| Rate for Payer: HFN Commercial |
$254.90
|
| Rate for Payer: Multiplan Commercial |
$214.66
|
| Rate for Payer: Preferred Network Access Commercial |
$254.90
|
| Rate for Payer: Quartz Beloit One Network |
$118.06
|
| Rate for Payer: Quartz Commercial |
$152.94
|
| Rate for Payer: The Alliance Commercial |
$134.16
|
| Rate for Payer: WEA Trust Commercial |
$147.58
|
| Rate for Payer: WPS Commercial |
$198.74
|
|
|
Multihance 10 ml
|
Facility
|
IP
|
$258.00
|
|
| Hospital Charge Code |
1486806
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$131.48 |
| Max. Negotiated Rate |
$246.85 |
| Rate for Payer: Aetna Commercial |
$241.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$230.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$142.21
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna Commercial |
$246.85
|
| Rate for Payer: Health EOS Commercial |
$238.80
|
| Rate for Payer: HFN Commercial |
$246.85
|
| Rate for Payer: Multiplan Commercial |
$214.66
|
| Rate for Payer: Preferred Network Access Commercial |
$246.85
|
| Rate for Payer: Quartz Beloit One Network |
$131.48
|
| Rate for Payer: Quartz Commercial |
$160.99
|
| Rate for Payer: WEA Trust Commercial |
$147.58
|
| Rate for Payer: WPS Commercial |
$198.74
|
|
|
Multihance 15 ml
|
Facility
|
OP
|
$370.00
|
|
| Hospital Charge Code |
1486808
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$107.74 |
| Max. Negotiated Rate |
$354.02 |
| Rate for Payer: Aetna Commercial |
$346.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$330.93
|
| Rate for Payer: Aetna Managed Medicare |
$107.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$250.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$192.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$184.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$203.94
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cigna Commercial |
$354.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$215.34
|
| Rate for Payer: Health EOS Commercial |
$342.47
|
| Rate for Payer: HFN Commercial |
$354.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$288.60
|
| Rate for Payer: Multiplan Commercial |
$307.84
|
| Rate for Payer: NAPHCARE Commercial |
$230.88
|
| Rate for Payer: Preferred Network Access Commercial |
$354.02
|
| Rate for Payer: Quartz Beloit One Network |
$188.55
|
| Rate for Payer: Quartz Commercial |
$250.12
|
| Rate for Payer: Quartz Medicare Advantage |
$230.88
|
| Rate for Payer: The Alliance Commercial |
$192.40
|
| Rate for Payer: WEA Trust Commercial |
$211.64
|
| Rate for Payer: WPS Commercial |
$285.01
|
|
|
Multihance 15 ml
|
Professional
|
Both
|
$370.00
|
|
| Hospital Charge Code |
1486808
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$169.31 |
| Max. Negotiated Rate |
$365.56 |
| Rate for Payer: Aetna Commercial |
$365.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$330.93
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cigna Commercial |
$365.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$192.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$230.88
|
| Rate for Payer: Health EOS Commercial |
$350.17
|
| Rate for Payer: HFN Commercial |
$365.56
|
| Rate for Payer: Multiplan Commercial |
$307.84
|
| Rate for Payer: Preferred Network Access Commercial |
$365.56
|
| Rate for Payer: Quartz Beloit One Network |
$169.31
|
| Rate for Payer: Quartz Commercial |
$219.34
|
| Rate for Payer: The Alliance Commercial |
$192.40
|
| Rate for Payer: WEA Trust Commercial |
$211.64
|
| Rate for Payer: WPS Commercial |
$285.01
|
|
|
Multihance 15 ml
|
Facility
|
IP
|
$370.00
|
|
| Hospital Charge Code |
1486808
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$188.55 |
| Max. Negotiated Rate |
$354.02 |
| Rate for Payer: Aetna Commercial |
$346.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$330.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$203.94
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cigna Commercial |
$354.02
|
| Rate for Payer: Health EOS Commercial |
$342.47
|
| Rate for Payer: HFN Commercial |
$354.02
|
| Rate for Payer: Multiplan Commercial |
$307.84
|
| Rate for Payer: Preferred Network Access Commercial |
$354.02
|
| Rate for Payer: Quartz Beloit One Network |
$188.55
|
| Rate for Payer: Quartz Commercial |
$230.88
|
| Rate for Payer: WEA Trust Commercial |
$211.64
|
| Rate for Payer: WPS Commercial |
$285.01
|
|
|
Multihance 20 ml
|
Professional
|
Both
|
$482.00
|
|
| Hospital Charge Code |
1486810
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$220.56 |
| Max. Negotiated Rate |
$476.22 |
| Rate for Payer: Aetna Commercial |
$476.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$431.10
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cigna Commercial |
$476.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$250.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$300.77
|
| Rate for Payer: Health EOS Commercial |
$456.16
|
| Rate for Payer: HFN Commercial |
$476.22
|
| Rate for Payer: Multiplan Commercial |
$401.02
|
| Rate for Payer: Preferred Network Access Commercial |
$476.22
|
| Rate for Payer: Quartz Beloit One Network |
$220.56
|
| Rate for Payer: Quartz Commercial |
$285.73
|
| Rate for Payer: The Alliance Commercial |
$250.64
|
| Rate for Payer: WEA Trust Commercial |
$275.70
|
| Rate for Payer: WPS Commercial |
$371.28
|
|
|
Multihance 20 ml
|
Facility
|
OP
|
$482.00
|
|
| Hospital Charge Code |
1486810
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$140.36 |
| Max. Negotiated Rate |
$461.18 |
| Rate for Payer: Aetna Commercial |
$451.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$431.10
|
| Rate for Payer: Aetna Managed Medicare |
$140.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$325.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$250.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$240.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$265.68
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cigna Commercial |
$461.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$280.52
|
| Rate for Payer: Health EOS Commercial |
$446.14
|
| Rate for Payer: HFN Commercial |
$461.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$375.96
|
| Rate for Payer: Multiplan Commercial |
$401.02
|
| Rate for Payer: NAPHCARE Commercial |
$300.77
|
| Rate for Payer: Preferred Network Access Commercial |
$461.18
|
| Rate for Payer: Quartz Beloit One Network |
$245.63
|
| Rate for Payer: Quartz Commercial |
$325.83
|
| Rate for Payer: Quartz Medicare Advantage |
$300.77
|
| Rate for Payer: The Alliance Commercial |
$250.64
|
| Rate for Payer: WEA Trust Commercial |
$275.70
|
| Rate for Payer: WPS Commercial |
$371.28
|
|
|
Multihance 20 ml
|
Facility
|
IP
|
$482.00
|
|
| Hospital Charge Code |
1486810
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$245.63 |
| Max. Negotiated Rate |
$461.18 |
| Rate for Payer: Aetna Commercial |
$451.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$431.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$265.68
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cigna Commercial |
$461.18
|
| Rate for Payer: Health EOS Commercial |
$446.14
|
| Rate for Payer: HFN Commercial |
$461.18
|
| Rate for Payer: Multiplan Commercial |
$401.02
|
| Rate for Payer: Preferred Network Access Commercial |
$461.18
|
| Rate for Payer: Quartz Beloit One Network |
$245.63
|
| Rate for Payer: Quartz Commercial |
$300.77
|
| Rate for Payer: WEA Trust Commercial |
$275.70
|
| Rate for Payer: WPS Commercial |
$371.28
|
|
|
Multi-Leaf Design 7733826
|
Professional
|
Both
|
$2,357.00
|
|
|
Service Code
|
CPT 77338 26
|
| Hospital Charge Code |
5258641
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$226.32 |
| Max. Negotiated Rate |
$2,328.72 |
| Rate for Payer: Aetna Commercial |
$2,328.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,108.10
|
| Rate for Payer: Aetna Managed Medicare |
$226.32
|
| Rate for Payer: Anthem Medicare Advantage |
$226.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$226.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$226.32
|
| Rate for Payer: Cash Price |
$707.10
|
| Rate for Payer: Cash Price |
$707.10
|
| Rate for Payer: Cash Price |
$707.10
|
| Rate for Payer: Cigna Commercial |
$2,328.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,225.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$226.32
|
| Rate for Payer: Health EOS Commercial |
$2,230.66
|
| Rate for Payer: HFN Commercial |
$2,328.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$802.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$802.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$226.32
|
| Rate for Payer: Multiplan Commercial |
$1,961.02
|
| Rate for Payer: NAPHCARE Commercial |
$339.49
|
| Rate for Payer: Preferred Network Access Commercial |
$2,328.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,078.56
|
| Rate for Payer: Quartz Commercial |
$1,397.23
|
| Rate for Payer: Quartz Medicare Advantage |
$226.32
|
| Rate for Payer: The Alliance Commercial |
$860.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$226.32
|
| Rate for Payer: WEA Trust Commercial |
$1,348.20
|
| Rate for Payer: WPS Commercial |
$1,131.62
|
|
|
Multiple Lead Implantable Cardioverter-Defib 9328426
|
Professional
|
Both
|
$356.00
|
|
|
Service Code
|
CPT 93284 26
|
| Hospital Charge Code |
3375523
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$39.52 |
| Max. Negotiated Rate |
$351.73 |
| Rate for Payer: Aetna Commercial |
$351.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$318.41
|
| Rate for Payer: Aetna Managed Medicare |
$59.78
|
| Rate for Payer: Anthem Medicare Advantage |
$59.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$59.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$59.78
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$351.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$39.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$59.78
|
| Rate for Payer: Health EOS Commercial |
$336.92
|
| Rate for Payer: HFN Commercial |
$351.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$223.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$223.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$59.78
|
| Rate for Payer: Multiplan Commercial |
$296.19
|
| Rate for Payer: NAPHCARE Commercial |
$89.67
|
| Rate for Payer: Preferred Network Access Commercial |
$351.73
|
| Rate for Payer: Quartz Beloit One Network |
$162.91
|
| Rate for Payer: Quartz Commercial |
$211.04
|
| Rate for Payer: Quartz Medicare Advantage |
$59.78
|
| Rate for Payer: The Alliance Commercial |
$227.16
|
| Rate for Payer: United Healthcare Medicaid |
$39.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$59.78
|
| Rate for Payer: WEA Trust Commercial |
$203.63
|
| Rate for Payer: WPS Commercial |
$239.12
|
|
|
Multiple Lead Pacemaker System 9328126
|
Professional
|
Both
|
$809.00
|
|
|
Service Code
|
CPT 93281 26
|
| Hospital Charge Code |
4464703
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$40.52 |
| Max. Negotiated Rate |
$799.29 |
| Rate for Payer: Aetna Commercial |
$799.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$723.57
|
| Rate for Payer: Aetna Managed Medicare |
$41.13
|
| Rate for Payer: Anthem Medicare Advantage |
$41.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$41.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$41.13
|
| Rate for Payer: Cash Price |
$242.70
|
| Rate for Payer: Cash Price |
$242.70
|
| Rate for Payer: Cash Price |
$242.70
|
| Rate for Payer: Cigna Commercial |
$799.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$40.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.13
|
| Rate for Payer: Health EOS Commercial |
$765.64
|
| Rate for Payer: HFN Commercial |
$799.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$152.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$152.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$41.13
|
| Rate for Payer: Multiplan Commercial |
$673.09
|
| Rate for Payer: NAPHCARE Commercial |
$61.70
|
| Rate for Payer: Preferred Network Access Commercial |
$799.29
|
| Rate for Payer: Quartz Beloit One Network |
$370.20
|
| Rate for Payer: Quartz Commercial |
$479.58
|
| Rate for Payer: Quartz Medicare Advantage |
$41.13
|
| Rate for Payer: The Alliance Commercial |
$156.30
|
| Rate for Payer: United Healthcare Medicaid |
$40.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$41.13
|
| Rate for Payer: WEA Trust Commercial |
$462.75
|
| Rate for Payer: WPS Commercial |
$164.53
|
|
|
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL
|
Facility
|
IP
|
$32,705.80
|
|
|
Service Code
|
APR-DRG 2991
|
| Min. Negotiated Rate |
$29,051.33 |
| Max. Negotiated Rate |
$32,705.80 |
| Rate for Payer: Anthem Medicaid |
$31,317.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$31,317.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$31,317.60
|
| Rate for Payer: Dean Health Medicaid |
$31,317.60
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$29,051.33
|
| Rate for Payer: Managed Health Services Medicaid |
$32,705.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$31,317.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$31,317.60
|
| Rate for Payer: United Healthcare Medicaid |
$31,317.60
|
|
|
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL
|
Facility
|
IP
|
$68,392.82
|
|
|
Service Code
|
APR-DRG 2994
|
| Min. Negotiated Rate |
$60,750.77 |
| Max. Negotiated Rate |
$68,392.82 |
| Rate for Payer: Anthem Medicaid |
$65,489.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$65,489.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$65,489.89
|
| Rate for Payer: Dean Health Medicaid |
$65,489.89
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$60,750.77
|
| Rate for Payer: Managed Health Services Medicaid |
$68,392.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$65,489.89
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$65,489.89
|
| Rate for Payer: United Healthcare Medicaid |
$65,489.89
|
|
|
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL
|
Facility
|
IP
|
$53,486.69
|
|
|
Service Code
|
APR-DRG 2993
|
| Min. Negotiated Rate |
$47,510.22 |
| Max. Negotiated Rate |
$53,486.69 |
| Rate for Payer: Anthem Medicaid |
$51,216.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$51,216.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$51,216.45
|
| Rate for Payer: Dean Health Medicaid |
$51,216.45
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$47,510.22
|
| Rate for Payer: Managed Health Services Medicaid |
$53,486.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$51,216.45
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$51,216.45
|
| Rate for Payer: United Healthcare Medicaid |
$51,216.45
|
|
|
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL
|
Facility
|
IP
|
$39,369.71
|
|
|
Service Code
|
APR-DRG 2992
|
| Min. Negotiated Rate |
$34,970.63 |
| Max. Negotiated Rate |
$39,369.71 |
| Rate for Payer: Anthem Medicaid |
$37,698.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$37,698.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$37,698.67
|
| Rate for Payer: Dean Health Medicaid |
$37,698.67
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$34,970.63
|
| Rate for Payer: Managed Health Services Medicaid |
$39,369.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$37,698.67
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$37,698.67
|
| Rate for Payer: United Healthcare Medicaid |
$37,698.67
|
|
|
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH CC
|
Facility
|
IP
|
$157,504.08
|
|
|
Service Code
|
MSDRG 427
|
| Min. Negotiated Rate |
$55,788.24 |
| Max. Negotiated Rate |
$157,504.08 |
| Rate for Payer: Aetna Managed Medicare |
$55,788.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$157,504.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$120,725.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$114,697.20
|
| Rate for Payer: Anthem Medicare Advantage |
$55,788.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$55,788.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$55,788.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$55,788.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$127,324.41
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$55,788.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$55,788.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$55,788.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$55,788.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$55,788.24
|
| Rate for Payer: NAPHCARE Commercial |
$83,682.36
|
| Rate for Payer: Quartz Medicare Advantage |
$55,788.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$55,788.24
|
| Rate for Payer: Wellcare Medicare |
$55,788.24
|
|
|
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE
|
Facility
|
IP
|
$240,473.77
|
|
|
Service Code
|
MSDRG 426
|
| Min. Negotiated Rate |
$84,909.28 |
| Max. Negotiated Rate |
$240,473.77 |
| Rate for Payer: Aetna Managed Medicare |
$84,909.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$240,473.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$184,321.19
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$175,117.17
|
| Rate for Payer: Anthem Medicare Advantage |
$84,909.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$84,909.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$84,909.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$84,909.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$194,396.11
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$84,909.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$84,909.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$84,909.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$84,909.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$84,909.28
|
| Rate for Payer: NAPHCARE Commercial |
$127,363.92
|
| Rate for Payer: Quartz Medicare Advantage |
$84,909.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$84,909.28
|
| Rate for Payer: Wellcare Medicare |
$84,909.28
|
|
|
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITHOUT CC/MCC
|
Facility
|
IP
|
$122,667.54
|
|
|
Service Code
|
MSDRG 428
|
| Min. Negotiated Rate |
$43,561.16 |
| Max. Negotiated Rate |
$122,667.54 |
| Rate for Payer: Aetna Managed Medicare |
$43,561.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$122,667.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$94,023.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$89,328.63
|
| Rate for Payer: Anthem Medicare Advantage |
$43,561.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$43,561.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$43,561.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$43,561.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$99,162.97
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$43,561.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$43,561.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$43,561.16
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$43,561.16
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$43,561.16
|
| Rate for Payer: NAPHCARE Commercial |
$65,341.74
|
| Rate for Payer: Quartz Medicare Advantage |
$43,561.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43,561.16
|
| Rate for Payer: Wellcare Medicare |
$43,561.16
|
|
|
MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE
|
Facility
|
IP
|
$145,787.17
|
|
|
Service Code
|
MSDRG 447
|
| Min. Negotiated Rate |
$51,675.79 |
| Max. Negotiated Rate |
$145,787.17 |
| Rate for Payer: Aetna Managed Medicare |
$51,675.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$145,787.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$111,744.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$106,164.74
|
| Rate for Payer: Anthem Medicare Advantage |
$51,675.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$51,675.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$51,675.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$51,675.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$117,852.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$51,675.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$51,675.79
|
| Rate for Payer: Independent Care Health Plan Medicare |
$51,675.79
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$51,675.79
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$51,675.79
|
| Rate for Payer: NAPHCARE Commercial |
$77,513.69
|
| Rate for Payer: Quartz Medicare Advantage |
$51,675.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$51,675.79
|
| Rate for Payer: Wellcare Medicare |
$51,675.79
|
|
|
MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC
|
Facility
|
IP
|
$92,530.86
|
|
|
Service Code
|
MSDRG 448
|
| Min. Negotiated Rate |
$32,983.66 |
| Max. Negotiated Rate |
$92,530.86 |
| Rate for Payer: Aetna Managed Medicare |
$32,983.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$92,530.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$70,924.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$67,382.58
|
| Rate for Payer: Anthem Medicare Advantage |
$32,983.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$32,983.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$32,983.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$32,983.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$74,800.84
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$32,983.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$32,983.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$32,983.66
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$32,983.66
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$32,983.66
|
| Rate for Payer: NAPHCARE Commercial |
$49,475.49
|
| Rate for Payer: Quartz Medicare Advantage |
$32,983.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32,983.66
|
| Rate for Payer: Wellcare Medicare |
$32,983.66
|
|
|
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC
|
Facility
|
IP
|
$33,158.32
|
|
|
Service Code
|
MSDRG 059
|
| Min. Negotiated Rate |
$10,009.83 |
| Max. Negotiated Rate |
$33,158.32 |
| Rate for Payer: Aetna Managed Medicare |
$10,009.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$27,075.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20,753.11
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19,716.81
|
| Rate for Payer: Anthem Medicare Advantage |
$10,009.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,009.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,009.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,009.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21,887.47
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,009.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24,076.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,009.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,009.83
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,009.83
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,009.83
|
| Rate for Payer: NAPHCARE Commercial |
$15,014.75
|
| Rate for Payer: Quartz Medicare Advantage |
$10,009.83
|
| Rate for Payer: The Alliance Commercial |
$33,158.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,009.83
|
| Rate for Payer: United Healthcare PPO |
$18,743.80
|
| Rate for Payer: Wellcare Medicare |
$10,009.83
|
|
|
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC
|
Facility
|
IP
|
$48,108.32
|
|
|
Service Code
|
MSDRG 058
|
| Min. Negotiated Rate |
$13,598.47 |
| Max. Negotiated Rate |
$48,108.32 |
| Rate for Payer: Aetna Managed Medicare |
$13,598.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$37,299.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28,590.09
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27,162.45
|
| Rate for Payer: Anthem Medicare Advantage |
$13,598.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,598.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,598.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,598.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30,152.81
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,598.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$35,041.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,598.47
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,598.47
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,598.47
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,598.47
|
| Rate for Payer: NAPHCARE Commercial |
$20,397.70
|
| Rate for Payer: Quartz Medicare Advantage |
$13,598.47
|
| Rate for Payer: The Alliance Commercial |
$48,108.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,598.47
|
| Rate for Payer: United Healthcare PPO |
$27,280.50
|
| Rate for Payer: Wellcare Medicare |
$13,598.47
|
|
|
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC
|
Facility
|
IP
|
$25,146.16
|
|
|
Service Code
|
MSDRG 060
|
| Min. Negotiated Rate |
$7,550.80 |
| Max. Negotiated Rate |
$25,146.16 |
| Rate for Payer: Aetna Managed Medicare |
$7,550.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20,069.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15,382.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14,614.81
|
| Rate for Payer: Anthem Medicare Advantage |
$7,550.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,550.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,550.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,550.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16,223.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,550.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18,199.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,550.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,550.80
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,550.80
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,550.80
|
| Rate for Payer: NAPHCARE Commercial |
$11,326.19
|
| Rate for Payer: Quartz Medicare Advantage |
$7,550.80
|
| Rate for Payer: The Alliance Commercial |
$25,146.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,550.80
|
| Rate for Payer: United Healthcare PPO |
$14,168.37
|
| Rate for Payer: Wellcare Medicare |
$7,550.80
|
|
|
MULTIPLE SCLEROSIS AND OTHER DEMYELINATING DISEASES
|
Facility
|
OP
|
$87.79
|
|
|
Service Code
|
EAPG 00523
|
| Min. Negotiated Rate |
$84.41 |
| Max. Negotiated Rate |
$87.79 |
| Rate for Payer: Anthem Medicaid |
$84.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$84.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$84.41
|
| Rate for Payer: Dean Health Medicaid |
$84.41
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$84.41
|
| Rate for Payer: Managed Health Services Medicaid |
$87.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$84.41
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$84.41
|
| Rate for Payer: United Healthcare Medicaid |
$84.41
|
|
|
MULTIPLE SCLEROSIS, OTHER DEMYELINATING DISEASE AND INFLAMMATORY NEUROPATHIES
|
Facility
|
IP
|
$9,382.09
|
|
|
Service Code
|
APR-DRG 0431
|
| Min. Negotiated Rate |
$8,333.76 |
| Max. Negotiated Rate |
$9,382.09 |
| Rate for Payer: Anthem Medicaid |
$8,983.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$8,983.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8,983.87
|
| Rate for Payer: Dean Health Medicaid |
$8,983.87
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8,333.76
|
| Rate for Payer: Managed Health Services Medicaid |
$9,382.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,983.87
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8,983.87
|
| Rate for Payer: United Healthcare Medicaid |
$8,983.87
|
|
