|
PERICARDIECTOMY
|
Facility
|
OP
|
$15,505.00
|
|
| Hospital Charge Code |
2960313
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,341.40 |
| Max. Negotiated Rate |
$62,020.00 |
| Rate for Payer: Aetna Commercial |
$13,954.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,334.30
|
| Rate for Payer: Aetna Managed Medicare |
$4,341.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,078.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,752.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,442.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,217.65
|
| Rate for Payer: Cash Price |
$4,651.50
|
| Rate for Payer: Cigna Commercial |
$14,264.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,676.60
|
| Rate for Payer: Health EOS Commercial |
$13,799.45
|
| Rate for Payer: HFN Commercial |
$14,264.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,628.75
|
| Rate for Payer: Multiplan Commercial |
$12,404.00
|
| Rate for Payer: NAPHCARE Commercial |
$9,303.00
|
| Rate for Payer: Preferred Network Access Commercial |
$14,264.60
|
| Rate for Payer: Quartz Beloit One Network |
$7,597.45
|
| Rate for Payer: Quartz Commercial |
$10,078.25
|
| Rate for Payer: Quartz Medicare Advantage |
$9,303.00
|
| Rate for Payer: The Alliance Commercial |
$62,020.00
|
| Rate for Payer: WEA Trust Commercial |
$8,527.75
|
| Rate for Payer: WPS Commercial |
$11,484.55
|
|
|
PERICARDIECTOMY
|
Facility
|
IP
|
$15,505.00
|
|
| Hospital Charge Code |
2960313
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,597.45 |
| Max. Negotiated Rate |
$14,264.60 |
| Rate for Payer: Aetna Commercial |
$13,954.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,334.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,217.65
|
| Rate for Payer: Cash Price |
$4,651.50
|
| Rate for Payer: Cigna Commercial |
$14,264.60
|
| Rate for Payer: Health EOS Commercial |
$13,799.45
|
| Rate for Payer: HFN Commercial |
$14,264.60
|
| Rate for Payer: Multiplan Commercial |
$12,404.00
|
| Rate for Payer: NAPHCARE Commercial |
$9,303.00
|
| Rate for Payer: Preferred Network Access Commercial |
$14,264.60
|
| Rate for Payer: Quartz Beloit One Network |
$7,597.45
|
| Rate for Payer: Quartz Commercial |
$9,303.00
|
| Rate for Payer: WEA Trust Commercial |
$8,527.75
|
| Rate for Payer: WPS Commercial |
$11,484.55
|
|
|
Pericardiocentesis F/U
|
Facility
|
IP
|
$517.00
|
|
| Hospital Charge Code |
4125712
|
| Min. Negotiated Rate |
$253.33 |
| Max. Negotiated Rate |
$475.64 |
| Rate for Payer: Aetna Commercial |
$465.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$444.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$274.01
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Cigna Commercial |
$475.64
|
| Rate for Payer: Health EOS Commercial |
$460.13
|
| Rate for Payer: HFN Commercial |
$475.64
|
| Rate for Payer: Multiplan Commercial |
$413.60
|
| Rate for Payer: NAPHCARE Commercial |
$310.20
|
| Rate for Payer: Preferred Network Access Commercial |
$475.64
|
| Rate for Payer: Quartz Beloit One Network |
$253.33
|
| Rate for Payer: Quartz Commercial |
$310.20
|
| Rate for Payer: WEA Trust Commercial |
$284.35
|
| Rate for Payer: WPS Commercial |
$382.94
|
|
|
Pericardiocentesis F/U
|
Facility
|
OP
|
$517.00
|
|
| Hospital Charge Code |
4125712
|
| Min. Negotiated Rate |
$144.76 |
| Max. Negotiated Rate |
$2,068.00 |
| Rate for Payer: Aetna Commercial |
$465.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$444.62
|
| Rate for Payer: Aetna Managed Medicare |
$144.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$336.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$258.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$248.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$274.01
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Cigna Commercial |
$475.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$289.31
|
| Rate for Payer: Health EOS Commercial |
$460.13
|
| Rate for Payer: HFN Commercial |
$475.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$387.75
|
| Rate for Payer: Multiplan Commercial |
$413.60
|
| Rate for Payer: NAPHCARE Commercial |
$310.20
|
| Rate for Payer: Preferred Network Access Commercial |
$475.64
|
| Rate for Payer: Quartz Beloit One Network |
$253.33
|
| Rate for Payer: Quartz Commercial |
$336.05
|
| Rate for Payer: Quartz Medicare Advantage |
$310.20
|
| Rate for Payer: The Alliance Commercial |
$2,068.00
|
| Rate for Payer: WEA Trust Commercial |
$284.35
|
| Rate for Payer: WPS Commercial |
$382.94
|
|
|
Pericardiocentesis Including Imaging Guidance
|
Facility
|
OP
|
$2,870.00
|
|
|
Service Code
|
CPT 33016
|
| Hospital Charge Code |
5565259
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,377.60 |
| Max. Negotiated Rate |
$6,331.88 |
| Rate for Payer: Aetna Commercial |
$2,583.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,468.20
|
| Rate for Payer: Aetna Managed Medicare |
$1,582.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,865.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,435.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,377.60
|
| Rate for Payer: Anthem Medicare Advantage |
$1,582.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,521.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,582.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,582.97
|
| Rate for Payer: Cash Price |
$861.00
|
| Rate for Payer: Cash Price |
$861.00
|
| Rate for Payer: Cigna Commercial |
$2,640.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,582.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,582.97
|
| Rate for Payer: Health EOS Commercial |
$2,554.30
|
| Rate for Payer: HFN Commercial |
$2,640.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,888.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,582.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,582.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,582.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,582.97
|
| Rate for Payer: Multiplan Commercial |
$2,296.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,374.46
|
| Rate for Payer: Preferred Network Access Commercial |
$2,640.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,406.30
|
| Rate for Payer: Quartz Commercial |
$1,865.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,582.97
|
| Rate for Payer: The Alliance Commercial |
$6,331.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,582.97
|
| Rate for Payer: WEA Trust Commercial |
$1,578.50
|
| Rate for Payer: Wellcare Medicare |
$1,582.97
|
| Rate for Payer: WPS Commercial |
$2,125.81
|
|
|
Pericardiocentesis Including Imaging Guidance
|
Facility
|
IP
|
$2,870.00
|
|
|
Service Code
|
CPT 33016
|
| Hospital Charge Code |
5565259
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,406.30 |
| Max. Negotiated Rate |
$2,640.40 |
| Rate for Payer: Aetna Commercial |
$2,583.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,468.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,521.10
|
| Rate for Payer: Cash Price |
$861.00
|
| Rate for Payer: Cigna Commercial |
$2,640.40
|
| Rate for Payer: Health EOS Commercial |
$2,554.30
|
| Rate for Payer: HFN Commercial |
$2,640.40
|
| Rate for Payer: Multiplan Commercial |
$2,296.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,722.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,640.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,406.30
|
| Rate for Payer: Quartz Commercial |
$1,722.00
|
| Rate for Payer: WEA Trust Commercial |
$1,578.50
|
| Rate for Payer: WPS Commercial |
$2,125.81
|
|
|
Periodic Comprehensive Preventive Medicine 12-17 Years Established
|
Professional
|
Both
|
$271.00
|
|
|
Service Code
|
CPT 99394
|
| Hospital Charge Code |
1122830
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$76.45 |
| Max. Negotiated Rate |
$291.08 |
| Rate for Payer: Aetna Commercial |
$257.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.06
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cigna Commercial |
$257.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$76.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$162.60
|
| Rate for Payer: Health EOS Commercial |
$246.61
|
| Rate for Payer: HFN Commercial |
$257.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$291.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$291.08
|
| Rate for Payer: Multiplan Commercial |
$216.80
|
| Rate for Payer: Preferred Network Access Commercial |
$257.45
|
| Rate for Payer: Quartz Beloit One Network |
$119.24
|
| Rate for Payer: Quartz Commercial |
$154.47
|
| Rate for Payer: The Alliance Commercial |
$135.50
|
| Rate for Payer: United Healthcare Medicaid |
$76.45
|
| Rate for Payer: WEA Trust Commercial |
$149.05
|
| Rate for Payer: WPS Commercial |
$200.73
|
|
|
Periodic Comprehensive Preventive Medicine 1-4 Years Established
|
Professional
|
Both
|
$207.00
|
|
|
Service Code
|
CPT 99392
|
| Hospital Charge Code |
1122828
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$70.13 |
| Max. Negotiated Rate |
$256.81 |
| Rate for Payer: Aetna Commercial |
$196.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$178.02
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cigna Commercial |
$196.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$70.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$124.20
|
| Rate for Payer: Health EOS Commercial |
$188.37
|
| Rate for Payer: HFN Commercial |
$196.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$256.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$256.81
|
| Rate for Payer: Multiplan Commercial |
$165.60
|
| Rate for Payer: Preferred Network Access Commercial |
$196.65
|
| Rate for Payer: Quartz Beloit One Network |
$91.08
|
| Rate for Payer: Quartz Commercial |
$117.99
|
| Rate for Payer: The Alliance Commercial |
$103.50
|
| Rate for Payer: United Healthcare Medicaid |
$70.13
|
| Rate for Payer: WEA Trust Commercial |
$113.85
|
| Rate for Payer: WPS Commercial |
$153.32
|
|
|
Periodic Comprehensive Preventive Medicine 18-39 Years Established
|
Professional
|
Both
|
$280.00
|
|
|
Service Code
|
CPT 99395
|
| Hospital Charge Code |
1122831
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$78.16 |
| Max. Negotiated Rate |
$299.56 |
| Rate for Payer: Aetna Commercial |
$266.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$240.80
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cigna Commercial |
$266.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$78.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$168.00
|
| Rate for Payer: Health EOS Commercial |
$254.80
|
| Rate for Payer: HFN Commercial |
$266.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$299.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$299.56
|
| Rate for Payer: Multiplan Commercial |
$224.00
|
| Rate for Payer: Preferred Network Access Commercial |
$266.00
|
| Rate for Payer: Quartz Beloit One Network |
$123.20
|
| Rate for Payer: Quartz Commercial |
$159.60
|
| Rate for Payer: The Alliance Commercial |
$140.00
|
| Rate for Payer: United Healthcare Medicaid |
$78.16
|
| Rate for Payer: WEA Trust Commercial |
$154.00
|
| Rate for Payer: WPS Commercial |
$207.40
|
|
|
Periodic Comprehensive Preventive Medicine < 1 Year Established
|
Professional
|
Both
|
$187.00
|
|
|
Service Code
|
CPT 99391
|
| Hospital Charge Code |
1122827
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$65.77 |
| Max. Negotiated Rate |
$234.25 |
| Rate for Payer: Aetna Commercial |
$177.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.82
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cigna Commercial |
$177.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$65.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$112.20
|
| Rate for Payer: Health EOS Commercial |
$170.17
|
| Rate for Payer: HFN Commercial |
$177.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$234.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$234.25
|
| Rate for Payer: Multiplan Commercial |
$149.60
|
| Rate for Payer: Preferred Network Access Commercial |
$177.65
|
| Rate for Payer: Quartz Beloit One Network |
$82.28
|
| Rate for Payer: Quartz Commercial |
$106.59
|
| Rate for Payer: The Alliance Commercial |
$93.50
|
| Rate for Payer: United Healthcare Medicaid |
$65.77
|
| Rate for Payer: WEA Trust Commercial |
$102.85
|
| Rate for Payer: WPS Commercial |
$138.51
|
|
|
Periodic Comprehensive Preventive Medicine 40-64 Years Established
|
Professional
|
Both
|
$305.00
|
|
|
Service Code
|
CPT 99396
|
| Hospital Charge Code |
1122832
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$83.07 |
| Max. Negotiated Rate |
$325.36 |
| Rate for Payer: Aetna Commercial |
$289.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$262.30
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cigna Commercial |
$289.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$83.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$183.00
|
| Rate for Payer: Health EOS Commercial |
$277.55
|
| Rate for Payer: HFN Commercial |
$289.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$325.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$325.36
|
| Rate for Payer: Multiplan Commercial |
$244.00
|
| Rate for Payer: Preferred Network Access Commercial |
$289.75
|
| Rate for Payer: Quartz Beloit One Network |
$134.20
|
| Rate for Payer: Quartz Commercial |
$173.85
|
| Rate for Payer: The Alliance Commercial |
$152.50
|
| Rate for Payer: United Healthcare Medicaid |
$83.07
|
| Rate for Payer: WEA Trust Commercial |
$167.75
|
| Rate for Payer: WPS Commercial |
$225.91
|
|
|
Periodic Comprehensive Preventive Medicine 5-11 Years Established
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
CPT 99393
|
| Hospital Charge Code |
1122829
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$69.90 |
| Max. Negotiated Rate |
$256.81 |
| Rate for Payer: Aetna Commercial |
$228.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$206.40
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$228.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$69.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$144.00
|
| Rate for Payer: Health EOS Commercial |
$218.40
|
| Rate for Payer: HFN Commercial |
$228.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$256.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$256.81
|
| Rate for Payer: Multiplan Commercial |
$192.00
|
| Rate for Payer: Preferred Network Access Commercial |
$228.00
|
| Rate for Payer: Quartz Beloit One Network |
$105.60
|
| Rate for Payer: Quartz Commercial |
$136.80
|
| Rate for Payer: The Alliance Commercial |
$120.00
|
| Rate for Payer: United Healthcare Medicaid |
$69.90
|
| Rate for Payer: WEA Trust Commercial |
$132.00
|
| Rate for Payer: WPS Commercial |
$177.77
|
|
|
Periodic Comprehensive Preventive Medicine 65 Years and older Established
|
Professional
|
Both
|
$370.00
|
|
|
Service Code
|
CPT 99397
|
| Hospital Charge Code |
1122833
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$89.57 |
| Max. Negotiated Rate |
$351.50 |
| Rate for Payer: Aetna Commercial |
$351.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$318.20
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cigna Commercial |
$351.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$89.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$222.00
|
| Rate for Payer: Health EOS Commercial |
$336.70
|
| Rate for Payer: HFN Commercial |
$351.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$341.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$341.53
|
| Rate for Payer: Multiplan Commercial |
$296.00
|
| Rate for Payer: Preferred Network Access Commercial |
$351.50
|
| Rate for Payer: Quartz Beloit One Network |
$162.80
|
| Rate for Payer: Quartz Commercial |
$210.90
|
| Rate for Payer: The Alliance Commercial |
$185.00
|
| Rate for Payer: United Healthcare Medicaid |
$89.57
|
| Rate for Payer: WEA Trust Commercial |
$203.50
|
| Rate for Payer: WPS Commercial |
$274.06
|
|
|
PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR
|
Facility
|
IP
|
$59,626.00
|
|
|
Service Code
|
MSDRG 041
|
| Min. Negotiated Rate |
$21,448.10 |
| Max. Negotiated Rate |
$59,626.00 |
| Rate for Payer: Aetna Managed Medicare |
$21,448.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46,785.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$35,860.63
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34,069.94
|
| Rate for Payer: Anthem Medicare Advantage |
$21,448.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21,448.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21,448.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$21,448.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37,820.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$21,448.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43,498.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21,448.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21,448.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$21,448.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$21,448.10
|
| Rate for Payer: NAPHCARE Commercial |
$32,172.15
|
| Rate for Payer: Quartz Medicare Advantage |
$21,448.10
|
| Rate for Payer: The Alliance Commercial |
$59,626.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21,448.10
|
| Rate for Payer: United Healthcare PPO |
$33,864.26
|
| Rate for Payer: Wellcare Medicare |
$21,448.10
|
|
|
PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC
|
Facility
|
IP
|
$102,690.00
|
|
|
Service Code
|
MSDRG 040
|
| Min. Negotiated Rate |
$36,938.73 |
| Max. Negotiated Rate |
$102,690.00 |
| Rate for Payer: Aetna Managed Medicare |
$36,938.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$80,773.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$61,911.85
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$58,820.30
|
| Rate for Payer: Anthem Medicare Advantage |
$36,938.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36,938.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36,938.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$36,938.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$65,295.92
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$36,938.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$75,084.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$36,938.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36,938.73
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$36,938.73
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$36,938.73
|
| Rate for Payer: NAPHCARE Commercial |
$55,408.10
|
| Rate for Payer: Quartz Medicare Advantage |
$36,938.73
|
| Rate for Payer: The Alliance Commercial |
$102,690.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36,938.73
|
| Rate for Payer: United Healthcare PPO |
$58,454.44
|
| Rate for Payer: Wellcare Medicare |
$36,938.73
|
|
|
PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$46,575.00
|
|
|
Service Code
|
MSDRG 042
|
| Min. Negotiated Rate |
$16,753.49 |
| Max. Negotiated Rate |
$46,575.00 |
| Rate for Payer: Aetna Managed Medicare |
$16,753.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$36,505.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27,980.94
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26,583.72
|
| Rate for Payer: Anthem Medicare Advantage |
$16,753.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16,753.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16,753.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16,753.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29,510.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16,753.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33,926.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16,753.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16,753.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16,753.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16,753.49
|
| Rate for Payer: NAPHCARE Commercial |
$25,130.24
|
| Rate for Payer: Quartz Medicare Advantage |
$16,753.49
|
| Rate for Payer: The Alliance Commercial |
$46,575.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16,753.49
|
| Rate for Payer: United Healthcare PPO |
$26,411.90
|
| Rate for Payer: Wellcare Medicare |
$16,753.49
|
|
|
PERIPHERAL VASCULAR DISORDERS WITH CC
|
Facility
|
IP
|
$28,688.00
|
|
|
Service Code
|
MSDRG 300
|
| Min. Negotiated Rate |
$10,319.31 |
| Max. Negotiated Rate |
$28,688.00 |
| Rate for Payer: Aetna Managed Medicare |
$10,319.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22,448.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17,206.67
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16,347.46
|
| Rate for Payer: Anthem Medicare Advantage |
$10,319.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,319.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,319.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,319.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18,147.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,319.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,806.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,319.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,319.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,319.31
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,319.31
|
| Rate for Payer: NAPHCARE Commercial |
$15,478.96
|
| Rate for Payer: Quartz Medicare Advantage |
$10,319.31
|
| Rate for Payer: The Alliance Commercial |
$28,688.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,319.31
|
| Rate for Payer: United Healthcare PPO |
$16,198.13
|
| Rate for Payer: Wellcare Medicare |
$10,319.31
|
|
|
PERIPHERAL VASCULAR DISORDERS WITH MCC
|
Facility
|
IP
|
$42,225.00
|
|
|
Service Code
|
MSDRG 299
|
| Min. Negotiated Rate |
$15,188.93 |
| Max. Negotiated Rate |
$42,225.00 |
| Rate for Payer: Aetna Managed Medicare |
$15,188.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33,148.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25,407.98
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24,139.24
|
| Rate for Payer: Anthem Medicare Advantage |
$15,188.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15,188.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15,188.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15,188.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26,796.77
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15,188.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30,735.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15,188.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15,188.93
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15,188.93
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15,188.93
|
| Rate for Payer: NAPHCARE Commercial |
$22,783.40
|
| Rate for Payer: Quartz Medicare Advantage |
$15,188.93
|
| Rate for Payer: The Alliance Commercial |
$42,225.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15,188.93
|
| Rate for Payer: United Healthcare PPO |
$23,928.29
|
| Rate for Payer: Wellcare Medicare |
$15,188.93
|
|
|
PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$19,191.00
|
|
|
Service Code
|
MSDRG 301
|
| Min. Negotiated Rate |
$6,903.29 |
| Max. Negotiated Rate |
$19,191.00 |
| Rate for Payer: Aetna Managed Medicare |
$6,903.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14,895.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,417.51
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,847.38
|
| Rate for Payer: Anthem Medicare Advantage |
$6,903.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,903.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,903.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,903.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,041.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,903.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,841.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,903.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,903.29
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,903.29
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,903.29
|
| Rate for Payer: NAPHCARE Commercial |
$10,354.94
|
| Rate for Payer: Quartz Medicare Advantage |
$6,903.29
|
| Rate for Payer: The Alliance Commercial |
$19,191.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,903.29
|
| Rate for Payer: United Healthcare PPO |
$10,775.47
|
| Rate for Payer: Wellcare Medicare |
$6,903.29
|
|
|
PERI-PROCEDURAL DEVICE EVALUATION 9328626
|
Professional
|
Both
|
$213.00
|
|
|
Service Code
|
CPT 93286 26
|
| Hospital Charge Code |
3015360
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$25.36 |
| Max. Negotiated Rate |
$202.35 |
| Rate for Payer: Aetna Commercial |
$202.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$183.18
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna Commercial |
$202.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$25.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$127.80
|
| Rate for Payer: Health EOS Commercial |
$193.83
|
| Rate for Payer: HFN Commercial |
$202.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$52.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$52.39
|
| Rate for Payer: Multiplan Commercial |
$170.40
|
| Rate for Payer: Preferred Network Access Commercial |
$202.35
|
| Rate for Payer: Quartz Beloit One Network |
$93.72
|
| Rate for Payer: Quartz Commercial |
$121.41
|
| Rate for Payer: The Alliance Commercial |
$106.50
|
| Rate for Payer: United Healthcare Medicaid |
$25.36
|
| Rate for Payer: WEA Trust Commercial |
$117.15
|
| Rate for Payer: WPS Commercial |
$157.77
|
|
|
PERI-STRIPS DRY WITH VERITAS BAXTER FOR ECHELON 60 PSD6006ECHV
|
Facility
|
OP
|
$2,557.00
|
|
|
Service Code
|
HCPCS Q4100
|
| Hospital Charge Code |
5917673
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$715.96 |
| Max. Negotiated Rate |
$10,228.00 |
| Rate for Payer: Aetna Commercial |
$2,301.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,199.02
|
| Rate for Payer: Aetna Managed Medicare |
$715.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,662.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,278.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,227.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,355.21
|
| Rate for Payer: Cash Price |
$767.10
|
| Rate for Payer: Cigna Commercial |
$2,352.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,430.90
|
| Rate for Payer: Health EOS Commercial |
$2,275.73
|
| Rate for Payer: HFN Commercial |
$2,352.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,917.75
|
| Rate for Payer: Multiplan Commercial |
$2,045.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,534.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,352.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,252.93
|
| Rate for Payer: Quartz Commercial |
$1,662.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,534.20
|
| Rate for Payer: The Alliance Commercial |
$10,228.00
|
| Rate for Payer: WEA Trust Commercial |
$1,406.35
|
| Rate for Payer: WPS Commercial |
$1,893.97
|
|
|
PERI-STRIPS DRY WITH VERITAS BAXTER FOR ECHELON 60 PSD6006ECHV
|
Facility
|
IP
|
$2,557.00
|
|
|
Service Code
|
HCPCS Q4100
|
| Hospital Charge Code |
5917673
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,252.93 |
| Max. Negotiated Rate |
$2,352.44 |
| Rate for Payer: Aetna Commercial |
$2,301.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,199.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,355.21
|
| Rate for Payer: Cash Price |
$767.10
|
| Rate for Payer: Cigna Commercial |
$2,352.44
|
| Rate for Payer: Health EOS Commercial |
$2,275.73
|
| Rate for Payer: HFN Commercial |
$2,352.44
|
| Rate for Payer: Multiplan Commercial |
$2,045.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,534.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,352.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,252.93
|
| Rate for Payer: Quartz Commercial |
$1,534.20
|
| Rate for Payer: WEA Trust Commercial |
$1,406.35
|
| Rate for Payer: WPS Commercial |
$1,893.97
|
|
|
PERITONEAL ADHESIOLYSIS WITH CC
|
Facility
|
IP
|
$56,292.00
|
|
|
Service Code
|
MSDRG 336
|
| Min. Negotiated Rate |
$20,248.86 |
| Max. Negotiated Rate |
$56,292.00 |
| Rate for Payer: Aetna Managed Medicare |
$20,248.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44,267.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33,930.91
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32,236.58
|
| Rate for Payer: Anthem Medicare Advantage |
$20,248.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20,248.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20,248.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$20,248.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35,785.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$20,248.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$41,053.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20,248.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20,248.86
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$20,248.86
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$20,248.86
|
| Rate for Payer: NAPHCARE Commercial |
$30,373.29
|
| Rate for Payer: Quartz Medicare Advantage |
$20,248.86
|
| Rate for Payer: The Alliance Commercial |
$56,292.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20,248.86
|
| Rate for Payer: United Healthcare PPO |
$31,960.56
|
| Rate for Payer: Wellcare Medicare |
$20,248.86
|
|
|
PERITONEAL ADHESIOLYSIS WITH MCC
|
Facility
|
IP
|
$95,365.00
|
|
|
Service Code
|
MSDRG 335
|
| Min. Negotiated Rate |
$34,304.03 |
| Max. Negotiated Rate |
$95,365.00 |
| Rate for Payer: Aetna Managed Medicare |
$34,304.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$75,108.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$57,569.98
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$54,695.24
|
| Rate for Payer: Anthem Medicare Advantage |
$34,304.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$34,304.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$34,304.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$34,304.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$60,716.73
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$34,304.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69,712.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$34,304.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$34,304.03
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$34,304.03
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$34,304.03
|
| Rate for Payer: NAPHCARE Commercial |
$51,456.04
|
| Rate for Payer: Quartz Medicare Advantage |
$34,304.03
|
| Rate for Payer: The Alliance Commercial |
$95,365.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$34,304.03
|
| Rate for Payer: United Healthcare PPO |
$54,272.08
|
| Rate for Payer: Wellcare Medicare |
$34,304.03
|
|
|
PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC
|
Facility
|
IP
|
$40,104.00
|
|
|
Service Code
|
MSDRG 337
|
| Min. Negotiated Rate |
$14,425.77 |
| Max. Negotiated Rate |
$40,104.00 |
| Rate for Payer: United Healthcare PPO |
$22,716.85
|
| Rate for Payer: Wellcare Medicare |
$14,425.77
|
| Rate for Payer: Aetna Managed Medicare |
$14,425.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31,470.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24,121.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22,917.00
|
| Rate for Payer: Anthem Medicare Advantage |
$14,425.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14,425.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14,425.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14,425.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25,439.97
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14,425.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29,179.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14,425.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14,425.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14,425.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14,425.77
|
| Rate for Payer: NAPHCARE Commercial |
$21,638.66
|
| Rate for Payer: Quartz Medicare Advantage |
$14,425.77
|
| Rate for Payer: The Alliance Commercial |
$40,104.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14,425.77
|
|
