|
PEN ISOLATOR TRANSPOLAR MAX1
|
Facility
|
OP
|
$15,713.00
|
|
| Hospital Charge Code |
2964754
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,575.63 |
| Max. Negotiated Rate |
$15,034.20 |
| Rate for Payer: Aetna Commercial |
$14,707.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,053.71
|
| Rate for Payer: Aetna Managed Medicare |
$4,575.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,621.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,170.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,843.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,661.01
|
| Rate for Payer: Cash Price |
$4,713.90
|
| Rate for Payer: Cigna Commercial |
$15,034.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,144.97
|
| Rate for Payer: Health EOS Commercial |
$14,543.95
|
| Rate for Payer: HFN Commercial |
$15,034.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,256.14
|
| Rate for Payer: Multiplan Commercial |
$13,073.22
|
| Rate for Payer: NAPHCARE Commercial |
$9,804.91
|
| Rate for Payer: Preferred Network Access Commercial |
$15,034.20
|
| Rate for Payer: Quartz Beloit One Network |
$8,007.34
|
| Rate for Payer: Quartz Commercial |
$10,621.99
|
| Rate for Payer: Quartz Medicare Advantage |
$9,804.91
|
| Rate for Payer: The Alliance Commercial |
$8,170.76
|
| Rate for Payer: WEA Trust Commercial |
$8,987.84
|
| Rate for Payer: WPS Commercial |
$12,103.72
|
|
|
PEN ISOLATOR TRANSPOLAR MAX1
|
Facility
|
IP
|
$15,713.00
|
|
| Hospital Charge Code |
2964754
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8,007.34 |
| Max. Negotiated Rate |
$15,034.20 |
| Rate for Payer: Aetna Commercial |
$14,707.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,053.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,661.01
|
| Rate for Payer: Cash Price |
$4,713.90
|
| Rate for Payer: Cigna Commercial |
$15,034.20
|
| Rate for Payer: Health EOS Commercial |
$14,543.95
|
| Rate for Payer: HFN Commercial |
$15,034.20
|
| Rate for Payer: Multiplan Commercial |
$13,073.22
|
| Rate for Payer: Preferred Network Access Commercial |
$15,034.20
|
| Rate for Payer: Quartz Beloit One Network |
$8,007.34
|
| Rate for Payer: Quartz Commercial |
$9,804.91
|
| Rate for Payer: WEA Trust Commercial |
$8,987.84
|
| Rate for Payer: WPS Commercial |
$12,103.72
|
|
|
PENIS PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$60,354.32
|
|
|
Service Code
|
MSDRG 709
|
| Min. Negotiated Rate |
$18,328.17 |
| Max. Negotiated Rate |
$60,354.32 |
| Rate for Payer: Aetna Managed Medicare |
$18,328.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50,775.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$38,918.98
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$36,975.57
|
| Rate for Payer: Anthem Medicare Advantage |
$18,328.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18,328.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18,328.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18,328.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41,046.27
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18,328.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42,993.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18,328.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18,328.17
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18,328.17
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18,328.17
|
| Rate for Payer: NAPHCARE Commercial |
$27,492.25
|
| Rate for Payer: Quartz Medicare Advantage |
$18,328.17
|
| Rate for Payer: The Alliance Commercial |
$60,354.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18,328.17
|
| Rate for Payer: United Healthcare PPO |
$33,471.07
|
| Rate for Payer: Wellcare Medicare |
$18,328.17
|
|
|
PENIS PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$36,202.40
|
|
|
Service Code
|
MSDRG 710
|
| Min. Negotiated Rate |
$11,237.45 |
| Max. Negotiated Rate |
$36,202.40 |
| Rate for Payer: Aetna Managed Medicare |
$11,237.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30,573.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23,434.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22,263.83
|
| Rate for Payer: Anthem Medicare Advantage |
$11,237.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,237.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,237.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,237.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24,714.90
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,237.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25,031.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,237.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,237.45
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,237.45
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,237.45
|
| Rate for Payer: NAPHCARE Commercial |
$16,856.17
|
| Rate for Payer: Quartz Medicare Advantage |
$11,237.45
|
| Rate for Payer: The Alliance Commercial |
$36,202.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,237.45
|
| Rate for Payer: United Healthcare PPO |
$19,487.43
|
| Rate for Payer: Wellcare Medicare |
$11,237.45
|
|
|
PENIS STUDY 54240
|
Professional
|
Both
|
$383.00
|
|
|
Service Code
|
CPT 54240
|
| Hospital Charge Code |
3015030
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$110.17 |
| Max. Negotiated Rate |
$495.75 |
| Rate for Payer: Aetna Commercial |
$378.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$342.56
|
| Rate for Payer: Aetna Managed Medicare |
$110.17
|
| Rate for Payer: Anthem Medicare Advantage |
$110.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$110.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$110.17
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Cigna Commercial |
$378.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$199.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$110.17
|
| Rate for Payer: Health EOS Commercial |
$362.47
|
| Rate for Payer: HFN Commercial |
$378.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$363.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$363.33
|
| Rate for Payer: Independent Care Health Plan Medicare |
$110.17
|
| Rate for Payer: Multiplan Commercial |
$318.66
|
| Rate for Payer: NAPHCARE Commercial |
$165.25
|
| Rate for Payer: Preferred Network Access Commercial |
$378.40
|
| Rate for Payer: Quartz Beloit One Network |
$175.26
|
| Rate for Payer: Quartz Commercial |
$227.04
|
| Rate for Payer: Quartz Medicare Advantage |
$110.17
|
| Rate for Payer: The Alliance Commercial |
$468.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$110.17
|
| Rate for Payer: WEA Trust Commercial |
$219.08
|
| Rate for Payer: WPS Commercial |
$495.75
|
|
|
PENIS, TESTES AND SCROTAL PROCEDURES
|
Facility
|
IP
|
$13,240.15
|
|
|
Service Code
|
APR-DRG 4832
|
| 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
|
|
|
PENIS, TESTES AND SCROTAL PROCEDURES
|
Facility
|
IP
|
$34,985.56
|
|
|
Service Code
|
APR-DRG 4834
|
| Min. Negotiated Rate |
$31,076.35 |
| Max. Negotiated Rate |
$34,985.56 |
| Rate for Payer: Anthem Medicaid |
$33,500.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$33,500.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$33,500.60
|
| Rate for Payer: Dean Health Medicaid |
$33,500.60
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$31,076.35
|
| Rate for Payer: Managed Health Services Medicaid |
$34,985.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$33,500.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$33,500.60
|
| Rate for Payer: United Healthcare Medicaid |
$33,500.60
|
|
|
PENIS, TESTES AND SCROTAL PROCEDURES
|
Facility
|
IP
|
$19,991.75
|
|
|
Service Code
|
APR-DRG 4833
|
| Min. Negotiated Rate |
$17,757.92 |
| Max. Negotiated Rate |
$19,991.75 |
| Rate for Payer: Anthem Medicaid |
$19,143.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$19,143.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19,143.20
|
| Rate for Payer: Dean Health Medicaid |
$19,143.20
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17,757.92
|
| Rate for Payer: Managed Health Services Medicaid |
$19,991.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$19,143.20
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19,143.20
|
| Rate for Payer: United Healthcare Medicaid |
$19,143.20
|
|
|
PENIS, TESTES AND SCROTAL PROCEDURES
|
Facility
|
IP
|
$8,680.63
|
|
|
Service Code
|
APR-DRG 4831
|
| Min. Negotiated Rate |
$7,710.67 |
| Max. Negotiated Rate |
$8,680.63 |
| Rate for Payer: Anthem Medicaid |
$8,312.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$8,312.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8,312.18
|
| Rate for Payer: Dean Health Medicaid |
$8,312.18
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$7,710.67
|
| Rate for Payer: Managed Health Services Medicaid |
$8,680.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,312.18
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8,312.18
|
| Rate for Payer: United Healthcare Medicaid |
$8,312.18
|
|
|
PEP therapy
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
CPT 94667
|
| Hospital Charge Code |
2989712
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$69.39 |
| Max. Negotiated Rate |
$560.06 |
| Rate for Payer: Aetna Commercial |
$130.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$124.32
|
| Rate for Payer: Aetna Managed Medicare |
$140.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$93.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$72.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$69.39
|
| Rate for Payer: Anthem Medicare Advantage |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$76.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$140.02
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cigna Commercial |
$133.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$140.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$80.90
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$140.02
|
| Rate for Payer: Health EOS Commercial |
$128.66
|
| Rate for Payer: HFN Commercial |
$133.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$520.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$140.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$140.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$140.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$140.02
|
| Rate for Payer: Multiplan Commercial |
$115.65
|
| Rate for Payer: NAPHCARE Commercial |
$210.02
|
| Rate for Payer: Preferred Network Access Commercial |
$133.00
|
| Rate for Payer: Quartz Beloit One Network |
$70.83
|
| Rate for Payer: Quartz Commercial |
$93.96
|
| Rate for Payer: Quartz Medicare Advantage |
$140.02
|
| Rate for Payer: The Alliance Commercial |
$560.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.02
|
| Rate for Payer: United Healthcare PPO |
$108.42
|
| Rate for Payer: WEA Trust Commercial |
$79.51
|
| Rate for Payer: Wellcare Medicare |
$140.02
|
| Rate for Payer: WPS Commercial |
$107.07
|
|
|
PEP therapy
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
CPT 94667
|
| Hospital Charge Code |
2989712
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$70.83 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Aetna Commercial |
$130.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$124.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$76.62
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cigna Commercial |
$133.00
|
| Rate for Payer: Health EOS Commercial |
$128.66
|
| Rate for Payer: HFN Commercial |
$133.00
|
| Rate for Payer: Multiplan Commercial |
$115.65
|
| Rate for Payer: Preferred Network Access Commercial |
$133.00
|
| Rate for Payer: Quartz Beloit One Network |
$70.83
|
| Rate for Payer: Quartz Commercial |
$86.74
|
| Rate for Payer: WEA Trust Commercial |
$79.51
|
| Rate for Payer: WPS Commercial |
$107.07
|
|
|
PEPTIC ULCER AND GASTRITIS
|
Facility
|
OP
|
$111.38
|
|
|
Service Code
|
EAPG 00621
|
| Min. Negotiated Rate |
$107.09 |
| Max. Negotiated Rate |
$111.38 |
| Rate for Payer: Anthem Medicaid |
$107.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$107.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$107.09
|
| Rate for Payer: Dean Health Medicaid |
$107.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$107.09
|
| Rate for Payer: Managed Health Services Medicaid |
$111.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$107.09
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$107.09
|
| Rate for Payer: United Healthcare Medicaid |
$107.09
|
|
|
PEPTIC ULCER AND GASTRITIS
|
Facility
|
IP
|
$20,956.26
|
|
|
Service Code
|
APR-DRG 2414
|
| Min. Negotiated Rate |
$18,614.66 |
| Max. Negotiated Rate |
$20,956.26 |
| Rate for Payer: Anthem Medicaid |
$20,066.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$20,066.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$20,066.77
|
| Rate for Payer: Dean Health Medicaid |
$20,066.77
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18,614.66
|
| Rate for Payer: Managed Health Services Medicaid |
$20,956.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$20,066.77
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$20,066.77
|
| Rate for Payer: United Healthcare Medicaid |
$20,066.77
|
|
|
PEPTIC ULCER AND GASTRITIS
|
Facility
|
IP
|
$7,453.06
|
|
|
Service Code
|
APR-DRG 2412
|
| Min. Negotiated Rate |
$6,620.28 |
| Max. Negotiated Rate |
$7,453.06 |
| Rate for Payer: Anthem Medicaid |
$7,136.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$7,136.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7,136.72
|
| Rate for Payer: Dean Health Medicaid |
$7,136.72
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6,620.28
|
| Rate for Payer: Managed Health Services Medicaid |
$7,453.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,136.72
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$7,136.72
|
| Rate for Payer: United Healthcare Medicaid |
$7,136.72
|
|
|
PEPTIC ULCER AND GASTRITIS
|
Facility
|
IP
|
$6,137.82
|
|
|
Service Code
|
APR-DRG 2411
|
| Min. Negotiated Rate |
$5,451.99 |
| Max. Negotiated Rate |
$6,137.82 |
| Rate for Payer: Anthem Medicaid |
$5,877.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$5,877.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,877.30
|
| Rate for Payer: Dean Health Medicaid |
$5,877.30
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5,451.99
|
| Rate for Payer: Managed Health Services Medicaid |
$6,137.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,877.30
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5,877.30
|
| Rate for Payer: United Healthcare Medicaid |
$5,877.30
|
|
|
PEPTIC ULCER AND GASTRITIS
|
Facility
|
IP
|
$11,048.07
|
|
|
Service Code
|
APR-DRG 2413
|
| Min. Negotiated Rate |
$9,813.59 |
| Max. Negotiated Rate |
$11,048.07 |
| Rate for Payer: Anthem Medicaid |
$10,579.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$10,579.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10,579.14
|
| Rate for Payer: Dean Health Medicaid |
$10,579.14
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9,813.59
|
| Rate for Payer: Managed Health Services Medicaid |
$11,048.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,579.14
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$10,579.14
|
| Rate for Payer: United Healthcare Medicaid |
$10,579.14
|
|
|
Perclose
|
Facility
|
IP
|
$2,646.00
|
|
| Hospital Charge Code |
5273178
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,348.40 |
| Max. Negotiated Rate |
$2,531.69 |
| Rate for Payer: Aetna Commercial |
$2,476.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,366.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,458.48
|
| Rate for Payer: Cash Price |
$793.80
|
| Rate for Payer: Cigna Commercial |
$2,531.69
|
| Rate for Payer: Health EOS Commercial |
$2,449.14
|
| Rate for Payer: HFN Commercial |
$2,531.69
|
| Rate for Payer: Multiplan Commercial |
$2,201.47
|
| Rate for Payer: Preferred Network Access Commercial |
$2,531.69
|
| Rate for Payer: Quartz Beloit One Network |
$1,348.40
|
| Rate for Payer: Quartz Commercial |
$1,651.10
|
| Rate for Payer: WEA Trust Commercial |
$1,513.51
|
| Rate for Payer: WPS Commercial |
$2,038.21
|
|
|
Perclose
|
Facility
|
OP
|
$2,646.00
|
|
| Hospital Charge Code |
5273178
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$770.52 |
| Max. Negotiated Rate |
$2,531.69 |
| Rate for Payer: Aetna Commercial |
$2,476.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,366.58
|
| Rate for Payer: Aetna Managed Medicare |
$770.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,788.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,375.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,320.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,458.48
|
| Rate for Payer: Cash Price |
$793.80
|
| Rate for Payer: Cigna Commercial |
$2,531.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,539.97
|
| Rate for Payer: Health EOS Commercial |
$2,449.14
|
| Rate for Payer: HFN Commercial |
$2,531.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,063.88
|
| Rate for Payer: Multiplan Commercial |
$2,201.47
|
| Rate for Payer: NAPHCARE Commercial |
$1,651.10
|
| Rate for Payer: Preferred Network Access Commercial |
$2,531.69
|
| Rate for Payer: Quartz Beloit One Network |
$1,348.40
|
| Rate for Payer: Quartz Commercial |
$1,788.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,651.10
|
| Rate for Payer: The Alliance Commercial |
$1,375.92
|
| Rate for Payer: WEA Trust Commercial |
$1,513.51
|
| Rate for Payer: WPS Commercial |
$2,038.21
|
|
|
Perc Test with Venom 95017
|
Professional
|
Both
|
$142.00
|
|
|
Service Code
|
CPT 95017
|
| Hospital Charge Code |
3353531
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2.87 |
| Max. Negotiated Rate |
$140.30 |
| Rate for Payer: Aetna Commercial |
$140.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$127.00
|
| Rate for Payer: Aetna Managed Medicare |
$2.87
|
| Rate for Payer: Anthem Medicare Advantage |
$2.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2.87
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cigna Commercial |
$140.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.87
|
| Rate for Payer: Health EOS Commercial |
$134.39
|
| Rate for Payer: HFN Commercial |
$140.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$29.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2.87
|
| Rate for Payer: Multiplan Commercial |
$118.14
|
| Rate for Payer: NAPHCARE Commercial |
$4.31
|
| Rate for Payer: Preferred Network Access Commercial |
$140.30
|
| Rate for Payer: Quartz Beloit One Network |
$64.98
|
| Rate for Payer: Quartz Commercial |
$84.18
|
| Rate for Payer: Quartz Medicare Advantage |
$2.87
|
| Rate for Payer: The Alliance Commercial |
$7.18
|
| Rate for Payer: United Healthcare Medicaid |
$7.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.87
|
| Rate for Payer: WEA Trust Commercial |
$81.22
|
| Rate for Payer: WPS Commercial |
$11.48
|
|
|
PERCUTANEOUS ACCESS NEEDLE 18GA X 20CM M0067001220
|
Facility
|
OP
|
$624.00
|
|
|
Service Code
|
HCPCS A4215
|
| Hospital Charge Code |
5415302
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$181.71 |
| Max. Negotiated Rate |
$597.04 |
| Rate for Payer: Aetna Commercial |
$584.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$558.11
|
| Rate for Payer: Aetna Managed Medicare |
$181.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$421.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$324.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$311.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$343.95
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cigna Commercial |
$597.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$363.17
|
| Rate for Payer: Health EOS Commercial |
$577.57
|
| Rate for Payer: HFN Commercial |
$597.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$486.72
|
| Rate for Payer: Multiplan Commercial |
$519.17
|
| Rate for Payer: NAPHCARE Commercial |
$389.38
|
| Rate for Payer: Preferred Network Access Commercial |
$597.04
|
| Rate for Payer: Quartz Beloit One Network |
$317.99
|
| Rate for Payer: Quartz Commercial |
$421.82
|
| Rate for Payer: Quartz Medicare Advantage |
$389.38
|
| Rate for Payer: The Alliance Commercial |
$324.48
|
| Rate for Payer: WEA Trust Commercial |
$356.93
|
| Rate for Payer: WPS Commercial |
$480.67
|
|
|
PERCUTANEOUS ACCESS NEEDLE 18GA X 20CM M0067001220
|
Facility
|
IP
|
$624.00
|
|
|
Service Code
|
HCPCS A4215
|
| Hospital Charge Code |
5415302
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$317.99 |
| Max. Negotiated Rate |
$597.04 |
| Rate for Payer: Aetna Commercial |
$584.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$558.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$343.95
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cigna Commercial |
$597.04
|
| Rate for Payer: Health EOS Commercial |
$577.57
|
| Rate for Payer: HFN Commercial |
$597.04
|
| Rate for Payer: Multiplan Commercial |
$519.17
|
| Rate for Payer: Preferred Network Access Commercial |
$597.04
|
| Rate for Payer: Quartz Beloit One Network |
$317.99
|
| Rate for Payer: Quartz Commercial |
$389.38
|
| Rate for Payer: WEA Trust Commercial |
$356.93
|
| Rate for Payer: WPS Commercial |
$480.67
|
|
|
PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC
|
Facility
|
IP
|
$108,083.04
|
|
|
Service Code
|
MSDRG 273
|
| Min. Negotiated Rate |
$32,100.67 |
| Max. Negotiated Rate |
$108,083.04 |
| Rate for Payer: Aetna Managed Medicare |
$32,100.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$90,015.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$68,995.85
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$65,550.56
|
| Rate for Payer: Anthem Medicare Advantage |
$32,100.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$32,100.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$32,100.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$32,100.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$72,767.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$32,100.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$79,031.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$32,100.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$32,100.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$32,100.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$32,100.67
|
| Rate for Payer: NAPHCARE Commercial |
$48,151.01
|
| Rate for Payer: Quartz Medicare Advantage |
$32,100.67
|
| Rate for Payer: The Alliance Commercial |
$108,083.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32,100.67
|
| Rate for Payer: United Healthcare PPO |
$61,526.77
|
| Rate for Payer: Wellcare Medicare |
$32,100.67
|
|
|
PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC
|
Facility
|
IP
|
$89,939.20
|
|
|
Service Code
|
MSDRG 274
|
| Min. Negotiated Rate |
$25,715.28 |
| Max. Negotiated Rate |
$89,939.20 |
| Rate for Payer: Aetna Managed Medicare |
$25,715.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$71,822.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$55,051.18
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$52,302.22
|
| Rate for Payer: Anthem Medicare Advantage |
$25,715.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25,715.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25,715.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$25,715.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$58,060.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$25,715.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65,723.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$25,715.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25,715.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$25,715.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$25,715.28
|
| Rate for Payer: NAPHCARE Commercial |
$38,572.92
|
| Rate for Payer: Quartz Medicare Advantage |
$25,715.28
|
| Rate for Payer: The Alliance Commercial |
$89,939.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25,715.28
|
| Rate for Payer: United Healthcare PPO |
$51,166.52
|
| Rate for Payer: Wellcare Medicare |
$25,715.28
|
|
|
PERCUTANEOUS CARDIAC INTERVENTION WITH AMI
|
Facility
|
IP
|
$33,670.31
|
|
|
Service Code
|
APR-DRG 1744
|
| Min. Negotiated Rate |
$29,908.07 |
| Max. Negotiated Rate |
$33,670.31 |
| Rate for Payer: Anthem Medicaid |
$32,241.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$32,241.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$32,241.18
|
| Rate for Payer: Dean Health Medicaid |
$32,241.18
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$29,908.07
|
| Rate for Payer: Managed Health Services Medicaid |
$33,670.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$32,241.18
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$32,241.18
|
| Rate for Payer: United Healthcare Medicaid |
$32,241.18
|
|
|
PERCUTANEOUS CARDIAC INTERVENTION WITH AMI
|
Facility
|
IP
|
$20,167.11
|
|
|
Service Code
|
APR-DRG 1742
|
| Min. Negotiated Rate |
$17,913.69 |
| Max. Negotiated Rate |
$20,167.11 |
| Rate for Payer: Anthem Medicaid |
$19,311.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$19,311.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19,311.12
|
| Rate for Payer: Dean Health Medicaid |
$19,311.12
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17,913.69
|
| Rate for Payer: Managed Health Services Medicaid |
$20,167.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$19,311.12
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19,311.12
|
| Rate for Payer: United Healthcare Medicaid |
$19,311.12
|
|
