|
PERCUTANEOUS CARDIAC INTERVENTION WITH AMI
|
Facility
|
IP
|
$15,958.32
|
|
|
Service Code
|
APR-DRG 1741
|
| Min. Negotiated Rate |
$14,175.18 |
| Max. Negotiated Rate |
$15,958.32 |
| Rate for Payer: Anthem Medicaid |
$15,280.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$15,280.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15,280.97
|
| Rate for Payer: Dean Health Medicaid |
$15,280.97
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14,175.18
|
| Rate for Payer: Managed Health Services Medicaid |
$15,958.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$15,280.97
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$15,280.97
|
| Rate for Payer: United Healthcare Medicaid |
$15,280.97
|
|
|
PERCUTANEOUS CARDIAC INTERVENTION WITH AMI
|
Facility
|
IP
|
$23,762.12
|
|
|
Service Code
|
APR-DRG 1743
|
| Min. Negotiated Rate |
$21,107.00 |
| Max. Negotiated Rate |
$23,762.12 |
| Rate for Payer: Anthem Medicaid |
$22,753.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$22,753.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$22,753.54
|
| Rate for Payer: Dean Health Medicaid |
$22,753.54
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$21,107.00
|
| Rate for Payer: Managed Health Services Medicaid |
$23,762.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$22,753.54
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$22,753.54
|
| Rate for Payer: United Healthcare Medicaid |
$22,753.54
|
|
|
PERCUTANEOUS CARDIAC INTERVENTION WITHOUT AMI
|
Facility
|
IP
|
$27,620.18
|
|
|
Service Code
|
APR-DRG 1753
|
| Min. Negotiated Rate |
$24,533.96 |
| Max. Negotiated Rate |
$27,620.18 |
| Rate for Payer: Anthem Medicaid |
$26,447.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$26,447.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$26,447.84
|
| Rate for Payer: Dean Health Medicaid |
$26,447.84
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$24,533.96
|
| Rate for Payer: Managed Health Services Medicaid |
$27,620.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,447.84
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$26,447.84
|
| Rate for Payer: United Healthcare Medicaid |
$26,447.84
|
|
|
PERCUTANEOUS CARDIAC INTERVENTION WITHOUT AMI
|
Facility
|
IP
|
$37,879.10
|
|
|
Service Code
|
APR-DRG 1754
|
| Min. Negotiated Rate |
$33,646.58 |
| Max. Negotiated Rate |
$37,879.10 |
| Rate for Payer: Anthem Medicaid |
$36,271.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$36,271.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$36,271.32
|
| Rate for Payer: Dean Health Medicaid |
$36,271.32
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$33,646.58
|
| Rate for Payer: Managed Health Services Medicaid |
$37,879.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$36,271.32
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$36,271.32
|
| Rate for Payer: United Healthcare Medicaid |
$36,271.32
|
|
|
PERCUTANEOUS CARDIAC INTERVENTION WITHOUT AMI
|
Facility
|
IP
|
$24,112.85
|
|
|
Service Code
|
APR-DRG 1752
|
| Min. Negotiated Rate |
$21,418.54 |
| Max. Negotiated Rate |
$24,112.85 |
| Rate for Payer: Anthem Medicaid |
$23,089.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$23,089.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$23,089.38
|
| Rate for Payer: Dean Health Medicaid |
$23,089.38
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$21,418.54
|
| Rate for Payer: Managed Health Services Medicaid |
$24,112.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$23,089.38
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$23,089.38
|
| Rate for Payer: United Healthcare Medicaid |
$23,089.38
|
|
|
PERCUTANEOUS CARDIAC INTERVENTION WITHOUT AMI
|
Facility
|
IP
|
$18,238.08
|
|
|
Service Code
|
APR-DRG 1751
|
| Min. Negotiated Rate |
$16,200.20 |
| Max. Negotiated Rate |
$18,238.08 |
| Rate for Payer: Anthem Medicaid |
$17,463.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$17,463.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17,463.97
|
| Rate for Payer: Dean Health Medicaid |
$17,463.97
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$16,200.20
|
| Rate for Payer: Managed Health Services Medicaid |
$18,238.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$17,463.97
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17,463.97
|
| Rate for Payer: United Healthcare Medicaid |
$17,463.97
|
|
|
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITH MCC OR 4+ ARTERIES/INTRALUMINAL DEVICES
|
Facility
|
IP
|
$79,816.88
|
|
|
Service Code
|
MSDRG 321
|
| Min. Negotiated Rate |
$21,343.20 |
| Max. Negotiated Rate |
$79,816.88 |
| Rate for Payer: Aetna Managed Medicare |
$21,343.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$59,365.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$45,503.31
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$43,231.12
|
| Rate for Payer: Anthem Medicare Advantage |
$21,343.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21,343.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21,343.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$21,343.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47,990.50
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$21,343.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58,298.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21,343.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21,343.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$21,343.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$21,343.20
|
| Rate for Payer: NAPHCARE Commercial |
$32,014.80
|
| Rate for Payer: Quartz Medicare Advantage |
$21,343.20
|
| Rate for Payer: The Alliance Commercial |
$79,816.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21,343.20
|
| Rate for Payer: United Healthcare PPO |
$45,386.45
|
| Rate for Payer: Wellcare Medicare |
$21,343.20
|
|
|
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITHOUT MCC
|
Facility
|
IP
|
$50,748.88
|
|
|
Service Code
|
MSDRG 322
|
| Min. Negotiated Rate |
$14,421.73 |
| Max. Negotiated Rate |
$50,748.88 |
| Rate for Payer: Aetna Managed Medicare |
$14,421.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$38,467.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29,484.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28,012.52
|
| Rate for Payer: Anthem Medicare Advantage |
$14,421.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14,421.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14,421.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14,421.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31,096.46
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14,421.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36,978.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14,421.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14,421.73
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14,421.73
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14,421.73
|
| Rate for Payer: NAPHCARE Commercial |
$21,632.60
|
| Rate for Payer: Quartz Medicare Advantage |
$14,421.73
|
| Rate for Payer: The Alliance Commercial |
$50,748.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14,421.73
|
| Rate for Payer: United Healthcare PPO |
$28,788.28
|
| Rate for Payer: Wellcare Medicare |
$14,421.73
|
|
|
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITH MCC
|
Facility
|
IP
|
$65,331.76
|
|
|
Service Code
|
MSDRG 250
|
| Min. Negotiated Rate |
$17,717.36 |
| Max. Negotiated Rate |
$65,331.76 |
| Rate for Payer: Aetna Managed Medicare |
$17,717.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$47,620.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36,500.65
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34,678.00
|
| Rate for Payer: Anthem Medicare Advantage |
$17,717.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17,717.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17,717.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17,717.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38,495.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17,717.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47,674.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17,717.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17,717.36
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17,717.36
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17,717.36
|
| Rate for Payer: NAPHCARE Commercial |
$26,576.04
|
| Rate for Payer: Quartz Medicare Advantage |
$17,717.36
|
| Rate for Payer: The Alliance Commercial |
$65,331.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,717.36
|
| Rate for Payer: United Healthcare PPO |
$37,114.99
|
| Rate for Payer: Wellcare Medicare |
$17,717.36
|
|
|
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITHOUT MCC
|
Facility
|
IP
|
$44,210.40
|
|
|
Service Code
|
MSDRG 251
|
| Min. Negotiated Rate |
$11,951.96 |
| Max. Negotiated Rate |
$44,210.40 |
| Rate for Payer: Aetna Managed Medicare |
$11,951.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32,608.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24,994.38
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23,746.29
|
| Rate for Payer: Anthem Medicare Advantage |
$11,951.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,951.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,951.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,951.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26,360.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,951.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32,182.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,951.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,951.96
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,951.96
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,951.96
|
| Rate for Payer: NAPHCARE Commercial |
$17,927.94
|
| Rate for Payer: Quartz Medicare Advantage |
$11,951.96
|
| Rate for Payer: The Alliance Commercial |
$44,210.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,951.96
|
| Rate for Payer: United Healthcare PPO |
$25,054.36
|
| Rate for Payer: Wellcare Medicare |
$11,951.96
|
|
|
PERCUTANEOUS CORONARY ATHERECTOMY WITH INTRALUMINAL DEVICE WITH MCC
|
Facility
|
IP
|
$75,027.50
|
|
|
Service Code
|
MSDRG 359
|
| Min. Negotiated Rate |
$26,840.27 |
| Max. Negotiated Rate |
$75,027.50 |
| Rate for Payer: Aetna Managed Medicare |
$26,840.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$75,027.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$57,507.97
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$54,636.33
|
| Rate for Payer: Anthem Medicare Advantage |
$26,840.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26,840.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26,840.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$26,840.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$60,651.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$26,840.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$26,840.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26,840.27
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$26,840.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$26,840.27
|
| Rate for Payer: NAPHCARE Commercial |
$40,260.40
|
| Rate for Payer: Quartz Medicare Advantage |
$26,840.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26,840.27
|
| Rate for Payer: Wellcare Medicare |
$26,840.27
|
|
|
PERCUTANEOUS CORONARY ATHERECTOMY WITH INTRALUMINAL DEVICE WITHOUT MCC
|
Facility
|
IP
|
$52,678.09
|
|
|
Service Code
|
MSDRG 360
|
| Min. Negotiated Rate |
$18,995.97 |
| Max. Negotiated Rate |
$52,678.09 |
| Rate for Payer: Aetna Managed Medicare |
$18,995.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$52,678.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$40,377.33
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$38,361.10
|
| Rate for Payer: Anthem Medicare Advantage |
$18,995.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18,995.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18,995.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18,995.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$42,584.34
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18,995.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18,995.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18,995.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18,995.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18,995.97
|
| Rate for Payer: NAPHCARE Commercial |
$28,493.96
|
| Rate for Payer: Quartz Medicare Advantage |
$18,995.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18,995.97
|
| Rate for Payer: Wellcare Medicare |
$18,995.97
|
|
|
PERCUTANEOUS CORONARY ATHERECTOMY WITHOUT INTRALUMINAL DEVICE
|
Facility
|
IP
|
$52,850.47
|
|
|
Service Code
|
MSDRG 318
|
| Min. Negotiated Rate |
$19,056.46 |
| Max. Negotiated Rate |
$52,850.47 |
| Rate for Payer: Aetna Managed Medicare |
$19,056.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$52,850.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$40,509.45
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$38,486.63
|
| Rate for Payer: Anthem Medicare Advantage |
$19,056.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19,056.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19,056.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19,056.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$42,723.68
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19,056.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19,056.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19,056.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19,056.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19,056.46
|
| Rate for Payer: NAPHCARE Commercial |
$28,584.69
|
| Rate for Payer: Quartz Medicare Advantage |
$19,056.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19,056.46
|
| Rate for Payer: Wellcare Medicare |
$19,056.46
|
|
|
PERCUTANEOUS ENDOSCOPIC GASTROSTOMY TUBE PLACEMENT
|
Facility
|
OP
|
$4,957.00
|
|
| Hospital Charge Code |
2960562
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,443.48 |
| Max. Negotiated Rate |
$4,742.86 |
| Rate for Payer: Aetna Commercial |
$4,639.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,433.54
|
| Rate for Payer: Aetna Managed Medicare |
$1,443.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,350.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,577.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,474.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,732.30
|
| Rate for Payer: Cash Price |
$1,487.10
|
| Rate for Payer: Cigna Commercial |
$4,742.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,884.97
|
| Rate for Payer: Health EOS Commercial |
$4,588.20
|
| Rate for Payer: HFN Commercial |
$4,742.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,866.46
|
| Rate for Payer: Multiplan Commercial |
$4,124.22
|
| Rate for Payer: NAPHCARE Commercial |
$3,093.17
|
| Rate for Payer: Preferred Network Access Commercial |
$4,742.86
|
| Rate for Payer: Quartz Beloit One Network |
$2,526.09
|
| Rate for Payer: Quartz Commercial |
$3,350.93
|
| Rate for Payer: Quartz Medicare Advantage |
$3,093.17
|
| Rate for Payer: The Alliance Commercial |
$2,577.64
|
| Rate for Payer: WEA Trust Commercial |
$2,835.40
|
| Rate for Payer: WPS Commercial |
$3,818.38
|
|
|
PERCUTANEOUS ENDOSCOPIC GASTROSTOMY TUBE PLACEMENT
|
Facility
|
IP
|
$4,957.00
|
|
| Hospital Charge Code |
2960562
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,526.09 |
| Max. Negotiated Rate |
$4,742.86 |
| Rate for Payer: Aetna Commercial |
$4,639.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,433.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,732.30
|
| Rate for Payer: Cash Price |
$1,487.10
|
| Rate for Payer: Cigna Commercial |
$4,742.86
|
| Rate for Payer: Health EOS Commercial |
$4,588.20
|
| Rate for Payer: HFN Commercial |
$4,742.86
|
| Rate for Payer: Multiplan Commercial |
$4,124.22
|
| Rate for Payer: Preferred Network Access Commercial |
$4,742.86
|
| Rate for Payer: Quartz Beloit One Network |
$2,526.09
|
| Rate for Payer: Quartz Commercial |
$3,093.17
|
| Rate for Payer: WEA Trust Commercial |
$2,835.40
|
| Rate for Payer: WPS Commercial |
$3,818.38
|
|
|
PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODE ARRAY, EPIDURAL
|
Facility
|
OP
|
$26,827.47
|
|
|
Service Code
|
CPT 63650
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,947.89 |
| Max. Negotiated Rate |
$26,827.47 |
| Rate for Payer: Aetna Managed Medicare |
$6,706.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,394.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,394.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,919.20
|
| Rate for Payer: Anthem Medicare Advantage |
$6,706.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,706.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,706.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,706.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,706.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24,949.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,706.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,706.87
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,706.87
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,706.87
|
| Rate for Payer: NAPHCARE Commercial |
$10,060.30
|
| Rate for Payer: Quartz Medicare Advantage |
$6,706.87
|
| Rate for Payer: The Alliance Commercial |
$26,827.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,706.87
|
| Rate for Payer: United Healthcare PPO |
$9,979.84
|
| Rate for Payer: Wellcare Medicare |
$6,706.87
|
|
|
PERCUTANEOUS INSERTION KIT 2.4MM PUSHLOCK AR-2922PK
|
Facility
|
OP
|
$3,222.00
|
|
| Hospital Charge Code |
5659714
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$938.25 |
| Max. Negotiated Rate |
$3,082.81 |
| Rate for Payer: Aetna Commercial |
$3,015.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,881.76
|
| Rate for Payer: Aetna Managed Medicare |
$938.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,178.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,675.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,608.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,775.97
|
| Rate for Payer: Cash Price |
$966.60
|
| Rate for Payer: Cigna Commercial |
$3,082.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,875.20
|
| Rate for Payer: Health EOS Commercial |
$2,982.28
|
| Rate for Payer: HFN Commercial |
$3,082.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,513.16
|
| Rate for Payer: Multiplan Commercial |
$2,680.70
|
| Rate for Payer: NAPHCARE Commercial |
$2,010.53
|
| Rate for Payer: Preferred Network Access Commercial |
$3,082.81
|
| Rate for Payer: Quartz Beloit One Network |
$1,641.93
|
| Rate for Payer: Quartz Commercial |
$2,178.07
|
| Rate for Payer: Quartz Medicare Advantage |
$2,010.53
|
| Rate for Payer: The Alliance Commercial |
$1,675.44
|
| Rate for Payer: WEA Trust Commercial |
$1,842.98
|
| Rate for Payer: WPS Commercial |
$2,481.91
|
|
|
PERCUTANEOUS INSERTION KIT 2.4MM PUSHLOCK AR-2922PK
|
Facility
|
IP
|
$3,222.00
|
|
| Hospital Charge Code |
5659714
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,641.93 |
| Max. Negotiated Rate |
$3,082.81 |
| Rate for Payer: Aetna Commercial |
$3,015.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,881.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,775.97
|
| Rate for Payer: Cash Price |
$966.60
|
| Rate for Payer: Cigna Commercial |
$3,082.81
|
| Rate for Payer: Health EOS Commercial |
$2,982.28
|
| Rate for Payer: HFN Commercial |
$3,082.81
|
| Rate for Payer: Multiplan Commercial |
$2,680.70
|
| Rate for Payer: Preferred Network Access Commercial |
$3,082.81
|
| Rate for Payer: Quartz Beloit One Network |
$1,641.93
|
| Rate for Payer: Quartz Commercial |
$2,010.53
|
| Rate for Payer: WEA Trust Commercial |
$1,842.98
|
| Rate for Payer: WPS Commercial |
$2,481.91
|
|
|
PERCUTANEOUS INSERTION KIT 2.9MM PUSHLOCK AR-1923PK
|
Facility
|
IP
|
$2,164.00
|
|
| Hospital Charge Code |
5977660
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,102.77 |
| Max. Negotiated Rate |
$2,070.52 |
| Rate for Payer: Aetna Commercial |
$2,025.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,935.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,192.80
|
| Rate for Payer: Cash Price |
$649.20
|
| Rate for Payer: Cigna Commercial |
$2,070.52
|
| Rate for Payer: Health EOS Commercial |
$2,003.00
|
| Rate for Payer: HFN Commercial |
$2,070.52
|
| Rate for Payer: Multiplan Commercial |
$1,800.45
|
| Rate for Payer: Preferred Network Access Commercial |
$2,070.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,102.77
|
| Rate for Payer: Quartz Commercial |
$1,350.34
|
| Rate for Payer: WEA Trust Commercial |
$1,237.81
|
| Rate for Payer: WPS Commercial |
$1,666.93
|
|
|
PERCUTANEOUS INSERTION KIT 2.9MM PUSHLOCK AR-1923PK
|
Facility
|
OP
|
$2,164.00
|
|
| Hospital Charge Code |
5977660
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$630.16 |
| Max. Negotiated Rate |
$2,070.52 |
| Rate for Payer: Aetna Commercial |
$2,025.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,935.48
|
| Rate for Payer: Aetna Managed Medicare |
$630.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,462.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,125.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,080.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,192.80
|
| Rate for Payer: Cash Price |
$649.20
|
| Rate for Payer: Cigna Commercial |
$2,070.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,259.45
|
| Rate for Payer: Health EOS Commercial |
$2,003.00
|
| Rate for Payer: HFN Commercial |
$2,070.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,687.92
|
| Rate for Payer: Multiplan Commercial |
$1,800.45
|
| Rate for Payer: NAPHCARE Commercial |
$1,350.34
|
| Rate for Payer: Preferred Network Access Commercial |
$2,070.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,102.77
|
| Rate for Payer: Quartz Commercial |
$1,462.86
|
| Rate for Payer: Quartz Medicare Advantage |
$1,350.34
|
| Rate for Payer: The Alliance Commercial |
$1,125.28
|
| Rate for Payer: WEA Trust Commercial |
$1,237.81
|
| Rate for Payer: WPS Commercial |
$1,666.93
|
|
|
PERCUTANEOUS INTRA-ABDOMINAL OR INTRATHORACIC VASCULAR PROCEDURES
|
Facility
|
OP
|
$1,107.20
|
|
|
Service Code
|
EAPG 00122
|
| Min. Negotiated Rate |
$1,064.62 |
| Max. Negotiated Rate |
$1,107.20 |
| Rate for Payer: Anthem Medicaid |
$1,064.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$1,064.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,064.62
|
| Rate for Payer: Dean Health Medicaid |
$1,064.62
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$1,064.62
|
| Rate for Payer: Managed Health Services Medicaid |
$1,107.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,064.62
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$1,064.62
|
| Rate for Payer: United Healthcare Medicaid |
$1,064.62
|
|
|
PERCUTANEOUS INTRACRANIAL AND EXTRACRANIAL VASCULAR PROCEDURES
|
Facility
|
IP
|
$30,513.72
|
|
|
Service Code
|
APR-DRG 0303
|
| Min. Negotiated Rate |
$27,104.19 |
| Max. Negotiated Rate |
$30,513.72 |
| Rate for Payer: Anthem Medicaid |
$29,218.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$29,218.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$29,218.57
|
| Rate for Payer: Dean Health Medicaid |
$29,218.57
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$27,104.19
|
| Rate for Payer: Managed Health Services Medicaid |
$30,513.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$29,218.57
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$29,218.57
|
| Rate for Payer: United Healthcare Medicaid |
$29,218.57
|
|
|
PERCUTANEOUS INTRACRANIAL AND EXTRACRANIAL VASCULAR PROCEDURES
|
Facility
|
OP
|
$1,886.83
|
|
|
Service Code
|
EAPG 00265
|
| Min. Negotiated Rate |
$1,814.26 |
| Max. Negotiated Rate |
$1,886.83 |
| Rate for Payer: Anthem Medicaid |
$1,814.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$1,814.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,814.26
|
| Rate for Payer: Dean Health Medicaid |
$1,814.26
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$1,814.26
|
| Rate for Payer: Managed Health Services Medicaid |
$1,886.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,814.26
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$1,814.26
|
| Rate for Payer: United Healthcare Medicaid |
$1,814.26
|
|
|
PERCUTANEOUS INTRACRANIAL AND EXTRACRANIAL VASCULAR PROCEDURES
|
Facility
|
IP
|
$41,211.06
|
|
|
Service Code
|
APR-DRG 0304
|
| Min. Negotiated Rate |
$36,606.23 |
| Max. Negotiated Rate |
$41,211.06 |
| Rate for Payer: Anthem Medicaid |
$39,461.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$39,461.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$39,461.86
|
| Rate for Payer: Dean Health Medicaid |
$39,461.86
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$36,606.23
|
| Rate for Payer: Managed Health Services Medicaid |
$41,211.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$39,461.86
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$39,461.86
|
| Rate for Payer: United Healthcare Medicaid |
$39,461.86
|
|
|
PERCUTANEOUS INTRACRANIAL AND EXTRACRANIAL VASCULAR PROCEDURES
|
Facility
|
IP
|
$23,849.80
|
|
|
Service Code
|
APR-DRG 0302
|
| Min. Negotiated Rate |
$21,184.88 |
| Max. Negotiated Rate |
$23,849.80 |
| Rate for Payer: Anthem Medicaid |
$22,837.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$22,837.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$22,837.50
|
| Rate for Payer: Dean Health Medicaid |
$22,837.50
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$21,184.88
|
| Rate for Payer: Managed Health Services Medicaid |
$23,849.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$22,837.50
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$22,837.50
|
| Rate for Payer: United Healthcare Medicaid |
$22,837.50
|
|
