|
PERCUTANEOUS INTRACRANIAL AND EXTRACRANIAL VASCULAR PROCEDURES
|
Facility
|
IP
|
$13,853.93
|
|
|
Service Code
|
APR-DRG 0301
|
| Min. Negotiated Rate |
$12,305.92 |
| Max. Negotiated Rate |
$13,853.93 |
| Rate for Payer: Anthem Medicaid |
$13,265.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$13,265.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13,265.90
|
| Rate for Payer: Dean Health Medicaid |
$13,265.90
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12,305.92
|
| Rate for Payer: Managed Health Services Medicaid |
$13,853.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,265.90
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13,265.90
|
| Rate for Payer: United Healthcare Medicaid |
$13,265.90
|
|
|
PERCUTANEOUS NEEDLE ACCESS NAVIGUIDE 18GA X 20CM M0067001330
|
Facility
|
OP
|
$780.00
|
|
| Hospital Charge Code |
5459835
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.14 |
| Max. Negotiated Rate |
$746.30 |
| Rate for Payer: Aetna Commercial |
$730.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$697.63
|
| Rate for Payer: Aetna Managed Medicare |
$227.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$527.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$405.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$389.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$429.94
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cigna Commercial |
$746.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$453.96
|
| Rate for Payer: Health EOS Commercial |
$721.97
|
| Rate for Payer: HFN Commercial |
$746.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$608.40
|
| Rate for Payer: Multiplan Commercial |
$648.96
|
| Rate for Payer: NAPHCARE Commercial |
$486.72
|
| Rate for Payer: Preferred Network Access Commercial |
$746.30
|
| Rate for Payer: Quartz Beloit One Network |
$397.49
|
| Rate for Payer: Quartz Commercial |
$527.28
|
| Rate for Payer: Quartz Medicare Advantage |
$486.72
|
| Rate for Payer: The Alliance Commercial |
$405.60
|
| Rate for Payer: WEA Trust Commercial |
$446.16
|
| Rate for Payer: WPS Commercial |
$600.83
|
|
|
PERCUTANEOUS NEEDLE ACCESS NAVIGUIDE 18GA X 20CM M0067001330
|
Facility
|
IP
|
$780.00
|
|
| Hospital Charge Code |
5459835
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$397.49 |
| Max. Negotiated Rate |
$746.30 |
| Rate for Payer: Aetna Commercial |
$730.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$697.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$429.94
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cigna Commercial |
$746.30
|
| Rate for Payer: Health EOS Commercial |
$721.97
|
| Rate for Payer: HFN Commercial |
$746.30
|
| Rate for Payer: Multiplan Commercial |
$648.96
|
| Rate for Payer: Preferred Network Access Commercial |
$746.30
|
| Rate for Payer: Quartz Beloit One Network |
$397.49
|
| Rate for Payer: Quartz Commercial |
$486.72
|
| Rate for Payer: WEA Trust Commercial |
$446.16
|
| Rate for Payer: WPS Commercial |
$600.83
|
|
|
PERCUTANEOUS PINNING, HAND/WRIST/FINGER FRACTURE
|
Facility
|
IP
|
$1,757.00
|
|
| Hospital Charge Code |
2950338
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$895.37 |
| Max. Negotiated Rate |
$1,681.10 |
| Rate for Payer: Aetna Commercial |
$1,644.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,571.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$968.46
|
| Rate for Payer: Cash Price |
$527.10
|
| Rate for Payer: Cigna Commercial |
$1,681.10
|
| Rate for Payer: Health EOS Commercial |
$1,626.28
|
| Rate for Payer: HFN Commercial |
$1,681.10
|
| Rate for Payer: Multiplan Commercial |
$1,461.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,681.10
|
| Rate for Payer: Quartz Beloit One Network |
$895.37
|
| Rate for Payer: Quartz Commercial |
$1,096.37
|
| Rate for Payer: WEA Trust Commercial |
$1,005.00
|
| Rate for Payer: WPS Commercial |
$1,353.42
|
|
|
PERCUTANEOUS PINNING, HAND/WRIST/FINGER FRACTURE
|
Facility
|
OP
|
$1,757.00
|
|
| Hospital Charge Code |
2950338
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$511.64 |
| Max. Negotiated Rate |
$1,681.10 |
| Rate for Payer: Aetna Commercial |
$1,644.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,571.46
|
| Rate for Payer: Aetna Managed Medicare |
$511.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,187.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$913.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$877.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$968.46
|
| Rate for Payer: Cash Price |
$527.10
|
| Rate for Payer: Cigna Commercial |
$1,681.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,022.57
|
| Rate for Payer: Health EOS Commercial |
$1,626.28
|
| Rate for Payer: HFN Commercial |
$1,681.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,370.46
|
| Rate for Payer: Multiplan Commercial |
$1,461.82
|
| Rate for Payer: NAPHCARE Commercial |
$1,096.37
|
| Rate for Payer: Preferred Network Access Commercial |
$1,681.10
|
| Rate for Payer: Quartz Beloit One Network |
$895.37
|
| Rate for Payer: Quartz Commercial |
$1,187.73
|
| Rate for Payer: Quartz Medicare Advantage |
$1,096.37
|
| Rate for Payer: The Alliance Commercial |
$913.64
|
| Rate for Payer: WEA Trust Commercial |
$1,005.00
|
| Rate for Payer: WPS Commercial |
$1,353.42
|
|
|
PERCUTANEOUS SKELETAL FIXATION OF METACARPAL FRACTURE, EACH BONE
|
Facility
|
OP
|
$13,773.68
|
|
|
Service Code
|
CPT 26608
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,443.42 |
| Max. Negotiated Rate |
$13,773.68 |
| Rate for Payer: Aetna Managed Medicare |
$3,443.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,443.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,443.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,443.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,443.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,107.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,443.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,809.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,443.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,443.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,443.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,443.42
|
| Rate for Payer: NAPHCARE Commercial |
$5,165.13
|
| Rate for Payer: Quartz Medicare Advantage |
$3,443.42
|
| Rate for Payer: The Alliance Commercial |
$13,773.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,443.42
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$3,443.42
|
|
|
PERCUTANEOUS SKELETAL FIXATION OF METATARSOPHALANGEAL JOINT DISLOCATION, WITH MANIPULATION
|
Facility
|
OP
|
$13,773.68
|
|
|
Service Code
|
CPT 28636
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,443.42 |
| Max. Negotiated Rate |
$13,773.68 |
| Rate for Payer: Aetna Managed Medicare |
$3,443.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,443.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,443.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,443.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,443.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,443.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,809.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,443.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,443.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,443.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,443.42
|
| Rate for Payer: NAPHCARE Commercial |
$5,165.13
|
| Rate for Payer: Quartz Medicare Advantage |
$3,443.42
|
| Rate for Payer: The Alliance Commercial |
$13,773.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,443.42
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$3,443.42
|
|
|
PERCUTANEOUS SKELETAL FIXATION OF UNSTABLE PHALANGEAL SHAFT FRACTURE, PROXIMAL OR MIDDLE PHALANX, FINGER OR THUMB, WITH MANIPULATION, EACH
|
Facility
|
OP
|
$13,773.68
|
|
|
Service Code
|
CPT 26727
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,443.42 |
| Max. Negotiated Rate |
$13,773.68 |
| Rate for Payer: Aetna Managed Medicare |
$3,443.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,443.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,443.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,443.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,443.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,105.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,443.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,809.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,443.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,443.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,443.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,443.42
|
| Rate for Payer: NAPHCARE Commercial |
$5,165.13
|
| Rate for Payer: Quartz Medicare Advantage |
$3,443.42
|
| Rate for Payer: The Alliance Commercial |
$13,773.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,443.42
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$3,443.42
|
|
|
PERCUTANEOUS STRUCTURAL CARDIAC PROCEDURES
|
Facility
|
IP
|
$34,810.19
|
|
|
Service Code
|
APR-DRG 1832
|
| Min. Negotiated Rate |
$30,920.58 |
| Max. Negotiated Rate |
$34,810.19 |
| Rate for Payer: Anthem Medicaid |
$33,332.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$33,332.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$33,332.68
|
| Rate for Payer: Dean Health Medicaid |
$33,332.68
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$30,920.58
|
| Rate for Payer: Managed Health Services Medicaid |
$34,810.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$33,332.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$33,332.68
|
| Rate for Payer: United Healthcare Medicaid |
$33,332.68
|
|
|
PERCUTANEOUS STRUCTURAL CARDIAC PROCEDURES
|
Facility
|
IP
|
$59,799.87
|
|
|
Service Code
|
APR-DRG 1834
|
| Min. Negotiated Rate |
$53,117.98 |
| Max. Negotiated Rate |
$59,799.87 |
| Rate for Payer: Anthem Medicaid |
$57,261.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$57,261.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$57,261.67
|
| Rate for Payer: Dean Health Medicaid |
$57,261.67
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$53,117.98
|
| Rate for Payer: Managed Health Services Medicaid |
$59,799.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$57,261.67
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$57,261.67
|
| Rate for Payer: United Healthcare Medicaid |
$57,261.67
|
|
|
PERCUTANEOUS STRUCTURAL CARDIAC PROCEDURES
|
Facility
|
IP
|
$43,403.13
|
|
|
Service Code
|
APR-DRG 1833
|
| Min. Negotiated Rate |
$38,553.37 |
| Max. Negotiated Rate |
$43,403.13 |
| Rate for Payer: Anthem Medicaid |
$41,560.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$41,560.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$41,560.89
|
| Rate for Payer: Dean Health Medicaid |
$41,560.89
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$38,553.37
|
| Rate for Payer: Managed Health Services Medicaid |
$43,403.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$41,560.89
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$41,560.89
|
| Rate for Payer: United Healthcare Medicaid |
$41,560.89
|
|
|
PERCUTANEOUS STRUCTURAL CARDIAC PROCEDURES
|
Facility
|
IP
|
$32,092.01
|
|
|
Service Code
|
APR-DRG 1831
|
| Min. Negotiated Rate |
$28,506.13 |
| Max. Negotiated Rate |
$32,092.01 |
| Rate for Payer: Anthem Medicaid |
$30,729.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$30,729.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$30,729.87
|
| Rate for Payer: Dean Health Medicaid |
$30,729.87
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$28,506.13
|
| Rate for Payer: Managed Health Services Medicaid |
$32,092.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$30,729.87
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$30,729.87
|
| Rate for Payer: United Healthcare Medicaid |
$30,729.87
|
|
|
PERCUTANEOUS TRANSLUMINAL MECHANICAL THROMBECTOMY AND/OR INFUSION FOR THROMBOLYSIS, DIALYSIS CIRCUIT, ANY METHOD, INCLUDING ALL IMAGING AND RADIOLOGICAL SUPERVISION AND INTERPRETATION, DIAGNOSTIC ANGIOGRAPHY, FLUOROSCOPIC GUIDANCE, CATHETER PLACEMENT(S), AND INTRAPROCEDURAL PHARMACOLOGICAL THROMBOLYTIC INJECTION(S);
|
Facility
|
OP
|
$23,958.98
|
|
|
Service Code
|
CPT 36904
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,386.95 |
| Max. Negotiated Rate |
$23,958.98 |
| Rate for Payer: Aetna Managed Medicare |
$5,989.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,970.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,336.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,619.84
|
| Rate for Payer: Anthem Medicare Advantage |
$5,989.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,989.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,989.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,989.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,989.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22,281.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,989.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,989.74
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,989.74
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,989.74
|
| Rate for Payer: NAPHCARE Commercial |
$8,984.62
|
| Rate for Payer: Quartz Medicare Advantage |
$5,989.74
|
| Rate for Payer: The Alliance Commercial |
$23,958.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,989.74
|
| Rate for Payer: United Healthcare PPO |
$6,400.16
|
| Rate for Payer: Wellcare Medicare |
$5,989.74
|
|
|
PERCUTANEOUS TRANSLUMINAL MECHANICAL THROMBECTOMY AND/OR INFUSION FOR THROMBOLYSIS, DIALYSIS CIRCUIT, ANY METHOD, INCLUDING ALL IMAGING AND RADIOLOGICAL SUPERVISION AND INTERPRETATION, DIAGNOSTIC ANGIOGRAPHY, FLUOROSCOPIC GUIDANCE, CATHETER PLACEMENT(S), AND INTRAPROCEDURAL PHARMACOLOGICAL THROMBOLYTIC INJECTION(S); WITH TRANSLUMINAL BALLOON ANGIOPLASTY, PERIPHERAL DIALYSIS SEGMENT, INCLUDING ALL IMAGING AND RADIOLOGICAL SUPERVISION AND INTERPRETATION NECESSARY TO PERFORM THE ANGIOPLASTY
|
Facility
|
OP
|
$45,194.20
|
|
|
Service Code
|
CPT 36905
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,979.84 |
| Max. Negotiated Rate |
$45,194.20 |
| Rate for Payer: Aetna Managed Medicare |
$12,148.98
|
| 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 |
$12,148.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12,148.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12,148.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12,148.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12,148.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45,194.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12,148.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12,148.98
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12,148.98
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12,148.98
|
| Rate for Payer: NAPHCARE Commercial |
$18,223.47
|
| Rate for Payer: Quartz Medicare Advantage |
$12,148.98
|
| Rate for Payer: The Alliance Commercial |
$20,653.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,148.98
|
| Rate for Payer: United Healthcare PPO |
$9,979.84
|
| Rate for Payer: Wellcare Medicare |
$12,148.98
|
|
|
PERCUTANEOUS ULTRASONIC LITHOTRIPSY WITH LITHOCLAST
|
Facility
|
OP
|
$17,872.00
|
|
|
Service Code
|
CPT 50081
|
| Hospital Charge Code |
5433010
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,107.57 |
| Max. Negotiated Rate |
$37,060.13 |
| Rate for Payer: Aetna Commercial |
$16,728.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,984.72
|
| Rate for Payer: Aetna Managed Medicare |
$9,962.40
|
| 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 |
$9,962.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,851.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,962.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,962.40
|
| Rate for Payer: Cash Price |
$5,361.60
|
| Rate for Payer: Cash Price |
$5,361.60
|
| Rate for Payer: Cash Price |
$5,361.60
|
| Rate for Payer: Cigna Commercial |
$17,099.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,962.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,962.40
|
| Rate for Payer: Health EOS Commercial |
$16,542.32
|
| Rate for Payer: HFN Commercial |
$17,099.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37,060.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,962.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9,962.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9,962.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,962.40
|
| Rate for Payer: Multiplan Commercial |
$14,869.50
|
| Rate for Payer: NAPHCARE Commercial |
$14,943.60
|
| Rate for Payer: Preferred Network Access Commercial |
$17,099.93
|
| Rate for Payer: Quartz Beloit One Network |
$9,107.57
|
| Rate for Payer: Quartz Commercial |
$12,081.47
|
| Rate for Payer: Quartz Medicare Advantage |
$9,962.40
|
| Rate for Payer: The Alliance Commercial |
$16,936.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,962.40
|
| Rate for Payer: United Healthcare PPO |
$9,979.84
|
| Rate for Payer: WEA Trust Commercial |
$10,222.78
|
| Rate for Payer: Wellcare Medicare |
$9,962.40
|
| Rate for Payer: WPS Commercial |
$13,766.80
|
|
|
PERCUTANEOUS ULTRASONIC LITHOTRIPSY WITH LITHOCLAST
|
Facility
|
IP
|
$17,872.00
|
|
|
Service Code
|
CPT 50081
|
| Hospital Charge Code |
5433010
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,107.57 |
| Max. Negotiated Rate |
$17,099.93 |
| Rate for Payer: Aetna Commercial |
$16,728.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,984.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,851.05
|
| Rate for Payer: Cash Price |
$5,361.60
|
| Rate for Payer: Cigna Commercial |
$17,099.93
|
| Rate for Payer: Health EOS Commercial |
$16,542.32
|
| Rate for Payer: HFN Commercial |
$17,099.93
|
| Rate for Payer: Multiplan Commercial |
$14,869.50
|
| Rate for Payer: Preferred Network Access Commercial |
$17,099.93
|
| Rate for Payer: Quartz Beloit One Network |
$9,107.57
|
| Rate for Payer: Quartz Commercial |
$11,152.13
|
| Rate for Payer: WEA Trust Commercial |
$10,222.78
|
| Rate for Payer: WPS Commercial |
$13,766.80
|
|
|
Percutaneous Vertebroplsty Lumbosacral w/guidance 22511
|
Professional
|
Both
|
$3,961.00
|
|
|
Service Code
|
CPT 22511
|
| Hospital Charge Code |
5232607
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$346.34 |
| Max. Negotiated Rate |
$3,913.47 |
| Rate for Payer: Aetna Commercial |
$3,913.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,542.72
|
| Rate for Payer: Aetna Managed Medicare |
$346.34
|
| Rate for Payer: Anthem Medicare Advantage |
$346.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$346.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$346.34
|
| Rate for Payer: Cash Price |
$1,188.30
|
| Rate for Payer: Cash Price |
$1,188.30
|
| Rate for Payer: Cash Price |
$1,188.30
|
| Rate for Payer: Cigna Commercial |
$3,913.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,383.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$346.34
|
| Rate for Payer: Health EOS Commercial |
$3,748.69
|
| Rate for Payer: HFN Commercial |
$3,913.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,405.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,405.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$346.34
|
| Rate for Payer: Multiplan Commercial |
$3,295.55
|
| Rate for Payer: NAPHCARE Commercial |
$519.51
|
| Rate for Payer: Preferred Network Access Commercial |
$3,913.47
|
| Rate for Payer: Quartz Beloit One Network |
$1,812.55
|
| Rate for Payer: Quartz Commercial |
$2,348.08
|
| Rate for Payer: Quartz Medicare Advantage |
$346.34
|
| Rate for Payer: The Alliance Commercial |
$1,471.95
|
| Rate for Payer: United Healthcare Medicaid |
$1,383.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$346.34
|
| Rate for Payer: WEA Trust Commercial |
$2,265.69
|
| Rate for Payer: WPS Commercial |
$1,558.53
|
|
|
Percutans Test Sequtl/Incremtl,W/Drgs,Bio Or Venms,Immed React
|
Professional
|
Both
|
$23.00
|
|
| Hospital Charge Code |
1188808
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$10.52 |
| Max. Negotiated Rate |
$22.72 |
| Rate for Payer: Aetna Commercial |
$22.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20.57
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cigna Commercial |
$22.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.35
|
| Rate for Payer: Health EOS Commercial |
$21.77
|
| Rate for Payer: HFN Commercial |
$22.72
|
| Rate for Payer: Multiplan Commercial |
$19.14
|
| Rate for Payer: Preferred Network Access Commercial |
$22.72
|
| Rate for Payer: Quartz Beloit One Network |
$10.52
|
| Rate for Payer: Quartz Commercial |
$13.63
|
| Rate for Payer: The Alliance Commercial |
$11.96
|
| Rate for Payer: WEA Trust Commercial |
$13.16
|
| Rate for Payer: WPS Commercial |
$17.72
|
|
|
Pericardial DRG 6YR+ W/O CGen Car Anomaly
|
Facility
|
IP
|
$3,065.00
|
|
|
Service Code
|
CPT 33017
|
| Hospital Charge Code |
6172827
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,561.92 |
| Max. Negotiated Rate |
$2,932.59 |
| Rate for Payer: Aetna Commercial |
$2,868.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,741.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,689.43
|
| Rate for Payer: Cash Price |
$919.50
|
| Rate for Payer: Cigna Commercial |
$2,932.59
|
| Rate for Payer: Health EOS Commercial |
$2,836.96
|
| Rate for Payer: HFN Commercial |
$2,932.59
|
| Rate for Payer: Multiplan Commercial |
$2,550.08
|
| Rate for Payer: Preferred Network Access Commercial |
$2,932.59
|
| Rate for Payer: Quartz Beloit One Network |
$1,561.92
|
| Rate for Payer: Quartz Commercial |
$1,912.56
|
| Rate for Payer: WEA Trust Commercial |
$1,753.18
|
| Rate for Payer: WPS Commercial |
$2,360.97
|
|
|
Pericardial DRG 6YR+ W/O CGen Car Anomaly
|
Facility
|
OP
|
$3,065.00
|
|
|
Service Code
|
CPT 33017
|
| Hospital Charge Code |
6172827
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$785.57 |
| Max. Negotiated Rate |
$4,947.89 |
| Rate for Payer: Aetna Commercial |
$2,868.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,741.34
|
| Rate for Payer: Aetna Managed Medicare |
$892.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,071.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,593.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,530.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,689.43
|
| Rate for Payer: Cash Price |
$919.50
|
| Rate for Payer: Cash Price |
$919.50
|
| Rate for Payer: Cigna Commercial |
$2,932.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Health EOS Commercial |
$2,836.96
|
| Rate for Payer: HFN Commercial |
$2,932.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,390.70
|
| Rate for Payer: Multiplan Commercial |
$2,550.08
|
| Rate for Payer: NAPHCARE Commercial |
$1,912.56
|
| Rate for Payer: Preferred Network Access Commercial |
$2,932.59
|
| Rate for Payer: Quartz Beloit One Network |
$1,561.92
|
| Rate for Payer: Quartz Commercial |
$2,071.94
|
| Rate for Payer: Quartz Medicare Advantage |
$1,912.56
|
| Rate for Payer: The Alliance Commercial |
$785.57
|
| Rate for Payer: WEA Trust Commercial |
$1,753.18
|
| Rate for Payer: WPS Commercial |
$2,360.97
|
|
|
PERICARDIAL WINDOW
|
Facility
|
OP
|
$4,238.00
|
|
| Hospital Charge Code |
4494602
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,234.11 |
| Max. Negotiated Rate |
$4,054.92 |
| Rate for Payer: Aetna Commercial |
$3,966.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,790.47
|
| Rate for Payer: Aetna Managed Medicare |
$1,234.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,864.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,203.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,115.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,335.99
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$4,054.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,466.52
|
| Rate for Payer: Health EOS Commercial |
$3,922.69
|
| Rate for Payer: HFN Commercial |
$4,054.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,305.64
|
| Rate for Payer: Multiplan Commercial |
$3,526.02
|
| Rate for Payer: NAPHCARE Commercial |
$2,644.51
|
| Rate for Payer: Preferred Network Access Commercial |
$4,054.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,159.68
|
| Rate for Payer: Quartz Commercial |
$2,864.89
|
| Rate for Payer: Quartz Medicare Advantage |
$2,644.51
|
| Rate for Payer: The Alliance Commercial |
$2,203.76
|
| Rate for Payer: WEA Trust Commercial |
$2,424.14
|
| Rate for Payer: WPS Commercial |
$3,264.53
|
|
|
PERICARDIAL WINDOW
|
Facility
|
IP
|
$4,238.00
|
|
| Hospital Charge Code |
4494602
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,159.68 |
| Max. Negotiated Rate |
$4,054.92 |
| Rate for Payer: Aetna Commercial |
$3,966.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,790.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,335.99
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$4,054.92
|
| Rate for Payer: Health EOS Commercial |
$3,922.69
|
| Rate for Payer: HFN Commercial |
$4,054.92
|
| Rate for Payer: Multiplan Commercial |
$3,526.02
|
| Rate for Payer: Preferred Network Access Commercial |
$4,054.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,159.68
|
| Rate for Payer: Quartz Commercial |
$2,644.51
|
| Rate for Payer: WEA Trust Commercial |
$2,424.14
|
| Rate for Payer: WPS Commercial |
$3,264.53
|
|
|
PERICARDIECTOMY
|
Facility
|
OP
|
$15,505.00
|
|
| Hospital Charge Code |
2960313
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,515.06 |
| Max. Negotiated Rate |
$14,835.18 |
| Rate for Payer: Aetna Commercial |
$14,512.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,867.67
|
| Rate for Payer: Aetna Managed Medicare |
$4,515.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,481.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,062.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,740.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,546.36
|
| Rate for Payer: Cash Price |
$4,651.50
|
| Rate for Payer: Cigna Commercial |
$14,835.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,023.91
|
| Rate for Payer: Health EOS Commercial |
$14,351.43
|
| Rate for Payer: HFN Commercial |
$14,835.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,093.90
|
| Rate for Payer: Multiplan Commercial |
$12,900.16
|
| Rate for Payer: NAPHCARE Commercial |
$9,675.12
|
| Rate for Payer: Preferred Network Access Commercial |
$14,835.18
|
| Rate for Payer: Quartz Beloit One Network |
$7,901.35
|
| Rate for Payer: Quartz Commercial |
$10,481.38
|
| Rate for Payer: Quartz Medicare Advantage |
$9,675.12
|
| Rate for Payer: The Alliance Commercial |
$8,062.60
|
| Rate for Payer: WEA Trust Commercial |
$8,868.86
|
| Rate for Payer: WPS Commercial |
$11,943.50
|
|
|
PERICARDIECTOMY
|
Facility
|
IP
|
$15,505.00
|
|
| Hospital Charge Code |
2960313
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,901.35 |
| Max. Negotiated Rate |
$14,835.18 |
| Rate for Payer: Aetna Commercial |
$14,512.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,867.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,546.36
|
| Rate for Payer: Cash Price |
$4,651.50
|
| Rate for Payer: Cigna Commercial |
$14,835.18
|
| Rate for Payer: Health EOS Commercial |
$14,351.43
|
| Rate for Payer: HFN Commercial |
$14,835.18
|
| Rate for Payer: Multiplan Commercial |
$12,900.16
|
| Rate for Payer: Preferred Network Access Commercial |
$14,835.18
|
| Rate for Payer: Quartz Beloit One Network |
$7,901.35
|
| Rate for Payer: Quartz Commercial |
$9,675.12
|
| Rate for Payer: WEA Trust Commercial |
$8,868.86
|
| Rate for Payer: WPS Commercial |
$11,943.50
|
|
|
Pericardiocentesis F/U
|
Facility
|
IP
|
$517.00
|
|
| Hospital Charge Code |
4125712
|
| Min. Negotiated Rate |
$263.46 |
| Max. Negotiated Rate |
$494.67 |
| Rate for Payer: Aetna Commercial |
$483.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$462.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$284.97
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Cigna Commercial |
$494.67
|
| Rate for Payer: Health EOS Commercial |
$478.54
|
| Rate for Payer: HFN Commercial |
$494.67
|
| Rate for Payer: Multiplan Commercial |
$430.14
|
| Rate for Payer: Preferred Network Access Commercial |
$494.67
|
| Rate for Payer: Quartz Beloit One Network |
$263.46
|
| Rate for Payer: Quartz Commercial |
$322.61
|
| Rate for Payer: WEA Trust Commercial |
$295.72
|
| Rate for Payer: WPS Commercial |
$398.25
|
|
