|
Pericardiocentesis F/U
|
Facility
|
OP
|
$517.00
|
|
| Hospital Charge Code |
4125712
|
| Min. Negotiated Rate |
$150.55 |
| Max. Negotiated Rate |
$494.67 |
| Rate for Payer: Aetna Commercial |
$483.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$462.40
|
| Rate for Payer: Aetna Managed Medicare |
$150.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$349.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$268.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$258.09
|
| 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: Dean Health DHI/DHP/ASO |
$300.89
|
| Rate for Payer: Health EOS Commercial |
$478.54
|
| Rate for Payer: HFN Commercial |
$494.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$403.26
|
| Rate for Payer: Multiplan Commercial |
$430.14
|
| Rate for Payer: NAPHCARE Commercial |
$322.61
|
| Rate for Payer: Preferred Network Access Commercial |
$494.67
|
| Rate for Payer: Quartz Beloit One Network |
$263.46
|
| Rate for Payer: Quartz Commercial |
$349.49
|
| Rate for Payer: Quartz Medicare Advantage |
$322.61
|
| Rate for Payer: The Alliance Commercial |
$268.84
|
| Rate for Payer: WEA Trust Commercial |
$295.72
|
| Rate for Payer: WPS Commercial |
$398.25
|
|
|
Pericardiocentesis Including Imaging Guidance
|
Facility
|
OP
|
$2,870.00
|
|
|
Service Code
|
CPT 33016
|
| Hospital Charge Code |
5565259
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,432.70 |
| Max. Negotiated Rate |
$6,626.51 |
| Rate for Payer: Aetna Commercial |
$2,686.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,566.93
|
| Rate for Payer: Aetna Managed Medicare |
$1,656.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,940.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,492.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,432.70
|
| Rate for Payer: Anthem Medicare Advantage |
$1,656.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,581.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,656.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,656.63
|
| Rate for Payer: Cash Price |
$861.00
|
| Rate for Payer: Cash Price |
$861.00
|
| Rate for Payer: Cigna Commercial |
$2,746.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,656.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,656.63
|
| Rate for Payer: Health EOS Commercial |
$2,656.47
|
| Rate for Payer: HFN Commercial |
$2,746.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,162.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,656.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,656.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,656.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,656.63
|
| Rate for Payer: Multiplan Commercial |
$2,387.84
|
| Rate for Payer: NAPHCARE Commercial |
$2,484.94
|
| Rate for Payer: Preferred Network Access Commercial |
$2,746.02
|
| Rate for Payer: Quartz Beloit One Network |
$1,462.55
|
| Rate for Payer: Quartz Commercial |
$1,940.12
|
| Rate for Payer: Quartz Medicare Advantage |
$1,656.63
|
| Rate for Payer: The Alliance Commercial |
$6,626.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,656.63
|
| Rate for Payer: WEA Trust Commercial |
$1,641.64
|
| Rate for Payer: Wellcare Medicare |
$1,656.63
|
| Rate for Payer: WPS Commercial |
$2,210.76
|
|
|
Pericardiocentesis Including Imaging Guidance
|
Facility
|
IP
|
$2,870.00
|
|
|
Service Code
|
CPT 33016
|
| Hospital Charge Code |
5565259
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,462.55 |
| Max. Negotiated Rate |
$2,746.02 |
| Rate for Payer: Aetna Commercial |
$2,686.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,566.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,581.94
|
| Rate for Payer: Cash Price |
$861.00
|
| Rate for Payer: Cigna Commercial |
$2,746.02
|
| Rate for Payer: Health EOS Commercial |
$2,656.47
|
| Rate for Payer: HFN Commercial |
$2,746.02
|
| Rate for Payer: Multiplan Commercial |
$2,387.84
|
| Rate for Payer: Preferred Network Access Commercial |
$2,746.02
|
| Rate for Payer: Quartz Beloit One Network |
$1,462.55
|
| Rate for Payer: Quartz Commercial |
$1,790.88
|
| Rate for Payer: WEA Trust Commercial |
$1,641.64
|
| Rate for Payer: WPS Commercial |
$2,210.76
|
|
|
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 |
$79.51 |
| Max. Negotiated Rate |
$302.72 |
| Rate for Payer: Aetna Commercial |
$267.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$242.38
|
| 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 |
$267.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$79.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$169.10
|
| Rate for Payer: Health EOS Commercial |
$256.47
|
| Rate for Payer: HFN Commercial |
$267.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$302.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$302.72
|
| Rate for Payer: Multiplan Commercial |
$225.47
|
| Rate for Payer: Preferred Network Access Commercial |
$267.75
|
| Rate for Payer: Quartz Beloit One Network |
$124.01
|
| Rate for Payer: Quartz Commercial |
$160.65
|
| Rate for Payer: The Alliance Commercial |
$140.92
|
| Rate for Payer: United Healthcare Medicaid |
$79.51
|
| Rate for Payer: WEA Trust Commercial |
$155.01
|
| Rate for Payer: WPS Commercial |
$208.75
|
|
|
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 |
$72.94 |
| Max. Negotiated Rate |
$267.08 |
| Rate for Payer: Aetna Commercial |
$204.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$185.14
|
| 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 |
$204.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$72.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$129.17
|
| Rate for Payer: Health EOS Commercial |
$195.90
|
| Rate for Payer: HFN Commercial |
$204.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$267.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$267.08
|
| Rate for Payer: Multiplan Commercial |
$172.22
|
| Rate for Payer: Preferred Network Access Commercial |
$204.52
|
| Rate for Payer: Quartz Beloit One Network |
$94.72
|
| Rate for Payer: Quartz Commercial |
$122.71
|
| Rate for Payer: The Alliance Commercial |
$107.64
|
| Rate for Payer: United Healthcare Medicaid |
$72.94
|
| Rate for Payer: WEA Trust Commercial |
$118.40
|
| Rate for Payer: WPS Commercial |
$159.45
|
|
|
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 |
$81.29 |
| Max. Negotiated Rate |
$311.54 |
| Rate for Payer: Aetna Commercial |
$276.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$250.43
|
| 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 |
$276.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$81.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$174.72
|
| Rate for Payer: Health EOS Commercial |
$264.99
|
| Rate for Payer: HFN Commercial |
$276.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$311.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$311.54
|
| Rate for Payer: Multiplan Commercial |
$232.96
|
| Rate for Payer: Preferred Network Access Commercial |
$276.64
|
| Rate for Payer: Quartz Beloit One Network |
$128.13
|
| Rate for Payer: Quartz Commercial |
$165.98
|
| Rate for Payer: The Alliance Commercial |
$145.60
|
| Rate for Payer: United Healthcare Medicaid |
$81.29
|
| Rate for Payer: WEA Trust Commercial |
$160.16
|
| Rate for Payer: WPS Commercial |
$215.68
|
|
|
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 |
$68.40 |
| Max. Negotiated Rate |
$243.62 |
| Rate for Payer: Aetna Commercial |
$184.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$167.25
|
| 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 |
$184.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$68.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$116.69
|
| Rate for Payer: Health EOS Commercial |
$176.98
|
| Rate for Payer: HFN Commercial |
$184.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$243.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$243.62
|
| Rate for Payer: Multiplan Commercial |
$155.58
|
| Rate for Payer: Preferred Network Access Commercial |
$184.76
|
| Rate for Payer: Quartz Beloit One Network |
$85.57
|
| Rate for Payer: Quartz Commercial |
$110.85
|
| Rate for Payer: The Alliance Commercial |
$97.24
|
| Rate for Payer: United Healthcare Medicaid |
$68.40
|
| Rate for Payer: WEA Trust Commercial |
$106.96
|
| Rate for Payer: WPS Commercial |
$144.05
|
|
|
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 |
$86.39 |
| Max. Negotiated Rate |
$338.37 |
| Rate for Payer: Aetna Commercial |
$301.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$272.79
|
| 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 |
$301.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$86.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$190.32
|
| Rate for Payer: Health EOS Commercial |
$288.65
|
| Rate for Payer: HFN Commercial |
$301.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$338.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$338.37
|
| Rate for Payer: Multiplan Commercial |
$253.76
|
| Rate for Payer: Preferred Network Access Commercial |
$301.34
|
| Rate for Payer: Quartz Beloit One Network |
$139.57
|
| Rate for Payer: Quartz Commercial |
$180.80
|
| Rate for Payer: The Alliance Commercial |
$158.60
|
| Rate for Payer: United Healthcare Medicaid |
$86.39
|
| Rate for Payer: WEA Trust Commercial |
$174.46
|
| Rate for Payer: WPS Commercial |
$234.94
|
|
|
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 |
$72.70 |
| Max. Negotiated Rate |
$267.08 |
| Rate for Payer: Aetna Commercial |
$237.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$214.66
|
| 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 |
$237.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$72.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$149.76
|
| Rate for Payer: Health EOS Commercial |
$227.14
|
| Rate for Payer: HFN Commercial |
$237.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$267.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$267.08
|
| Rate for Payer: Multiplan Commercial |
$199.68
|
| Rate for Payer: Preferred Network Access Commercial |
$237.12
|
| Rate for Payer: Quartz Beloit One Network |
$109.82
|
| Rate for Payer: Quartz Commercial |
$142.27
|
| Rate for Payer: The Alliance Commercial |
$124.80
|
| Rate for Payer: United Healthcare Medicaid |
$72.70
|
| Rate for Payer: WEA Trust Commercial |
$137.28
|
| Rate for Payer: WPS Commercial |
$184.87
|
|
|
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 |
$93.15 |
| Max. Negotiated Rate |
$365.56 |
| Rate for Payer: Aetna Commercial |
$365.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$330.93
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cigna Commercial |
$365.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$93.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$230.88
|
| Rate for Payer: Health EOS Commercial |
$350.17
|
| Rate for Payer: HFN Commercial |
$365.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$355.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$355.19
|
| Rate for Payer: Multiplan Commercial |
$307.84
|
| Rate for Payer: Preferred Network Access Commercial |
$365.56
|
| Rate for Payer: Quartz Beloit One Network |
$169.31
|
| Rate for Payer: Quartz Commercial |
$219.34
|
| Rate for Payer: The Alliance Commercial |
$192.40
|
| Rate for Payer: United Healthcare Medicaid |
$93.15
|
| Rate for Payer: WEA Trust Commercial |
$211.64
|
| Rate for Payer: WPS Commercial |
$285.01
|
|
|
PERIPHERAL AND CRANIAL NERVE DIAGNOSES
|
Facility
|
OP
|
$90.41
|
|
|
Service Code
|
EAPG 00527
|
| Min. Negotiated Rate |
$86.93 |
| Max. Negotiated Rate |
$90.41 |
| Rate for Payer: Anthem Medicaid |
$86.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$86.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$86.93
|
| Rate for Payer: Dean Health Medicaid |
$86.93
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$86.93
|
| Rate for Payer: Managed Health Services Medicaid |
$90.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$86.93
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$86.93
|
| Rate for Payer: United Healthcare Medicaid |
$86.93
|
|
|
PERIPHERAL AND OTHER VASCULAR DIAGNOSES
|
Facility
|
OP
|
$99.58
|
|
|
Service Code
|
EAPG 00596
|
| Min. Negotiated Rate |
$95.75 |
| Max. Negotiated Rate |
$99.58 |
| Rate for Payer: Anthem Medicaid |
$95.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$95.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$95.75
|
| Rate for Payer: Dean Health Medicaid |
$95.75
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$95.75
|
| Rate for Payer: Managed Health Services Medicaid |
$99.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$95.75
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$95.75
|
| Rate for Payer: United Healthcare Medicaid |
$95.75
|
|
|
PERIPHERAL AND OTHER VASCULAR DISORDERS
|
Facility
|
IP
|
$5,260.99
|
|
|
Service Code
|
APR-DRG 1971
|
| Min. Negotiated Rate |
$4,673.14 |
| Max. Negotiated Rate |
$5,260.99 |
| Rate for Payer: Anthem Medicaid |
$5,037.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$5,037.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,037.68
|
| Rate for Payer: Dean Health Medicaid |
$5,037.68
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4,673.14
|
| Rate for Payer: Managed Health Services Medicaid |
$5,260.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,037.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5,037.68
|
| Rate for Payer: United Healthcare Medicaid |
$5,037.68
|
|
|
PERIPHERAL AND OTHER VASCULAR DISORDERS
|
Facility
|
IP
|
$19,202.60
|
|
|
Service Code
|
APR-DRG 1974
|
| Min. Negotiated Rate |
$17,056.95 |
| Max. Negotiated Rate |
$19,202.60 |
| Rate for Payer: Anthem Medicaid |
$18,387.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$18,387.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18,387.55
|
| Rate for Payer: Dean Health Medicaid |
$18,387.55
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17,056.95
|
| Rate for Payer: Managed Health Services Medicaid |
$19,202.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$18,387.55
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$18,387.55
|
| Rate for Payer: United Healthcare Medicaid |
$18,387.55
|
|
|
PERIPHERAL AND OTHER VASCULAR DISORDERS
|
Facility
|
IP
|
$10,785.02
|
|
|
Service Code
|
APR-DRG 1973
|
| Min. Negotiated Rate |
$9,579.93 |
| Max. Negotiated Rate |
$10,785.02 |
| Rate for Payer: Anthem Medicaid |
$10,327.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$10,327.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10,327.25
|
| Rate for Payer: Dean Health Medicaid |
$10,327.25
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9,579.93
|
| Rate for Payer: Managed Health Services Medicaid |
$10,785.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,327.25
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$10,327.25
|
| Rate for Payer: United Healthcare Medicaid |
$10,327.25
|
|
|
PERIPHERAL AND OTHER VASCULAR DISORDERS
|
Facility
|
IP
|
$6,839.28
|
|
|
Service Code
|
APR-DRG 1972
|
| Min. Negotiated Rate |
$6,075.08 |
| Max. Negotiated Rate |
$6,839.28 |
| Rate for Payer: Anthem Medicaid |
$6,548.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$6,548.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,548.99
|
| Rate for Payer: Dean Health Medicaid |
$6,548.99
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6,075.08
|
| Rate for Payer: Managed Health Services Medicaid |
$6,839.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,548.99
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6,548.99
|
| Rate for Payer: United Healthcare Medicaid |
$6,548.99
|
|
|
PERIPHERAL AND OTHER VASCULAR RELATED INJURIES
|
Facility
|
OP
|
$102.20
|
|
|
Service Code
|
EAPG 00548
|
| Min. Negotiated Rate |
$98.27 |
| Max. Negotiated Rate |
$102.20 |
| Rate for Payer: Anthem Medicaid |
$98.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$98.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$98.27
|
| Rate for Payer: Dean Health Medicaid |
$98.27
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$98.27
|
| Rate for Payer: Managed Health Services Medicaid |
$102.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$98.27
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$98.27
|
| Rate for Payer: United Healthcare Medicaid |
$98.27
|
|
|
PERIPHERAL, CRANIAL AND AUTONOMIC NERVE DISORDERS
|
Facility
|
IP
|
$7,716.11
|
|
|
Service Code
|
APR-DRG 0482
|
| Min. Negotiated Rate |
$6,853.93 |
| Max. Negotiated Rate |
$7,716.11 |
| Rate for Payer: Anthem Medicaid |
$7,388.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$7,388.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7,388.60
|
| Rate for Payer: Dean Health Medicaid |
$7,388.60
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6,853.93
|
| Rate for Payer: Managed Health Services Medicaid |
$7,716.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,388.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$7,388.60
|
| Rate for Payer: United Healthcare Medicaid |
$7,388.60
|
|
|
PERIPHERAL, CRANIAL AND AUTONOMIC NERVE DISORDERS
|
Facility
|
IP
|
$6,313.18
|
|
|
Service Code
|
APR-DRG 0481
|
| Min. Negotiated Rate |
$5,607.76 |
| Max. Negotiated Rate |
$6,313.18 |
| Rate for Payer: Anthem Medicaid |
$6,045.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$6,045.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,045.22
|
| Rate for Payer: Dean Health Medicaid |
$6,045.22
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5,607.76
|
| Rate for Payer: Managed Health Services Medicaid |
$6,313.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,045.22
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6,045.22
|
| Rate for Payer: United Healthcare Medicaid |
$6,045.22
|
|
|
PERIPHERAL, CRANIAL AND AUTONOMIC NERVE DISORDERS
|
Facility
|
IP
|
$19,114.92
|
|
|
Service Code
|
APR-DRG 0484
|
| Min. Negotiated Rate |
$16,979.06 |
| Max. Negotiated Rate |
$19,114.92 |
| Rate for Payer: Anthem Medicaid |
$18,303.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$18,303.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18,303.59
|
| Rate for Payer: Dean Health Medicaid |
$18,303.59
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$16,979.06
|
| Rate for Payer: Managed Health Services Medicaid |
$19,114.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$18,303.59
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$18,303.59
|
| Rate for Payer: United Healthcare Medicaid |
$18,303.59
|
|
|
PERIPHERAL, CRANIAL AND AUTONOMIC NERVE DISORDERS
|
Facility
|
IP
|
$11,048.07
|
|
|
Service Code
|
APR-DRG 0483
|
| 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
|
|
|
PERIPHERAL, CRANIAL, AND AUTONOMIC NERVE INJURIES
|
Facility
|
OP
|
$95.65
|
|
|
Service Code
|
EAPG 00545
|
| Min. Negotiated Rate |
$91.97 |
| Max. Negotiated Rate |
$95.65 |
| Rate for Payer: Anthem Medicaid |
$91.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$91.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$91.97
|
| Rate for Payer: Dean Health Medicaid |
$91.97
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$91.97
|
| Rate for Payer: Managed Health Services Medicaid |
$95.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$91.97
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$91.97
|
| Rate for Payer: United Healthcare Medicaid |
$91.97
|
|
|
PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR
|
Facility
|
IP
|
$62,011.04
|
|
|
Service Code
|
MSDRG 041
|
| Min. Negotiated Rate |
$17,344.85 |
| Max. Negotiated Rate |
$62,011.04 |
| Rate for Payer: Aetna Managed Medicare |
$17,344.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$47,973.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36,771.59
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34,935.41
|
| Rate for Payer: Anthem Medicare Advantage |
$17,344.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17,344.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17,344.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17,344.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38,781.51
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17,344.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45,238.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17,344.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17,344.85
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17,344.85
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17,344.85
|
| Rate for Payer: NAPHCARE Commercial |
$26,017.27
|
| Rate for Payer: Quartz Medicare Advantage |
$17,344.85
|
| Rate for Payer: The Alliance Commercial |
$62,011.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,344.85
|
| Rate for Payer: United Healthcare PPO |
$35,218.83
|
| Rate for Payer: Wellcare Medicare |
$17,344.85
|
|
|
PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC
|
Facility
|
IP
|
$106,797.60
|
|
|
Service Code
|
MSDRG 040
|
| Min. Negotiated Rate |
$30,076.61 |
| Max. Negotiated Rate |
$106,797.60 |
| Rate for Payer: Aetna Managed Medicare |
$30,076.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$84,248.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$64,575.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$61,351.07
|
| Rate for Payer: Anthem Medicare Advantage |
$30,076.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30,076.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30,076.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$30,076.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$68,105.31
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$30,076.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$78,088.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$30,076.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30,076.61
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$30,076.61
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$30,076.61
|
| Rate for Payer: NAPHCARE Commercial |
$45,114.92
|
| Rate for Payer: Quartz Medicare Advantage |
$30,076.61
|
| Rate for Payer: The Alliance Commercial |
$106,797.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30,076.61
|
| Rate for Payer: United Healthcare PPO |
$60,792.62
|
| Rate for Payer: Wellcare Medicare |
$30,076.61
|
|
|
PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$48,438.00
|
|
|
Service Code
|
MSDRG 042
|
| Min. Negotiated Rate |
$13,737.85 |
| Max. Negotiated Rate |
$48,438.00 |
| Rate for Payer: Aetna Managed Medicare |
$13,737.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$37,697.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28,894.47
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27,451.63
|
| Rate for Payer: Anthem Medicare Advantage |
$13,737.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,737.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,737.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,737.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30,473.83
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,737.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$35,283.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,737.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,737.85
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,737.85
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,737.85
|
| Rate for Payer: NAPHCARE Commercial |
$20,606.77
|
| Rate for Payer: Quartz Medicare Advantage |
$13,737.85
|
| Rate for Payer: The Alliance Commercial |
$48,438.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,737.85
|
| Rate for Payer: United Healthcare PPO |
$27,468.38
|
| Rate for Payer: Wellcare Medicare |
$13,737.85
|
|
