|
PERIPHERAL VASCULAR BYPASS PROCEDURES
|
Facility
|
OP
|
$1,679.80
|
|
|
Service Code
|
EAPG 00123
|
| Min. Negotiated Rate |
$1,615.19 |
| Max. Negotiated Rate |
$1,679.80 |
| Rate for Payer: Anthem Medicaid |
$1,615.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$1,615.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,615.19
|
| Rate for Payer: Dean Health Medicaid |
$1,615.19
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$1,615.19
|
| Rate for Payer: Managed Health Services Medicaid |
$1,679.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,615.19
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$1,615.19
|
| Rate for Payer: United Healthcare Medicaid |
$1,615.19
|
|
|
PERIPHERAL VASCULAR DISORDERS WITH CC
|
Facility
|
IP
|
$29,835.52
|
|
|
Service Code
|
MSDRG 300
|
| Min. Negotiated Rate |
$8,681.90 |
| Max. Negotiated Rate |
$29,835.52 |
| Rate for Payer: Aetna Managed Medicare |
$8,681.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23,292.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17,853.13
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16,961.64
|
| Rate for Payer: Anthem Medicare Advantage |
$8,681.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,681.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,681.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,681.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18,828.97
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,681.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21,638.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,681.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,681.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,681.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,681.90
|
| Rate for Payer: NAPHCARE Commercial |
$13,022.85
|
| Rate for Payer: Quartz Medicare Advantage |
$8,681.90
|
| Rate for Payer: The Alliance Commercial |
$29,835.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,681.90
|
| Rate for Payer: United Healthcare PPO |
$16,846.06
|
| Rate for Payer: Wellcare Medicare |
$8,681.90
|
|
|
PERIPHERAL VASCULAR DISORDERS WITH MCC
|
Facility
|
IP
|
$43,914.00
|
|
|
Service Code
|
MSDRG 299
|
| Min. Negotiated Rate |
$13,010.33 |
| Max. Negotiated Rate |
$43,914.00 |
| Rate for Payer: Aetna Managed Medicare |
$13,010.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$35,624.21
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27,305.67
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25,942.17
|
| Rate for Payer: Anthem Medicare Advantage |
$13,010.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,010.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,010.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,010.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28,798.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,010.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31,965.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,010.33
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,010.33
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,010.33
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,010.33
|
| Rate for Payer: NAPHCARE Commercial |
$19,515.49
|
| Rate for Payer: Quartz Medicare Advantage |
$13,010.33
|
| Rate for Payer: The Alliance Commercial |
$43,914.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,010.33
|
| Rate for Payer: United Healthcare PPO |
$24,885.42
|
| Rate for Payer: Wellcare Medicare |
$13,010.33
|
|
|
PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$19,958.64
|
|
|
Service Code
|
MSDRG 301
|
| Min. Negotiated Rate |
$6,018.39 |
| Max. Negotiated Rate |
$19,958.64 |
| Rate for Payer: Aetna Managed Medicare |
$6,018.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,703.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,036.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,435.40
|
| Rate for Payer: Anthem Medicare Advantage |
$6,018.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,018.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,018.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,018.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,694.34
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,018.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,394.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,018.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,018.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,018.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,018.39
|
| Rate for Payer: NAPHCARE Commercial |
$9,027.58
|
| Rate for Payer: Quartz Medicare Advantage |
$6,018.39
|
| Rate for Payer: The Alliance Commercial |
$19,958.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,018.39
|
| Rate for Payer: United Healthcare PPO |
$11,206.49
|
| Rate for Payer: Wellcare Medicare |
$6,018.39
|
|
|
PERI-PROCEDURAL DEVICE EVALUATION 9328626
|
Professional
|
Both
|
$213.00
|
|
|
Service Code
|
CPT 93286 26
|
| Hospital Charge Code |
3015360
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$14.51 |
| Max. Negotiated Rate |
$210.44 |
| Rate for Payer: Aetna Commercial |
$210.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$190.51
|
| Rate for Payer: Aetna Managed Medicare |
$14.51
|
| Rate for Payer: Anthem Medicare Advantage |
$14.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.51
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna Commercial |
$210.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.51
|
| Rate for Payer: Health EOS Commercial |
$201.58
|
| Rate for Payer: HFN Commercial |
$210.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$54.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.51
|
| Rate for Payer: Multiplan Commercial |
$177.22
|
| Rate for Payer: NAPHCARE Commercial |
$21.76
|
| Rate for Payer: Preferred Network Access Commercial |
$210.44
|
| Rate for Payer: Quartz Beloit One Network |
$97.47
|
| Rate for Payer: Quartz Commercial |
$126.27
|
| Rate for Payer: Quartz Medicare Advantage |
$14.51
|
| Rate for Payer: The Alliance Commercial |
$55.13
|
| Rate for Payer: United Healthcare Medicaid |
$15.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.51
|
| Rate for Payer: WEA Trust Commercial |
$121.84
|
| Rate for Payer: WPS Commercial |
$58.03
|
|
|
PERI-STRIPS DRY WITH VERITAS BAXTER FOR ECHELON 60 PSD6006ECHV
|
Facility
|
IP
|
$2,557.00
|
|
|
Service Code
|
HCPCS Q4100
|
| Hospital Charge Code |
5917673
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,303.05 |
| Max. Negotiated Rate |
$2,446.54 |
| Rate for Payer: Aetna Commercial |
$2,393.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,286.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,409.42
|
| Rate for Payer: Cash Price |
$767.10
|
| Rate for Payer: Cigna Commercial |
$2,446.54
|
| Rate for Payer: Health EOS Commercial |
$2,366.76
|
| Rate for Payer: HFN Commercial |
$2,446.54
|
| Rate for Payer: Multiplan Commercial |
$2,127.42
|
| Rate for Payer: Preferred Network Access Commercial |
$2,446.54
|
| Rate for Payer: Quartz Beloit One Network |
$1,303.05
|
| Rate for Payer: Quartz Commercial |
$1,595.57
|
| Rate for Payer: WEA Trust Commercial |
$1,462.60
|
| Rate for Payer: WPS Commercial |
$1,969.66
|
|
|
PERI-STRIPS DRY WITH VERITAS BAXTER FOR ECHELON 60 PSD6006ECHV
|
Facility
|
OP
|
$2,557.00
|
|
|
Service Code
|
HCPCS Q4100
|
| Hospital Charge Code |
5917673
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$744.60 |
| Max. Negotiated Rate |
$2,446.54 |
| Rate for Payer: Aetna Commercial |
$2,393.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,286.98
|
| Rate for Payer: Aetna Managed Medicare |
$744.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,728.53
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,329.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,276.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,409.42
|
| Rate for Payer: Cash Price |
$767.10
|
| Rate for Payer: Cigna Commercial |
$2,446.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,488.17
|
| Rate for Payer: Health EOS Commercial |
$2,366.76
|
| Rate for Payer: HFN Commercial |
$2,446.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,994.46
|
| Rate for Payer: Multiplan Commercial |
$2,127.42
|
| Rate for Payer: NAPHCARE Commercial |
$1,595.57
|
| Rate for Payer: Preferred Network Access Commercial |
$2,446.54
|
| Rate for Payer: Quartz Beloit One Network |
$1,303.05
|
| Rate for Payer: Quartz Commercial |
$1,728.53
|
| Rate for Payer: Quartz Medicare Advantage |
$1,595.57
|
| Rate for Payer: The Alliance Commercial |
$1,329.64
|
| Rate for Payer: WEA Trust Commercial |
$1,462.60
|
| Rate for Payer: WPS Commercial |
$1,969.66
|
|
|
PERITONEAL ADHESIOLYSIS
|
Facility
|
IP
|
$14,467.71
|
|
|
Service Code
|
APR-DRG 2242
|
| Min. Negotiated Rate |
$12,851.12 |
| Max. Negotiated Rate |
$14,467.71 |
| Rate for Payer: Anthem Medicaid |
$13,853.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$13,853.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13,853.63
|
| Rate for Payer: Dean Health Medicaid |
$13,853.63
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12,851.12
|
| Rate for Payer: Managed Health Services Medicaid |
$14,467.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,853.63
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13,853.63
|
| Rate for Payer: United Healthcare Medicaid |
$13,853.63
|
|
|
PERITONEAL ADHESIOLYSIS
|
Facility
|
IP
|
$11,574.17
|
|
|
Service Code
|
APR-DRG 2241
|
| Min. Negotiated Rate |
$10,280.90 |
| Max. Negotiated Rate |
$11,574.17 |
| Rate for Payer: Anthem Medicaid |
$11,082.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$11,082.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11,082.90
|
| Rate for Payer: Dean Health Medicaid |
$11,082.90
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$10,280.90
|
| Rate for Payer: Managed Health Services Medicaid |
$11,574.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,082.90
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11,082.90
|
| Rate for Payer: United Healthcare Medicaid |
$11,082.90
|
|
|
PERITONEAL ADHESIOLYSIS
|
Facility
|
IP
|
$21,745.41
|
|
|
Service Code
|
APR-DRG 2243
|
| Min. Negotiated Rate |
$19,315.63 |
| Max. Negotiated Rate |
$21,745.41 |
| Rate for Payer: Anthem Medicaid |
$20,822.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$20,822.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$20,822.43
|
| Rate for Payer: Dean Health Medicaid |
$20,822.43
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19,315.63
|
| Rate for Payer: Managed Health Services Medicaid |
$21,745.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$20,822.43
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$20,822.43
|
| Rate for Payer: United Healthcare Medicaid |
$20,822.43
|
|
|
PERITONEAL ADHESIOLYSIS
|
Facility
|
IP
|
$33,319.58
|
|
|
Service Code
|
APR-DRG 2244
|
| Min. Negotiated Rate |
$29,596.53 |
| Max. Negotiated Rate |
$33,319.58 |
| Rate for Payer: Anthem Medicaid |
$31,905.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$31,905.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$31,905.33
|
| Rate for Payer: Dean Health Medicaid |
$31,905.33
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$29,596.53
|
| Rate for Payer: Managed Health Services Medicaid |
$33,319.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$31,905.33
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$31,905.33
|
| Rate for Payer: United Healthcare Medicaid |
$31,905.33
|
|
|
PERITONEAL ADHESIOLYSIS WITH CC
|
Facility
|
IP
|
$58,543.68
|
|
|
Service Code
|
MSDRG 336
|
| Min. Negotiated Rate |
$16,655.62 |
| Max. Negotiated Rate |
$58,543.68 |
| Rate for Payer: Aetna Managed Medicare |
$16,655.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46,010.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$35,266.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$33,505.39
|
| Rate for Payer: Anthem Medicare Advantage |
$16,655.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16,655.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16,655.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16,655.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37,194.05
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16,655.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42,695.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16,655.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16,655.62
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16,655.62
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16,655.62
|
| Rate for Payer: NAPHCARE Commercial |
$24,983.43
|
| Rate for Payer: Quartz Medicare Advantage |
$16,655.62
|
| Rate for Payer: The Alliance Commercial |
$58,543.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16,655.62
|
| Rate for Payer: United Healthcare PPO |
$33,238.98
|
| Rate for Payer: Wellcare Medicare |
$16,655.62
|
|
|
PERITONEAL ADHESIOLYSIS WITH MCC
|
Facility
|
IP
|
$99,179.60
|
|
|
Service Code
|
MSDRG 335
|
| Min. Negotiated Rate |
$27,853.44 |
| Max. Negotiated Rate |
$99,179.60 |
| Rate for Payer: Aetna Managed Medicare |
$27,853.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$77,914.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$59,720.59
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$56,738.46
|
| Rate for Payer: Anthem Medicare Advantage |
$27,853.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27,853.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27,853.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$27,853.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$62,984.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$27,853.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72,501.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$27,853.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27,853.44
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$27,853.44
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$27,853.44
|
| Rate for Payer: NAPHCARE Commercial |
$41,780.15
|
| Rate for Payer: Quartz Medicare Advantage |
$27,853.44
|
| Rate for Payer: The Alliance Commercial |
$99,179.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27,853.44
|
| Rate for Payer: United Healthcare PPO |
$56,442.96
|
| Rate for Payer: Wellcare Medicare |
$27,853.44
|
|
|
PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC
|
Facility
|
IP
|
$41,708.16
|
|
|
Service Code
|
MSDRG 337
|
| Min. Negotiated Rate |
$12,262.12 |
| Max. Negotiated Rate |
$41,708.16 |
| Rate for Payer: Aetna Managed Medicare |
$12,262.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33,492.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25,671.71
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24,389.80
|
| Rate for Payer: Anthem Medicare Advantage |
$12,262.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12,262.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12,262.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12,262.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27,074.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12,262.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30,346.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12,262.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12,262.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12,262.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12,262.12
|
| Rate for Payer: NAPHCARE Commercial |
$18,393.18
|
| Rate for Payer: Quartz Medicare Advantage |
$12,262.12
|
| Rate for Payer: The Alliance Commercial |
$41,708.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,262.12
|
| Rate for Payer: United Healthcare PPO |
$23,625.52
|
| Rate for Payer: Wellcare Medicare |
$12,262.12
|
|
|
Peritoneal Cath
|
Facility
|
OP
|
$2,790.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
5364787
|
|
Hospital Revenue Code
|
621
|
| Min. Negotiated Rate |
$812.45 |
| Max. Negotiated Rate |
$2,669.47 |
| Rate for Payer: Aetna Commercial |
$2,611.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,495.38
|
| Rate for Payer: Aetna Managed Medicare |
$812.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,886.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,450.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,392.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,537.85
|
| Rate for Payer: Cash Price |
$837.00
|
| Rate for Payer: Cigna Commercial |
$2,669.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,623.78
|
| Rate for Payer: Health EOS Commercial |
$2,582.42
|
| Rate for Payer: HFN Commercial |
$2,669.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,176.20
|
| Rate for Payer: Multiplan Commercial |
$2,321.28
|
| Rate for Payer: NAPHCARE Commercial |
$1,740.96
|
| Rate for Payer: Preferred Network Access Commercial |
$2,669.47
|
| Rate for Payer: Quartz Beloit One Network |
$1,421.78
|
| Rate for Payer: Quartz Commercial |
$1,886.04
|
| Rate for Payer: Quartz Medicare Advantage |
$1,740.96
|
| Rate for Payer: The Alliance Commercial |
$1,450.80
|
| Rate for Payer: WEA Trust Commercial |
$1,595.88
|
| Rate for Payer: WPS Commercial |
$2,149.14
|
|
|
Peritoneal Cath
|
Professional
|
Both
|
$2,790.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
5364787
|
|
Hospital Revenue Code
|
621
|
| Min. Negotiated Rate |
$1,276.70 |
| Max. Negotiated Rate |
$2,756.52 |
| Rate for Payer: Aetna Commercial |
$2,756.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,495.38
|
| Rate for Payer: Cash Price |
$837.00
|
| Rate for Payer: Cigna Commercial |
$2,756.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,450.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,740.96
|
| Rate for Payer: Health EOS Commercial |
$2,640.46
|
| Rate for Payer: HFN Commercial |
$2,756.52
|
| Rate for Payer: Multiplan Commercial |
$2,321.28
|
| Rate for Payer: Preferred Network Access Commercial |
$2,756.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,276.70
|
| Rate for Payer: Quartz Commercial |
$1,653.91
|
| Rate for Payer: The Alliance Commercial |
$1,450.80
|
| Rate for Payer: WEA Trust Commercial |
$1,595.88
|
| Rate for Payer: WPS Commercial |
$2,149.14
|
|
|
Peritoneal Cath
|
Facility
|
IP
|
$2,790.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
5364787
|
|
Hospital Revenue Code
|
621
|
| Min. Negotiated Rate |
$1,421.78 |
| Max. Negotiated Rate |
$2,669.47 |
| Rate for Payer: Aetna Commercial |
$2,611.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,495.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,537.85
|
| Rate for Payer: Cash Price |
$837.00
|
| Rate for Payer: Cigna Commercial |
$2,669.47
|
| Rate for Payer: Health EOS Commercial |
$2,582.42
|
| Rate for Payer: HFN Commercial |
$2,669.47
|
| Rate for Payer: Multiplan Commercial |
$2,321.28
|
| Rate for Payer: Preferred Network Access Commercial |
$2,669.47
|
| Rate for Payer: Quartz Beloit One Network |
$1,421.78
|
| Rate for Payer: Quartz Commercial |
$1,740.96
|
| Rate for Payer: WEA Trust Commercial |
$1,595.88
|
| Rate for Payer: WPS Commercial |
$2,149.14
|
|
|
Peritoneal Dial Insertion Kit
|
Facility
|
IP
|
$1,838.00
|
|
| Hospital Charge Code |
3603568
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$936.64 |
| Max. Negotiated Rate |
$1,758.60 |
| Rate for Payer: Aetna Commercial |
$1,720.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,643.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,013.11
|
| Rate for Payer: Cash Price |
$551.40
|
| Rate for Payer: Cigna Commercial |
$1,758.60
|
| Rate for Payer: Health EOS Commercial |
$1,701.25
|
| Rate for Payer: HFN Commercial |
$1,758.60
|
| Rate for Payer: Multiplan Commercial |
$1,529.22
|
| Rate for Payer: Preferred Network Access Commercial |
$1,758.60
|
| Rate for Payer: Quartz Beloit One Network |
$936.64
|
| Rate for Payer: Quartz Commercial |
$1,146.91
|
| Rate for Payer: WEA Trust Commercial |
$1,051.34
|
| Rate for Payer: WPS Commercial |
$1,415.81
|
|
|
Peritoneal Dial Insertion Kit
|
Facility
|
OP
|
$1,838.00
|
|
| Hospital Charge Code |
3603568
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$535.23 |
| Max. Negotiated Rate |
$1,758.60 |
| Rate for Payer: Aetna Commercial |
$1,720.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,643.91
|
| Rate for Payer: Aetna Managed Medicare |
$535.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,242.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$955.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$917.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,013.11
|
| Rate for Payer: Cash Price |
$551.40
|
| Rate for Payer: Cigna Commercial |
$1,758.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,069.72
|
| Rate for Payer: Health EOS Commercial |
$1,701.25
|
| Rate for Payer: HFN Commercial |
$1,758.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,433.64
|
| Rate for Payer: Multiplan Commercial |
$1,529.22
|
| Rate for Payer: NAPHCARE Commercial |
$1,146.91
|
| Rate for Payer: Preferred Network Access Commercial |
$1,758.60
|
| Rate for Payer: Quartz Beloit One Network |
$936.64
|
| Rate for Payer: Quartz Commercial |
$1,242.49
|
| Rate for Payer: Quartz Medicare Advantage |
$1,146.91
|
| Rate for Payer: The Alliance Commercial |
$955.76
|
| Rate for Payer: WEA Trust Commercial |
$1,051.34
|
| Rate for Payer: WPS Commercial |
$1,415.81
|
|
|
PERITONEAL LAVAGE W/WO IMAGING GUIDANCE - UNLISTED LAPS 49329-49084
|
Professional
|
Both
|
$670.00
|
|
|
Service Code
|
CPT 49329
|
| Hospital Charge Code |
6178394
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$306.59 |
| Max. Negotiated Rate |
$661.96 |
| Rate for Payer: Aetna Commercial |
$661.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$599.25
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cigna Commercial |
$661.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$348.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$418.08
|
| Rate for Payer: Health EOS Commercial |
$634.09
|
| Rate for Payer: HFN Commercial |
$661.96
|
| Rate for Payer: Multiplan Commercial |
$557.44
|
| Rate for Payer: Preferred Network Access Commercial |
$661.96
|
| Rate for Payer: Quartz Beloit One Network |
$306.59
|
| Rate for Payer: Quartz Commercial |
$397.18
|
| Rate for Payer: The Alliance Commercial |
$348.40
|
| Rate for Payer: WEA Trust Commercial |
$383.24
|
| Rate for Payer: WPS Commercial |
$516.10
|
|
|
Perivac Kit
|
Facility
|
IP
|
$2,004.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
4538649
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,021.24 |
| Max. Negotiated Rate |
$1,917.43 |
| Rate for Payer: Aetna Commercial |
$1,875.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,792.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,104.60
|
| Rate for Payer: Cash Price |
$601.20
|
| Rate for Payer: Cigna Commercial |
$1,917.43
|
| Rate for Payer: Health EOS Commercial |
$1,854.90
|
| Rate for Payer: HFN Commercial |
$1,917.43
|
| Rate for Payer: Multiplan Commercial |
$1,667.33
|
| Rate for Payer: Preferred Network Access Commercial |
$1,917.43
|
| Rate for Payer: Quartz Beloit One Network |
$1,021.24
|
| Rate for Payer: Quartz Commercial |
$1,250.50
|
| Rate for Payer: WEA Trust Commercial |
$1,146.29
|
| Rate for Payer: WPS Commercial |
$1,543.68
|
|
|
Perivac Kit
|
Facility
|
OP
|
$2,004.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
4538649
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$583.56 |
| Max. Negotiated Rate |
$1,917.43 |
| Rate for Payer: Aetna Commercial |
$1,875.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,792.38
|
| Rate for Payer: Aetna Managed Medicare |
$583.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,354.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,042.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,000.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,104.60
|
| Rate for Payer: Cash Price |
$601.20
|
| Rate for Payer: Cigna Commercial |
$1,917.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,166.33
|
| Rate for Payer: Health EOS Commercial |
$1,854.90
|
| Rate for Payer: HFN Commercial |
$1,917.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,563.12
|
| Rate for Payer: Multiplan Commercial |
$1,667.33
|
| Rate for Payer: NAPHCARE Commercial |
$1,250.50
|
| Rate for Payer: Preferred Network Access Commercial |
$1,917.43
|
| Rate for Payer: Quartz Beloit One Network |
$1,021.24
|
| Rate for Payer: Quartz Commercial |
$1,354.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,250.50
|
| Rate for Payer: The Alliance Commercial |
$1,042.08
|
| Rate for Payer: WEA Trust Commercial |
$1,146.29
|
| Rate for Payer: WPS Commercial |
$1,543.68
|
|
|
PERMANENT CARDIAC PACEMAKER IMPLANT WITH AMI, HEART FAILURE OR SHOCK
|
Facility
|
IP
|
$19,202.60
|
|
|
Service Code
|
APR-DRG 1701
|
| 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
|
|
|
PERMANENT CARDIAC PACEMAKER IMPLANT WITH AMI, HEART FAILURE OR SHOCK
|
Facility
|
IP
|
$20,517.85
|
|
|
Service Code
|
APR-DRG 1702
|
| Min. Negotiated Rate |
$18,225.23 |
| Max. Negotiated Rate |
$20,517.85 |
| Rate for Payer: Anthem Medicaid |
$19,646.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$19,646.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19,646.97
|
| Rate for Payer: Dean Health Medicaid |
$19,646.97
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18,225.23
|
| Rate for Payer: Managed Health Services Medicaid |
$20,517.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$19,646.97
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19,646.97
|
| Rate for Payer: United Healthcare Medicaid |
$19,646.97
|
|
|
PERMANENT CARDIAC PACEMAKER IMPLANT WITH AMI, HEART FAILURE OR SHOCK
|
Facility
|
IP
|
$41,123.37
|
|
|
Service Code
|
APR-DRG 1704
|
| Min. Negotiated Rate |
$36,528.35 |
| Max. Negotiated Rate |
$41,123.37 |
| Rate for Payer: Anthem Medicaid |
$39,377.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$39,377.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$39,377.90
|
| Rate for Payer: Dean Health Medicaid |
$39,377.90
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$36,528.35
|
| Rate for Payer: Managed Health Services Medicaid |
$41,123.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$39,377.90
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$39,377.90
|
| Rate for Payer: United Healthcare Medicaid |
$39,377.90
|
|
