|
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
|
$46.42
|
|
|
Service Code
|
EAPG 00548
|
| Min. Negotiated Rate |
$44.63 |
| Max. Negotiated Rate |
$46.42 |
| Rate for Payer: Anthem Medicaid |
$44.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$44.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$44.63
|
| Rate for Payer: Dean Health Medicaid |
$44.63
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$44.63
|
| Rate for Payer: Managed Health Services Medicaid |
$46.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$44.63
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$44.63
|
| Rate for Payer: United Healthcare Medicaid |
$44.63
|
|
|
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
|
$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 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
|
$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 INJURIES
|
Facility
|
OP
|
$33.86
|
|
|
Service Code
|
EAPG 00545
|
| Min. Negotiated Rate |
$32.55 |
| Max. Negotiated Rate |
$33.86 |
| Rate for Payer: Anthem Medicaid |
$32.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$32.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$32.55
|
| Rate for Payer: Dean Health Medicaid |
$32.55
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$32.55
|
| Rate for Payer: Managed Health Services Medicaid |
$33.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$32.55
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$32.55
|
| Rate for Payer: United Healthcare Medicaid |
$32.55
|
|
|
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
|
|
|
PERIPHERAL VASCULAR BYPASS PROCEDURES
|
Facility
|
OP
|
$1,060.51
|
|
|
Service Code
|
EAPG 00123
|
| Min. Negotiated Rate |
$1,019.72 |
| Max. Negotiated Rate |
$1,060.51 |
| Rate for Payer: Anthem Medicaid |
$1,019.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$1,019.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,019.72
|
| Rate for Payer: Dean Health Medicaid |
$1,019.72
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$1,019.72
|
| Rate for Payer: Managed Health Services Medicaid |
$1,060.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,019.72
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$1,019.72
|
| Rate for Payer: United Healthcare Medicaid |
$1,019.72
|
|
|
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
|
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
|
|
|
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
|
|
|
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
|
$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
|
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
|
$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 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
|
|
