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 |
$8,757.28 |
Max. Negotiated Rate |
$33,872.50 |
Rate for Payer: Aetna Commercial |
$16,084.80
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,369.92
|
Rate for Payer: Aetna Managed Medicare |
$9,105.51
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,649.00
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,649.00
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,230.00
|
Rate for Payer: Anthem Medicare Advantage |
$9,105.51
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,472.16
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,105.51
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,105.51
|
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 |
$16,442.24
|
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,105.51
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,105.51
|
Rate for Payer: Health EOS Commercial |
$15,906.08
|
Rate for Payer: HFN Commercial |
$16,442.24
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33,872.50
|
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,105.51
|
Rate for Payer: Independent Care Health Plan Medicare |
$9,105.51
|
Rate for Payer: Managed Health Services Medicare Advantage |
$9,105.51
|
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,105.51
|
Rate for Payer: Multiplan Commercial |
$14,297.60
|
Rate for Payer: NAPHCARE Commercial |
$13,658.26
|
Rate for Payer: Preferred Network Access Commercial |
$16,442.24
|
Rate for Payer: Quartz Beloit One Network |
$8,757.28
|
Rate for Payer: Quartz Commercial |
$11,616.80
|
Rate for Payer: Quartz Medicare Advantage |
$9,105.51
|
Rate for Payer: The Alliance Commercial |
$15,479.37
|
Rate for Payer: United Healthcare Medicare Advantage |
$9,105.51
|
Rate for Payer: United Healthcare PPO |
$9,596.00
|
Rate for Payer: WEA Trust Commercial |
$9,829.60
|
Rate for Payer: Wellcare Medicare |
$9,105.51
|
Rate for Payer: WPS Commercial |
$13,237.79
|
|
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 |
$1,330.00 |
Max. Negotiated Rate |
$3,762.95 |
Rate for Payer: Aetna Commercial |
$3,762.95
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,406.46
|
Rate for Payer: Cash Price |
$1,188.30
|
Rate for Payer: Cash Price |
$1,188.30
|
Rate for Payer: Cigna Commercial |
$3,762.95
|
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,330.00
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$2,376.60
|
Rate for Payer: Health EOS Commercial |
$3,604.51
|
Rate for Payer: HFN Commercial |
$3,762.95
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,351.78
|
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,351.78
|
Rate for Payer: Multiplan Commercial |
$3,168.80
|
Rate for Payer: Preferred Network Access Commercial |
$3,762.95
|
Rate for Payer: Quartz Beloit One Network |
$1,742.84
|
Rate for Payer: Quartz Commercial |
$2,257.77
|
Rate for Payer: The Alliance Commercial |
$1,980.50
|
Rate for Payer: United Healthcare Medicaid |
$1,330.00
|
Rate for Payer: WEA Trust Commercial |
$2,178.55
|
Rate for Payer: WPS Commercial |
$2,933.91
|
|
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 |
$10.12 |
Max. Negotiated Rate |
$21.85 |
Rate for Payer: Aetna Commercial |
$21.85
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19.78
|
Rate for Payer: Cash Price |
$6.90
|
Rate for Payer: Cigna Commercial |
$21.85
|
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11.50
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$13.80
|
Rate for Payer: Health EOS Commercial |
$20.93
|
Rate for Payer: HFN Commercial |
$21.85
|
Rate for Payer: Multiplan Commercial |
$18.40
|
Rate for Payer: Preferred Network Access Commercial |
$21.85
|
Rate for Payer: Quartz Beloit One Network |
$10.12
|
Rate for Payer: Quartz Commercial |
$13.11
|
Rate for Payer: The Alliance Commercial |
$11.50
|
Rate for Payer: WEA Trust Commercial |
$12.65
|
Rate for Payer: WPS Commercial |
$17.04
|
|
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 |
$858.20 |
Max. Negotiated Rate |
$12,260.00 |
Rate for Payer: Aetna Commercial |
$2,758.50
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,635.90
|
Rate for Payer: Aetna Managed Medicare |
$858.20
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,992.25
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,532.50
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,471.20
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,624.45
|
Rate for Payer: Cash Price |
$919.50
|
Rate for Payer: Cash Price |
$919.50
|
Rate for Payer: Cigna Commercial |
$2,819.80
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
Rate for Payer: Health EOS Commercial |
$2,727.85
|
Rate for Payer: HFN Commercial |
$2,819.80
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,298.75
|
Rate for Payer: Multiplan Commercial |
$2,452.00
|
Rate for Payer: NAPHCARE Commercial |
$1,839.00
|
Rate for Payer: Preferred Network Access Commercial |
$2,819.80
|
Rate for Payer: Quartz Beloit One Network |
$1,501.85
|
Rate for Payer: Quartz Commercial |
$1,992.25
|
Rate for Payer: Quartz Medicare Advantage |
$1,839.00
|
Rate for Payer: The Alliance Commercial |
$12,260.00
|
Rate for Payer: WEA Trust Commercial |
$1,685.75
|
Rate for Payer: WPS Commercial |
$2,270.25
|
|
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 |
$1,501.85 |
Max. Negotiated Rate |
$2,819.80 |
Rate for Payer: Aetna Commercial |
$2,758.50
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,635.90
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,624.45
|
Rate for Payer: Cash Price |
$919.50
|
Rate for Payer: Cigna Commercial |
$2,819.80
|
Rate for Payer: Health EOS Commercial |
$2,727.85
|
Rate for Payer: HFN Commercial |
$2,819.80
|
Rate for Payer: Multiplan Commercial |
$2,452.00
|
Rate for Payer: NAPHCARE Commercial |
$1,839.00
|
Rate for Payer: Preferred Network Access Commercial |
$2,819.80
|
Rate for Payer: Quartz Beloit One Network |
$1,501.85
|
Rate for Payer: Quartz Commercial |
$1,839.00
|
Rate for Payer: WEA Trust Commercial |
$1,685.75
|
Rate for Payer: WPS Commercial |
$2,270.25
|
|
PERICARDIAL WINDOW
|
Facility
|
IP
|
$4,238.00
|
|
Hospital Charge Code |
4494602
|
Hospital Revenue Code
|
360
|
Min. Negotiated Rate |
$2,076.62 |
Max. Negotiated Rate |
$3,898.96 |
Rate for Payer: Aetna Commercial |
$3,814.20
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,644.68
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,246.14
|
Rate for Payer: Cash Price |
$1,271.40
|
Rate for Payer: Cigna Commercial |
$3,898.96
|
Rate for Payer: Health EOS Commercial |
$3,771.82
|
Rate for Payer: HFN Commercial |
$3,898.96
|
Rate for Payer: Multiplan Commercial |
$3,390.40
|
Rate for Payer: NAPHCARE Commercial |
$2,542.80
|
Rate for Payer: Preferred Network Access Commercial |
$3,898.96
|
Rate for Payer: Quartz Beloit One Network |
$2,076.62
|
Rate for Payer: Quartz Commercial |
$2,542.80
|
Rate for Payer: WEA Trust Commercial |
$2,330.90
|
Rate for Payer: WPS Commercial |
$3,139.09
|
|
PERICARDIAL WINDOW
|
Facility
|
OP
|
$4,238.00
|
|
Hospital Charge Code |
4494602
|
Hospital Revenue Code
|
360
|
Min. Negotiated Rate |
$1,186.64 |
Max. Negotiated Rate |
$16,952.00 |
Rate for Payer: Aetna Commercial |
$3,814.20
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,644.68
|
Rate for Payer: Aetna Managed Medicare |
$1,186.64
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,754.70
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,119.00
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,034.24
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,246.14
|
Rate for Payer: Cash Price |
$1,271.40
|
Rate for Payer: Cigna Commercial |
$3,898.96
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$2,371.58
|
Rate for Payer: Health EOS Commercial |
$3,771.82
|
Rate for Payer: HFN Commercial |
$3,898.96
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,178.50
|
Rate for Payer: Multiplan Commercial |
$3,390.40
|
Rate for Payer: NAPHCARE Commercial |
$2,542.80
|
Rate for Payer: Preferred Network Access Commercial |
$3,898.96
|
Rate for Payer: Quartz Beloit One Network |
$2,076.62
|
Rate for Payer: Quartz Commercial |
$2,754.70
|
Rate for Payer: Quartz Medicare Advantage |
$2,542.80
|
Rate for Payer: The Alliance Commercial |
$16,952.00
|
Rate for Payer: WEA Trust Commercial |
$2,330.90
|
Rate for Payer: WPS Commercial |
$3,139.09
|
|
PERICARDIECTOMY
|
Facility
|
OP
|
$15,505.00
|
|
Hospital Charge Code |
2960313
|
Hospital Revenue Code
|
360
|
Min. Negotiated Rate |
$4,341.40 |
Max. Negotiated Rate |
$62,020.00 |
Rate for Payer: Aetna Commercial |
$13,954.50
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,334.30
|
Rate for Payer: Aetna Managed Medicare |
$4,341.40
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,078.25
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,752.50
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,442.40
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,217.65
|
Rate for Payer: Cash Price |
$4,651.50
|
Rate for Payer: Cigna Commercial |
$14,264.60
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$8,676.60
|
Rate for Payer: Health EOS Commercial |
$13,799.45
|
Rate for Payer: HFN Commercial |
$14,264.60
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,628.75
|
Rate for Payer: Multiplan Commercial |
$12,404.00
|
Rate for Payer: NAPHCARE Commercial |
$9,303.00
|
Rate for Payer: Preferred Network Access Commercial |
$14,264.60
|
Rate for Payer: Quartz Beloit One Network |
$7,597.45
|
Rate for Payer: Quartz Commercial |
$10,078.25
|
Rate for Payer: Quartz Medicare Advantage |
$9,303.00
|
Rate for Payer: The Alliance Commercial |
$62,020.00
|
Rate for Payer: WEA Trust Commercial |
$8,527.75
|
Rate for Payer: WPS Commercial |
$11,484.55
|
|
PERICARDIECTOMY
|
Facility
|
IP
|
$15,505.00
|
|
Hospital Charge Code |
2960313
|
Hospital Revenue Code
|
360
|
Min. Negotiated Rate |
$7,597.45 |
Max. Negotiated Rate |
$14,264.60 |
Rate for Payer: Aetna Commercial |
$13,954.50
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,334.30
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,217.65
|
Rate for Payer: Cash Price |
$4,651.50
|
Rate for Payer: Cigna Commercial |
$14,264.60
|
Rate for Payer: Health EOS Commercial |
$13,799.45
|
Rate for Payer: HFN Commercial |
$14,264.60
|
Rate for Payer: Multiplan Commercial |
$12,404.00
|
Rate for Payer: NAPHCARE Commercial |
$9,303.00
|
Rate for Payer: Preferred Network Access Commercial |
$14,264.60
|
Rate for Payer: Quartz Beloit One Network |
$7,597.45
|
Rate for Payer: Quartz Commercial |
$9,303.00
|
Rate for Payer: WEA Trust Commercial |
$8,527.75
|
Rate for Payer: WPS Commercial |
$11,484.55
|
|
Pericardiocentesis F/U
|
Facility
|
IP
|
$517.00
|
|
Hospital Charge Code |
4125712
|
Min. Negotiated Rate |
$253.33 |
Max. Negotiated Rate |
$475.64 |
Rate for Payer: Aetna Commercial |
$465.30
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$444.62
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$274.01
|
Rate for Payer: Cash Price |
$155.10
|
Rate for Payer: Cigna Commercial |
$475.64
|
Rate for Payer: Health EOS Commercial |
$460.13
|
Rate for Payer: HFN Commercial |
$475.64
|
Rate for Payer: Multiplan Commercial |
$413.60
|
Rate for Payer: NAPHCARE Commercial |
$310.20
|
Rate for Payer: Preferred Network Access Commercial |
$475.64
|
Rate for Payer: Quartz Beloit One Network |
$253.33
|
Rate for Payer: Quartz Commercial |
$310.20
|
Rate for Payer: WEA Trust Commercial |
$284.35
|
Rate for Payer: WPS Commercial |
$382.94
|
|
Pericardiocentesis F/U
|
Facility
|
OP
|
$517.00
|
|
Hospital Charge Code |
4125712
|
Min. Negotiated Rate |
$144.76 |
Max. Negotiated Rate |
$2,068.00 |
Rate for Payer: Aetna Commercial |
$465.30
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$444.62
|
Rate for Payer: Aetna Managed Medicare |
$144.76
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$336.05
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$258.50
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$248.16
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$274.01
|
Rate for Payer: Cash Price |
$155.10
|
Rate for Payer: Cigna Commercial |
$475.64
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$289.31
|
Rate for Payer: Health EOS Commercial |
$460.13
|
Rate for Payer: HFN Commercial |
$475.64
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$387.75
|
Rate for Payer: Multiplan Commercial |
$413.60
|
Rate for Payer: NAPHCARE Commercial |
$310.20
|
Rate for Payer: Preferred Network Access Commercial |
$475.64
|
Rate for Payer: Quartz Beloit One Network |
$253.33
|
Rate for Payer: Quartz Commercial |
$336.05
|
Rate for Payer: Quartz Medicare Advantage |
$310.20
|
Rate for Payer: The Alliance Commercial |
$2,068.00
|
Rate for Payer: WEA Trust Commercial |
$284.35
|
Rate for Payer: WPS Commercial |
$382.94
|
|
Pericardiocentesis Including Imaging Guidance
|
Facility
|
OP
|
$2,870.00
|
|
Service Code
|
CPT 33016
|
Hospital Charge Code |
5565259
|
Hospital Revenue Code
|
481
|
Min. Negotiated Rate |
$1,377.60 |
Max. Negotiated Rate |
$6,331.88 |
Rate for Payer: Aetna Commercial |
$2,583.00
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,468.20
|
Rate for Payer: Aetna Managed Medicare |
$1,582.97
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,865.50
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,435.00
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,377.60
|
Rate for Payer: Anthem Medicare Advantage |
$1,582.97
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,521.10
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,582.97
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,582.97
|
Rate for Payer: Cash Price |
$861.00
|
Rate for Payer: Cash Price |
$861.00
|
Rate for Payer: Cigna Commercial |
$2,640.40
|
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,582.97
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,582.97
|
Rate for Payer: Health EOS Commercial |
$2,554.30
|
Rate for Payer: HFN Commercial |
$2,640.40
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,888.65
|
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,582.97
|
Rate for Payer: Independent Care Health Plan Medicare |
$1,582.97
|
Rate for Payer: Managed Health Services Medicare Advantage |
$1,582.97
|
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,582.97
|
Rate for Payer: Multiplan Commercial |
$2,296.00
|
Rate for Payer: NAPHCARE Commercial |
$2,374.46
|
Rate for Payer: Preferred Network Access Commercial |
$2,640.40
|
Rate for Payer: Quartz Beloit One Network |
$1,406.30
|
Rate for Payer: Quartz Commercial |
$1,865.50
|
Rate for Payer: Quartz Medicare Advantage |
$1,582.97
|
Rate for Payer: The Alliance Commercial |
$6,331.88
|
Rate for Payer: United Healthcare Medicare Advantage |
$1,582.97
|
Rate for Payer: WEA Trust Commercial |
$1,578.50
|
Rate for Payer: Wellcare Medicare |
$1,582.97
|
Rate for Payer: WPS Commercial |
$2,125.81
|
|
Pericardiocentesis Including Imaging Guidance
|
Facility
|
IP
|
$2,870.00
|
|
Service Code
|
CPT 33016
|
Hospital Charge Code |
5565259
|
Hospital Revenue Code
|
481
|
Min. Negotiated Rate |
$1,406.30 |
Max. Negotiated Rate |
$2,640.40 |
Rate for Payer: Aetna Commercial |
$2,583.00
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,468.20
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,521.10
|
Rate for Payer: Cash Price |
$861.00
|
Rate for Payer: Cigna Commercial |
$2,640.40
|
Rate for Payer: Health EOS Commercial |
$2,554.30
|
Rate for Payer: HFN Commercial |
$2,640.40
|
Rate for Payer: Multiplan Commercial |
$2,296.00
|
Rate for Payer: NAPHCARE Commercial |
$1,722.00
|
Rate for Payer: Preferred Network Access Commercial |
$2,640.40
|
Rate for Payer: Quartz Beloit One Network |
$1,406.30
|
Rate for Payer: Quartz Commercial |
$1,722.00
|
Rate for Payer: WEA Trust Commercial |
$1,578.50
|
Rate for Payer: WPS Commercial |
$2,125.81
|
|
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 |
$76.45 |
Max. Negotiated Rate |
$291.08 |
Rate for Payer: Aetna Commercial |
$257.45
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.06
|
Rate for Payer: Cash Price |
$81.30
|
Rate for Payer: Cash Price |
$81.30
|
Rate for Payer: Cigna Commercial |
$257.45
|
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$76.45
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$162.60
|
Rate for Payer: Health EOS Commercial |
$246.61
|
Rate for Payer: HFN Commercial |
$257.45
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$291.08
|
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$291.08
|
Rate for Payer: Multiplan Commercial |
$216.80
|
Rate for Payer: Preferred Network Access Commercial |
$257.45
|
Rate for Payer: Quartz Beloit One Network |
$119.24
|
Rate for Payer: Quartz Commercial |
$154.47
|
Rate for Payer: The Alliance Commercial |
$135.50
|
Rate for Payer: United Healthcare Medicaid |
$76.45
|
Rate for Payer: WEA Trust Commercial |
$149.05
|
Rate for Payer: WPS Commercial |
$200.73
|
|
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 |
$70.13 |
Max. Negotiated Rate |
$256.81 |
Rate for Payer: Aetna Commercial |
$196.65
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$178.02
|
Rate for Payer: Cash Price |
$62.10
|
Rate for Payer: Cash Price |
$62.10
|
Rate for Payer: Cigna Commercial |
$196.65
|
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$70.13
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$124.20
|
Rate for Payer: Health EOS Commercial |
$188.37
|
Rate for Payer: HFN Commercial |
$196.65
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$256.81
|
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$256.81
|
Rate for Payer: Multiplan Commercial |
$165.60
|
Rate for Payer: Preferred Network Access Commercial |
$196.65
|
Rate for Payer: Quartz Beloit One Network |
$91.08
|
Rate for Payer: Quartz Commercial |
$117.99
|
Rate for Payer: The Alliance Commercial |
$103.50
|
Rate for Payer: United Healthcare Medicaid |
$70.13
|
Rate for Payer: WEA Trust Commercial |
$113.85
|
Rate for Payer: WPS Commercial |
$153.32
|
|
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 |
$78.16 |
Max. Negotiated Rate |
$299.56 |
Rate for Payer: Aetna Commercial |
$266.00
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$240.80
|
Rate for Payer: Cash Price |
$84.00
|
Rate for Payer: Cash Price |
$84.00
|
Rate for Payer: Cigna Commercial |
$266.00
|
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$78.16
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$168.00
|
Rate for Payer: Health EOS Commercial |
$254.80
|
Rate for Payer: HFN Commercial |
$266.00
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$299.56
|
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$299.56
|
Rate for Payer: Multiplan Commercial |
$224.00
|
Rate for Payer: Preferred Network Access Commercial |
$266.00
|
Rate for Payer: Quartz Beloit One Network |
$123.20
|
Rate for Payer: Quartz Commercial |
$159.60
|
Rate for Payer: The Alliance Commercial |
$140.00
|
Rate for Payer: United Healthcare Medicaid |
$78.16
|
Rate for Payer: WEA Trust Commercial |
$154.00
|
Rate for Payer: WPS Commercial |
$207.40
|
|
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 |
$65.77 |
Max. Negotiated Rate |
$234.25 |
Rate for Payer: Aetna Commercial |
$177.65
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.82
|
Rate for Payer: Cash Price |
$56.10
|
Rate for Payer: Cash Price |
$56.10
|
Rate for Payer: Cigna Commercial |
$177.65
|
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$65.77
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$112.20
|
Rate for Payer: Health EOS Commercial |
$170.17
|
Rate for Payer: HFN Commercial |
$177.65
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$234.25
|
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$234.25
|
Rate for Payer: Multiplan Commercial |
$149.60
|
Rate for Payer: Preferred Network Access Commercial |
$177.65
|
Rate for Payer: Quartz Beloit One Network |
$82.28
|
Rate for Payer: Quartz Commercial |
$106.59
|
Rate for Payer: The Alliance Commercial |
$93.50
|
Rate for Payer: United Healthcare Medicaid |
$65.77
|
Rate for Payer: WEA Trust Commercial |
$102.85
|
Rate for Payer: WPS Commercial |
$138.51
|
|
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 |
$83.07 |
Max. Negotiated Rate |
$325.36 |
Rate for Payer: Aetna Commercial |
$289.75
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$262.30
|
Rate for Payer: Cash Price |
$91.50
|
Rate for Payer: Cash Price |
$91.50
|
Rate for Payer: Cigna Commercial |
$289.75
|
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$83.07
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$183.00
|
Rate for Payer: Health EOS Commercial |
$277.55
|
Rate for Payer: HFN Commercial |
$289.75
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$325.36
|
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$325.36
|
Rate for Payer: Multiplan Commercial |
$244.00
|
Rate for Payer: Preferred Network Access Commercial |
$289.75
|
Rate for Payer: Quartz Beloit One Network |
$134.20
|
Rate for Payer: Quartz Commercial |
$173.85
|
Rate for Payer: The Alliance Commercial |
$152.50
|
Rate for Payer: United Healthcare Medicaid |
$83.07
|
Rate for Payer: WEA Trust Commercial |
$167.75
|
Rate for Payer: WPS Commercial |
$225.91
|
|
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 |
$69.90 |
Max. Negotiated Rate |
$256.81 |
Rate for Payer: Aetna Commercial |
$228.00
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$206.40
|
Rate for Payer: Cash Price |
$72.00
|
Rate for Payer: Cash Price |
$72.00
|
Rate for Payer: Cigna Commercial |
$228.00
|
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$69.90
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$144.00
|
Rate for Payer: Health EOS Commercial |
$218.40
|
Rate for Payer: HFN Commercial |
$228.00
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$256.81
|
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$256.81
|
Rate for Payer: Multiplan Commercial |
$192.00
|
Rate for Payer: Preferred Network Access Commercial |
$228.00
|
Rate for Payer: Quartz Beloit One Network |
$105.60
|
Rate for Payer: Quartz Commercial |
$136.80
|
Rate for Payer: The Alliance Commercial |
$120.00
|
Rate for Payer: United Healthcare Medicaid |
$69.90
|
Rate for Payer: WEA Trust Commercial |
$132.00
|
Rate for Payer: WPS Commercial |
$177.77
|
|
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 |
$89.57 |
Max. Negotiated Rate |
$351.50 |
Rate for Payer: Aetna Commercial |
$351.50
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$318.20
|
Rate for Payer: Cash Price |
$111.00
|
Rate for Payer: Cash Price |
$111.00
|
Rate for Payer: Cigna Commercial |
$351.50
|
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$89.57
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$222.00
|
Rate for Payer: Health EOS Commercial |
$336.70
|
Rate for Payer: HFN Commercial |
$351.50
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$341.53
|
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$341.53
|
Rate for Payer: Multiplan Commercial |
$296.00
|
Rate for Payer: Preferred Network Access Commercial |
$351.50
|
Rate for Payer: Quartz Beloit One Network |
$162.80
|
Rate for Payer: Quartz Commercial |
$210.90
|
Rate for Payer: The Alliance Commercial |
$185.00
|
Rate for Payer: United Healthcare Medicaid |
$89.57
|
Rate for Payer: WEA Trust Commercial |
$203.50
|
Rate for Payer: WPS Commercial |
$274.06
|
|
PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR
|
Facility
|
IP
|
$59,626.00
|
|
Service Code
|
MSDRG 041
|
Min. Negotiated Rate |
$21,448.10 |
Max. Negotiated Rate |
$59,626.00 |
Rate for Payer: Aetna Managed Medicare |
$21,448.10
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46,785.40
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$35,860.63
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34,069.94
|
Rate for Payer: Anthem Medicare Advantage |
$21,448.10
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21,448.10
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21,448.10
|
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$21,448.10
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$37,820.76
|
Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$21,448.10
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43,498.65
|
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21,448.10
|
Rate for Payer: Independent Care Health Plan Medicare |
$21,448.10
|
Rate for Payer: Managed Health Services Medicare Advantage |
$21,448.10
|
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$21,448.10
|
Rate for Payer: NAPHCARE Commercial |
$32,172.15
|
Rate for Payer: Quartz Medicare Advantage |
$21,448.10
|
Rate for Payer: The Alliance Commercial |
$59,626.00
|
Rate for Payer: United Healthcare Medicare Advantage |
$21,448.10
|
Rate for Payer: United Healthcare PPO |
$33,864.26
|
Rate for Payer: Wellcare Medicare |
$21,448.10
|
|
PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC
|
Facility
|
IP
|
$102,690.00
|
|
Service Code
|
MSDRG 040
|
Min. Negotiated Rate |
$36,938.73 |
Max. Negotiated Rate |
$102,690.00 |
Rate for Payer: Aetna Managed Medicare |
$36,938.73
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$80,773.00
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$61,911.85
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$58,820.30
|
Rate for Payer: Anthem Medicare Advantage |
$36,938.73
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36,938.73
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36,938.73
|
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$36,938.73
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$65,295.92
|
Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$36,938.73
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$75,084.75
|
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$36,938.73
|
Rate for Payer: Independent Care Health Plan Medicare |
$36,938.73
|
Rate for Payer: Managed Health Services Medicare Advantage |
$36,938.73
|
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$36,938.73
|
Rate for Payer: NAPHCARE Commercial |
$55,408.10
|
Rate for Payer: Quartz Medicare Advantage |
$36,938.73
|
Rate for Payer: The Alliance Commercial |
$102,690.00
|
Rate for Payer: United Healthcare Medicare Advantage |
$36,938.73
|
Rate for Payer: United Healthcare PPO |
$58,454.44
|
Rate for Payer: Wellcare Medicare |
$36,938.73
|
|
PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$46,575.00
|
|
Service Code
|
MSDRG 042
|
Min. Negotiated Rate |
$16,753.49 |
Max. Negotiated Rate |
$46,575.00 |
Rate for Payer: Aetna Managed Medicare |
$16,753.49
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$36,505.20
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27,980.94
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26,583.72
|
Rate for Payer: Anthem Medicare Advantage |
$16,753.49
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16,753.49
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16,753.49
|
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16,753.49
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$29,510.37
|
Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16,753.49
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33,926.10
|
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16,753.49
|
Rate for Payer: Independent Care Health Plan Medicare |
$16,753.49
|
Rate for Payer: Managed Health Services Medicare Advantage |
$16,753.49
|
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16,753.49
|
Rate for Payer: NAPHCARE Commercial |
$25,130.24
|
Rate for Payer: Quartz Medicare Advantage |
$16,753.49
|
Rate for Payer: The Alliance Commercial |
$46,575.00
|
Rate for Payer: United Healthcare Medicare Advantage |
$16,753.49
|
Rate for Payer: United Healthcare PPO |
$26,411.90
|
Rate for Payer: Wellcare Medicare |
$16,753.49
|
|
PERIPHERAL VASCULAR DISORDERS WITH CC
|
Facility
|
IP
|
$28,688.00
|
|
Service Code
|
MSDRG 300
|
Min. Negotiated Rate |
$10,319.31 |
Max. Negotiated Rate |
$28,688.00 |
Rate for Payer: Aetna Managed Medicare |
$10,319.31
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22,448.60
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17,206.67
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16,347.46
|
Rate for Payer: Anthem Medicare Advantage |
$10,319.31
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,319.31
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,319.31
|
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,319.31
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$18,147.18
|
Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,319.31
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,806.50
|
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,319.31
|
Rate for Payer: Independent Care Health Plan Medicare |
$10,319.31
|
Rate for Payer: Managed Health Services Medicare Advantage |
$10,319.31
|
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,319.31
|
Rate for Payer: NAPHCARE Commercial |
$15,478.96
|
Rate for Payer: Quartz Medicare Advantage |
$10,319.31
|
Rate for Payer: The Alliance Commercial |
$28,688.00
|
Rate for Payer: United Healthcare Medicare Advantage |
$10,319.31
|
Rate for Payer: United Healthcare PPO |
$16,198.13
|
Rate for Payer: Wellcare Medicare |
$10,319.31
|
|
PERIPHERAL VASCULAR DISORDERS WITH MCC
|
Facility
|
IP
|
$42,225.00
|
|
Service Code
|
MSDRG 299
|
Min. Negotiated Rate |
$15,188.93 |
Max. Negotiated Rate |
$42,225.00 |
Rate for Payer: Aetna Managed Medicare |
$15,188.93
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33,148.40
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25,407.98
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24,139.24
|
Rate for Payer: Anthem Medicare Advantage |
$15,188.93
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15,188.93
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15,188.93
|
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15,188.93
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$26,796.77
|
Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15,188.93
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30,735.90
|
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15,188.93
|
Rate for Payer: Independent Care Health Plan Medicare |
$15,188.93
|
Rate for Payer: Managed Health Services Medicare Advantage |
$15,188.93
|
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15,188.93
|
Rate for Payer: NAPHCARE Commercial |
$22,783.40
|
Rate for Payer: Quartz Medicare Advantage |
$15,188.93
|
Rate for Payer: The Alliance Commercial |
$42,225.00
|
Rate for Payer: United Healthcare Medicare Advantage |
$15,188.93
|
Rate for Payer: United Healthcare PPO |
$23,928.29
|
Rate for Payer: Wellcare Medicare |
$15,188.93
|
|