|
SPINAL ANES - SET-UP CHARGE
|
Facility
|
OP
|
$1,160.00
|
|
| Hospital Charge Code |
4519579
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$324.80 |
| Max. Negotiated Rate |
$4,640.00 |
| Rate for Payer: Aetna Commercial |
$1,044.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$997.60
|
| Rate for Payer: Aetna Managed Medicare |
$324.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$754.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$580.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$556.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$614.80
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Cigna Commercial |
$1,067.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$649.14
|
| Rate for Payer: Health EOS Commercial |
$1,032.40
|
| Rate for Payer: HFN Commercial |
$1,067.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$870.00
|
| Rate for Payer: Multiplan Commercial |
$928.00
|
| Rate for Payer: NAPHCARE Commercial |
$696.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,067.20
|
| Rate for Payer: Quartz Beloit One Network |
$568.40
|
| Rate for Payer: Quartz Commercial |
$754.00
|
| Rate for Payer: Quartz Medicare Advantage |
$696.00
|
| Rate for Payer: The Alliance Commercial |
$4,640.00
|
| Rate for Payer: WEA Trust Commercial |
$638.00
|
| Rate for Payer: WPS Commercial |
$859.21
|
|
|
SPINAL ANES - SET-UP CHARGE
|
Facility
|
IP
|
$1,160.00
|
|
| Hospital Charge Code |
4519579
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$568.40 |
| Max. Negotiated Rate |
$1,067.20 |
| Rate for Payer: Aetna Commercial |
$1,044.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$997.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$614.80
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Cigna Commercial |
$1,067.20
|
| Rate for Payer: Health EOS Commercial |
$1,032.40
|
| Rate for Payer: HFN Commercial |
$1,067.20
|
| Rate for Payer: Multiplan Commercial |
$928.00
|
| Rate for Payer: NAPHCARE Commercial |
$696.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,067.20
|
| Rate for Payer: Quartz Beloit One Network |
$568.40
|
| Rate for Payer: Quartz Commercial |
$696.00
|
| Rate for Payer: WEA Trust Commercial |
$638.00
|
| Rate for Payer: WPS Commercial |
$859.21
|
|
|
SPINAL DISORDERS AND INJURIES WITH CC/MCC
|
Facility
|
IP
|
$52,017.00
|
|
|
Service Code
|
MSDRG 052
|
| Min. Negotiated Rate |
$18,711.09 |
| Max. Negotiated Rate |
$52,017.00 |
| Rate for Payer: Aetna Managed Medicare |
$18,711.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$40,701.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31,197.14
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29,639.32
|
| Rate for Payer: Anthem Medicare Advantage |
$18,711.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18,711.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18,711.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18,711.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32,902.36
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18,711.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37,917.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18,711.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18,711.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18,711.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18,711.09
|
| Rate for Payer: NAPHCARE Commercial |
$28,066.64
|
| Rate for Payer: Quartz Medicare Advantage |
$18,711.09
|
| Rate for Payer: The Alliance Commercial |
$52,017.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18,711.09
|
| Rate for Payer: United Healthcare PPO |
$29,519.45
|
| Rate for Payer: Wellcare Medicare |
$18,711.09
|
|
|
SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC
|
Facility
|
IP
|
$26,476.00
|
|
|
Service Code
|
MSDRG 053
|
| Min. Negotiated Rate |
$9,523.64 |
| Max. Negotiated Rate |
$26,476.00 |
| Rate for Payer: Aetna Managed Medicare |
$9,523.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20,560.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15,759.38
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14,972.44
|
| Rate for Payer: Anthem Medicare Advantage |
$9,523.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,523.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,523.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,523.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16,620.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,523.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19,184.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,523.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9,523.64
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9,523.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,523.64
|
| Rate for Payer: NAPHCARE Commercial |
$14,285.46
|
| Rate for Payer: Quartz Medicare Advantage |
$9,523.64
|
| Rate for Payer: The Alliance Commercial |
$26,476.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,523.64
|
| Rate for Payer: United Healthcare PPO |
$14,935.07
|
| Rate for Payer: Wellcare Medicare |
$9,523.64
|
|
|
SPINAL FIXATION, ANTERIOR
|
Facility
|
OP
|
$7,778.00
|
|
| Hospital Charge Code |
2960383
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,177.84 |
| Max. Negotiated Rate |
$31,112.00 |
| Rate for Payer: Aetna Commercial |
$7,000.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,689.08
|
| Rate for Payer: Aetna Managed Medicare |
$2,177.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,055.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,889.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,733.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,122.34
|
| Rate for Payer: Cash Price |
$2,333.40
|
| Rate for Payer: Cigna Commercial |
$7,155.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,352.57
|
| Rate for Payer: Health EOS Commercial |
$6,922.42
|
| Rate for Payer: HFN Commercial |
$7,155.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,833.50
|
| Rate for Payer: Multiplan Commercial |
$6,222.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,666.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,155.76
|
| Rate for Payer: Quartz Beloit One Network |
$3,811.22
|
| Rate for Payer: Quartz Commercial |
$5,055.70
|
| Rate for Payer: Quartz Medicare Advantage |
$4,666.80
|
| Rate for Payer: The Alliance Commercial |
$31,112.00
|
| Rate for Payer: WEA Trust Commercial |
$4,277.90
|
| Rate for Payer: WPS Commercial |
$5,761.16
|
|
|
SPINAL FIXATION, ANTERIOR
|
Facility
|
IP
|
$7,778.00
|
|
| Hospital Charge Code |
2960383
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,811.22 |
| Max. Negotiated Rate |
$7,155.76 |
| Rate for Payer: Aetna Commercial |
$7,000.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,689.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,122.34
|
| Rate for Payer: Cash Price |
$2,333.40
|
| Rate for Payer: Cigna Commercial |
$7,155.76
|
| Rate for Payer: Health EOS Commercial |
$6,922.42
|
| Rate for Payer: HFN Commercial |
$7,155.76
|
| Rate for Payer: Multiplan Commercial |
$6,222.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,666.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,155.76
|
| Rate for Payer: Quartz Beloit One Network |
$3,811.22
|
| Rate for Payer: Quartz Commercial |
$4,666.80
|
| Rate for Payer: WEA Trust Commercial |
$4,277.90
|
| Rate for Payer: WPS Commercial |
$5,761.16
|
|
|
SPINAL FIXATION, POSTERIOR
|
Facility
|
OP
|
$7,778.00
|
|
| Hospital Charge Code |
2960384
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,177.84 |
| Max. Negotiated Rate |
$31,112.00 |
| Rate for Payer: Aetna Commercial |
$7,000.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,689.08
|
| Rate for Payer: Aetna Managed Medicare |
$2,177.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,055.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,889.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,733.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,122.34
|
| Rate for Payer: Cash Price |
$2,333.40
|
| Rate for Payer: Cigna Commercial |
$7,155.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,352.57
|
| Rate for Payer: Health EOS Commercial |
$6,922.42
|
| Rate for Payer: HFN Commercial |
$7,155.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,833.50
|
| Rate for Payer: Multiplan Commercial |
$6,222.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,666.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,155.76
|
| Rate for Payer: Quartz Beloit One Network |
$3,811.22
|
| Rate for Payer: Quartz Commercial |
$5,055.70
|
| Rate for Payer: Quartz Medicare Advantage |
$4,666.80
|
| Rate for Payer: The Alliance Commercial |
$31,112.00
|
| Rate for Payer: WEA Trust Commercial |
$4,277.90
|
| Rate for Payer: WPS Commercial |
$5,761.16
|
|
|
SPINAL FIXATION, POSTERIOR
|
Facility
|
IP
|
$7,778.00
|
|
| Hospital Charge Code |
2960384
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,811.22 |
| Max. Negotiated Rate |
$7,155.76 |
| Rate for Payer: Aetna Commercial |
$7,000.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,689.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,122.34
|
| Rate for Payer: Cash Price |
$2,333.40
|
| Rate for Payer: Cigna Commercial |
$7,155.76
|
| Rate for Payer: Health EOS Commercial |
$6,922.42
|
| Rate for Payer: HFN Commercial |
$7,155.76
|
| Rate for Payer: Multiplan Commercial |
$6,222.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,666.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,155.76
|
| Rate for Payer: Quartz Beloit One Network |
$3,811.22
|
| Rate for Payer: Quartz Commercial |
$4,666.80
|
| Rate for Payer: WEA Trust Commercial |
$4,277.90
|
| Rate for Payer: WPS Commercial |
$5,761.16
|
|
|
SPINAL FUSION EXCEPT CERVICAL WITH MCC
|
Facility
|
IP
|
$176,647.00
|
|
|
Service Code
|
MSDRG 459
|
| Min. Negotiated Rate |
$63,541.91 |
| Max. Negotiated Rate |
$176,647.00 |
| Rate for Payer: Quartz Medicare Advantage |
$63,541.91
|
| Rate for Payer: The Alliance Commercial |
$176,647.00
|
| Rate for Payer: Aetna Managed Medicare |
$63,541.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$139,097.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$106,617.03
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$101,293.14
|
| Rate for Payer: Anthem Medicare Advantage |
$63,541.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$63,541.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$63,541.91
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$63,541.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$112,444.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$63,541.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$129,329.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$63,541.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$63,541.91
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$63,541.91
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$63,541.91
|
| Rate for Payer: NAPHCARE Commercial |
$95,312.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$63,541.91
|
| Rate for Payer: United Healthcare PPO |
$100,684.95
|
| Rate for Payer: Wellcare Medicare |
$63,541.91
|
|
|
SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC
|
Facility
|
IP
|
$97,569.00
|
|
|
Service Code
|
MSDRG 460
|
| Min. Negotiated Rate |
$35,096.84 |
| Max. Negotiated Rate |
$97,569.00 |
| Rate for Payer: Aetna Managed Medicare |
$35,096.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$76,786.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$58,856.46
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$55,917.48
|
| Rate for Payer: Anthem Medicare Advantage |
$35,096.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35,096.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35,096.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$35,096.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$62,073.53
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$35,096.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$71,329.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35,096.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35,096.84
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$35,096.84
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$35,096.84
|
| Rate for Payer: NAPHCARE Commercial |
$52,645.26
|
| Rate for Payer: Quartz Medicare Advantage |
$35,096.84
|
| Rate for Payer: The Alliance Commercial |
$97,569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35,096.84
|
| Rate for Payer: United Healthcare PPO |
$55,530.58
|
| Rate for Payer: Wellcare Medicare |
$35,096.84
|
|
|
SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH CC
|
Facility
|
IP
|
$161,838.00
|
|
|
Service Code
|
MSDRG 457
|
| Min. Negotiated Rate |
$58,215.15 |
| Max. Negotiated Rate |
$161,838.00 |
| Rate for Payer: Aetna Managed Medicare |
$58,215.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$127,558.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$97,772.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$92,890.24
|
| Rate for Payer: Anthem Medicare Advantage |
$58,215.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$58,215.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$58,215.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$58,215.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$103,116.68
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$58,215.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$118,468.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$58,215.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$58,215.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$58,215.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$58,215.15
|
| Rate for Payer: NAPHCARE Commercial |
$87,322.72
|
| Rate for Payer: Quartz Medicare Advantage |
$58,215.15
|
| Rate for Payer: The Alliance Commercial |
$161,838.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$58,215.15
|
| Rate for Payer: United Healthcare PPO |
$92,229.13
|
| Rate for Payer: Wellcare Medicare |
$58,215.15
|
|
|
SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH MCC
|
Facility
|
IP
|
$224,424.00
|
|
|
Service Code
|
MSDRG 456
|
| Min. Negotiated Rate |
$80,728.11 |
| Max. Negotiated Rate |
$224,424.00 |
| Rate for Payer: Aetna Managed Medicare |
$80,728.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$176,861.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$135,562.83
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$128,793.54
|
| Rate for Payer: Anthem Medicare Advantage |
$80,728.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$80,728.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$80,728.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$80,728.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$142,972.63
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$80,728.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$164,373.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$80,728.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$80,728.11
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$80,728.11
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$80,728.11
|
| Rate for Payer: NAPHCARE Commercial |
$121,092.16
|
| Rate for Payer: Quartz Medicare Advantage |
$80,728.11
|
| Rate for Payer: The Alliance Commercial |
$224,424.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$80,728.11
|
| Rate for Payer: United Healthcare PPO |
$127,966.72
|
| Rate for Payer: Wellcare Medicare |
$80,728.11
|
|
|
SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITHOUT CC/MCC
|
Facility
|
IP
|
$120,781.00
|
|
|
Service Code
|
MSDRG 458
|
| Min. Negotiated Rate |
$43,446.55 |
| Max. Negotiated Rate |
$120,781.00 |
| Rate for Payer: Aetna Managed Medicare |
$43,446.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$95,039.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$72,846.93
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$69,209.34
|
| Rate for Payer: Anthem Medicare Advantage |
$43,446.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$43,446.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$43,446.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$43,446.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$76,828.71
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$43,446.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$88,354.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$43,446.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$43,446.55
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$43,446.55
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$43,446.55
|
| Rate for Payer: NAPHCARE Commercial |
$65,169.82
|
| Rate for Payer: Quartz Medicare Advantage |
$43,446.55
|
| Rate for Payer: The Alliance Commercial |
$120,781.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43,446.55
|
| Rate for Payer: United Healthcare PPO |
$68,785.11
|
| Rate for Payer: Wellcare Medicare |
$43,446.55
|
|
|
SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS
|
Facility
|
IP
|
$91,462.00
|
|
|
Service Code
|
MSDRG 029
|
| Min. Negotiated Rate |
$32,900.16 |
| Max. Negotiated Rate |
$91,462.00 |
| Rate for Payer: Aetna Managed Medicare |
$32,900.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$71,961.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$55,157.83
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$52,403.54
|
| Rate for Payer: Anthem Medicare Advantage |
$32,900.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$32,900.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$32,900.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$32,900.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$58,172.73
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$32,900.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66,849.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$32,900.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$32,900.16
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$32,900.16
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$32,900.16
|
| Rate for Payer: NAPHCARE Commercial |
$49,350.24
|
| Rate for Payer: Quartz Medicare Advantage |
$32,900.16
|
| Rate for Payer: The Alliance Commercial |
$91,462.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32,900.16
|
| Rate for Payer: United Healthcare PPO |
$52,043.50
|
| Rate for Payer: Wellcare Medicare |
$32,900.16
|
|
|
SPINAL PROCEDURES WITH MCC
|
Facility
|
IP
|
$160,530.00
|
|
|
Service Code
|
MSDRG 028
|
| Min. Negotiated Rate |
$57,744.63 |
| Max. Negotiated Rate |
$160,530.00 |
| Rate for Payer: Aetna Managed Medicare |
$57,744.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$126,509.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$96,968.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$92,126.34
|
| Rate for Payer: Anthem Medicare Advantage |
$57,744.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$57,744.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$57,744.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$57,744.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$102,268.68
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$57,744.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$117,509.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$57,744.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$57,744.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$57,744.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$57,744.63
|
| Rate for Payer: NAPHCARE Commercial |
$86,616.94
|
| Rate for Payer: Quartz Medicare Advantage |
$57,744.63
|
| Rate for Payer: The Alliance Commercial |
$160,530.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$57,744.63
|
| Rate for Payer: United Healthcare PPO |
$91,482.22
|
| Rate for Payer: Wellcare Medicare |
$57,744.63
|
|
|
SPINAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$61,973.00
|
|
|
Service Code
|
MSDRG 030
|
| Min. Negotiated Rate |
$22,292.55 |
| Max. Negotiated Rate |
$61,973.00 |
| Rate for Payer: NAPHCARE Commercial |
$33,438.82
|
| Rate for Payer: Quartz Medicare Advantage |
$22,292.55
|
| Rate for Payer: The Alliance Commercial |
$61,973.00
|
| Rate for Payer: Aetna Managed Medicare |
$22,292.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48,673.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$37,307.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35,444.96
|
| Rate for Payer: Anthem Medicare Advantage |
$22,292.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22,292.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22,292.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$22,292.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$39,347.15
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$22,292.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45,220.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22,292.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22,292.55
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$22,292.55
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$22,292.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22,292.55
|
| Rate for Payer: United Healthcare PPO |
$35,204.74
|
| Rate for Payer: Wellcare Medicare |
$22,292.55
|
|
|
Spinal Puncture Lumbar Diag
|
Professional
|
Both
|
$1,802.00
|
|
|
Service Code
|
CPT 62328
|
| Hospital Charge Code |
3072726
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$200.49 |
| Max. Negotiated Rate |
$1,711.90 |
| Rate for Payer: Aetna Commercial |
$1,711.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,549.72
|
| Rate for Payer: Cash Price |
$540.60
|
| Rate for Payer: Cash Price |
$540.60
|
| Rate for Payer: Cash Price |
$540.60
|
| Rate for Payer: Cigna Commercial |
$1,711.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$200.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,081.20
|
| Rate for Payer: Health EOS Commercial |
$1,639.82
|
| Rate for Payer: HFN Commercial |
$1,711.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$293.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$293.41
|
| Rate for Payer: Multiplan Commercial |
$1,441.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,711.90
|
| Rate for Payer: Quartz Beloit One Network |
$792.88
|
| Rate for Payer: Quartz Commercial |
$1,027.14
|
| Rate for Payer: The Alliance Commercial |
$901.00
|
| Rate for Payer: United Healthcare Medicaid |
$200.49
|
| Rate for Payer: WEA Trust Commercial |
$991.10
|
| Rate for Payer: WPS Commercial |
$1,334.74
|
|
|
Spinal Puncture Lumbar Diag
|
Facility
|
OP
|
$1,802.00
|
|
|
Service Code
|
CPT 62328
|
| Hospital Charge Code |
3072726
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$683.53 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$1,621.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,549.72
|
| Rate for Payer: Aetna Managed Medicare |
$683.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,171.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$901.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$864.96
|
| Rate for Payer: Anthem Medicare Advantage |
$683.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$955.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$683.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$683.53
|
| Rate for Payer: Cash Price |
$540.60
|
| Rate for Payer: Cash Price |
$540.60
|
| Rate for Payer: Cigna Commercial |
$1,657.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$683.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$683.53
|
| Rate for Payer: Health EOS Commercial |
$1,603.78
|
| Rate for Payer: HFN Commercial |
$1,657.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,542.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$683.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$683.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$683.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$683.53
|
| Rate for Payer: Multiplan Commercial |
$1,441.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,025.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,657.84
|
| Rate for Payer: Quartz Beloit One Network |
$882.98
|
| Rate for Payer: Quartz Commercial |
$1,171.30
|
| Rate for Payer: Quartz Medicare Advantage |
$683.53
|
| Rate for Payer: The Alliance Commercial |
$2,734.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$683.53
|
| Rate for Payer: WEA Trust Commercial |
$991.10
|
| Rate for Payer: Wellcare Medicare |
$683.53
|
| Rate for Payer: WPS Commercial |
$1,334.74
|
|
|
Spinal Puncture Lumbar Diag
|
Facility
|
IP
|
$1,802.00
|
|
|
Service Code
|
CPT 62328
|
| Hospital Charge Code |
3072726
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$882.98 |
| Max. Negotiated Rate |
$1,657.84 |
| Rate for Payer: Aetna Commercial |
$1,621.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,549.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$955.06
|
| Rate for Payer: Cash Price |
$540.60
|
| Rate for Payer: Cigna Commercial |
$1,657.84
|
| Rate for Payer: Health EOS Commercial |
$1,603.78
|
| Rate for Payer: HFN Commercial |
$1,657.84
|
| Rate for Payer: Multiplan Commercial |
$1,441.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,081.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,657.84
|
| Rate for Payer: Quartz Beloit One Network |
$882.98
|
| Rate for Payer: Quartz Commercial |
$1,081.20
|
| Rate for Payer: WEA Trust Commercial |
$991.10
|
| Rate for Payer: WPS Commercial |
$1,334.74
|
|
|
Spinal Puncture, Lumbar, Diagnostic 62270
|
Professional
|
Both
|
$508.00
|
|
|
Service Code
|
CPT 62270
|
| Hospital Charge Code |
1190835
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$59.29 |
| Max. Negotiated Rate |
$482.60 |
| Rate for Payer: Aetna Commercial |
$482.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$436.88
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cigna Commercial |
$482.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$59.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$304.80
|
| Rate for Payer: Health EOS Commercial |
$462.28
|
| Rate for Payer: HFN Commercial |
$482.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$203.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$203.68
|
| Rate for Payer: Multiplan Commercial |
$406.40
|
| Rate for Payer: Preferred Network Access Commercial |
$482.60
|
| Rate for Payer: Quartz Beloit One Network |
$223.52
|
| Rate for Payer: Quartz Commercial |
$289.56
|
| Rate for Payer: The Alliance Commercial |
$254.00
|
| Rate for Payer: United Healthcare Medicaid |
$59.29
|
| Rate for Payer: WEA Trust Commercial |
$279.40
|
| Rate for Payer: WPS Commercial |
$376.28
|
|
|
SPINAL WITH GENERAL ANES - SET-UP CHARGE
|
Facility
|
OP
|
$1,668.00
|
|
| Hospital Charge Code |
4519588
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$467.04 |
| Max. Negotiated Rate |
$6,672.00 |
| Rate for Payer: Aetna Commercial |
$1,501.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,434.48
|
| Rate for Payer: Aetna Managed Medicare |
$467.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,084.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$834.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$800.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$884.04
|
| Rate for Payer: Cash Price |
$500.40
|
| Rate for Payer: Cigna Commercial |
$1,534.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$933.41
|
| Rate for Payer: Health EOS Commercial |
$1,484.52
|
| Rate for Payer: HFN Commercial |
$1,534.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,251.00
|
| Rate for Payer: Multiplan Commercial |
$1,334.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,000.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,534.56
|
| Rate for Payer: Quartz Beloit One Network |
$817.32
|
| Rate for Payer: Quartz Commercial |
$1,084.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,000.80
|
| Rate for Payer: The Alliance Commercial |
$6,672.00
|
| Rate for Payer: WEA Trust Commercial |
$917.40
|
| Rate for Payer: WPS Commercial |
$1,235.49
|
|
|
SPINAL WITH GENERAL ANES - SET-UP CHARGE
|
Facility
|
IP
|
$1,668.00
|
|
| Hospital Charge Code |
4519588
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$817.32 |
| Max. Negotiated Rate |
$1,534.56 |
| Rate for Payer: Aetna Commercial |
$1,501.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,434.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$884.04
|
| Rate for Payer: Cash Price |
$500.40
|
| Rate for Payer: Cigna Commercial |
$1,534.56
|
| Rate for Payer: Health EOS Commercial |
$1,484.52
|
| Rate for Payer: HFN Commercial |
$1,534.56
|
| Rate for Payer: Multiplan Commercial |
$1,334.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,000.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,534.56
|
| Rate for Payer: Quartz Beloit One Network |
$817.32
|
| Rate for Payer: Quartz Commercial |
$1,000.80
|
| Rate for Payer: WEA Trust Commercial |
$917.40
|
| Rate for Payer: WPS Commercial |
$1,235.49
|
|
|
SPIRAL BLADE 34MM TITANIUM
|
Facility
|
IP
|
$6,225.00
|
|
| Hospital Charge Code |
2966585
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,050.25 |
| Max. Negotiated Rate |
$5,727.00 |
| Rate for Payer: Aetna Commercial |
$5,602.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,353.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,299.25
|
| Rate for Payer: Cash Price |
$1,867.50
|
| Rate for Payer: Cigna Commercial |
$5,727.00
|
| Rate for Payer: Health EOS Commercial |
$5,540.25
|
| Rate for Payer: HFN Commercial |
$5,727.00
|
| Rate for Payer: Multiplan Commercial |
$4,980.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,735.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,727.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,050.25
|
| Rate for Payer: Quartz Commercial |
$3,735.00
|
| Rate for Payer: WEA Trust Commercial |
$3,423.75
|
| Rate for Payer: WPS Commercial |
$4,610.86
|
|
|
SPIRAL BLADE 34MM TITANIUM
|
Facility
|
OP
|
$6,225.00
|
|
| Hospital Charge Code |
2966585
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,743.00 |
| Max. Negotiated Rate |
$24,900.00 |
| Rate for Payer: Aetna Commercial |
$5,602.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,353.50
|
| Rate for Payer: Aetna Managed Medicare |
$1,743.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,046.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,112.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,988.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,299.25
|
| Rate for Payer: Cash Price |
$1,867.50
|
| Rate for Payer: Cigna Commercial |
$5,727.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,483.51
|
| Rate for Payer: Health EOS Commercial |
$5,540.25
|
| Rate for Payer: HFN Commercial |
$5,727.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,668.75
|
| Rate for Payer: Multiplan Commercial |
$4,980.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,735.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,727.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,050.25
|
| Rate for Payer: Quartz Commercial |
$4,046.25
|
| Rate for Payer: Quartz Medicare Advantage |
$3,735.00
|
| Rate for Payer: The Alliance Commercial |
$24,900.00
|
| Rate for Payer: WEA Trust Commercial |
$3,423.75
|
| Rate for Payer: WPS Commercial |
$4,610.86
|
|
|
Spirometry - AMB 94010
|
Professional
|
Both
|
$197.00
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
1152822
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$41.87 |
| Max. Negotiated Rate |
$187.15 |
| Rate for Payer: Aetna Commercial |
$187.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.42
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cigna Commercial |
$187.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$41.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$118.20
|
| Rate for Payer: Health EOS Commercial |
$179.27
|
| Rate for Payer: HFN Commercial |
$187.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$99.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$99.40
|
| Rate for Payer: Multiplan Commercial |
$157.60
|
| Rate for Payer: Preferred Network Access Commercial |
$187.15
|
| Rate for Payer: Quartz Beloit One Network |
$86.68
|
| Rate for Payer: Quartz Commercial |
$112.29
|
| Rate for Payer: The Alliance Commercial |
$98.50
|
| Rate for Payer: United Healthcare Medicaid |
$41.87
|
| Rate for Payer: WEA Trust Commercial |
$108.35
|
| Rate for Payer: WPS Commercial |
$145.92
|
|
