|
SPINAL WITH GENERAL ANES - SET-UP CHARGE
|
Facility
|
OP
|
$1,668.00
|
|
| Hospital Charge Code |
4519588
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$485.72 |
| Max. Negotiated Rate |
$1,595.94 |
| Rate for Payer: Aetna Commercial |
$1,561.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,491.86
|
| Rate for Payer: Aetna Managed Medicare |
$485.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,127.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$867.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$832.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$919.40
|
| Rate for Payer: Cash Price |
$500.40
|
| Rate for Payer: Cigna Commercial |
$1,595.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$970.78
|
| Rate for Payer: Health EOS Commercial |
$1,543.90
|
| Rate for Payer: HFN Commercial |
$1,595.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,301.04
|
| Rate for Payer: Multiplan Commercial |
$1,387.78
|
| Rate for Payer: NAPHCARE Commercial |
$1,040.83
|
| Rate for Payer: Preferred Network Access Commercial |
$1,595.94
|
| Rate for Payer: Quartz Beloit One Network |
$850.01
|
| Rate for Payer: Quartz Commercial |
$1,127.57
|
| Rate for Payer: Quartz Medicare Advantage |
$1,040.83
|
| Rate for Payer: The Alliance Commercial |
$867.36
|
| Rate for Payer: WEA Trust Commercial |
$954.10
|
| Rate for Payer: WPS Commercial |
$1,284.86
|
|
|
SPINE INJECTIONS AND OTHER RELATED PROCEDURES
|
Facility
|
OP
|
$395.71
|
|
|
Service Code
|
EAPG 00053
|
| Min. Negotiated Rate |
$380.49 |
| Max. Negotiated Rate |
$395.71 |
| Rate for Payer: Anthem Medicaid |
$380.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$380.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$380.49
|
| Rate for Payer: Dean Health Medicaid |
$380.49
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$380.49
|
| Rate for Payer: Managed Health Services Medicaid |
$395.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$380.49
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$380.49
|
| Rate for Payer: United Healthcare Medicaid |
$380.49
|
|
|
SPIRAL BLADE 34MM TITANIUM
|
Facility
|
OP
|
$6,225.00
|
|
| Hospital Charge Code |
2966585
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,812.72 |
| Max. Negotiated Rate |
$5,956.08 |
| Rate for Payer: Aetna Commercial |
$5,826.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,567.64
|
| Rate for Payer: Aetna Managed Medicare |
$1,812.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,208.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,237.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,107.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,431.22
|
| Rate for Payer: Cash Price |
$1,867.50
|
| Rate for Payer: Cigna Commercial |
$5,956.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,622.95
|
| Rate for Payer: Health EOS Commercial |
$5,761.86
|
| Rate for Payer: HFN Commercial |
$5,956.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,855.50
|
| Rate for Payer: Multiplan Commercial |
$5,179.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,884.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,956.08
|
| Rate for Payer: Quartz Beloit One Network |
$3,172.26
|
| Rate for Payer: Quartz Commercial |
$4,208.10
|
| Rate for Payer: Quartz Medicare Advantage |
$3,884.40
|
| Rate for Payer: The Alliance Commercial |
$3,237.00
|
| Rate for Payer: WEA Trust Commercial |
$3,560.70
|
| Rate for Payer: WPS Commercial |
$4,795.12
|
|
|
SPIRAL BLADE 34MM TITANIUM
|
Facility
|
IP
|
$6,225.00
|
|
| Hospital Charge Code |
2966585
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,172.26 |
| Max. Negotiated Rate |
$5,956.08 |
| Rate for Payer: Aetna Commercial |
$5,826.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,567.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,431.22
|
| Rate for Payer: Cash Price |
$1,867.50
|
| Rate for Payer: Cigna Commercial |
$5,956.08
|
| Rate for Payer: Health EOS Commercial |
$5,761.86
|
| Rate for Payer: HFN Commercial |
$5,956.08
|
| Rate for Payer: Multiplan Commercial |
$5,179.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,956.08
|
| Rate for Payer: Quartz Beloit One Network |
$3,172.26
|
| Rate for Payer: Quartz Commercial |
$3,884.40
|
| Rate for Payer: WEA Trust Commercial |
$3,560.70
|
| Rate for Payer: WPS Commercial |
$4,795.12
|
|
|
Spirometry - AMB 94010
|
Professional
|
Both
|
$197.00
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
1152822
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$29.41 |
| Max. Negotiated Rate |
$194.64 |
| Rate for Payer: Aetna Commercial |
$194.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$176.20
|
| Rate for Payer: Aetna Managed Medicare |
$29.41
|
| Rate for Payer: Anthem Medicare Advantage |
$29.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$29.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$29.41
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cigna Commercial |
$194.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$43.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.41
|
| Rate for Payer: Health EOS Commercial |
$186.44
|
| Rate for Payer: HFN Commercial |
$194.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$103.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$103.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$29.41
|
| Rate for Payer: Multiplan Commercial |
$163.90
|
| Rate for Payer: NAPHCARE Commercial |
$44.12
|
| Rate for Payer: Preferred Network Access Commercial |
$194.64
|
| Rate for Payer: Quartz Beloit One Network |
$90.15
|
| Rate for Payer: Quartz Commercial |
$116.78
|
| Rate for Payer: Quartz Medicare Advantage |
$29.41
|
| Rate for Payer: The Alliance Commercial |
$73.53
|
| Rate for Payer: United Healthcare Medicaid |
$43.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.41
|
| Rate for Payer: WEA Trust Commercial |
$112.68
|
| Rate for Payer: WPS Commercial |
$117.64
|
|
|
Spirometry - AMB 94010 (in office)
|
Professional
|
Both
|
$253.00
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
5494672
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$29.41 |
| Max. Negotiated Rate |
$249.96 |
| Rate for Payer: Aetna Commercial |
$249.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$226.28
|
| Rate for Payer: Aetna Managed Medicare |
$29.41
|
| Rate for Payer: Anthem Medicare Advantage |
$29.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$29.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$29.41
|
| Rate for Payer: Cash Price |
$75.90
|
| Rate for Payer: Cash Price |
$75.90
|
| Rate for Payer: Cigna Commercial |
$249.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$43.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.41
|
| Rate for Payer: Health EOS Commercial |
$239.44
|
| Rate for Payer: HFN Commercial |
$249.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$103.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$103.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$29.41
|
| Rate for Payer: Multiplan Commercial |
$210.50
|
| Rate for Payer: NAPHCARE Commercial |
$44.12
|
| Rate for Payer: Preferred Network Access Commercial |
$249.96
|
| Rate for Payer: Quartz Beloit One Network |
$115.77
|
| Rate for Payer: Quartz Commercial |
$149.98
|
| Rate for Payer: Quartz Medicare Advantage |
$29.41
|
| Rate for Payer: The Alliance Commercial |
$73.53
|
| Rate for Payer: United Healthcare Medicaid |
$43.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.41
|
| Rate for Payer: WEA Trust Commercial |
$144.72
|
| Rate for Payer: WPS Commercial |
$117.64
|
|
|
Spirometry-Bronchospasm Eval 94060
|
Professional
|
Both
|
$215.00
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
1152823
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$43.12 |
| Max. Negotiated Rate |
$212.42 |
| Rate for Payer: Aetna Commercial |
$212.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$192.30
|
| Rate for Payer: Aetna Managed Medicare |
$43.12
|
| Rate for Payer: Anthem Medicare Advantage |
$43.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$43.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$43.12
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cigna Commercial |
$212.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$54.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.12
|
| Rate for Payer: Health EOS Commercial |
$203.48
|
| Rate for Payer: HFN Commercial |
$212.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$162.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$162.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$43.12
|
| Rate for Payer: Multiplan Commercial |
$178.88
|
| Rate for Payer: NAPHCARE Commercial |
$64.68
|
| Rate for Payer: Preferred Network Access Commercial |
$212.42
|
| Rate for Payer: Quartz Beloit One Network |
$98.38
|
| Rate for Payer: Quartz Commercial |
$127.45
|
| Rate for Payer: Quartz Medicare Advantage |
$43.12
|
| Rate for Payer: The Alliance Commercial |
$107.80
|
| Rate for Payer: United Healthcare Medicaid |
$54.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.12
|
| Rate for Payer: WEA Trust Commercial |
$122.98
|
| Rate for Payer: WPS Commercial |
$172.47
|
|
|
SPLENECTOMYSPLENORRHAPHY
|
Facility
|
IP
|
$4,460.00
|
|
| Hospital Charge Code |
2960385
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,272.82 |
| Max. Negotiated Rate |
$4,267.33 |
| Rate for Payer: Aetna Commercial |
$4,174.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,989.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,458.35
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,267.33
|
| Rate for Payer: Health EOS Commercial |
$4,128.18
|
| Rate for Payer: HFN Commercial |
$4,267.33
|
| Rate for Payer: Multiplan Commercial |
$3,710.72
|
| Rate for Payer: Preferred Network Access Commercial |
$4,267.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,272.82
|
| Rate for Payer: Quartz Commercial |
$2,783.04
|
| Rate for Payer: WEA Trust Commercial |
$2,551.12
|
| Rate for Payer: WPS Commercial |
$3,435.54
|
|
|
SPLENECTOMYSPLENORRHAPHY
|
Facility
|
OP
|
$4,460.00
|
|
| Hospital Charge Code |
2960385
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,298.75 |
| Max. Negotiated Rate |
$4,267.33 |
| Rate for Payer: Aetna Commercial |
$4,174.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,989.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,298.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,014.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,319.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,226.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,458.35
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,267.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,595.72
|
| Rate for Payer: Health EOS Commercial |
$4,128.18
|
| Rate for Payer: HFN Commercial |
$4,267.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,478.80
|
| Rate for Payer: Multiplan Commercial |
$3,710.72
|
| Rate for Payer: NAPHCARE Commercial |
$2,783.04
|
| Rate for Payer: Preferred Network Access Commercial |
$4,267.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,272.82
|
| Rate for Payer: Quartz Commercial |
$3,014.96
|
| Rate for Payer: Quartz Medicare Advantage |
$2,783.04
|
| Rate for Payer: The Alliance Commercial |
$2,319.20
|
| Rate for Payer: WEA Trust Commercial |
$2,551.12
|
| Rate for Payer: WPS Commercial |
$3,435.54
|
|
|
SPLENIC PROCEDURES
|
Facility
|
IP
|
$18,764.18
|
|
|
Service Code
|
APR-DRG 6502
|
| Min. Negotiated Rate |
$16,667.52 |
| Max. Negotiated Rate |
$18,764.18 |
| Rate for Payer: Anthem Medicaid |
$17,967.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$17,967.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17,967.74
|
| Rate for Payer: Dean Health Medicaid |
$17,967.74
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$16,667.52
|
| Rate for Payer: Managed Health Services Medicaid |
$18,764.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$17,967.74
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17,967.74
|
| Rate for Payer: United Healthcare Medicaid |
$17,967.74
|
|
|
SPLENIC PROCEDURES
|
Facility
|
IP
|
$23,323.70
|
|
|
Service Code
|
APR-DRG 6503
|
| Min. Negotiated Rate |
$20,717.57 |
| Max. Negotiated Rate |
$23,323.70 |
| Rate for Payer: Anthem Medicaid |
$22,333.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$22,333.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$22,333.73
|
| Rate for Payer: Dean Health Medicaid |
$22,333.73
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$20,717.57
|
| Rate for Payer: Managed Health Services Medicaid |
$23,323.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$22,333.73
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$22,333.73
|
| Rate for Payer: United Healthcare Medicaid |
$22,333.73
|
|
|
SPLENIC PROCEDURES
|
Facility
|
IP
|
$37,002.27
|
|
|
Service Code
|
APR-DRG 6504
|
| Min. Negotiated Rate |
$32,867.72 |
| Max. Negotiated Rate |
$37,002.27 |
| Rate for Payer: Anthem Medicaid |
$35,431.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$35,431.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$35,431.71
|
| Rate for Payer: Dean Health Medicaid |
$35,431.71
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$32,867.72
|
| Rate for Payer: Managed Health Services Medicaid |
$37,002.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$35,431.71
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$35,431.71
|
| Rate for Payer: United Healthcare Medicaid |
$35,431.71
|
|
|
SPLENIC PROCEDURES
|
Facility
|
IP
|
$12,889.42
|
|
|
Service Code
|
APR-DRG 6501
|
| Min. Negotiated Rate |
$11,449.18 |
| Max. Negotiated Rate |
$12,889.42 |
| Rate for Payer: Anthem Medicaid |
$12,342.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$12,342.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12,342.33
|
| Rate for Payer: Dean Health Medicaid |
$12,342.33
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11,449.18
|
| Rate for Payer: Managed Health Services Medicaid |
$12,889.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,342.33
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12,342.33
|
| Rate for Payer: United Healthcare Medicaid |
$12,342.33
|
|
|
SPLENIC PROCEDURES WITH CC
|
Facility
|
IP
|
$78,241.28
|
|
|
Service Code
|
MSDRG 800
|
| Min. Negotiated Rate |
$22,021.72 |
| Max. Negotiated Rate |
$78,241.28 |
| Rate for Payer: Aetna Managed Medicare |
$22,021.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$61,298.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$46,985.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$44,638.89
|
| Rate for Payer: Anthem Medicare Advantage |
$22,021.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22,021.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22,021.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$22,021.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49,553.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$22,021.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$57,142.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22,021.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22,021.72
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$22,021.72
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$22,021.72
|
| Rate for Payer: NAPHCARE Commercial |
$33,032.58
|
| Rate for Payer: Quartz Medicare Advantage |
$22,021.72
|
| Rate for Payer: The Alliance Commercial |
$78,241.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22,021.72
|
| Rate for Payer: United Healthcare PPO |
$44,486.52
|
| Rate for Payer: Wellcare Medicare |
$22,021.72
|
|
|
SPLENIC PROCEDURES WITH MCC
|
Facility
|
IP
|
$137,324.72
|
|
|
Service Code
|
MSDRG 799
|
| Min. Negotiated Rate |
$35,189.99 |
| Max. Negotiated Rate |
$137,324.72 |
| Rate for Payer: Aetna Managed Medicare |
$35,189.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$98,816.97
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$75,742.41
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$71,960.24
|
| Rate for Payer: Anthem Medicare Advantage |
$35,189.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35,189.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35,189.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$35,189.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$79,882.46
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$35,189.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$100,479.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35,189.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35,189.99
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$35,189.99
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$35,189.99
|
| Rate for Payer: NAPHCARE Commercial |
$52,784.99
|
| Rate for Payer: Quartz Medicare Advantage |
$35,189.99
|
| Rate for Payer: The Alliance Commercial |
$137,324.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35,189.99
|
| Rate for Payer: United Healthcare PPO |
$78,224.41
|
| Rate for Payer: Wellcare Medicare |
$35,189.99
|
|
|
SPLENIC PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$49,817.04
|
|
|
Service Code
|
MSDRG 801
|
| Min. Negotiated Rate |
$15,125.52 |
| Max. Negotiated Rate |
$49,817.04 |
| Rate for Payer: Aetna Managed Medicare |
$15,125.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$41,650.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31,924.90
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30,330.74
|
| Rate for Payer: Anthem Medicare Advantage |
$15,125.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15,125.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15,125.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15,125.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33,669.90
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15,125.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36,295.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15,125.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15,125.52
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15,125.52
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15,125.52
|
| Rate for Payer: NAPHCARE Commercial |
$22,688.28
|
| Rate for Payer: Quartz Medicare Advantage |
$15,125.52
|
| Rate for Payer: The Alliance Commercial |
$49,817.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15,125.52
|
| Rate for Payer: United Healthcare PPO |
$28,256.22
|
| Rate for Payer: Wellcare Medicare |
$15,125.52
|
|
|
SPLINT 1 1/4 DIGITAL 11
|
Facility
|
IP
|
$129.00
|
|
| Hospital Charge Code |
2969019
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$65.74 |
| Max. Negotiated Rate |
$123.43 |
| Rate for Payer: Aetna Commercial |
$120.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$115.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$71.10
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cigna Commercial |
$123.43
|
| Rate for Payer: Health EOS Commercial |
$119.40
|
| Rate for Payer: HFN Commercial |
$123.43
|
| Rate for Payer: Multiplan Commercial |
$107.33
|
| Rate for Payer: Preferred Network Access Commercial |
$123.43
|
| Rate for Payer: Quartz Beloit One Network |
$65.74
|
| Rate for Payer: Quartz Commercial |
$80.50
|
| Rate for Payer: WEA Trust Commercial |
$73.79
|
| Rate for Payer: WPS Commercial |
$99.37
|
|
|
SPLINT 1 1/4 DIGITAL 11
|
Facility
|
OP
|
$129.00
|
|
| Hospital Charge Code |
2969019
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$37.56 |
| Max. Negotiated Rate |
$123.43 |
| Rate for Payer: Aetna Commercial |
$120.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$115.38
|
| Rate for Payer: Aetna Managed Medicare |
$37.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$87.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$67.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$64.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$71.10
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cigna Commercial |
$123.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$75.08
|
| Rate for Payer: Health EOS Commercial |
$119.40
|
| Rate for Payer: HFN Commercial |
$123.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$100.62
|
| Rate for Payer: Multiplan Commercial |
$107.33
|
| Rate for Payer: NAPHCARE Commercial |
$80.50
|
| Rate for Payer: Preferred Network Access Commercial |
$123.43
|
| Rate for Payer: Quartz Beloit One Network |
$65.74
|
| Rate for Payer: Quartz Commercial |
$87.20
|
| Rate for Payer: Quartz Medicare Advantage |
$80.50
|
| Rate for Payer: The Alliance Commercial |
$67.08
|
| Rate for Payer: WEA Trust Commercial |
$73.79
|
| Rate for Payer: WPS Commercial |
$99.37
|
|
|
SPLINT 3 1/4 DIGITAL 13
|
Facility
|
IP
|
$121.00
|
|
| Hospital Charge Code |
2969021
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$61.66 |
| Max. Negotiated Rate |
$115.77 |
| Rate for Payer: Aetna Commercial |
$113.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$108.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.70
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$115.77
|
| Rate for Payer: Health EOS Commercial |
$112.00
|
| Rate for Payer: HFN Commercial |
$115.77
|
| Rate for Payer: Multiplan Commercial |
$100.67
|
| Rate for Payer: Preferred Network Access Commercial |
$115.77
|
| Rate for Payer: Quartz Beloit One Network |
$61.66
|
| Rate for Payer: Quartz Commercial |
$75.50
|
| Rate for Payer: WEA Trust Commercial |
$69.21
|
| Rate for Payer: WPS Commercial |
$93.21
|
|
|
SPLINT 3 1/4 DIGITAL 13
|
Facility
|
OP
|
$121.00
|
|
| Hospital Charge Code |
2969021
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$35.24 |
| Max. Negotiated Rate |
$115.77 |
| Rate for Payer: Aetna Commercial |
$113.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$108.22
|
| Rate for Payer: Aetna Managed Medicare |
$35.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$81.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$62.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$60.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.70
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$115.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$70.42
|
| Rate for Payer: Health EOS Commercial |
$112.00
|
| Rate for Payer: HFN Commercial |
$115.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$94.38
|
| Rate for Payer: Multiplan Commercial |
$100.67
|
| Rate for Payer: NAPHCARE Commercial |
$75.50
|
| Rate for Payer: Preferred Network Access Commercial |
$115.77
|
| Rate for Payer: Quartz Beloit One Network |
$61.66
|
| Rate for Payer: Quartz Commercial |
$81.80
|
| Rate for Payer: Quartz Medicare Advantage |
$75.50
|
| Rate for Payer: The Alliance Commercial |
$62.92
|
| Rate for Payer: WEA Trust Commercial |
$69.21
|
| Rate for Payer: WPS Commercial |
$93.21
|
|
|
SPLINT 3 1/4 DIGITAL/BULB 15
|
Facility
|
OP
|
$129.00
|
|
| Hospital Charge Code |
2969023
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$37.56 |
| Max. Negotiated Rate |
$123.43 |
| Rate for Payer: Aetna Commercial |
$120.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$115.38
|
| Rate for Payer: Aetna Managed Medicare |
$37.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$87.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$67.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$64.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$71.10
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cigna Commercial |
$123.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$75.08
|
| Rate for Payer: Health EOS Commercial |
$119.40
|
| Rate for Payer: HFN Commercial |
$123.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$100.62
|
| Rate for Payer: Multiplan Commercial |
$107.33
|
| Rate for Payer: NAPHCARE Commercial |
$80.50
|
| Rate for Payer: Preferred Network Access Commercial |
$123.43
|
| Rate for Payer: Quartz Beloit One Network |
$65.74
|
| Rate for Payer: Quartz Commercial |
$87.20
|
| Rate for Payer: Quartz Medicare Advantage |
$80.50
|
| Rate for Payer: The Alliance Commercial |
$67.08
|
| Rate for Payer: WEA Trust Commercial |
$73.79
|
| Rate for Payer: WPS Commercial |
$99.37
|
|
|
SPLINT 3 1/4 DIGITAL/BULB 15
|
Facility
|
IP
|
$129.00
|
|
| Hospital Charge Code |
2969023
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$65.74 |
| Max. Negotiated Rate |
$123.43 |
| Rate for Payer: Aetna Commercial |
$120.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$115.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$71.10
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cigna Commercial |
$123.43
|
| Rate for Payer: Health EOS Commercial |
$119.40
|
| Rate for Payer: HFN Commercial |
$123.43
|
| Rate for Payer: Multiplan Commercial |
$107.33
|
| Rate for Payer: Preferred Network Access Commercial |
$123.43
|
| Rate for Payer: Quartz Beloit One Network |
$65.74
|
| Rate for Payer: Quartz Commercial |
$80.50
|
| Rate for Payer: WEA Trust Commercial |
$73.79
|
| Rate for Payer: WPS Commercial |
$99.37
|
|
|
SPLINT 4 1/4 DIGITAL 14
|
Facility
|
OP
|
$129.00
|
|
| Hospital Charge Code |
2969022
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$37.56 |
| Max. Negotiated Rate |
$123.43 |
| Rate for Payer: Aetna Commercial |
$120.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$115.38
|
| Rate for Payer: Aetna Managed Medicare |
$37.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$87.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$67.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$64.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$71.10
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cigna Commercial |
$123.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$75.08
|
| Rate for Payer: Health EOS Commercial |
$119.40
|
| Rate for Payer: HFN Commercial |
$123.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$100.62
|
| Rate for Payer: Multiplan Commercial |
$107.33
|
| Rate for Payer: NAPHCARE Commercial |
$80.50
|
| Rate for Payer: Preferred Network Access Commercial |
$123.43
|
| Rate for Payer: Quartz Beloit One Network |
$65.74
|
| Rate for Payer: Quartz Commercial |
$87.20
|
| Rate for Payer: Quartz Medicare Advantage |
$80.50
|
| Rate for Payer: The Alliance Commercial |
$67.08
|
| Rate for Payer: WEA Trust Commercial |
$73.79
|
| Rate for Payer: WPS Commercial |
$99.37
|
|
|
SPLINT 4 1/4 DIGITAL 14
|
Facility
|
IP
|
$129.00
|
|
| Hospital Charge Code |
2969022
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$65.74 |
| Max. Negotiated Rate |
$123.43 |
| Rate for Payer: Aetna Commercial |
$120.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$115.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$71.10
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cigna Commercial |
$123.43
|
| Rate for Payer: Health EOS Commercial |
$119.40
|
| Rate for Payer: HFN Commercial |
$123.43
|
| Rate for Payer: Multiplan Commercial |
$107.33
|
| Rate for Payer: Preferred Network Access Commercial |
$123.43
|
| Rate for Payer: Quartz Beloit One Network |
$65.74
|
| Rate for Payer: Quartz Commercial |
$80.50
|
| Rate for Payer: WEA Trust Commercial |
$73.79
|
| Rate for Payer: WPS Commercial |
$99.37
|
|
|
SPLINT 4 1/4 DIGITAL/BULB 16
|
Facility
|
OP
|
$134.00
|
|
| Hospital Charge Code |
2969024
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$39.02 |
| Max. Negotiated Rate |
$128.21 |
| Rate for Payer: Aetna Commercial |
$125.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$119.85
|
| Rate for Payer: Aetna Managed Medicare |
$39.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$90.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$69.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$66.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.86
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cigna Commercial |
$128.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$77.99
|
| Rate for Payer: Health EOS Commercial |
$124.03
|
| Rate for Payer: HFN Commercial |
$128.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$104.52
|
| Rate for Payer: Multiplan Commercial |
$111.49
|
| Rate for Payer: NAPHCARE Commercial |
$83.62
|
| Rate for Payer: Preferred Network Access Commercial |
$128.21
|
| Rate for Payer: Quartz Beloit One Network |
$68.29
|
| Rate for Payer: Quartz Commercial |
$90.58
|
| Rate for Payer: Quartz Medicare Advantage |
$83.62
|
| Rate for Payer: The Alliance Commercial |
$69.68
|
| Rate for Payer: WEA Trust Commercial |
$76.65
|
| Rate for Payer: WPS Commercial |
$103.22
|
|
