|
SPHINCTEROTOME JAGTOME RX39 M00573080
|
Facility
|
OP
|
$3,649.00
|
|
| Hospital Charge Code |
2973416
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,021.72 |
| Max. Negotiated Rate |
$14,596.00 |
| Rate for Payer: Aetna Commercial |
$3,284.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,138.14
|
| Rate for Payer: Aetna Managed Medicare |
$1,021.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,371.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,824.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,751.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,933.97
|
| Rate for Payer: Cash Price |
$1,094.70
|
| Rate for Payer: Cigna Commercial |
$3,357.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,041.98
|
| Rate for Payer: Health EOS Commercial |
$3,247.61
|
| Rate for Payer: HFN Commercial |
$3,357.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,736.75
|
| Rate for Payer: Multiplan Commercial |
$2,919.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,189.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,357.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,788.01
|
| Rate for Payer: Quartz Commercial |
$2,371.85
|
| Rate for Payer: Quartz Medicare Advantage |
$2,189.40
|
| Rate for Payer: The Alliance Commercial |
$14,596.00
|
| Rate for Payer: WEA Trust Commercial |
$2,006.95
|
| Rate for Payer: WPS Commercial |
$2,702.81
|
|
|
SPHYGMOMANOMETER ADULT CUFF
|
Facility
|
OP
|
$762.00
|
|
| Hospital Charge Code |
2971610
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$213.36 |
| Max. Negotiated Rate |
$3,048.00 |
| Rate for Payer: Aetna Commercial |
$685.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$655.32
|
| Rate for Payer: Aetna Managed Medicare |
$213.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$495.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$381.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$365.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$403.86
|
| Rate for Payer: Cash Price |
$228.60
|
| Rate for Payer: Cigna Commercial |
$701.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$426.42
|
| Rate for Payer: Health EOS Commercial |
$678.18
|
| Rate for Payer: HFN Commercial |
$701.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$571.50
|
| Rate for Payer: Multiplan Commercial |
$609.60
|
| Rate for Payer: NAPHCARE Commercial |
$457.20
|
| Rate for Payer: Preferred Network Access Commercial |
$701.04
|
| Rate for Payer: Quartz Beloit One Network |
$373.38
|
| Rate for Payer: Quartz Commercial |
$495.30
|
| Rate for Payer: Quartz Medicare Advantage |
$457.20
|
| Rate for Payer: The Alliance Commercial |
$3,048.00
|
| Rate for Payer: WEA Trust Commercial |
$419.10
|
| Rate for Payer: WPS Commercial |
$564.41
|
|
|
SPHYGMOMANOMETER ADULT CUFF
|
Facility
|
IP
|
$762.00
|
|
| Hospital Charge Code |
2971610
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$373.38 |
| Max. Negotiated Rate |
$701.04 |
| Rate for Payer: Aetna Commercial |
$685.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$655.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$403.86
|
| Rate for Payer: Cash Price |
$228.60
|
| Rate for Payer: Cigna Commercial |
$701.04
|
| Rate for Payer: Health EOS Commercial |
$678.18
|
| Rate for Payer: HFN Commercial |
$701.04
|
| Rate for Payer: Multiplan Commercial |
$609.60
|
| Rate for Payer: NAPHCARE Commercial |
$457.20
|
| Rate for Payer: Preferred Network Access Commercial |
$701.04
|
| Rate for Payer: Quartz Beloit One Network |
$373.38
|
| Rate for Payer: Quartz Commercial |
$457.20
|
| Rate for Payer: WEA Trust Commercial |
$419.10
|
| Rate for Payer: WPS Commercial |
$564.41
|
|
|
Spider Distal Protection
|
Facility
|
OP
|
$8,714.00
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
4139307
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,439.92 |
| Max. Negotiated Rate |
$34,856.00 |
| Rate for Payer: Aetna Commercial |
$7,842.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,494.04
|
| Rate for Payer: Aetna Managed Medicare |
$2,439.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,664.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,357.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,182.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,618.42
|
| Rate for Payer: Cash Price |
$2,614.20
|
| Rate for Payer: Cigna Commercial |
$8,016.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,876.35
|
| Rate for Payer: Health EOS Commercial |
$7,755.46
|
| Rate for Payer: HFN Commercial |
$8,016.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,535.50
|
| Rate for Payer: Multiplan Commercial |
$6,971.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,228.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,016.88
|
| Rate for Payer: Quartz Beloit One Network |
$4,269.86
|
| Rate for Payer: Quartz Commercial |
$5,664.10
|
| Rate for Payer: Quartz Medicare Advantage |
$5,228.40
|
| Rate for Payer: The Alliance Commercial |
$34,856.00
|
| Rate for Payer: WEA Trust Commercial |
$4,792.70
|
| Rate for Payer: WPS Commercial |
$6,454.46
|
|
|
Spider Distal Protection
|
Facility
|
IP
|
$8,714.00
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
4139307
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,269.86 |
| Max. Negotiated Rate |
$8,016.88 |
| Rate for Payer: Aetna Commercial |
$7,842.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,494.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,618.42
|
| Rate for Payer: Cash Price |
$2,614.20
|
| Rate for Payer: Cigna Commercial |
$8,016.88
|
| Rate for Payer: Health EOS Commercial |
$7,755.46
|
| Rate for Payer: HFN Commercial |
$8,016.88
|
| Rate for Payer: Multiplan Commercial |
$6,971.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,228.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,016.88
|
| Rate for Payer: Quartz Beloit One Network |
$4,269.86
|
| Rate for Payer: Quartz Commercial |
$5,228.40
|
| Rate for Payer: WEA Trust Commercial |
$4,792.70
|
| Rate for Payer: WPS Commercial |
$6,454.46
|
|
|
SPIDER PLATE LT 814100002
|
Facility
|
OP
|
$1,714.00
|
|
| Hospital Charge Code |
2965023
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$479.92 |
| Max. Negotiated Rate |
$6,856.00 |
| Rate for Payer: Aetna Commercial |
$1,542.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,474.04
|
| Rate for Payer: Aetna Managed Medicare |
$479.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,114.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$857.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$822.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$908.42
|
| Rate for Payer: Cash Price |
$514.20
|
| Rate for Payer: Cigna Commercial |
$1,576.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$959.15
|
| Rate for Payer: Health EOS Commercial |
$1,525.46
|
| Rate for Payer: HFN Commercial |
$1,576.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,285.50
|
| Rate for Payer: Multiplan Commercial |
$1,371.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,028.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,576.88
|
| Rate for Payer: Quartz Beloit One Network |
$839.86
|
| Rate for Payer: Quartz Commercial |
$1,114.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,028.40
|
| Rate for Payer: The Alliance Commercial |
$6,856.00
|
| Rate for Payer: WEA Trust Commercial |
$942.70
|
| Rate for Payer: WPS Commercial |
$1,269.56
|
|
|
SPIDER PLATE LT 814100002
|
Facility
|
IP
|
$1,714.00
|
|
| Hospital Charge Code |
2965023
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$839.86 |
| Max. Negotiated Rate |
$1,576.88 |
| Rate for Payer: Aetna Commercial |
$1,542.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,474.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$908.42
|
| Rate for Payer: Cash Price |
$514.20
|
| Rate for Payer: Cigna Commercial |
$1,576.88
|
| Rate for Payer: Health EOS Commercial |
$1,525.46
|
| Rate for Payer: HFN Commercial |
$1,576.88
|
| Rate for Payer: Multiplan Commercial |
$1,371.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,028.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,576.88
|
| Rate for Payer: Quartz Beloit One Network |
$839.86
|
| Rate for Payer: Quartz Commercial |
$1,028.40
|
| Rate for Payer: WEA Trust Commercial |
$942.70
|
| Rate for Payer: WPS Commercial |
$1,269.56
|
|
|
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 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 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
|
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, 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, 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 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 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: 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: Quartz Medicare Advantage |
$63,541.91
|
| Rate for Payer: The Alliance Commercial |
$176,647.00
|
| 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: 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: 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: 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: 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
|
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
|
|
