|
SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH MCC
|
Facility
|
IP
|
$233,400.96
|
|
|
Service Code
|
MSDRG 456
|
| Min. Negotiated Rate |
$64,861.67 |
| Max. Negotiated Rate |
$233,400.96 |
| Rate for Payer: Aetna Managed Medicare |
$64,861.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$183,355.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$140,540.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$133,522.63
|
| Rate for Payer: Anthem Medicare Advantage |
$64,861.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$64,861.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$64,861.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$64,861.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$148,222.36
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$64,861.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$170,948.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$64,861.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$64,861.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$64,861.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$64,861.67
|
| Rate for Payer: NAPHCARE Commercial |
$97,292.50
|
| Rate for Payer: Quartz Medicare Advantage |
$64,861.67
|
| Rate for Payer: The Alliance Commercial |
$233,400.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$64,861.67
|
| Rate for Payer: United Healthcare PPO |
$133,085.39
|
| Rate for Payer: Wellcare Medicare |
$64,861.67
|
|
|
SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITHOUT CC/MCC
|
Facility
|
IP
|
$125,612.24
|
|
|
Service Code
|
MSDRG 458
|
| Min. Negotiated Rate |
$32,461.35 |
| Max. Negotiated Rate |
$125,612.24 |
| Rate for Payer: Aetna Managed Medicare |
$32,461.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$91,042.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$69,783.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$66,298.94
|
| Rate for Payer: Anthem Medicare Advantage |
$32,461.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$32,461.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$32,461.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$32,461.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$73,597.90
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$32,461.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$91,888.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$32,461.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$32,461.35
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$32,461.35
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$32,461.35
|
| Rate for Payer: NAPHCARE Commercial |
$48,692.03
|
| Rate for Payer: Quartz Medicare Advantage |
$32,461.35
|
| Rate for Payer: The Alliance Commercial |
$125,612.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32,461.35
|
| Rate for Payer: United Healthcare PPO |
$71,536.51
|
| Rate for Payer: Wellcare Medicare |
$32,461.35
|
|
|
SPINAL IMPLANTATION OF DRUG INFUSION DEVICE
|
Facility
|
OP
|
$2,648.21
|
|
|
Service Code
|
EAPG 03030
|
| Min. Negotiated Rate |
$2,546.35 |
| Max. Negotiated Rate |
$2,648.21 |
| Rate for Payer: Anthem Medicaid |
$2,546.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$2,546.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,546.35
|
| Rate for Payer: Dean Health Medicaid |
$2,546.35
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$2,546.35
|
| Rate for Payer: Managed Health Services Medicaid |
$2,648.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,546.35
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$2,546.35
|
| Rate for Payer: United Healthcare Medicaid |
$2,546.35
|
|
|
SPINAL PROCEDURES
|
Facility
|
IP
|
$15,169.18
|
|
|
Service Code
|
APR-DRG 0231
|
| Min. Negotiated Rate |
$13,474.21 |
| Max. Negotiated Rate |
$15,169.18 |
| Rate for Payer: Anthem Medicaid |
$14,525.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$14,525.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14,525.32
|
| Rate for Payer: Dean Health Medicaid |
$14,525.32
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13,474.21
|
| Rate for Payer: Managed Health Services Medicaid |
$15,169.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,525.32
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14,525.32
|
| Rate for Payer: United Healthcare Medicaid |
$14,525.32
|
|
|
SPINAL PROCEDURES
|
Facility
|
IP
|
$33,933.36
|
|
|
Service Code
|
APR-DRG 0233
|
| Min. Negotiated Rate |
$30,141.73 |
| Max. Negotiated Rate |
$33,933.36 |
| Rate for Payer: Anthem Medicaid |
$32,493.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$32,493.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$32,493.06
|
| Rate for Payer: Dean Health Medicaid |
$32,493.06
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$30,141.73
|
| Rate for Payer: Managed Health Services Medicaid |
$33,933.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$32,493.06
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$32,493.06
|
| Rate for Payer: United Healthcare Medicaid |
$32,493.06
|
|
|
SPINAL PROCEDURES
|
Facility
|
IP
|
$49,190.22
|
|
|
Service Code
|
APR-DRG 0234
|
| Min. Negotiated Rate |
$43,693.82 |
| Max. Negotiated Rate |
$49,190.22 |
| Rate for Payer: Anthem Medicaid |
$47,102.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$47,102.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$47,102.35
|
| Rate for Payer: Dean Health Medicaid |
$47,102.35
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$43,693.82
|
| Rate for Payer: Managed Health Services Medicaid |
$49,190.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$47,102.35
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$47,102.35
|
| Rate for Payer: United Healthcare Medicaid |
$47,102.35
|
|
|
SPINAL PROCEDURES
|
Facility
|
IP
|
$21,482.36
|
|
|
Service Code
|
APR-DRG 0232
|
| Min. Negotiated Rate |
$19,081.97 |
| Max. Negotiated Rate |
$21,482.36 |
| Rate for Payer: Anthem Medicaid |
$20,570.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$20,570.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$20,570.54
|
| Rate for Payer: Dean Health Medicaid |
$20,570.54
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19,081.97
|
| Rate for Payer: Managed Health Services Medicaid |
$21,482.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$20,570.54
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$20,570.54
|
| Rate for Payer: United Healthcare Medicaid |
$20,570.54
|
|
|
SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS
|
Facility
|
IP
|
$95,120.48
|
|
|
Service Code
|
MSDRG 029
|
| Min. Negotiated Rate |
$26,633.47 |
| Max. Negotiated Rate |
$95,120.48 |
| Rate for Payer: Aetna Managed Medicare |
$26,633.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$74,438.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$57,056.42
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$54,207.32
|
| Rate for Payer: Anthem Medicare Advantage |
$26,633.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26,633.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26,633.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$26,633.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$60,175.10
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$26,633.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69,523.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$26,633.47
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26,633.47
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$26,633.47
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$26,633.47
|
| Rate for Payer: NAPHCARE Commercial |
$39,950.21
|
| Rate for Payer: Quartz Medicare Advantage |
$26,633.47
|
| Rate for Payer: The Alliance Commercial |
$95,120.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26,633.47
|
| Rate for Payer: United Healthcare PPO |
$54,125.24
|
| Rate for Payer: Wellcare Medicare |
$26,633.47
|
|
|
SPINAL PROCEDURES WITH MCC
|
Facility
|
IP
|
$166,951.20
|
|
|
Service Code
|
MSDRG 028
|
| Min. Negotiated Rate |
$46,519.52 |
| Max. Negotiated Rate |
$166,951.20 |
| Rate for Payer: Aetna Managed Medicare |
$46,519.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$131,096.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$100,484.25
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$95,466.60
|
| Rate for Payer: Anthem Medicare Advantage |
$46,519.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$46,519.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$46,519.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$46,519.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$105,976.68
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$46,519.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$122,209.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46,519.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$46,519.52
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$46,519.52
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$46,519.52
|
| Rate for Payer: NAPHCARE Commercial |
$69,779.28
|
| Rate for Payer: Quartz Medicare Advantage |
$46,519.52
|
| Rate for Payer: The Alliance Commercial |
$166,951.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46,519.52
|
| Rate for Payer: United Healthcare PPO |
$95,141.51
|
| Rate for Payer: Wellcare Medicare |
$46,519.52
|
|
|
SPINAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$64,451.92
|
|
|
Service Code
|
MSDRG 030
|
| Min. Negotiated Rate |
$17,318.05 |
| Max. Negotiated Rate |
$64,451.92 |
| Rate for Payer: Aetna Managed Medicare |
$17,318.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$47,897.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36,713.05
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34,879.80
|
| Rate for Payer: Anthem Medicare Advantage |
$17,318.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17,318.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17,318.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17,318.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38,719.77
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17,318.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47,029.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17,318.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17,318.05
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17,318.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17,318.05
|
| Rate for Payer: NAPHCARE Commercial |
$25,977.07
|
| Rate for Payer: Quartz Medicare Advantage |
$17,318.05
|
| Rate for Payer: The Alliance Commercial |
$64,451.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,318.05
|
| Rate for Payer: United Healthcare PPO |
$36,612.93
|
| Rate for Payer: Wellcare Medicare |
$17,318.05
|
|
|
Spinal Puncture Lumbar Diag
|
Facility
|
IP
|
$1,802.00
|
|
|
Service Code
|
CPT 62328
|
| Hospital Charge Code |
3072726
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$918.30 |
| Max. Negotiated Rate |
$1,724.15 |
| Rate for Payer: Aetna Commercial |
$1,686.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,611.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$993.26
|
| Rate for Payer: Cash Price |
$540.60
|
| Rate for Payer: Cigna Commercial |
$1,724.15
|
| Rate for Payer: Health EOS Commercial |
$1,667.93
|
| Rate for Payer: HFN Commercial |
$1,724.15
|
| Rate for Payer: Multiplan Commercial |
$1,499.26
|
| Rate for Payer: Preferred Network Access Commercial |
$1,724.15
|
| Rate for Payer: Quartz Beloit One Network |
$918.30
|
| Rate for Payer: Quartz Commercial |
$1,124.45
|
| Rate for Payer: WEA Trust Commercial |
$1,030.74
|
| Rate for Payer: WPS Commercial |
$1,388.08
|
|
|
Spinal Puncture Lumbar Diag
|
Professional
|
Both
|
$1,802.00
|
|
|
Service Code
|
CPT 62328
|
| Hospital Charge Code |
3072726
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$71.61 |
| Max. Negotiated Rate |
$1,780.38 |
| Rate for Payer: Aetna Commercial |
$1,780.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,611.71
|
| Rate for Payer: Aetna Managed Medicare |
$71.61
|
| Rate for Payer: Anthem Medicare Advantage |
$71.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$71.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$71.61
|
| 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 |
$1,780.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$208.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$71.61
|
| Rate for Payer: Health EOS Commercial |
$1,705.41
|
| Rate for Payer: HFN Commercial |
$1,780.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$305.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$305.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$71.61
|
| Rate for Payer: Multiplan Commercial |
$1,499.26
|
| Rate for Payer: NAPHCARE Commercial |
$107.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,780.38
|
| Rate for Payer: Quartz Beloit One Network |
$824.60
|
| Rate for Payer: Quartz Commercial |
$1,068.23
|
| Rate for Payer: Quartz Medicare Advantage |
$71.61
|
| Rate for Payer: The Alliance Commercial |
$304.36
|
| Rate for Payer: United Healthcare Medicaid |
$208.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$71.61
|
| Rate for Payer: WEA Trust Commercial |
$1,030.74
|
| Rate for Payer: WPS Commercial |
$322.26
|
|
|
Spinal Puncture Lumbar Diag
|
Facility
|
OP
|
$1,802.00
|
|
|
Service Code
|
CPT 62328
|
| Hospital Charge Code |
3072726
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$742.86 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$1,686.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,611.71
|
| Rate for Payer: Aetna Managed Medicare |
$742.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,218.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$937.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$899.56
|
| Rate for Payer: Anthem Medicare Advantage |
$742.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$993.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$742.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$742.86
|
| Rate for Payer: Cash Price |
$540.60
|
| Rate for Payer: Cash Price |
$540.60
|
| Rate for Payer: Cigna Commercial |
$1,724.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$742.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$742.86
|
| Rate for Payer: Health EOS Commercial |
$1,667.93
|
| Rate for Payer: HFN Commercial |
$1,724.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,763.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$742.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$742.86
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$742.86
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$742.86
|
| Rate for Payer: Multiplan Commercial |
$1,499.26
|
| Rate for Payer: NAPHCARE Commercial |
$1,114.29
|
| Rate for Payer: Preferred Network Access Commercial |
$1,724.15
|
| Rate for Payer: Quartz Beloit One Network |
$918.30
|
| Rate for Payer: Quartz Commercial |
$1,218.15
|
| Rate for Payer: Quartz Medicare Advantage |
$742.86
|
| Rate for Payer: The Alliance Commercial |
$2,971.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$742.86
|
| Rate for Payer: WEA Trust Commercial |
$1,030.74
|
| Rate for Payer: Wellcare Medicare |
$742.86
|
| Rate for Payer: WPS Commercial |
$1,388.08
|
|
|
Spinal Puncture, Lumbar, Diagnostic 62270
|
Professional
|
Both
|
$508.00
|
|
|
Service Code
|
CPT 62270
|
| Hospital Charge Code |
1190835
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$53.76 |
| Max. Negotiated Rate |
$501.90 |
| Rate for Payer: Aetna Commercial |
$501.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$454.36
|
| Rate for Payer: Aetna Managed Medicare |
$53.76
|
| Rate for Payer: Anthem Medicare Advantage |
$53.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$53.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$53.76
|
| 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 |
$501.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$61.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$53.76
|
| Rate for Payer: Health EOS Commercial |
$480.77
|
| Rate for Payer: HFN Commercial |
$501.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$211.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$211.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$53.76
|
| Rate for Payer: Multiplan Commercial |
$422.66
|
| Rate for Payer: NAPHCARE Commercial |
$80.64
|
| Rate for Payer: Preferred Network Access Commercial |
$501.90
|
| Rate for Payer: Quartz Beloit One Network |
$232.46
|
| Rate for Payer: Quartz Commercial |
$301.14
|
| Rate for Payer: Quartz Medicare Advantage |
$53.76
|
| Rate for Payer: The Alliance Commercial |
$228.47
|
| Rate for Payer: United Healthcare Medicaid |
$61.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$53.76
|
| Rate for Payer: WEA Trust Commercial |
$290.58
|
| Rate for Payer: WPS Commercial |
$241.91
|
|
|
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
|
|
|
SPINAL WITH GENERAL ANES - SET-UP CHARGE
|
Facility
|
IP
|
$1,668.00
|
|
| Hospital Charge Code |
4519588
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$850.01 |
| 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: 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: Health EOS Commercial |
$1,543.90
|
| Rate for Payer: HFN Commercial |
$1,595.94
|
| Rate for Payer: Multiplan Commercial |
$1,387.78
|
| Rate for Payer: Preferred Network Access Commercial |
$1,595.94
|
| Rate for Payer: Quartz Beloit One Network |
$850.01
|
| Rate for Payer: Quartz Commercial |
$1,040.83
|
| Rate for Payer: WEA Trust Commercial |
$954.10
|
| Rate for Payer: WPS Commercial |
$1,284.86
|
|
|
SPINE INJECTIONS AND OTHER RELATED PROCEDURES
|
Facility
|
OP
|
$164.53
|
|
|
Service Code
|
EAPG 00053
|
| Min. Negotiated Rate |
$158.20 |
| Max. Negotiated Rate |
$164.53 |
| Rate for Payer: Anthem Medicaid |
$158.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$158.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$158.20
|
| Rate for Payer: Dean Health Medicaid |
$158.20
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$158.20
|
| Rate for Payer: Managed Health Services Medicaid |
$164.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$158.20
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$158.20
|
| Rate for Payer: United Healthcare Medicaid |
$158.20
|
|
|
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
|
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
|
|
|
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
|
|
|
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
|
|
