|
TRANSURETHRAL RESECTION; RESIDUAL OR REGROWTH OF OBSTRUCTIVE PROSTATE TISSUE INCLUDING CONTROL OF POSTOPERATIVE BLEEDING, COMPLETE (VASECTOMY, MEATOTOMY, CYSTOURETHROSCOPY, URETHRAL CALIBRATION AND/OR DILATION, AND INTERNAL URETHROTOMY ARE INCLUDED)
|
Facility
OP
|
$19,025.46
|
|
|
Service Code
|
CPT 52630
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,240.00 |
| Max. Negotiated Rate |
$19,025.46 |
| Rate for Payer: Aetna Managed Medicare |
$5,114.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,238.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,914.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,367.00
|
| Rate for Payer: Anthem Medicare Advantage |
$5,114.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,114.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,114.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,114.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,114.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19,025.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,114.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,114.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,114.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,114.37
|
| Rate for Payer: NAPHCARE Commercial |
$7,671.56
|
| Rate for Payer: Quartz Medicare Advantage |
$5,114.37
|
| Rate for Payer: The Alliance Commercial |
$11,915.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,114.37
|
| Rate for Payer: United Healthcare PPO |
$4,240.00
|
| Rate for Payer: Wellcare Medicare |
$5,114.37
|
|
|
TRANSVERSUS ABDOMINUS PLANE BLOCK
|
Facility
OP
|
$270.00
|
|
| Hospital Charge Code |
4494603
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$1,080.00 |
| Rate for Payer: Aetna Commercial |
$243.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$232.20
|
| Rate for Payer: Aetna Managed Medicare |
$75.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$175.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$135.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$129.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.10
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$248.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$151.09
|
| Rate for Payer: Health EOS Commercial |
$240.30
|
| Rate for Payer: HFN Commercial |
$248.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.50
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: NAPHCARE Commercial |
$162.00
|
| Rate for Payer: Preferred Network Access Commercial |
$248.40
|
| Rate for Payer: Quartz Beloit One Network |
$132.30
|
| Rate for Payer: Quartz Commercial |
$175.50
|
| Rate for Payer: Quartz Medicare Advantage |
$162.00
|
| Rate for Payer: The Alliance Commercial |
$1,080.00
|
| Rate for Payer: WEA Trust Commercial |
$148.50
|
| Rate for Payer: WPS Commercial |
$199.99
|
|
|
TRANSVERSUS ABDOMINUS PLANE BLOCK
|
Facility
IP
|
$270.00
|
|
| Hospital Charge Code |
4494603
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$132.30 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna Commercial |
$243.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.10
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$248.40
|
| Rate for Payer: Health EOS Commercial |
$240.30
|
| Rate for Payer: HFN Commercial |
$248.40
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: NAPHCARE Commercial |
$162.00
|
| Rate for Payer: Preferred Network Access Commercial |
$248.40
|
| Rate for Payer: Quartz Beloit One Network |
$132.30
|
| Rate for Payer: Quartz Commercial |
$162.00
|
| Rate for Payer: WEA Trust Commercial |
$148.50
|
| Rate for Payer: WPS Commercial |
$199.99
|
|
|
TRAP ETRAP POLY
|
Facility
OP
|
$168.00
|
|
| Hospital Charge Code |
2963981
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.04 |
| Max. Negotiated Rate |
$672.00 |
| Rate for Payer: Aetna Commercial |
$151.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$144.48
|
| Rate for Payer: Aetna Managed Medicare |
$47.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$109.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$84.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$80.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$89.04
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$154.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$94.01
|
| Rate for Payer: Health EOS Commercial |
$149.52
|
| Rate for Payer: HFN Commercial |
$154.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$126.00
|
| Rate for Payer: Multiplan Commercial |
$134.40
|
| Rate for Payer: NAPHCARE Commercial |
$100.80
|
| Rate for Payer: Preferred Network Access Commercial |
$154.56
|
| Rate for Payer: Quartz Beloit One Network |
$82.32
|
| Rate for Payer: Quartz Commercial |
$109.20
|
| Rate for Payer: Quartz Medicare Advantage |
$100.80
|
| Rate for Payer: The Alliance Commercial |
$672.00
|
| Rate for Payer: WEA Trust Commercial |
$92.40
|
| Rate for Payer: WPS Commercial |
$124.44
|
|
|
TRAP ETRAP POLY
|
Facility
IP
|
$168.00
|
|
| Hospital Charge Code |
2963981
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$82.32 |
| Max. Negotiated Rate |
$154.56 |
| Rate for Payer: Aetna Commercial |
$151.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$89.04
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$154.56
|
| Rate for Payer: Health EOS Commercial |
$149.52
|
| Rate for Payer: HFN Commercial |
$154.56
|
| Rate for Payer: Multiplan Commercial |
$134.40
|
| Rate for Payer: NAPHCARE Commercial |
$100.80
|
| Rate for Payer: Preferred Network Access Commercial |
$154.56
|
| Rate for Payer: Quartz Beloit One Network |
$82.32
|
| Rate for Payer: Quartz Commercial |
$100.80
|
| Rate for Payer: WEA Trust Commercial |
$92.40
|
| Rate for Payer: WPS Commercial |
$124.44
|
|
|
TRAPEZECTOMY
|
Facility
OP
|
$1,337.00
|
|
| Hospital Charge Code |
2960452
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$374.36 |
| Max. Negotiated Rate |
$5,348.00 |
| Rate for Payer: Aetna Commercial |
$1,203.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,149.82
|
| Rate for Payer: Aetna Managed Medicare |
$374.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$869.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$668.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$641.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$708.61
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: Cigna Commercial |
$1,230.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$748.19
|
| Rate for Payer: Health EOS Commercial |
$1,189.93
|
| Rate for Payer: HFN Commercial |
$1,230.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,002.75
|
| Rate for Payer: Multiplan Commercial |
$1,069.60
|
| Rate for Payer: NAPHCARE Commercial |
$802.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,230.04
|
| Rate for Payer: Quartz Beloit One Network |
$655.13
|
| Rate for Payer: Quartz Commercial |
$869.05
|
| Rate for Payer: Quartz Medicare Advantage |
$802.20
|
| Rate for Payer: The Alliance Commercial |
$5,348.00
|
| Rate for Payer: WEA Trust Commercial |
$735.35
|
| Rate for Payer: WPS Commercial |
$990.32
|
|
|
TRAPEZECTOMY
|
Facility
IP
|
$1,337.00
|
|
| Hospital Charge Code |
2960452
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$655.13 |
| Max. Negotiated Rate |
$1,230.04 |
| Rate for Payer: Aetna Commercial |
$1,203.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$708.61
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: Cigna Commercial |
$1,230.04
|
| Rate for Payer: Health EOS Commercial |
$1,189.93
|
| Rate for Payer: HFN Commercial |
$1,230.04
|
| Rate for Payer: Multiplan Commercial |
$1,069.60
|
| Rate for Payer: NAPHCARE Commercial |
$802.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,230.04
|
| Rate for Payer: Quartz Beloit One Network |
$655.13
|
| Rate for Payer: Quartz Commercial |
$802.20
|
| Rate for Payer: WEA Trust Commercial |
$735.35
|
| Rate for Payer: WPS Commercial |
$990.32
|
|
|
TRAP QUICKCATCH SUCTION GI H332
|
Facility
OP
|
$84.00
|
|
| Hospital Charge Code |
4595420
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$23.52 |
| Max. Negotiated Rate |
$336.00 |
| Rate for Payer: Aetna Commercial |
$75.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.24
|
| Rate for Payer: Aetna Managed Medicare |
$23.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$54.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$40.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.52
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$77.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.01
|
| Rate for Payer: Health EOS Commercial |
$74.76
|
| Rate for Payer: HFN Commercial |
$77.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.00
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: NAPHCARE Commercial |
$50.40
|
| Rate for Payer: Preferred Network Access Commercial |
$77.28
|
| Rate for Payer: Quartz Beloit One Network |
$41.16
|
| Rate for Payer: Quartz Commercial |
$54.60
|
| Rate for Payer: Quartz Medicare Advantage |
$50.40
|
| Rate for Payer: The Alliance Commercial |
$336.00
|
| Rate for Payer: WEA Trust Commercial |
$46.20
|
| Rate for Payer: WPS Commercial |
$62.22
|
|
|
TRAP QUICKCATCH SUCTION GI H332
|
Facility
IP
|
$84.00
|
|
| Hospital Charge Code |
4595420
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$41.16 |
| Max. Negotiated Rate |
$77.28 |
| Rate for Payer: Aetna Commercial |
$75.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.52
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$77.28
|
| Rate for Payer: Health EOS Commercial |
$74.76
|
| Rate for Payer: HFN Commercial |
$77.28
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: NAPHCARE Commercial |
$50.40
|
| Rate for Payer: Preferred Network Access Commercial |
$77.28
|
| Rate for Payer: Quartz Beloit One Network |
$41.16
|
| Rate for Payer: Quartz Commercial |
$50.40
|
| Rate for Payer: WEA Trust Commercial |
$46.20
|
| Rate for Payer: WPS Commercial |
$62.22
|
|
|
TRAUMATIC INJURY WITH MCC
|
Facility
IP
|
$40,053.00
|
|
|
Service Code
|
MS-DRG 913
|
| Min. Negotiated Rate |
$14,407.60 |
| Max. Negotiated Rate |
$40,053.00 |
| Rate for Payer: Aetna Managed Medicare |
$14,407.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31,260.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23,960.69
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22,764.22
|
| Rate for Payer: Anthem Medicare Advantage |
$14,407.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14,407.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14,407.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14,407.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25,270.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14,407.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29,142.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14,407.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14,407.60
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14,407.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14,407.60
|
| Rate for Payer: NAPHCARE Commercial |
$21,611.40
|
| Rate for Payer: Quartz Medicare Advantage |
$14,407.60
|
| Rate for Payer: The Alliance Commercial |
$40,053.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14,407.60
|
| Rate for Payer: United Healthcare PPO |
$22,688.00
|
| Rate for Payer: Wellcare Medicare |
$14,407.60
|
|
|
TRAUMATIC INJURY WITHOUT MCC
|
Facility
IP
|
$24,453.00
|
|
|
Service Code
|
MS-DRG 914
|
| Min. Negotiated Rate |
$8,795.87 |
| Max. Negotiated Rate |
$24,453.00 |
| Rate for Payer: Aetna Managed Medicare |
$8,795.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,091.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,633.71
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,902.98
|
| Rate for Payer: Anthem Medicare Advantage |
$8,795.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,795.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,795.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,795.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15,433.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,795.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17,700.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,795.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,795.87
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,795.87
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,795.87
|
| Rate for Payer: NAPHCARE Commercial |
$13,193.80
|
| Rate for Payer: Quartz Medicare Advantage |
$8,795.87
|
| Rate for Payer: The Alliance Commercial |
$24,453.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,795.87
|
| Rate for Payer: United Healthcare PPO |
$13,779.79
|
| Rate for Payer: Wellcare Medicare |
$8,795.87
|
|
|
TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC
|
Facility
IP
|
$35,337.00
|
|
|
Service Code
|
MS-DRG 086
|
| Min. Negotiated Rate |
$12,711.09 |
| Max. Negotiated Rate |
$35,337.00 |
| Rate for Payer: Aetna Managed Medicare |
$12,711.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$27,693.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21,226.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20,166.96
|
| Rate for Payer: Anthem Medicare Advantage |
$12,711.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12,711.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12,711.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12,711.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22,387.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12,711.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25,683.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12,711.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12,711.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12,711.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12,711.09
|
| Rate for Payer: NAPHCARE Commercial |
$19,066.64
|
| Rate for Payer: Quartz Medicare Advantage |
$12,711.09
|
| Rate for Payer: The Alliance Commercial |
$35,337.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,711.09
|
| Rate for Payer: United Healthcare PPO |
$19,994.90
|
| Rate for Payer: Wellcare Medicare |
$12,711.09
|
|
|
TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC
|
Facility
IP
|
$36,382.00
|
|
|
Service Code
|
MS-DRG 083
|
| Min. Negotiated Rate |
$13,086.92 |
| Max. Negotiated Rate |
$36,382.00 |
| Rate for Payer: Aetna Managed Medicare |
$13,086.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$28,532.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21,870.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20,778.08
|
| Rate for Payer: Anthem Medicare Advantage |
$13,086.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,086.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,086.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,086.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23,065.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,086.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26,449.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,086.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,086.92
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,086.92
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,086.92
|
| Rate for Payer: NAPHCARE Commercial |
$19,630.38
|
| Rate for Payer: Quartz Medicare Advantage |
$13,086.92
|
| Rate for Payer: The Alliance Commercial |
$36,382.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,086.92
|
| Rate for Payer: United Healthcare PPO |
$20,591.51
|
| Rate for Payer: Wellcare Medicare |
$13,086.92
|
|
|
TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC
|
Facility
IP
|
$60,745.00
|
|
|
Service Code
|
MS-DRG 085
|
| Min. Negotiated Rate |
$21,850.72 |
| Max. Negotiated Rate |
$60,745.00 |
| Rate for Payer: Aetna Managed Medicare |
$21,850.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$47,624.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36,503.87
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34,681.06
|
| Rate for Payer: Anthem Medicare Advantage |
$21,850.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21,850.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21,850.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$21,850.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38,499.15
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$21,850.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44,319.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21,850.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21,850.72
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$21,850.72
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$21,850.72
|
| Rate for Payer: NAPHCARE Commercial |
$32,776.08
|
| Rate for Payer: Quartz Medicare Advantage |
$21,850.72
|
| Rate for Payer: The Alliance Commercial |
$60,745.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21,850.72
|
| Rate for Payer: United Healthcare PPO |
$34,503.38
|
| Rate for Payer: Wellcare Medicare |
$21,850.72
|
|
|
TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC
|
Facility
IP
|
$60,891.00
|
|
|
Service Code
|
MS-DRG 082
|
| Min. Negotiated Rate |
$21,903.33 |
| Max. Negotiated Rate |
$60,891.00 |
| Rate for Payer: Aetna Managed Medicare |
$21,903.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$47,834.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36,664.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34,833.84
|
| Rate for Payer: Anthem Medicare Advantage |
$21,903.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21,903.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21,903.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$21,903.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38,668.75
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$21,903.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44,426.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21,903.33
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21,903.33
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$21,903.33
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$21,903.33
|
| Rate for Payer: NAPHCARE Commercial |
$32,855.00
|
| Rate for Payer: Quartz Medicare Advantage |
$21,903.33
|
| Rate for Payer: The Alliance Commercial |
$60,891.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21,903.33
|
| Rate for Payer: United Healthcare PPO |
$34,586.87
|
| Rate for Payer: Wellcare Medicare |
$21,903.33
|
|
|
TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC
|
Facility
IP
|
$23,881.00
|
|
|
Service Code
|
MS-DRG 087
|
| Min. Negotiated Rate |
$8,590.26 |
| Max. Negotiated Rate |
$23,881.00 |
| Rate for Payer: Aetna Managed Medicare |
$8,590.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,672.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,312.09
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,597.42
|
| Rate for Payer: Anthem Medicare Advantage |
$8,590.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,590.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,590.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,590.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15,094.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,590.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17,280.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,590.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,590.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,590.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,590.26
|
| Rate for Payer: NAPHCARE Commercial |
$12,885.39
|
| Rate for Payer: Quartz Medicare Advantage |
$8,590.26
|
| Rate for Payer: The Alliance Commercial |
$23,881.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,590.26
|
| Rate for Payer: United Healthcare PPO |
$13,453.40
|
| Rate for Payer: Wellcare Medicare |
$8,590.26
|
|
|
TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC
|
Facility
IP
|
$24,772.00
|
|
|
Service Code
|
MS-DRG 084
|
| Min. Negotiated Rate |
$8,910.63 |
| Max. Negotiated Rate |
$24,772.00 |
| Rate for Payer: Aetna Managed Medicare |
$8,910.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,301.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,794.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14,055.76
|
| Rate for Payer: Anthem Medicare Advantage |
$8,910.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,910.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,910.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,910.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15,603.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,910.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17,934.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,910.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,910.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,910.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,910.63
|
| Rate for Payer: NAPHCARE Commercial |
$13,365.94
|
| Rate for Payer: Quartz Medicare Advantage |
$8,910.63
|
| Rate for Payer: The Alliance Commercial |
$24,772.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,910.63
|
| Rate for Payer: United Healthcare PPO |
$13,961.97
|
| Rate for Payer: Wellcare Medicare |
$8,910.63
|
|
|
TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC
|
Facility
IP
|
$40,364.00
|
|
|
Service Code
|
MS-DRG 604
|
| Min. Negotiated Rate |
$14,519.49 |
| Max. Negotiated Rate |
$40,364.00 |
| Rate for Payer: Aetna Managed Medicare |
$14,519.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31,679.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24,282.31
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23,069.78
|
| Rate for Payer: Anthem Medicare Advantage |
$14,519.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14,519.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14,519.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14,519.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25,609.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14,519.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29,370.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14,519.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14,519.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14,519.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14,519.49
|
| Rate for Payer: NAPHCARE Commercial |
$21,779.24
|
| Rate for Payer: Quartz Medicare Advantage |
$14,519.49
|
| Rate for Payer: The Alliance Commercial |
$40,364.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14,519.49
|
| Rate for Payer: United Healthcare PPO |
$22,865.62
|
| Rate for Payer: Wellcare Medicare |
$14,519.49
|
|
|
TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC
|
Facility
IP
|
$24,482.00
|
|
|
Service Code
|
MS-DRG 605
|
| Min. Negotiated Rate |
$8,806.39 |
| Max. Negotiated Rate |
$24,482.00 |
| Rate for Payer: Aetna Managed Medicare |
$8,806.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,091.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,633.71
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,902.98
|
| Rate for Payer: Anthem Medicare Advantage |
$8,806.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,806.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,806.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,806.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15,433.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,806.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17,721.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,806.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,806.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,806.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,806.39
|
| Rate for Payer: NAPHCARE Commercial |
$13,209.58
|
| Rate for Payer: Quartz Medicare Advantage |
$8,806.39
|
| Rate for Payer: The Alliance Commercial |
$24,482.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,806.39
|
| Rate for Payer: United Healthcare PPO |
$13,796.49
|
| Rate for Payer: Wellcare Medicare |
$8,806.39
|
|
|
TRAY ACCUCATH IV 18GA X 2.25 IN CATHETER & GUIDEWIRE AC1182252
|
Facility
OP
|
$857.00
|
|
| Hospital Charge Code |
6171928
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$239.96 |
| Max. Negotiated Rate |
$3,428.00 |
| Rate for Payer: Aetna Commercial |
$771.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$737.02
|
| Rate for Payer: Aetna Managed Medicare |
$239.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$557.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$428.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$411.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$454.21
|
| Rate for Payer: Cash Price |
$257.10
|
| Rate for Payer: Cigna Commercial |
$788.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$479.58
|
| Rate for Payer: Health EOS Commercial |
$762.73
|
| Rate for Payer: HFN Commercial |
$788.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$642.75
|
| Rate for Payer: Multiplan Commercial |
$685.60
|
| Rate for Payer: NAPHCARE Commercial |
$514.20
|
| Rate for Payer: Preferred Network Access Commercial |
$788.44
|
| Rate for Payer: Quartz Beloit One Network |
$419.93
|
| Rate for Payer: Quartz Commercial |
$557.05
|
| Rate for Payer: Quartz Medicare Advantage |
$514.20
|
| Rate for Payer: The Alliance Commercial |
$3,428.00
|
| Rate for Payer: WEA Trust Commercial |
$471.35
|
| Rate for Payer: WPS Commercial |
$634.78
|
|
|
TRAY ACCUCATH IV 18GA X 2.25 IN CATHETER & GUIDEWIRE AC1182252
|
Facility
IP
|
$857.00
|
|
| Hospital Charge Code |
6171928
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$419.93 |
| Max. Negotiated Rate |
$788.44 |
| Rate for Payer: Aetna Commercial |
$771.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$454.21
|
| Rate for Payer: Cash Price |
$257.10
|
| Rate for Payer: Cigna Commercial |
$788.44
|
| Rate for Payer: Health EOS Commercial |
$762.73
|
| Rate for Payer: HFN Commercial |
$788.44
|
| Rate for Payer: Multiplan Commercial |
$685.60
|
| Rate for Payer: NAPHCARE Commercial |
$514.20
|
| Rate for Payer: Preferred Network Access Commercial |
$788.44
|
| Rate for Payer: Quartz Beloit One Network |
$419.93
|
| Rate for Payer: Quartz Commercial |
$514.20
|
| Rate for Payer: WEA Trust Commercial |
$471.35
|
| Rate for Payer: WPS Commercial |
$634.78
|
|
|
TRAY ACCUCATH IV 20GA X 2.25 IN CATHETER & GUIDEWIRE AC1202252
|
Facility
IP
|
$857.00
|
|
| Hospital Charge Code |
6171929
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$419.93 |
| Max. Negotiated Rate |
$788.44 |
| Rate for Payer: Aetna Commercial |
$771.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$454.21
|
| Rate for Payer: Cash Price |
$257.10
|
| Rate for Payer: Cigna Commercial |
$788.44
|
| Rate for Payer: Health EOS Commercial |
$762.73
|
| Rate for Payer: HFN Commercial |
$788.44
|
| Rate for Payer: Multiplan Commercial |
$685.60
|
| Rate for Payer: NAPHCARE Commercial |
$514.20
|
| Rate for Payer: Preferred Network Access Commercial |
$788.44
|
| Rate for Payer: Quartz Beloit One Network |
$419.93
|
| Rate for Payer: Quartz Commercial |
$514.20
|
| Rate for Payer: WEA Trust Commercial |
$471.35
|
| Rate for Payer: WPS Commercial |
$634.78
|
|
|
TRAY ACCUCATH IV 20GA X 2.25 IN CATHETER & GUIDEWIRE AC1202252
|
Facility
OP
|
$857.00
|
|
| Hospital Charge Code |
6171929
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$239.96 |
| Max. Negotiated Rate |
$3,428.00 |
| Rate for Payer: Aetna Commercial |
$771.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$737.02
|
| Rate for Payer: Aetna Managed Medicare |
$239.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$557.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$428.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$411.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$454.21
|
| Rate for Payer: Cash Price |
$257.10
|
| Rate for Payer: Cigna Commercial |
$788.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$479.58
|
| Rate for Payer: Health EOS Commercial |
$762.73
|
| Rate for Payer: HFN Commercial |
$788.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$642.75
|
| Rate for Payer: Multiplan Commercial |
$685.60
|
| Rate for Payer: NAPHCARE Commercial |
$514.20
|
| Rate for Payer: Preferred Network Access Commercial |
$788.44
|
| Rate for Payer: Quartz Beloit One Network |
$419.93
|
| Rate for Payer: Quartz Commercial |
$557.05
|
| Rate for Payer: Quartz Medicare Advantage |
$514.20
|
| Rate for Payer: The Alliance Commercial |
$3,428.00
|
| Rate for Payer: WEA Trust Commercial |
$471.35
|
| Rate for Payer: WPS Commercial |
$634.78
|
|
|
TRAY AMNIOCENTESIS 20 x 3.5
|
Facility
IP
|
$328.00
|
|
| Hospital Charge Code |
2963119
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$160.72 |
| Max. Negotiated Rate |
$301.76 |
| Rate for Payer: Aetna Commercial |
$295.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$173.84
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$301.76
|
| Rate for Payer: Health EOS Commercial |
$291.92
|
| Rate for Payer: HFN Commercial |
$301.76
|
| Rate for Payer: Multiplan Commercial |
$262.40
|
| Rate for Payer: NAPHCARE Commercial |
$196.80
|
| Rate for Payer: Preferred Network Access Commercial |
$301.76
|
| Rate for Payer: Quartz Beloit One Network |
$160.72
|
| Rate for Payer: Quartz Commercial |
$196.80
|
| Rate for Payer: WEA Trust Commercial |
$180.40
|
| Rate for Payer: WPS Commercial |
$242.95
|
|
|
TRAY AMNIOCENTESIS 20 x 3.5
|
Facility
OP
|
$328.00
|
|
| Hospital Charge Code |
2963119
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$91.84 |
| Max. Negotiated Rate |
$1,312.00 |
| Rate for Payer: Aetna Commercial |
$295.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$282.08
|
| Rate for Payer: Aetna Managed Medicare |
$91.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$213.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$164.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$157.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$173.84
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$301.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$183.55
|
| Rate for Payer: Health EOS Commercial |
$291.92
|
| Rate for Payer: HFN Commercial |
$301.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$246.00
|
| Rate for Payer: Multiplan Commercial |
$262.40
|
| Rate for Payer: NAPHCARE Commercial |
$196.80
|
| Rate for Payer: Preferred Network Access Commercial |
$301.76
|
| Rate for Payer: Quartz Beloit One Network |
$160.72
|
| Rate for Payer: Quartz Commercial |
$213.20
|
| Rate for Payer: Quartz Medicare Advantage |
$196.80
|
| Rate for Payer: The Alliance Commercial |
$1,312.00
|
| Rate for Payer: WEA Trust Commercial |
$180.40
|
| Rate for Payer: WPS Commercial |
$242.95
|
|
