|
TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC
|
Facility
|
IP
|
$26,835.12
|
|
|
Service Code
|
MSDRG 714
|
| Min. Negotiated Rate |
$8,604.55 |
| Max. Negotiated Rate |
$26,835.12 |
| Rate for Payer: Aetna Managed Medicare |
$8,604.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23,071.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17,684.21
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16,801.16
|
| Rate for Payer: Anthem Medicare Advantage |
$8,604.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,604.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,604.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,604.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18,650.82
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,604.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19,438.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,604.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,604.55
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,604.55
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,604.55
|
| Rate for Payer: NAPHCARE Commercial |
$12,906.83
|
| Rate for Payer: Quartz Medicare Advantage |
$8,604.55
|
| Rate for Payer: The Alliance Commercial |
$26,835.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,604.55
|
| Rate for Payer: United Healthcare PPO |
$15,133.03
|
| Rate for Payer: Wellcare Medicare |
$8,604.55
|
|
|
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
|
$22,570.79
|
|
|
Service Code
|
CPT 52630
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,409.60 |
| Max. Negotiated Rate |
$22,570.79 |
| Rate for Payer: Aetna Managed Medicare |
$5,642.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,727.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,350.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,781.68
|
| Rate for Payer: Anthem Medicare Advantage |
$5,642.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,642.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,642.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,642.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,642.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,990.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,642.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,642.70
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,642.70
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,642.70
|
| Rate for Payer: NAPHCARE Commercial |
$8,464.05
|
| Rate for Payer: Quartz Medicare Advantage |
$5,642.70
|
| Rate for Payer: The Alliance Commercial |
$22,570.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,642.70
|
| Rate for Payer: United Healthcare PPO |
$4,409.60
|
| Rate for Payer: Wellcare Medicare |
$5,642.70
|
|
|
TRANSVERSUS ABDOMINUS PLANE BLOCK
|
Facility
|
IP
|
$270.00
|
|
| Hospital Charge Code |
4494603
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$137.59 |
| Max. Negotiated Rate |
$258.34 |
| Rate for Payer: Aetna Commercial |
$252.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$241.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$148.82
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$258.34
|
| Rate for Payer: Health EOS Commercial |
$249.91
|
| Rate for Payer: HFN Commercial |
$258.34
|
| Rate for Payer: Multiplan Commercial |
$224.64
|
| Rate for Payer: Preferred Network Access Commercial |
$258.34
|
| Rate for Payer: Quartz Beloit One Network |
$137.59
|
| Rate for Payer: Quartz Commercial |
$168.48
|
| Rate for Payer: WEA Trust Commercial |
$154.44
|
| Rate for Payer: WPS Commercial |
$207.98
|
|
|
TRANSVERSUS ABDOMINUS PLANE BLOCK
|
Facility
|
OP
|
$270.00
|
|
| Hospital Charge Code |
4494603
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$78.62 |
| Max. Negotiated Rate |
$258.34 |
| Rate for Payer: Aetna Commercial |
$252.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$241.49
|
| Rate for Payer: Aetna Managed Medicare |
$78.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$182.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$140.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$134.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$148.82
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$258.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$157.14
|
| Rate for Payer: Health EOS Commercial |
$249.91
|
| Rate for Payer: HFN Commercial |
$258.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.60
|
| Rate for Payer: Multiplan Commercial |
$224.64
|
| Rate for Payer: NAPHCARE Commercial |
$168.48
|
| Rate for Payer: Preferred Network Access Commercial |
$258.34
|
| Rate for Payer: Quartz Beloit One Network |
$137.59
|
| Rate for Payer: Quartz Commercial |
$182.52
|
| Rate for Payer: Quartz Medicare Advantage |
$168.48
|
| Rate for Payer: The Alliance Commercial |
$140.40
|
| Rate for Payer: WEA Trust Commercial |
$154.44
|
| Rate for Payer: WPS Commercial |
$207.98
|
|
|
TRAP ETRAP POLY
|
Facility
|
IP
|
$168.00
|
|
| Hospital Charge Code |
2963981
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$85.61 |
| Max. Negotiated Rate |
$160.74 |
| Rate for Payer: Aetna Commercial |
$157.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$150.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$92.60
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$160.74
|
| Rate for Payer: Health EOS Commercial |
$155.50
|
| Rate for Payer: HFN Commercial |
$160.74
|
| Rate for Payer: Multiplan Commercial |
$139.78
|
| Rate for Payer: Preferred Network Access Commercial |
$160.74
|
| Rate for Payer: Quartz Beloit One Network |
$85.61
|
| Rate for Payer: Quartz Commercial |
$104.83
|
| Rate for Payer: WEA Trust Commercial |
$96.10
|
| Rate for Payer: WPS Commercial |
$129.41
|
|
|
TRAP ETRAP POLY
|
Facility
|
OP
|
$168.00
|
|
| Hospital Charge Code |
2963981
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.92 |
| Max. Negotiated Rate |
$160.74 |
| Rate for Payer: Aetna Commercial |
$157.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$150.26
|
| Rate for Payer: Aetna Managed Medicare |
$48.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$113.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$87.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$83.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$92.60
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$160.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$97.78
|
| Rate for Payer: Health EOS Commercial |
$155.50
|
| Rate for Payer: HFN Commercial |
$160.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$131.04
|
| Rate for Payer: Multiplan Commercial |
$139.78
|
| Rate for Payer: NAPHCARE Commercial |
$104.83
|
| Rate for Payer: Preferred Network Access Commercial |
$160.74
|
| Rate for Payer: Quartz Beloit One Network |
$85.61
|
| Rate for Payer: Quartz Commercial |
$113.57
|
| Rate for Payer: Quartz Medicare Advantage |
$104.83
|
| Rate for Payer: The Alliance Commercial |
$87.36
|
| Rate for Payer: WEA Trust Commercial |
$96.10
|
| Rate for Payer: WPS Commercial |
$129.41
|
|
|
TRAPEZECTOMY
|
Facility
|
IP
|
$1,337.00
|
|
| Hospital Charge Code |
2960452
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$681.34 |
| Max. Negotiated Rate |
$1,279.24 |
| Rate for Payer: Aetna Commercial |
$1,251.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,195.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$736.95
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: Cigna Commercial |
$1,279.24
|
| Rate for Payer: Health EOS Commercial |
$1,237.53
|
| Rate for Payer: HFN Commercial |
$1,279.24
|
| Rate for Payer: Multiplan Commercial |
$1,112.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,279.24
|
| Rate for Payer: Quartz Beloit One Network |
$681.34
|
| Rate for Payer: Quartz Commercial |
$834.29
|
| Rate for Payer: WEA Trust Commercial |
$764.76
|
| Rate for Payer: WPS Commercial |
$1,029.89
|
|
|
TRAPEZECTOMY
|
Facility
|
OP
|
$1,337.00
|
|
| Hospital Charge Code |
2960452
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$389.33 |
| Max. Negotiated Rate |
$1,279.24 |
| Rate for Payer: Aetna Commercial |
$1,251.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,195.81
|
| Rate for Payer: Aetna Managed Medicare |
$389.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$903.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$695.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$667.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$736.95
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: Cigna Commercial |
$1,279.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$778.13
|
| Rate for Payer: Health EOS Commercial |
$1,237.53
|
| Rate for Payer: HFN Commercial |
$1,279.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,042.86
|
| Rate for Payer: Multiplan Commercial |
$1,112.38
|
| Rate for Payer: NAPHCARE Commercial |
$834.29
|
| Rate for Payer: Preferred Network Access Commercial |
$1,279.24
|
| Rate for Payer: Quartz Beloit One Network |
$681.34
|
| Rate for Payer: Quartz Commercial |
$903.81
|
| Rate for Payer: Quartz Medicare Advantage |
$834.29
|
| Rate for Payer: The Alliance Commercial |
$695.24
|
| Rate for Payer: WEA Trust Commercial |
$764.76
|
| Rate for Payer: WPS Commercial |
$1,029.89
|
|
|
TRAP QUICKCATCH SUCTION GI H332
|
Facility
|
IP
|
$84.00
|
|
| Hospital Charge Code |
4595420
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$42.81 |
| Max. Negotiated Rate |
$80.37 |
| Rate for Payer: Aetna Commercial |
$78.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.30
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$80.37
|
| Rate for Payer: Health EOS Commercial |
$77.75
|
| Rate for Payer: HFN Commercial |
$80.37
|
| Rate for Payer: Multiplan Commercial |
$69.89
|
| Rate for Payer: Preferred Network Access Commercial |
$80.37
|
| Rate for Payer: Quartz Beloit One Network |
$42.81
|
| Rate for Payer: Quartz Commercial |
$52.42
|
| Rate for Payer: WEA Trust Commercial |
$48.05
|
| Rate for Payer: WPS Commercial |
$64.71
|
|
|
TRAP QUICKCATCH SUCTION GI H332
|
Facility
|
OP
|
$84.00
|
|
| Hospital Charge Code |
4595420
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$24.46 |
| Max. Negotiated Rate |
$80.37 |
| Rate for Payer: Aetna Commercial |
$78.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.13
|
| Rate for Payer: Aetna Managed Medicare |
$24.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$43.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$41.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.30
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$80.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.89
|
| Rate for Payer: Health EOS Commercial |
$77.75
|
| Rate for Payer: HFN Commercial |
$80.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.52
|
| Rate for Payer: Multiplan Commercial |
$69.89
|
| Rate for Payer: NAPHCARE Commercial |
$52.42
|
| Rate for Payer: Preferred Network Access Commercial |
$80.37
|
| Rate for Payer: Quartz Beloit One Network |
$42.81
|
| Rate for Payer: Quartz Commercial |
$56.78
|
| Rate for Payer: Quartz Medicare Advantage |
$52.42
|
| Rate for Payer: The Alliance Commercial |
$43.68
|
| Rate for Payer: WEA Trust Commercial |
$48.05
|
| Rate for Payer: WPS Commercial |
$64.71
|
|
|
TRAUMATIC INJURIES
|
Facility
|
OP
|
$107.44
|
|
|
Service Code
|
EAPG 00568
|
| Min. Negotiated Rate |
$103.31 |
| Max. Negotiated Rate |
$107.44 |
| Rate for Payer: Anthem Medicaid |
$103.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$103.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$103.31
|
| Rate for Payer: Dean Health Medicaid |
$103.31
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$103.31
|
| Rate for Payer: Managed Health Services Medicaid |
$107.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$103.31
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$103.31
|
| Rate for Payer: United Healthcare Medicaid |
$103.31
|
|
|
TRAUMATIC INJURY WITH MCC
|
Facility
|
IP
|
$41,655.12
|
|
|
Service Code
|
MSDRG 913
|
| Min. Negotiated Rate |
$13,024.87 |
| Max. Negotiated Rate |
$41,655.12 |
| Rate for Payer: Aetna Managed Medicare |
$13,024.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$35,665.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27,337.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25,972.36
|
| Rate for Payer: Anthem Medicare Advantage |
$13,024.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,024.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,024.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,024.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28,831.70
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,024.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30,308.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,024.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,024.87
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,024.87
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,024.87
|
| Rate for Payer: NAPHCARE Commercial |
$19,537.30
|
| Rate for Payer: Quartz Medicare Advantage |
$13,024.87
|
| Rate for Payer: The Alliance Commercial |
$41,655.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,024.87
|
| Rate for Payer: United Healthcare PPO |
$23,595.52
|
| Rate for Payer: Wellcare Medicare |
$13,024.87
|
|
|
TRAUMATIC INJURY WITHOUT MCC
|
Facility
|
IP
|
$25,431.12
|
|
|
Service Code
|
MSDRG 914
|
| Min. Negotiated Rate |
$7,288.11 |
| Max. Negotiated Rate |
$25,431.12 |
| Rate for Payer: Aetna Managed Medicare |
$7,288.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,320.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,809.31
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14,069.82
|
| Rate for Payer: Anthem Medicare Advantage |
$7,288.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,288.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,288.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,288.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15,618.79
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,288.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18,408.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,288.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,288.11
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,288.11
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,288.11
|
| Rate for Payer: NAPHCARE Commercial |
$10,932.17
|
| Rate for Payer: Quartz Medicare Advantage |
$7,288.11
|
| Rate for Payer: The Alliance Commercial |
$25,431.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,288.11
|
| Rate for Payer: United Healthcare PPO |
$14,330.98
|
| Rate for Payer: Wellcare Medicare |
$7,288.11
|
|
|
TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC
|
Facility
|
IP
|
$36,750.48
|
|
|
Service Code
|
MSDRG 086
|
| Min. Negotiated Rate |
$10,483.12 |
| Max. Negotiated Rate |
$36,750.48 |
| Rate for Payer: Aetna Managed Medicare |
$10,483.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$28,423.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21,786.67
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20,698.76
|
| Rate for Payer: Anthem Medicare Advantage |
$10,483.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,483.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,483.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,483.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22,977.52
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,483.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26,710.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,483.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,483.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,483.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,483.12
|
| Rate for Payer: NAPHCARE Commercial |
$15,724.68
|
| Rate for Payer: Quartz Medicare Advantage |
$10,483.12
|
| Rate for Payer: The Alliance Commercial |
$36,750.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,483.12
|
| Rate for Payer: United Healthcare PPO |
$20,794.70
|
| Rate for Payer: Wellcare Medicare |
$10,483.12
|
|
|
TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC
|
Facility
|
IP
|
$37,837.28
|
|
|
Service Code
|
MSDRG 083
|
| Min. Negotiated Rate |
$11,196.09 |
| Max. Negotiated Rate |
$37,837.28 |
| Rate for Payer: Aetna Managed Medicare |
$11,196.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30,455.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23,343.69
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22,178.03
|
| Rate for Payer: Anthem Medicare Advantage |
$11,196.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,196.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,196.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,196.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24,619.65
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,196.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27,507.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,196.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,196.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,196.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,196.09
|
| Rate for Payer: NAPHCARE Commercial |
$16,794.13
|
| Rate for Payer: Quartz Medicare Advantage |
$11,196.09
|
| Rate for Payer: The Alliance Commercial |
$37,837.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,196.09
|
| Rate for Payer: United Healthcare PPO |
$21,415.17
|
| Rate for Payer: Wellcare Medicare |
$11,196.09
|
|
|
TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC
|
Facility
|
IP
|
$63,174.80
|
|
|
Service Code
|
MSDRG 085
|
| Min. Negotiated Rate |
$17,905.44 |
| Max. Negotiated Rate |
$63,174.80 |
| Rate for Payer: Aetna Managed Medicare |
$17,905.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$49,571.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$37,995.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$36,098.49
|
| Rate for Payer: Anthem Medicare Advantage |
$17,905.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17,905.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17,905.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17,905.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40,072.64
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17,905.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46,092.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17,905.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17,905.44
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17,905.44
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17,905.44
|
| Rate for Payer: NAPHCARE Commercial |
$26,858.16
|
| Rate for Payer: Quartz Medicare Advantage |
$17,905.44
|
| Rate for Payer: The Alliance Commercial |
$63,174.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,905.44
|
| Rate for Payer: United Healthcare PPO |
$35,883.52
|
| Rate for Payer: Wellcare Medicare |
$17,905.44
|
|
|
TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC
|
Facility
|
IP
|
$63,326.64
|
|
|
Service Code
|
MSDRG 082
|
| Min. Negotiated Rate |
$18,010.36 |
| Max. Negotiated Rate |
$63,326.64 |
| Rate for Payer: Aetna Managed Medicare |
$18,010.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$49,869.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$38,224.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$36,316.17
|
| Rate for Payer: Anthem Medicare Advantage |
$18,010.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18,010.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18,010.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18,010.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40,314.28
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18,010.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46,203.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18,010.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18,010.36
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18,010.36
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18,010.36
|
| Rate for Payer: NAPHCARE Commercial |
$27,015.53
|
| Rate for Payer: Quartz Medicare Advantage |
$18,010.36
|
| Rate for Payer: The Alliance Commercial |
$63,326.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18,010.36
|
| Rate for Payer: United Healthcare PPO |
$35,970.34
|
| Rate for Payer: Wellcare Medicare |
$18,010.36
|
|
|
TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC
|
Facility
|
IP
|
$24,836.24
|
|
|
Service Code
|
MSDRG 087
|
| Min. Negotiated Rate |
$7,511.74 |
| Max. Negotiated Rate |
$24,836.24 |
| Rate for Payer: Aetna Managed Medicare |
$7,511.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,958.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15,297.66
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14,533.78
|
| Rate for Payer: Anthem Medicare Advantage |
$7,511.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,511.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,511.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,511.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16,133.83
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,511.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17,972.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,511.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,511.74
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,511.74
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,511.74
|
| Rate for Payer: NAPHCARE Commercial |
$11,267.61
|
| Rate for Payer: Quartz Medicare Advantage |
$7,511.74
|
| Rate for Payer: The Alliance Commercial |
$24,836.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,511.74
|
| Rate for Payer: United Healthcare PPO |
$13,991.54
|
| Rate for Payer: Wellcare Medicare |
$7,511.74
|
|
|
TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC
|
Facility
|
IP
|
$25,762.88
|
|
|
Service Code
|
MSDRG 084
|
| Min. Negotiated Rate |
$7,826.49 |
| Max. Negotiated Rate |
$25,762.88 |
| Rate for Payer: Aetna Managed Medicare |
$7,826.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20,854.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15,985.03
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,186.82
|
| Rate for Payer: Anthem Medicare Advantage |
$7,826.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,826.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,826.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,826.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16,858.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,826.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18,651.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,826.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,826.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,826.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,826.49
|
| Rate for Payer: NAPHCARE Commercial |
$11,739.73
|
| Rate for Payer: Quartz Medicare Advantage |
$7,826.49
|
| Rate for Payer: The Alliance Commercial |
$25,762.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,826.49
|
| Rate for Payer: United Healthcare PPO |
$14,520.45
|
| Rate for Payer: Wellcare Medicare |
$7,826.49
|
|
|
TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC
|
Facility
|
IP
|
$41,978.56
|
|
|
Service Code
|
MSDRG 604
|
| Min. Negotiated Rate |
$11,780.41 |
| Max. Negotiated Rate |
$41,978.56 |
| Rate for Payer: Aetna Managed Medicare |
$11,780.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32,120.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24,619.75
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23,390.37
|
| Rate for Payer: Anthem Medicare Advantage |
$11,780.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,780.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,780.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,780.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25,965.46
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,780.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30,545.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,780.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,780.41
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,780.41
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,780.41
|
| Rate for Payer: NAPHCARE Commercial |
$17,670.62
|
| Rate for Payer: Quartz Medicare Advantage |
$11,780.41
|
| Rate for Payer: The Alliance Commercial |
$41,978.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,780.41
|
| Rate for Payer: United Healthcare PPO |
$23,780.24
|
| Rate for Payer: Wellcare Medicare |
$11,780.41
|
|
|
TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC
|
Facility
|
IP
|
$25,461.28
|
|
|
Service Code
|
MSDRG 605
|
| Min. Negotiated Rate |
$7,521.69 |
| Max. Negotiated Rate |
$25,461.28 |
| Rate for Payer: Aetna Managed Medicare |
$7,521.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,986.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15,319.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14,554.43
|
| Rate for Payer: Anthem Medicare Advantage |
$7,521.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,521.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,521.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,521.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16,156.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,521.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18,430.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,521.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,521.69
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,521.69
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,521.69
|
| Rate for Payer: NAPHCARE Commercial |
$11,282.53
|
| Rate for Payer: Quartz Medicare Advantage |
$7,521.69
|
| Rate for Payer: The Alliance Commercial |
$25,461.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,521.69
|
| Rate for Payer: United Healthcare PPO |
$14,348.35
|
| Rate for Payer: Wellcare Medicare |
$7,521.69
|
|
|
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 |
$436.73 |
| Max. Negotiated Rate |
$819.98 |
| Rate for Payer: Aetna Commercial |
$802.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$766.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$472.38
|
| Rate for Payer: Cash Price |
$257.10
|
| Rate for Payer: Cigna Commercial |
$819.98
|
| Rate for Payer: Health EOS Commercial |
$793.24
|
| Rate for Payer: HFN Commercial |
$819.98
|
| Rate for Payer: Multiplan Commercial |
$713.02
|
| Rate for Payer: Preferred Network Access Commercial |
$819.98
|
| Rate for Payer: Quartz Beloit One Network |
$436.73
|
| Rate for Payer: Quartz Commercial |
$534.77
|
| Rate for Payer: WEA Trust Commercial |
$490.20
|
| Rate for Payer: WPS Commercial |
$660.15
|
|
|
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 |
$249.56 |
| Max. Negotiated Rate |
$819.98 |
| Rate for Payer: Aetna Commercial |
$802.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$766.50
|
| Rate for Payer: Aetna Managed Medicare |
$249.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$579.33
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$445.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$427.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$472.38
|
| Rate for Payer: Cash Price |
$257.10
|
| Rate for Payer: Cigna Commercial |
$819.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$498.77
|
| Rate for Payer: Health EOS Commercial |
$793.24
|
| Rate for Payer: HFN Commercial |
$819.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$668.46
|
| Rate for Payer: Multiplan Commercial |
$713.02
|
| Rate for Payer: NAPHCARE Commercial |
$534.77
|
| Rate for Payer: Preferred Network Access Commercial |
$819.98
|
| Rate for Payer: Quartz Beloit One Network |
$436.73
|
| Rate for Payer: Quartz Commercial |
$579.33
|
| Rate for Payer: Quartz Medicare Advantage |
$534.77
|
| Rate for Payer: The Alliance Commercial |
$445.64
|
| Rate for Payer: WEA Trust Commercial |
$490.20
|
| Rate for Payer: WPS Commercial |
$660.15
|
|
|
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 |
$436.73 |
| Max. Negotiated Rate |
$819.98 |
| Rate for Payer: Aetna Commercial |
$802.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$766.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$472.38
|
| Rate for Payer: Cash Price |
$257.10
|
| Rate for Payer: Cigna Commercial |
$819.98
|
| Rate for Payer: Health EOS Commercial |
$793.24
|
| Rate for Payer: HFN Commercial |
$819.98
|
| Rate for Payer: Multiplan Commercial |
$713.02
|
| Rate for Payer: Preferred Network Access Commercial |
$819.98
|
| Rate for Payer: Quartz Beloit One Network |
$436.73
|
| Rate for Payer: Quartz Commercial |
$534.77
|
| Rate for Payer: WEA Trust Commercial |
$490.20
|
| Rate for Payer: WPS Commercial |
$660.15
|
|
|
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 |
$249.56 |
| Max. Negotiated Rate |
$819.98 |
| Rate for Payer: Aetna Commercial |
$802.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$766.50
|
| Rate for Payer: Aetna Managed Medicare |
$249.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$579.33
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$445.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$427.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$472.38
|
| Rate for Payer: Cash Price |
$257.10
|
| Rate for Payer: Cigna Commercial |
$819.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$498.77
|
| Rate for Payer: Health EOS Commercial |
$793.24
|
| Rate for Payer: HFN Commercial |
$819.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$668.46
|
| Rate for Payer: Multiplan Commercial |
$713.02
|
| Rate for Payer: NAPHCARE Commercial |
$534.77
|
| Rate for Payer: Preferred Network Access Commercial |
$819.98
|
| Rate for Payer: Quartz Beloit One Network |
$436.73
|
| Rate for Payer: Quartz Commercial |
$579.33
|
| Rate for Payer: Quartz Medicare Advantage |
$534.77
|
| Rate for Payer: The Alliance Commercial |
$445.64
|
| Rate for Payer: WEA Trust Commercial |
$490.20
|
| Rate for Payer: WPS Commercial |
$660.15
|
|
