|
TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC
|
Facility
|
IP
|
$22,417.20
|
|
|
Service Code
|
MSDRG 069
|
| Min. Negotiated Rate |
$6,624.14 |
| Max. Negotiated Rate |
$22,417.20 |
| Rate for Payer: Aetna Managed Medicare |
$6,624.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17,429.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,359.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,692.23
|
| Rate for Payer: Anthem Medicare Advantage |
$6,624.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,624.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,624.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,624.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14,089.54
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,624.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16,197.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,624.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,624.14
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,624.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,624.14
|
| Rate for Payer: NAPHCARE Commercial |
$9,936.22
|
| Rate for Payer: Quartz Medicare Advantage |
$6,624.14
|
| Rate for Payer: The Alliance Commercial |
$22,417.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,624.14
|
| Rate for Payer: United Healthcare PPO |
$12,610.06
|
| Rate for Payer: Wellcare Medicare |
$6,624.14
|
|
|
TRANSLUMINAL BALLOON ANGIOPLASTY, CENTRAL DIALYSIS SEGMENT, PERFORMED THROUGH DIALYSIS CIRCUIT, INCLUDING ALL IMAGING AND RADIOLOGICAL SUPERVISION AND INTERPRETATION REQUIRED TO PERFORM THE ANGIOPLASTY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$12,349.86
|
|
|
Service Code
|
CPT 36907
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$484.93 |
| Max. Negotiated Rate |
$12,349.86 |
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: The Alliance Commercial |
$484.93
|
|
|
TRANSLUMINAL BALLOON ANGIOPLASTY (EXCEPT DIALYSIS CIRCUIT), OPEN OR PERCUTANEOUS, INCLUDING ALL IMAGING AND RADIOLOGICAL SUPERVISION AND INTERPRETATION NECESSARY TO PERFORM THE ANGIOPLASTY WITHIN THE SAME VEIN; INITIAL VEIN
|
Facility
|
OP
|
$23,958.98
|
|
|
Service Code
|
CPT 37248
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,989.74 |
| Max. Negotiated Rate |
$23,958.98 |
| Rate for Payer: Aetna Managed Medicare |
$5,989.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,970.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,336.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,619.84
|
| Rate for Payer: Anthem Medicare Advantage |
$5,989.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,989.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,989.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,989.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,989.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22,281.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,989.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,989.74
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,989.74
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,989.74
|
| Rate for Payer: NAPHCARE Commercial |
$8,984.62
|
| Rate for Payer: Quartz Medicare Advantage |
$5,989.74
|
| Rate for Payer: The Alliance Commercial |
$23,958.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,989.74
|
| Rate for Payer: United Healthcare PPO |
$6,400.16
|
| Rate for Payer: Wellcare Medicare |
$5,989.74
|
|
|
Transparent dressing charge
|
Facility
|
IP
|
$51.00
|
|
| Hospital Charge Code |
2844902
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$25.99 |
| Max. Negotiated Rate |
$48.80 |
| Rate for Payer: Aetna Commercial |
$47.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$45.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.11
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna Commercial |
$48.80
|
| Rate for Payer: Health EOS Commercial |
$47.21
|
| Rate for Payer: HFN Commercial |
$48.80
|
| Rate for Payer: Multiplan Commercial |
$42.43
|
| Rate for Payer: Preferred Network Access Commercial |
$48.80
|
| Rate for Payer: Quartz Beloit One Network |
$25.99
|
| Rate for Payer: Quartz Commercial |
$31.82
|
| Rate for Payer: WEA Trust Commercial |
$29.17
|
| Rate for Payer: WPS Commercial |
$39.29
|
|
|
Transparent dressing charge
|
Facility
|
OP
|
$51.00
|
|
| Hospital Charge Code |
2844902
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$14.85 |
| Max. Negotiated Rate |
$48.80 |
| Rate for Payer: Aetna Commercial |
$47.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$45.61
|
| Rate for Payer: Aetna Managed Medicare |
$14.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$34.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.11
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna Commercial |
$48.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.68
|
| Rate for Payer: Health EOS Commercial |
$47.21
|
| Rate for Payer: HFN Commercial |
$48.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39.78
|
| Rate for Payer: Multiplan Commercial |
$42.43
|
| Rate for Payer: NAPHCARE Commercial |
$31.82
|
| Rate for Payer: Preferred Network Access Commercial |
$48.80
|
| Rate for Payer: Quartz Beloit One Network |
$25.99
|
| Rate for Payer: Quartz Commercial |
$34.48
|
| Rate for Payer: Quartz Medicare Advantage |
$31.82
|
| Rate for Payer: The Alliance Commercial |
$26.52
|
| Rate for Payer: WEA Trust Commercial |
$29.17
|
| Rate for Payer: WPS Commercial |
$39.29
|
|
|
TRANSPERINEAL PLACEMENT SPACEOAR INJECTION W/IMAGE GUIDANCE
|
Facility
|
OP
|
$1,186.00
|
|
|
Service Code
|
CPT 55874
|
| Hospital Charge Code |
5454805
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$604.39 |
| Max. Negotiated Rate |
$22,570.79 |
| Rate for Payer: Aetna Commercial |
$1,110.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,060.76
|
| 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 Blue Cross PPO |
$653.72
|
| 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: Cash Price |
$355.80
|
| Rate for Payer: Cash Price |
$355.80
|
| Rate for Payer: Cash Price |
$355.80
|
| Rate for Payer: Cigna Commercial |
$1,134.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,642.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,107.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,642.70
|
| Rate for Payer: Health EOS Commercial |
$1,097.76
|
| Rate for Payer: HFN Commercial |
$1,134.76
|
| 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: Multiplan Commercial |
$986.75
|
| Rate for Payer: NAPHCARE Commercial |
$8,464.05
|
| Rate for Payer: Preferred Network Access Commercial |
$1,134.76
|
| Rate for Payer: Quartz Beloit One Network |
$604.39
|
| Rate for Payer: Quartz Commercial |
$801.74
|
| 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: WEA Trust Commercial |
$678.39
|
| Rate for Payer: Wellcare Medicare |
$5,642.70
|
| Rate for Payer: WPS Commercial |
$913.58
|
|
|
TRANSPERINEAL PLACEMENT SPACEOAR INJECTION W/IMAGE GUIDANCE
|
Facility
|
IP
|
$1,186.00
|
|
|
Service Code
|
CPT 55874
|
| Hospital Charge Code |
5454805
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$604.39 |
| Max. Negotiated Rate |
$1,134.76 |
| Rate for Payer: Aetna Commercial |
$1,110.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,060.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$653.72
|
| Rate for Payer: Cash Price |
$355.80
|
| Rate for Payer: Cigna Commercial |
$1,134.76
|
| Rate for Payer: Health EOS Commercial |
$1,097.76
|
| Rate for Payer: HFN Commercial |
$1,134.76
|
| Rate for Payer: Multiplan Commercial |
$986.75
|
| Rate for Payer: Preferred Network Access Commercial |
$1,134.76
|
| Rate for Payer: Quartz Beloit One Network |
$604.39
|
| Rate for Payer: Quartz Commercial |
$740.06
|
| Rate for Payer: WEA Trust Commercial |
$678.39
|
| Rate for Payer: WPS Commercial |
$913.58
|
|
|
TRANSRECTAL ULTRASOUND
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960450
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$315.66 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Aetna Managed Medicare |
$315.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$732.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$563.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$541.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$630.89
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.52
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: NAPHCARE Commercial |
$676.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$732.78
|
| Rate for Payer: Quartz Medicare Advantage |
$676.42
|
| Rate for Payer: The Alliance Commercial |
$563.68
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
TRANSRECTAL ULTRASOUND
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960450
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$552.41 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$676.42
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
Transtelephonic Pacemaker Eval 90 day
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
CPT 93293
|
| Hospital Charge Code |
2982420
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$229.32 |
| Max. Negotiated Rate |
$430.56 |
| Rate for Payer: Aetna Commercial |
$421.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$402.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$248.04
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna Commercial |
$430.56
|
| Rate for Payer: Health EOS Commercial |
$416.52
|
| Rate for Payer: HFN Commercial |
$430.56
|
| Rate for Payer: Multiplan Commercial |
$374.40
|
| Rate for Payer: Preferred Network Access Commercial |
$430.56
|
| Rate for Payer: Quartz Beloit One Network |
$229.32
|
| Rate for Payer: Quartz Commercial |
$280.80
|
| Rate for Payer: WEA Trust Commercial |
$257.40
|
| Rate for Payer: WPS Commercial |
$346.63
|
|
|
Transtelephonic Pacemaker Eval 90 day
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
CPT 93293
|
| Hospital Charge Code |
2982420
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$39.28 |
| Max. Negotiated Rate |
$430.56 |
| Rate for Payer: Aetna Commercial |
$421.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$402.48
|
| Rate for Payer: Aetna Managed Medicare |
$39.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$304.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$234.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$224.64
|
| Rate for Payer: Anthem Medicare Advantage |
$39.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$248.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.28
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna Commercial |
$430.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$39.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$261.90
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$39.28
|
| Rate for Payer: Health EOS Commercial |
$416.52
|
| Rate for Payer: HFN Commercial |
$430.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$146.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$39.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$39.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$39.28
|
| Rate for Payer: Multiplan Commercial |
$374.40
|
| Rate for Payer: NAPHCARE Commercial |
$58.92
|
| Rate for Payer: Preferred Network Access Commercial |
$430.56
|
| Rate for Payer: Quartz Beloit One Network |
$229.32
|
| Rate for Payer: Quartz Commercial |
$304.20
|
| Rate for Payer: Quartz Medicare Advantage |
$39.28
|
| Rate for Payer: The Alliance Commercial |
$157.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.28
|
| Rate for Payer: WEA Trust Commercial |
$257.40
|
| Rate for Payer: Wellcare Medicare |
$39.28
|
| Rate for Payer: WPS Commercial |
$346.63
|
|
|
Transtel Pacer 93293
|
Professional
|
Both
|
$864.00
|
|
|
Service Code
|
CPT 93293
|
| Hospital Charge Code |
3127518
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$39.58 |
| Max. Negotiated Rate |
$853.63 |
| Rate for Payer: Aetna Commercial |
$853.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$772.76
|
| Rate for Payer: Aetna Managed Medicare |
$39.58
|
| Rate for Payer: Anthem Medicare Advantage |
$39.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.58
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cigna Commercial |
$853.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$50.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$39.58
|
| Rate for Payer: Health EOS Commercial |
$817.69
|
| Rate for Payer: HFN Commercial |
$853.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$179.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$179.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.58
|
| Rate for Payer: Multiplan Commercial |
$718.85
|
| Rate for Payer: NAPHCARE Commercial |
$59.37
|
| Rate for Payer: Preferred Network Access Commercial |
$853.63
|
| Rate for Payer: Quartz Beloit One Network |
$395.37
|
| Rate for Payer: Quartz Commercial |
$512.18
|
| Rate for Payer: Quartz Medicare Advantage |
$39.58
|
| Rate for Payer: The Alliance Commercial |
$150.41
|
| Rate for Payer: United Healthcare Medicaid |
$50.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.58
|
| Rate for Payer: WEA Trust Commercial |
$494.21
|
| Rate for Payer: WPS Commercial |
$158.33
|
|
|
Transtel Pacer Interp 9329326
|
Professional
|
Both
|
$864.00
|
|
|
Service Code
|
CPT 93293 26
|
| Hospital Charge Code |
3127506
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$13.52 |
| Max. Negotiated Rate |
$853.63 |
| Rate for Payer: Aetna Commercial |
$853.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$772.76
|
| Rate for Payer: Aetna Managed Medicare |
$13.52
|
| Rate for Payer: Anthem Medicare Advantage |
$13.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.52
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cigna Commercial |
$853.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.52
|
| Rate for Payer: Health EOS Commercial |
$817.69
|
| Rate for Payer: HFN Commercial |
$853.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$53.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.52
|
| Rate for Payer: Multiplan Commercial |
$718.85
|
| Rate for Payer: NAPHCARE Commercial |
$20.28
|
| Rate for Payer: Preferred Network Access Commercial |
$853.63
|
| Rate for Payer: Quartz Beloit One Network |
$395.37
|
| Rate for Payer: Quartz Commercial |
$512.18
|
| Rate for Payer: Quartz Medicare Advantage |
$13.52
|
| Rate for Payer: The Alliance Commercial |
$51.38
|
| Rate for Payer: United Healthcare Medicaid |
$15.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.52
|
| Rate for Payer: WEA Trust Commercial |
$494.21
|
| Rate for Payer: WPS Commercial |
$54.08
|
|
|
TRANSTRACHEAL CATHETERS ADULT #C-11-2
|
Facility
|
IP
|
$1,892.00
|
|
| Hospital Charge Code |
2973305
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$964.16 |
| Max. Negotiated Rate |
$1,810.27 |
| Rate for Payer: Aetna Commercial |
$1,770.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,692.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,042.87
|
| Rate for Payer: Cash Price |
$567.60
|
| Rate for Payer: Cigna Commercial |
$1,810.27
|
| Rate for Payer: Health EOS Commercial |
$1,751.24
|
| Rate for Payer: HFN Commercial |
$1,810.27
|
| Rate for Payer: Multiplan Commercial |
$1,574.14
|
| Rate for Payer: Preferred Network Access Commercial |
$1,810.27
|
| Rate for Payer: Quartz Beloit One Network |
$964.16
|
| Rate for Payer: Quartz Commercial |
$1,180.61
|
| Rate for Payer: WEA Trust Commercial |
$1,082.22
|
| Rate for Payer: WPS Commercial |
$1,457.41
|
|
|
TRANSTRACHEAL CATHETERS ADULT #C-11-2
|
Facility
|
OP
|
$1,892.00
|
|
| Hospital Charge Code |
2973305
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$550.95 |
| Max. Negotiated Rate |
$1,810.27 |
| Rate for Payer: Aetna Commercial |
$1,770.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,692.20
|
| Rate for Payer: Aetna Managed Medicare |
$550.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,278.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$983.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$944.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,042.87
|
| Rate for Payer: Cash Price |
$567.60
|
| Rate for Payer: Cigna Commercial |
$1,810.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,101.14
|
| Rate for Payer: Health EOS Commercial |
$1,751.24
|
| Rate for Payer: HFN Commercial |
$1,810.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,475.76
|
| Rate for Payer: Multiplan Commercial |
$1,574.14
|
| Rate for Payer: NAPHCARE Commercial |
$1,180.61
|
| Rate for Payer: Preferred Network Access Commercial |
$1,810.27
|
| Rate for Payer: Quartz Beloit One Network |
$964.16
|
| Rate for Payer: Quartz Commercial |
$1,278.99
|
| Rate for Payer: Quartz Medicare Advantage |
$1,180.61
|
| Rate for Payer: The Alliance Commercial |
$983.84
|
| Rate for Payer: WEA Trust Commercial |
$1,082.22
|
| Rate for Payer: WPS Commercial |
$1,457.41
|
|
|
TRANSURETEROURETEROSTOMY
|
Facility
|
OP
|
$4,383.00
|
|
| Hospital Charge Code |
2960451
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,276.33 |
| Max. Negotiated Rate |
$4,193.65 |
| Rate for Payer: Aetna Commercial |
$4,102.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,920.16
|
| Rate for Payer: Aetna Managed Medicare |
$1,276.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,962.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,279.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,187.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,415.91
|
| Rate for Payer: Cash Price |
$1,314.90
|
| Rate for Payer: Cigna Commercial |
$4,193.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,550.91
|
| Rate for Payer: Health EOS Commercial |
$4,056.90
|
| Rate for Payer: HFN Commercial |
$4,193.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,418.74
|
| Rate for Payer: Multiplan Commercial |
$3,646.66
|
| Rate for Payer: NAPHCARE Commercial |
$2,734.99
|
| Rate for Payer: Preferred Network Access Commercial |
$4,193.65
|
| Rate for Payer: Quartz Beloit One Network |
$2,233.58
|
| Rate for Payer: Quartz Commercial |
$2,962.91
|
| Rate for Payer: Quartz Medicare Advantage |
$2,734.99
|
| Rate for Payer: The Alliance Commercial |
$2,279.16
|
| Rate for Payer: WEA Trust Commercial |
$2,507.08
|
| Rate for Payer: WPS Commercial |
$3,376.22
|
|
|
TRANSURETEROURETEROSTOMY
|
Facility
|
IP
|
$4,383.00
|
|
| Hospital Charge Code |
2960451
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,233.58 |
| Max. Negotiated Rate |
$4,193.65 |
| Rate for Payer: Aetna Commercial |
$4,102.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,920.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,415.91
|
| Rate for Payer: Cash Price |
$1,314.90
|
| Rate for Payer: Cigna Commercial |
$4,193.65
|
| Rate for Payer: Health EOS Commercial |
$4,056.90
|
| Rate for Payer: HFN Commercial |
$4,193.65
|
| Rate for Payer: Multiplan Commercial |
$3,646.66
|
| Rate for Payer: Preferred Network Access Commercial |
$4,193.65
|
| Rate for Payer: Quartz Beloit One Network |
$2,233.58
|
| Rate for Payer: Quartz Commercial |
$2,734.99
|
| Rate for Payer: WEA Trust Commercial |
$2,507.08
|
| Rate for Payer: WPS Commercial |
$3,376.22
|
|
|
Transurethral electrosurgical resection of prostate, 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 52601
|
|
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 |
$8,107.14
|
| 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
|
|
|
TRANSURETHRAL INCISION OF PROSTATE
|
Facility
|
OP
|
$14,838.60
|
|
|
Service Code
|
CPT 52450
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,709.65 |
| Max. Negotiated Rate |
$14,838.60 |
| Rate for Payer: Aetna Managed Medicare |
$3,709.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,709.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,709.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,709.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,709.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,709.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,799.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,709.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,709.65
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,709.65
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,709.65
|
| Rate for Payer: NAPHCARE Commercial |
$5,564.47
|
| Rate for Payer: Quartz Medicare Advantage |
$3,709.65
|
| Rate for Payer: The Alliance Commercial |
$14,838.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,709.65
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$3,709.65
|
|
|
TRANSURETHRAL PROCEDURES WITH CC
|
Facility
|
IP
|
$42,763.76
|
|
|
Service Code
|
MSDRG 669
|
| Min. Negotiated Rate |
$12,392.30 |
| Max. Negotiated Rate |
$42,763.76 |
| Rate for Payer: Aetna Managed Medicare |
$12,392.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33,863.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25,956.02
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24,659.91
|
| Rate for Payer: Anthem Medicare Advantage |
$12,392.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12,392.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12,392.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12,392.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27,374.77
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12,392.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31,121.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12,392.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12,392.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12,392.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12,392.30
|
| Rate for Payer: NAPHCARE Commercial |
$18,588.45
|
| Rate for Payer: Quartz Medicare Advantage |
$12,392.30
|
| Rate for Payer: The Alliance Commercial |
$42,763.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,392.30
|
| Rate for Payer: United Healthcare PPO |
$24,228.63
|
| Rate for Payer: Wellcare Medicare |
$12,392.30
|
|
|
TRANSURETHRAL PROCEDURES WITH MCC
|
Facility
|
IP
|
$78,249.60
|
|
|
Service Code
|
MSDRG 668
|
| Min. Negotiated Rate |
$22,868.72 |
| Max. Negotiated Rate |
$78,249.60 |
| Rate for Payer: Aetna Managed Medicare |
$22,868.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63,712.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$48,834.78
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46,396.23
|
| Rate for Payer: Anthem Medicare Advantage |
$22,868.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22,868.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22,868.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$22,868.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51,504.07
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$22,868.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$57,149.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22,868.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22,868.72
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$22,868.72
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$22,868.72
|
| Rate for Payer: NAPHCARE Commercial |
$34,303.07
|
| Rate for Payer: Quartz Medicare Advantage |
$22,868.72
|
| Rate for Payer: The Alliance Commercial |
$78,249.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22,868.72
|
| Rate for Payer: United Healthcare PPO |
$44,491.26
|
| Rate for Payer: Wellcare Medicare |
$22,868.72
|
|
|
TRANSURETHRAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$26,948.48
|
|
|
Service Code
|
MSDRG 670
|
| Min. Negotiated Rate |
$7,991.14 |
| Max. Negotiated Rate |
$26,948.48 |
| Rate for Payer: Aetna Managed Medicare |
$7,991.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21,323.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,344.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,528.44
|
| Rate for Payer: Anthem Medicare Advantage |
$7,991.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,991.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,991.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,991.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17,237.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,991.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19,521.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,991.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,991.14
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,991.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,991.14
|
| Rate for Payer: NAPHCARE Commercial |
$11,986.71
|
| Rate for Payer: Quartz Medicare Advantage |
$7,991.14
|
| Rate for Payer: The Alliance Commercial |
$26,948.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,991.14
|
| Rate for Payer: United Healthcare PPO |
$15,197.76
|
| Rate for Payer: Wellcare Medicare |
$7,991.14
|
|
|
TRANSURETHRAL PROSTATECTOMY
|
Facility
|
IP
|
$10,346.61
|
|
|
Service Code
|
APR-DRG 4822
|
| Min. Negotiated Rate |
$9,190.50 |
| Max. Negotiated Rate |
$10,346.61 |
| Rate for Payer: Anthem Medicaid |
$9,907.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$9,907.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9,907.45
|
| Rate for Payer: Dean Health Medicaid |
$9,907.45
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9,190.50
|
| Rate for Payer: Managed Health Services Medicaid |
$10,346.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,907.45
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$9,907.45
|
| Rate for Payer: United Healthcare Medicaid |
$9,907.45
|
|
|
TRANSURETHRAL PROSTATECTOMY
|
Facility
|
IP
|
$7,277.70
|
|
|
Service Code
|
APR-DRG 4821
|
| Min. Negotiated Rate |
$6,464.50 |
| Max. Negotiated Rate |
$7,277.70 |
| Rate for Payer: Anthem Medicaid |
$6,968.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$6,968.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,968.80
|
| Rate for Payer: Dean Health Medicaid |
$6,968.80
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6,464.50
|
| Rate for Payer: Managed Health Services Medicaid |
$7,277.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,968.80
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6,968.80
|
| Rate for Payer: United Healthcare Medicaid |
$6,968.80
|
|
|
TRANSURETHRAL PROSTATECTOMY
|
Facility
|
IP
|
$16,747.47
|
|
|
Service Code
|
APR-DRG 4823
|
| Min. Negotiated Rate |
$14,876.15 |
| Max. Negotiated Rate |
$16,747.47 |
| Rate for Payer: Anthem Medicaid |
$16,036.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$16,036.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16,036.63
|
| Rate for Payer: Dean Health Medicaid |
$16,036.63
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14,876.15
|
| Rate for Payer: Managed Health Services Medicaid |
$16,747.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$16,036.63
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$16,036.63
|
| Rate for Payer: United Healthcare Medicaid |
$16,036.63
|
|
