|
Venous Cath Replace Tunneled
|
Facility
|
OP
|
$2,904.00
|
|
|
Service Code
|
CPT 36581
|
| Hospital Charge Code |
3052429
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,479.88 |
| Max. Negotiated Rate |
$13,291.62 |
| Rate for Payer: Aetna Commercial |
$2,718.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,597.34
|
| Rate for Payer: Aetna Managed Medicare |
$3,322.90
|
| 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 |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,600.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,322.90
|
| Rate for Payer: Cash Price |
$871.20
|
| Rate for Payer: Cash Price |
$871.20
|
| Rate for Payer: Cash Price |
$871.20
|
| Rate for Payer: Cigna Commercial |
$2,778.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,322.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,322.90
|
| Rate for Payer: Health EOS Commercial |
$2,687.94
|
| Rate for Payer: HFN Commercial |
$2,778.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,361.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,322.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,322.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,322.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,322.90
|
| Rate for Payer: Multiplan Commercial |
$2,416.13
|
| Rate for Payer: NAPHCARE Commercial |
$4,984.36
|
| Rate for Payer: Preferred Network Access Commercial |
$2,778.55
|
| Rate for Payer: Quartz Beloit One Network |
$1,479.88
|
| Rate for Payer: Quartz Commercial |
$1,963.10
|
| Rate for Payer: Quartz Medicare Advantage |
$3,322.90
|
| Rate for Payer: The Alliance Commercial |
$13,291.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,322.90
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: WEA Trust Commercial |
$1,661.09
|
| Rate for Payer: Wellcare Medicare |
$3,322.90
|
| Rate for Payer: WPS Commercial |
$2,236.95
|
|
|
Venous Cath Reposition
|
Facility
|
OP
|
$442.00
|
|
|
Service Code
|
CPT 36597
|
| Hospital Charge Code |
3913415
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$225.24 |
| Max. Negotiated Rate |
$6,626.51 |
| Rate for Payer: Aetna Commercial |
$413.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$395.32
|
| Rate for Payer: Aetna Managed Medicare |
$1,656.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$1,656.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$243.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,656.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,656.63
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cigna Commercial |
$422.91
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,656.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,656.63
|
| Rate for Payer: Health EOS Commercial |
$409.12
|
| Rate for Payer: HFN Commercial |
$422.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,162.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,656.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,656.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,656.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,656.63
|
| Rate for Payer: Multiplan Commercial |
$367.74
|
| Rate for Payer: NAPHCARE Commercial |
$2,484.94
|
| Rate for Payer: Preferred Network Access Commercial |
$422.91
|
| Rate for Payer: Quartz Beloit One Network |
$225.24
|
| Rate for Payer: Quartz Commercial |
$298.79
|
| Rate for Payer: Quartz Medicare Advantage |
$1,656.63
|
| Rate for Payer: The Alliance Commercial |
$6,626.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,656.63
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: WEA Trust Commercial |
$252.82
|
| Rate for Payer: Wellcare Medicare |
$1,656.63
|
| Rate for Payer: WPS Commercial |
$340.47
|
|
|
Venous Cath Reposition
|
Facility
|
IP
|
$442.00
|
|
|
Service Code
|
CPT 36597
|
| Hospital Charge Code |
3913415
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$225.24 |
| Max. Negotiated Rate |
$422.91 |
| Rate for Payer: Aetna Commercial |
$413.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$395.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$243.63
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cigna Commercial |
$422.91
|
| Rate for Payer: Health EOS Commercial |
$409.12
|
| Rate for Payer: HFN Commercial |
$422.91
|
| Rate for Payer: Multiplan Commercial |
$367.74
|
| Rate for Payer: Preferred Network Access Commercial |
$422.91
|
| Rate for Payer: Quartz Beloit One Network |
$225.24
|
| Rate for Payer: Quartz Commercial |
$275.81
|
| Rate for Payer: WEA Trust Commercial |
$252.82
|
| Rate for Payer: WPS Commercial |
$340.47
|
|
|
VENOUS MECH THROMBECTOMY 37187
|
Professional
|
Both
|
$1,889.00
|
|
|
Service Code
|
CPT 37187
|
| Hospital Charge Code |
3014544
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$325.93 |
| Max. Negotiated Rate |
$2,424.62 |
| Rate for Payer: Aetna Commercial |
$1,866.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,689.52
|
| Rate for Payer: Aetna Managed Medicare |
$325.93
|
| Rate for Payer: Anthem Medicare Advantage |
$325.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$325.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$325.93
|
| Rate for Payer: Cash Price |
$566.70
|
| Rate for Payer: Cash Price |
$566.70
|
| Rate for Payer: Cash Price |
$566.70
|
| Rate for Payer: Cigna Commercial |
$1,866.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,424.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$325.93
|
| Rate for Payer: Health EOS Commercial |
$1,787.75
|
| Rate for Payer: HFN Commercial |
$1,866.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,336.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,336.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$325.93
|
| Rate for Payer: Multiplan Commercial |
$1,571.65
|
| Rate for Payer: NAPHCARE Commercial |
$488.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,866.33
|
| Rate for Payer: Quartz Beloit One Network |
$864.41
|
| Rate for Payer: Quartz Commercial |
$1,119.80
|
| Rate for Payer: Quartz Medicare Advantage |
$325.93
|
| Rate for Payer: The Alliance Commercial |
$1,385.18
|
| Rate for Payer: United Healthcare Medicaid |
$2,424.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$325.93
|
| Rate for Payer: WEA Trust Commercial |
$1,080.51
|
| Rate for Payer: WPS Commercial |
$1,466.67
|
|
|
VENT CATHETER LEFT 16FR HEART 12116
|
Facility
|
IP
|
$471.00
|
|
| Hospital Charge Code |
2971147
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$240.02 |
| Max. Negotiated Rate |
$450.65 |
| Rate for Payer: Aetna Commercial |
$440.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$421.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$259.62
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cigna Commercial |
$450.65
|
| Rate for Payer: Health EOS Commercial |
$435.96
|
| Rate for Payer: HFN Commercial |
$450.65
|
| Rate for Payer: Multiplan Commercial |
$391.87
|
| Rate for Payer: Preferred Network Access Commercial |
$450.65
|
| Rate for Payer: Quartz Beloit One Network |
$240.02
|
| Rate for Payer: Quartz Commercial |
$293.90
|
| Rate for Payer: WEA Trust Commercial |
$269.41
|
| Rate for Payer: WPS Commercial |
$362.81
|
|
|
VENT CATHETER LEFT 16FR HEART 12116
|
Facility
|
OP
|
$471.00
|
|
| Hospital Charge Code |
2971147
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$137.16 |
| Max. Negotiated Rate |
$450.65 |
| Rate for Payer: Aetna Commercial |
$440.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$421.26
|
| Rate for Payer: Aetna Managed Medicare |
$137.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$318.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$244.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$235.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$259.62
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cigna Commercial |
$450.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$274.12
|
| Rate for Payer: Health EOS Commercial |
$435.96
|
| Rate for Payer: HFN Commercial |
$450.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$367.38
|
| Rate for Payer: Multiplan Commercial |
$391.87
|
| Rate for Payer: NAPHCARE Commercial |
$293.90
|
| Rate for Payer: Preferred Network Access Commercial |
$450.65
|
| Rate for Payer: Quartz Beloit One Network |
$240.02
|
| Rate for Payer: Quartz Commercial |
$318.40
|
| Rate for Payer: Quartz Medicare Advantage |
$293.90
|
| Rate for Payer: The Alliance Commercial |
$244.92
|
| Rate for Payer: WEA Trust Commercial |
$269.41
|
| Rate for Payer: WPS Commercial |
$362.81
|
|
|
VENTILATING TUBE REMOVAL REQUIRING GENERAL ANESTHESIA
|
Facility
|
OP
|
$13,956.63
|
|
|
Service Code
|
CPT 69424
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,835.04 |
| Max. Negotiated Rate |
$13,956.63 |
| Rate for Payer: Aetna Managed Medicare |
$3,489.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$3,489.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,489.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,489.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,489.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,489.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,979.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,489.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,489.16
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,489.16
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,489.16
|
| Rate for Payer: NAPHCARE Commercial |
$5,233.74
|
| Rate for Payer: Quartz Medicare Advantage |
$3,489.16
|
| Rate for Payer: The Alliance Commercial |
$13,956.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,489.16
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$3,489.16
|
|
|
VENTILATION ASSISTANCE AND MANAGEMENT
|
Facility
|
OP
|
$134.96
|
|
|
Service Code
|
EAPG 00067
|
| Min. Negotiated Rate |
$129.77 |
| Max. Negotiated Rate |
$134.96 |
| Rate for Payer: Anthem Medicaid |
$129.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$129.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$129.77
|
| Rate for Payer: Dean Health Medicaid |
$129.77
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$129.77
|
| Rate for Payer: Managed Health Services Medicaid |
$134.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$129.77
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$129.77
|
| Rate for Payer: United Healthcare Medicaid |
$129.77
|
|
|
VENTRICULAR SHUNT PROCEDURES
|
Facility
|
IP
|
$15,870.64
|
|
|
Service Code
|
APR-DRG 0222
|
| Min. Negotiated Rate |
$14,097.29 |
| Max. Negotiated Rate |
$15,870.64 |
| Rate for Payer: Anthem Medicaid |
$15,197.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$15,197.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15,197.01
|
| Rate for Payer: Dean Health Medicaid |
$15,197.01
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14,097.29
|
| Rate for Payer: Managed Health Services Medicaid |
$15,870.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$15,197.01
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$15,197.01
|
| Rate for Payer: United Healthcare Medicaid |
$15,197.01
|
|
|
VENTRICULAR SHUNT PROCEDURES
|
Facility
|
IP
|
$12,626.37
|
|
|
Service Code
|
APR-DRG 0221
|
| Min. Negotiated Rate |
$11,215.53 |
| Max. Negotiated Rate |
$12,626.37 |
| Rate for Payer: Anthem Medicaid |
$12,090.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$12,090.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12,090.44
|
| Rate for Payer: Dean Health Medicaid |
$12,090.44
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11,215.53
|
| Rate for Payer: Managed Health Services Medicaid |
$12,626.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,090.44
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12,090.44
|
| Rate for Payer: United Healthcare Medicaid |
$12,090.44
|
|
|
VENTRICULAR SHUNT PROCEDURES
|
Facility
|
IP
|
$42,175.57
|
|
|
Service Code
|
APR-DRG 0224
|
| Min. Negotiated Rate |
$37,462.97 |
| Max. Negotiated Rate |
$42,175.57 |
| Rate for Payer: Anthem Medicaid |
$40,385.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$40,385.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$40,385.43
|
| Rate for Payer: Dean Health Medicaid |
$40,385.43
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$37,462.97
|
| Rate for Payer: Managed Health Services Medicaid |
$42,175.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$40,385.43
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$40,385.43
|
| Rate for Payer: United Healthcare Medicaid |
$40,385.43
|
|
|
VENTRICULAR SHUNT PROCEDURES
|
Facility
|
IP
|
$23,323.70
|
|
|
Service Code
|
APR-DRG 0223
|
| Min. Negotiated Rate |
$20,717.57 |
| Max. Negotiated Rate |
$23,323.70 |
| Rate for Payer: Anthem Medicaid |
$22,333.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$22,333.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$22,333.73
|
| Rate for Payer: Dean Health Medicaid |
$22,333.73
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$20,717.57
|
| Rate for Payer: Managed Health Services Medicaid |
$23,323.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$22,333.73
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$22,333.73
|
| Rate for Payer: United Healthcare Medicaid |
$22,333.73
|
|
|
VENTRICULAR SHUNT PROCEDURES WITH CC
|
Facility
|
IP
|
$59,884.24
|
|
|
Service Code
|
MSDRG 032
|
| Min. Negotiated Rate |
$16,826.40 |
| Max. Negotiated Rate |
$59,884.24 |
| Rate for Payer: Aetna Managed Medicare |
$16,826.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46,496.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$35,639.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$33,859.71
|
| Rate for Payer: Anthem Medicare Advantage |
$16,826.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16,826.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16,826.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16,826.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37,587.39
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16,826.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43,679.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16,826.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16,826.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16,826.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16,826.40
|
| Rate for Payer: NAPHCARE Commercial |
$25,239.60
|
| Rate for Payer: Quartz Medicare Advantage |
$16,826.40
|
| Rate for Payer: The Alliance Commercial |
$59,884.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16,826.40
|
| Rate for Payer: United Healthcare PPO |
$34,004.71
|
| Rate for Payer: Wellcare Medicare |
$16,826.40
|
|
|
VENTRICULAR SHUNT PROCEDURES WITH MCC
|
Facility
|
IP
|
$114,154.56
|
|
|
Service Code
|
MSDRG 031
|
| Min. Negotiated Rate |
$34,819.32 |
| Max. Negotiated Rate |
$114,154.56 |
| Rate for Payer: Aetna Managed Medicare |
$34,819.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$97,760.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$74,932.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$71,191.20
|
| Rate for Payer: Anthem Medicare Advantage |
$34,819.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$34,819.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$34,819.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$34,819.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$79,028.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$34,819.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83,484.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$34,819.32
|
| Rate for Payer: Independent Care Health Plan Medicare |
$34,819.32
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$34,819.32
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$34,819.32
|
| Rate for Payer: NAPHCARE Commercial |
$52,228.99
|
| Rate for Payer: Quartz Medicare Advantage |
$34,819.32
|
| Rate for Payer: The Alliance Commercial |
$114,154.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$34,819.32
|
| Rate for Payer: United Healthcare PPO |
$64,993.86
|
| Rate for Payer: Wellcare Medicare |
$34,819.32
|
|
|
VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$45,205.68
|
|
|
Service Code
|
MSDRG 033
|
| Min. Negotiated Rate |
$13,241.59 |
| Max. Negotiated Rate |
$45,205.68 |
| Rate for Payer: Aetna Managed Medicare |
$13,241.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$36,283.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27,810.74
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26,422.02
|
| Rate for Payer: Anthem Medicare Advantage |
$13,241.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,241.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,241.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,241.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29,330.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,241.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32,912.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,241.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,241.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,241.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,241.59
|
| Rate for Payer: NAPHCARE Commercial |
$19,862.39
|
| Rate for Payer: Quartz Medicare Advantage |
$13,241.59
|
| Rate for Payer: The Alliance Commercial |
$45,205.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,241.59
|
| Rate for Payer: United Healthcare PPO |
$25,622.73
|
| Rate for Payer: Wellcare Medicare |
$13,241.59
|
|
|
VENT TUBE COLLAR BUTTON 1.27MM FLUOROPLASTIC 145214-ENT
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
HCPCS L8613
|
| Hospital Charge Code |
4858870
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$101.92 |
| Max. Negotiated Rate |
$191.36 |
| Rate for Payer: Aetna Commercial |
$187.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$178.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$110.24
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$191.36
|
| Rate for Payer: Health EOS Commercial |
$185.12
|
| Rate for Payer: HFN Commercial |
$191.36
|
| Rate for Payer: Multiplan Commercial |
$166.40
|
| Rate for Payer: Preferred Network Access Commercial |
$191.36
|
| Rate for Payer: Quartz Beloit One Network |
$101.92
|
| Rate for Payer: Quartz Commercial |
$124.80
|
| Rate for Payer: WEA Trust Commercial |
$114.40
|
| Rate for Payer: WPS Commercial |
$154.06
|
|
|
VENT TUBE COLLAR BUTTON 1.27MM FLUOROPLASTIC 145214-ENT
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS L8613
|
| Hospital Charge Code |
4858870
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$58.24 |
| Max. Negotiated Rate |
$1,740.79 |
| Rate for Payer: Aetna Commercial |
$187.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$178.88
|
| Rate for Payer: Aetna Managed Medicare |
$58.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$135.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$104.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$99.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$110.24
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$191.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$116.40
|
| Rate for Payer: Health EOS Commercial |
$185.12
|
| Rate for Payer: HFN Commercial |
$191.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$156.00
|
| Rate for Payer: Multiplan Commercial |
$166.40
|
| Rate for Payer: NAPHCARE Commercial |
$124.80
|
| Rate for Payer: Preferred Network Access Commercial |
$191.36
|
| Rate for Payer: Quartz Beloit One Network |
$101.92
|
| Rate for Payer: Quartz Commercial |
$135.20
|
| Rate for Payer: Quartz Medicare Advantage |
$124.80
|
| Rate for Payer: The Alliance Commercial |
$1,740.79
|
| Rate for Payer: WEA Trust Commercial |
$114.40
|
| Rate for Payer: WPS Commercial |
$154.06
|
|
|
VENT TUBE COLLAR BUTTON 1.27MM SILICONE-ULTRASIL 70241314
|
Facility
|
OP
|
$254.00
|
|
| Hospital Charge Code |
2973366
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$73.96 |
| Max. Negotiated Rate |
$243.03 |
| Rate for Payer: Aetna Commercial |
$237.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$227.18
|
| Rate for Payer: Aetna Managed Medicare |
$73.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$171.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$132.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$126.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$140.00
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cigna Commercial |
$243.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$147.83
|
| Rate for Payer: Health EOS Commercial |
$235.10
|
| Rate for Payer: HFN Commercial |
$243.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$198.12
|
| Rate for Payer: Multiplan Commercial |
$211.33
|
| Rate for Payer: NAPHCARE Commercial |
$158.50
|
| Rate for Payer: Preferred Network Access Commercial |
$243.03
|
| Rate for Payer: Quartz Beloit One Network |
$129.44
|
| Rate for Payer: Quartz Commercial |
$171.70
|
| Rate for Payer: Quartz Medicare Advantage |
$158.50
|
| Rate for Payer: The Alliance Commercial |
$132.08
|
| Rate for Payer: WEA Trust Commercial |
$145.29
|
| Rate for Payer: WPS Commercial |
$195.66
|
|
|
VENT TUBE COLLAR BUTTON 1.27MM SILICONE-ULTRASIL 70241314
|
Facility
|
IP
|
$254.00
|
|
| Hospital Charge Code |
2973366
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$129.44 |
| Max. Negotiated Rate |
$243.03 |
| Rate for Payer: Aetna Commercial |
$237.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$227.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$140.00
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cigna Commercial |
$243.03
|
| Rate for Payer: Health EOS Commercial |
$235.10
|
| Rate for Payer: HFN Commercial |
$243.03
|
| Rate for Payer: Multiplan Commercial |
$211.33
|
| Rate for Payer: Preferred Network Access Commercial |
$243.03
|
| Rate for Payer: Quartz Beloit One Network |
$129.44
|
| Rate for Payer: Quartz Commercial |
$158.50
|
| Rate for Payer: WEA Trust Commercial |
$145.29
|
| Rate for Payer: WPS Commercial |
$195.66
|
|
|
VENT TUBE EAR ARMSTRONG 1.14MM FLUOROPLASTIC 140242
|
Facility
|
IP
|
$378.00
|
|
| Hospital Charge Code |
2965126
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$192.63 |
| Max. Negotiated Rate |
$361.67 |
| Rate for Payer: Aetna Commercial |
$353.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$338.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$208.35
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cigna Commercial |
$361.67
|
| Rate for Payer: Health EOS Commercial |
$349.88
|
| Rate for Payer: HFN Commercial |
$361.67
|
| Rate for Payer: Multiplan Commercial |
$314.50
|
| Rate for Payer: Preferred Network Access Commercial |
$361.67
|
| Rate for Payer: Quartz Beloit One Network |
$192.63
|
| Rate for Payer: Quartz Commercial |
$235.87
|
| Rate for Payer: WEA Trust Commercial |
$216.22
|
| Rate for Payer: WPS Commercial |
$291.17
|
|
|
VENT TUBE EAR ARMSTRONG 1.14MM FLUOROPLASTIC 140242
|
Facility
|
OP
|
$378.00
|
|
| Hospital Charge Code |
2965126
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$110.07 |
| Max. Negotiated Rate |
$361.67 |
| Rate for Payer: Aetna Commercial |
$353.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$338.08
|
| Rate for Payer: Aetna Managed Medicare |
$110.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$255.53
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$196.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$188.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$208.35
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cigna Commercial |
$361.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$220.00
|
| Rate for Payer: Health EOS Commercial |
$349.88
|
| Rate for Payer: HFN Commercial |
$361.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$294.84
|
| Rate for Payer: Multiplan Commercial |
$314.50
|
| Rate for Payer: NAPHCARE Commercial |
$235.87
|
| Rate for Payer: Preferred Network Access Commercial |
$361.67
|
| Rate for Payer: Quartz Beloit One Network |
$192.63
|
| Rate for Payer: Quartz Commercial |
$255.53
|
| Rate for Payer: Quartz Medicare Advantage |
$235.87
|
| Rate for Payer: The Alliance Commercial |
$196.56
|
| Rate for Payer: WEA Trust Commercial |
$216.22
|
| Rate for Payer: WPS Commercial |
$291.17
|
|
|
VENT TUBE EAR POPE BEVELED GROMMET 1.14MM POLYETHYLENE 145250
|
Facility
|
IP
|
$393.00
|
|
| Hospital Charge Code |
2965127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$200.27 |
| Max. Negotiated Rate |
$376.02 |
| Rate for Payer: Aetna Commercial |
$367.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$351.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$216.62
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Cigna Commercial |
$376.02
|
| Rate for Payer: Health EOS Commercial |
$363.76
|
| Rate for Payer: HFN Commercial |
$376.02
|
| Rate for Payer: Multiplan Commercial |
$326.98
|
| Rate for Payer: Preferred Network Access Commercial |
$376.02
|
| Rate for Payer: Quartz Beloit One Network |
$200.27
|
| Rate for Payer: Quartz Commercial |
$245.23
|
| Rate for Payer: WEA Trust Commercial |
$224.80
|
| Rate for Payer: WPS Commercial |
$302.73
|
|
|
VENT TUBE EAR POPE BEVELED GROMMET 1.14MM POLYETHYLENE 145250
|
Facility
|
OP
|
$393.00
|
|
| Hospital Charge Code |
2965127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$114.44 |
| Max. Negotiated Rate |
$376.02 |
| Rate for Payer: Aetna Commercial |
$367.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$351.50
|
| Rate for Payer: Aetna Managed Medicare |
$114.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$265.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$204.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$196.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$216.62
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Cigna Commercial |
$376.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$228.73
|
| Rate for Payer: Health EOS Commercial |
$363.76
|
| Rate for Payer: HFN Commercial |
$376.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$306.54
|
| Rate for Payer: Multiplan Commercial |
$326.98
|
| Rate for Payer: NAPHCARE Commercial |
$245.23
|
| Rate for Payer: Preferred Network Access Commercial |
$376.02
|
| Rate for Payer: Quartz Beloit One Network |
$200.27
|
| Rate for Payer: Quartz Commercial |
$265.67
|
| Rate for Payer: Quartz Medicare Advantage |
$245.23
|
| Rate for Payer: The Alliance Commercial |
$204.36
|
| Rate for Payer: WEA Trust Commercial |
$224.80
|
| Rate for Payer: WPS Commercial |
$302.73
|
|
|
VENT TUBE EAR REUTER BOBBIN WITH FLANGE HOLES 1.00MM TITANIUM 145215
|
Facility
|
OP
|
$587.00
|
|
| Hospital Charge Code |
3939328
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$170.93 |
| Max. Negotiated Rate |
$561.64 |
| Rate for Payer: Aetna Commercial |
$549.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$525.01
|
| Rate for Payer: Aetna Managed Medicare |
$170.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$396.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$305.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$293.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$323.55
|
| Rate for Payer: Cash Price |
$176.10
|
| Rate for Payer: Cigna Commercial |
$561.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$341.63
|
| Rate for Payer: Health EOS Commercial |
$543.33
|
| Rate for Payer: HFN Commercial |
$561.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$457.86
|
| Rate for Payer: Multiplan Commercial |
$488.38
|
| Rate for Payer: NAPHCARE Commercial |
$366.29
|
| Rate for Payer: Preferred Network Access Commercial |
$561.64
|
| Rate for Payer: Quartz Beloit One Network |
$299.14
|
| Rate for Payer: Quartz Commercial |
$396.81
|
| Rate for Payer: Quartz Medicare Advantage |
$366.29
|
| Rate for Payer: The Alliance Commercial |
$305.24
|
| Rate for Payer: WEA Trust Commercial |
$335.76
|
| Rate for Payer: WPS Commercial |
$452.17
|
|
|
VENT TUBE EAR REUTER BOBBIN WITH FLANGE HOLES 1.00MM TITANIUM 145215
|
Facility
|
IP
|
$587.00
|
|
| Hospital Charge Code |
3939328
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$299.14 |
| Max. Negotiated Rate |
$561.64 |
| Rate for Payer: Aetna Commercial |
$549.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$525.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$323.55
|
| Rate for Payer: Cash Price |
$176.10
|
| Rate for Payer: Cigna Commercial |
$561.64
|
| Rate for Payer: Health EOS Commercial |
$543.33
|
| Rate for Payer: HFN Commercial |
$561.64
|
| Rate for Payer: Multiplan Commercial |
$488.38
|
| Rate for Payer: Preferred Network Access Commercial |
$561.64
|
| Rate for Payer: Quartz Beloit One Network |
$299.14
|
| Rate for Payer: Quartz Commercial |
$366.29
|
| Rate for Payer: WEA Trust Commercial |
$335.76
|
| Rate for Payer: WPS Commercial |
$452.17
|
|
