|
Verigene Gram Negative PCR Report
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
5466692
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$108.04 |
| Max. Negotiated Rate |
$202.84 |
| Rate for Payer: Aetna Commercial |
$198.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$189.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$116.85
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cigna Commercial |
$202.84
|
| Rate for Payer: Health EOS Commercial |
$196.23
|
| Rate for Payer: HFN Commercial |
$202.84
|
| Rate for Payer: Multiplan Commercial |
$176.38
|
| Rate for Payer: Preferred Network Access Commercial |
$202.84
|
| Rate for Payer: Quartz Beloit One Network |
$108.04
|
| Rate for Payer: Quartz Commercial |
$132.29
|
| Rate for Payer: WEA Trust Commercial |
$121.26
|
| Rate for Payer: WPS Commercial |
$163.30
|
|
|
Verigene Gram Negative PCR Report
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
5454662
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$108.04 |
| Max. Negotiated Rate |
$202.84 |
| Rate for Payer: Aetna Commercial |
$198.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$189.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$116.85
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cigna Commercial |
$202.84
|
| Rate for Payer: Health EOS Commercial |
$196.23
|
| Rate for Payer: HFN Commercial |
$202.84
|
| Rate for Payer: Multiplan Commercial |
$176.38
|
| Rate for Payer: Preferred Network Access Commercial |
$202.84
|
| Rate for Payer: Quartz Beloit One Network |
$108.04
|
| Rate for Payer: Quartz Commercial |
$132.29
|
| Rate for Payer: WEA Trust Commercial |
$121.26
|
| Rate for Payer: WPS Commercial |
$163.30
|
|
|
Verigene Gram Positive PCR Report
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
5466693
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$108.04 |
| Max. Negotiated Rate |
$202.84 |
| Rate for Payer: Aetna Commercial |
$198.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$189.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$116.85
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cigna Commercial |
$202.84
|
| Rate for Payer: Health EOS Commercial |
$196.23
|
| Rate for Payer: HFN Commercial |
$202.84
|
| Rate for Payer: Multiplan Commercial |
$176.38
|
| Rate for Payer: Preferred Network Access Commercial |
$202.84
|
| Rate for Payer: Quartz Beloit One Network |
$108.04
|
| Rate for Payer: Quartz Commercial |
$132.29
|
| Rate for Payer: WEA Trust Commercial |
$121.26
|
| Rate for Payer: WPS Commercial |
$163.30
|
|
|
Verigene Gram Positive PCR Report
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
5454661
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.85 |
| Max. Negotiated Rate |
$202.84 |
| Rate for Payer: Aetna Commercial |
$198.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$189.61
|
| Rate for Payer: Aetna Managed Medicare |
$20.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$78.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36.49
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34.61
|
| Rate for Payer: Anthem Medicare Advantage |
$20.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$116.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.85
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cigna Commercial |
$202.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$20.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$123.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$20.85
|
| Rate for Payer: Health EOS Commercial |
$196.23
|
| Rate for Payer: HFN Commercial |
$202.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$77.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.85
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$20.85
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$20.85
|
| Rate for Payer: Multiplan Commercial |
$176.38
|
| Rate for Payer: NAPHCARE Commercial |
$31.28
|
| Rate for Payer: Preferred Network Access Commercial |
$202.84
|
| Rate for Payer: Quartz Beloit One Network |
$108.04
|
| Rate for Payer: Quartz Commercial |
$143.31
|
| Rate for Payer: Quartz Medicare Advantage |
$20.85
|
| Rate for Payer: The Alliance Commercial |
$83.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.85
|
| Rate for Payer: United Healthcare PPO |
$165.36
|
| Rate for Payer: WEA Trust Commercial |
$121.26
|
| Rate for Payer: Wellcare Medicare |
$20.85
|
| Rate for Payer: WPS Commercial |
$163.30
|
|
|
Verigene Gram Positive PCR Report
|
Professional
|
Both
|
$212.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
5454661
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.85 |
| Max. Negotiated Rate |
$209.46 |
| Rate for Payer: Aetna Commercial |
$209.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$189.61
|
| Rate for Payer: Aetna Managed Medicare |
$20.85
|
| Rate for Payer: Anthem Medicare Advantage |
$20.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.85
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cigna Commercial |
$209.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$110.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.85
|
| Rate for Payer: Health EOS Commercial |
$200.64
|
| Rate for Payer: HFN Commercial |
$209.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$73.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$73.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.85
|
| Rate for Payer: Multiplan Commercial |
$176.38
|
| Rate for Payer: NAPHCARE Commercial |
$31.28
|
| Rate for Payer: Preferred Network Access Commercial |
$209.46
|
| Rate for Payer: Quartz Beloit One Network |
$97.01
|
| Rate for Payer: Quartz Commercial |
$125.67
|
| Rate for Payer: Quartz Medicare Advantage |
$20.85
|
| Rate for Payer: The Alliance Commercial |
$82.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.85
|
| Rate for Payer: WEA Trust Commercial |
$121.26
|
| Rate for Payer: WPS Commercial |
$91.75
|
|
|
Verigene Gram Positive PCR Report
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
5466693
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.85 |
| Max. Negotiated Rate |
$202.84 |
| Rate for Payer: Aetna Commercial |
$198.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$189.61
|
| Rate for Payer: Aetna Managed Medicare |
$20.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$78.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36.49
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34.61
|
| Rate for Payer: Anthem Medicare Advantage |
$20.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$116.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.85
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cigna Commercial |
$202.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$20.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$123.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$20.85
|
| Rate for Payer: Health EOS Commercial |
$196.23
|
| Rate for Payer: HFN Commercial |
$202.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$77.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.85
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$20.85
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$20.85
|
| Rate for Payer: Multiplan Commercial |
$176.38
|
| Rate for Payer: NAPHCARE Commercial |
$31.28
|
| Rate for Payer: Preferred Network Access Commercial |
$202.84
|
| Rate for Payer: Quartz Beloit One Network |
$108.04
|
| Rate for Payer: Quartz Commercial |
$143.31
|
| Rate for Payer: Quartz Medicare Advantage |
$20.85
|
| Rate for Payer: The Alliance Commercial |
$83.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.85
|
| Rate for Payer: United Healthcare PPO |
$165.36
|
| Rate for Payer: WEA Trust Commercial |
$121.26
|
| Rate for Payer: Wellcare Medicare |
$20.85
|
| Rate for Payer: WPS Commercial |
$163.30
|
|
|
Verigene Gram Positive PCR Report
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
5454661
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$108.04 |
| Max. Negotiated Rate |
$202.84 |
| Rate for Payer: Aetna Commercial |
$198.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$189.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$116.85
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cigna Commercial |
$202.84
|
| Rate for Payer: Health EOS Commercial |
$196.23
|
| Rate for Payer: HFN Commercial |
$202.84
|
| Rate for Payer: Multiplan Commercial |
$176.38
|
| Rate for Payer: Preferred Network Access Commercial |
$202.84
|
| Rate for Payer: Quartz Beloit One Network |
$108.04
|
| Rate for Payer: Quartz Commercial |
$132.29
|
| Rate for Payer: WEA Trust Commercial |
$121.26
|
| Rate for Payer: WPS Commercial |
$163.30
|
|
|
Verigene Gram Positive PCR Report
|
Professional
|
Both
|
$212.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
5466693
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.85 |
| Max. Negotiated Rate |
$209.46 |
| Rate for Payer: Aetna Commercial |
$209.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$189.61
|
| Rate for Payer: Aetna Managed Medicare |
$20.85
|
| Rate for Payer: Anthem Medicare Advantage |
$20.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.85
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cigna Commercial |
$209.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$110.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.85
|
| Rate for Payer: Health EOS Commercial |
$200.64
|
| Rate for Payer: HFN Commercial |
$209.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$73.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$73.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.85
|
| Rate for Payer: Multiplan Commercial |
$176.38
|
| Rate for Payer: NAPHCARE Commercial |
$31.28
|
| Rate for Payer: Preferred Network Access Commercial |
$209.46
|
| Rate for Payer: Quartz Beloit One Network |
$97.01
|
| Rate for Payer: Quartz Commercial |
$125.67
|
| Rate for Payer: Quartz Medicare Advantage |
$20.85
|
| Rate for Payer: The Alliance Commercial |
$82.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.85
|
| Rate for Payer: WEA Trust Commercial |
$121.26
|
| Rate for Payer: WPS Commercial |
$91.75
|
|
|
VERSAJET 45DEG HANDSET 50637
|
Facility
|
IP
|
$6,239.00
|
|
| Hospital Charge Code |
2966058
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,179.39 |
| Max. Negotiated Rate |
$5,969.48 |
| Rate for Payer: Aetna Commercial |
$5,839.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,580.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,438.94
|
| Rate for Payer: Cash Price |
$1,871.70
|
| Rate for Payer: Cigna Commercial |
$5,969.48
|
| Rate for Payer: Health EOS Commercial |
$5,774.82
|
| Rate for Payer: HFN Commercial |
$5,969.48
|
| Rate for Payer: Multiplan Commercial |
$5,190.85
|
| Rate for Payer: Preferred Network Access Commercial |
$5,969.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,179.39
|
| Rate for Payer: Quartz Commercial |
$3,893.14
|
| Rate for Payer: WEA Trust Commercial |
$3,568.71
|
| Rate for Payer: WPS Commercial |
$4,805.90
|
|
|
VERSAJET 45DEG HANDSET 50637
|
Facility
|
OP
|
$6,239.00
|
|
| Hospital Charge Code |
2966058
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,816.80 |
| Max. Negotiated Rate |
$5,969.48 |
| Rate for Payer: Aetna Commercial |
$5,839.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,580.16
|
| Rate for Payer: Aetna Managed Medicare |
$1,816.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,217.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,244.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,114.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,438.94
|
| Rate for Payer: Cash Price |
$1,871.70
|
| Rate for Payer: Cigna Commercial |
$5,969.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,631.10
|
| Rate for Payer: Health EOS Commercial |
$5,774.82
|
| Rate for Payer: HFN Commercial |
$5,969.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,866.42
|
| Rate for Payer: Multiplan Commercial |
$5,190.85
|
| Rate for Payer: NAPHCARE Commercial |
$3,893.14
|
| Rate for Payer: Preferred Network Access Commercial |
$5,969.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,179.39
|
| Rate for Payer: Quartz Commercial |
$4,217.56
|
| Rate for Payer: Quartz Medicare Advantage |
$3,893.14
|
| Rate for Payer: The Alliance Commercial |
$3,244.28
|
| Rate for Payer: WEA Trust Commercial |
$3,568.71
|
| Rate for Payer: WPS Commercial |
$4,805.90
|
|
|
VERSYS 13 CR CALCAR FEM STEM
|
Facility
|
OP
|
$35,241.00
|
|
| Hospital Charge Code |
2967542
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,262.18 |
| Max. Negotiated Rate |
$33,718.59 |
| Rate for Payer: Aetna Commercial |
$32,985.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$31,519.55
|
| Rate for Payer: Aetna Managed Medicare |
$10,262.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23,822.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,325.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,592.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19,424.84
|
| Rate for Payer: Cash Price |
$10,572.30
|
| Rate for Payer: Cigna Commercial |
$33,718.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20,510.26
|
| Rate for Payer: Health EOS Commercial |
$32,619.07
|
| Rate for Payer: HFN Commercial |
$33,718.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27,487.98
|
| Rate for Payer: Multiplan Commercial |
$29,320.51
|
| Rate for Payer: NAPHCARE Commercial |
$21,990.38
|
| Rate for Payer: Preferred Network Access Commercial |
$33,718.59
|
| Rate for Payer: Quartz Beloit One Network |
$17,958.81
|
| Rate for Payer: Quartz Commercial |
$23,822.92
|
| Rate for Payer: Quartz Medicare Advantage |
$21,990.38
|
| Rate for Payer: The Alliance Commercial |
$18,325.32
|
| Rate for Payer: WEA Trust Commercial |
$20,157.85
|
| Rate for Payer: WPS Commercial |
$27,146.14
|
|
|
VERSYS 13 CR CALCAR FEM STEM
|
Facility
|
IP
|
$35,241.00
|
|
| Hospital Charge Code |
2967542
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17,958.81 |
| Max. Negotiated Rate |
$33,718.59 |
| Rate for Payer: Aetna Commercial |
$32,985.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$31,519.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19,424.84
|
| Rate for Payer: Cash Price |
$10,572.30
|
| Rate for Payer: Cigna Commercial |
$33,718.59
|
| Rate for Payer: Health EOS Commercial |
$32,619.07
|
| Rate for Payer: HFN Commercial |
$33,718.59
|
| Rate for Payer: Multiplan Commercial |
$29,320.51
|
| Rate for Payer: Preferred Network Access Commercial |
$33,718.59
|
| Rate for Payer: Quartz Beloit One Network |
$17,958.81
|
| Rate for Payer: Quartz Commercial |
$21,990.38
|
| Rate for Payer: WEA Trust Commercial |
$20,157.85
|
| Rate for Payer: WPS Commercial |
$27,146.14
|
|
|
VERTEBRAL AND INTERVERTEBRAL SPINAL PROCEDURES INCLUDING DISC PROCEDURES
|
Facility
|
IP
|
$32,355.06
|
|
|
Service Code
|
APR-DRG 3104
|
| Min. Negotiated Rate |
$28,739.79 |
| Max. Negotiated Rate |
$32,355.06 |
| Rate for Payer: Anthem Medicaid |
$30,981.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$30,981.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$30,981.76
|
| Rate for Payer: Dean Health Medicaid |
$30,981.76
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$28,739.79
|
| Rate for Payer: Managed Health Services Medicaid |
$32,355.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$30,981.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$30,981.76
|
| Rate for Payer: United Healthcare Medicaid |
$30,981.76
|
|
|
VERTEBRAL AND INTERVERTEBRAL SPINAL PROCEDURES INCLUDING DISC PROCEDURES
|
Facility
|
IP
|
$15,432.23
|
|
|
Service Code
|
APR-DRG 3102
|
| Min. Negotiated Rate |
$13,707.87 |
| Max. Negotiated Rate |
$15,432.23 |
| Rate for Payer: Anthem Medicaid |
$14,777.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$14,777.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14,777.21
|
| Rate for Payer: Dean Health Medicaid |
$14,777.21
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13,707.87
|
| Rate for Payer: Managed Health Services Medicaid |
$15,432.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,777.21
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14,777.21
|
| Rate for Payer: United Healthcare Medicaid |
$14,777.21
|
|
|
VERTEBRAL AND INTERVERTEBRAL SPINAL PROCEDURES INCLUDING DISC PROCEDURES
|
Facility
|
IP
|
$22,183.82
|
|
|
Service Code
|
APR-DRG 3103
|
| Min. Negotiated Rate |
$19,705.06 |
| Max. Negotiated Rate |
$22,183.82 |
| Rate for Payer: Anthem Medicaid |
$21,242.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$21,242.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$21,242.23
|
| Rate for Payer: Dean Health Medicaid |
$21,242.23
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19,705.06
|
| Rate for Payer: Managed Health Services Medicaid |
$22,183.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$21,242.23
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$21,242.23
|
| Rate for Payer: United Healthcare Medicaid |
$21,242.23
|
|
|
VERTEBRAL AND INTERVERTEBRAL SPINAL PROCEDURES INCLUDING DISC PROCEDURES
|
Facility
|
IP
|
$11,223.44
|
|
|
Service Code
|
APR-DRG 3101
|
| Min. Negotiated Rate |
$9,969.36 |
| Max. Negotiated Rate |
$11,223.44 |
| Rate for Payer: Anthem Medicaid |
$10,747.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$10,747.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10,747.06
|
| Rate for Payer: Dean Health Medicaid |
$10,747.06
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9,969.36
|
| Rate for Payer: Managed Health Services Medicaid |
$11,223.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,747.06
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$10,747.06
|
| Rate for Payer: United Healthcare Medicaid |
$10,747.06
|
|
|
Vertebroplasty addl inject 22512
|
Professional
|
Both
|
$2,163.00
|
|
|
Service Code
|
CPT 22512
|
| Hospital Charge Code |
6181379
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$170.13 |
| Max. Negotiated Rate |
$2,137.04 |
| Rate for Payer: Aetna Commercial |
$2,137.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,934.59
|
| Rate for Payer: Aetna Managed Medicare |
$170.13
|
| Rate for Payer: Anthem Medicare Advantage |
$170.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$170.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$170.13
|
| Rate for Payer: Cash Price |
$648.90
|
| Rate for Payer: Cash Price |
$648.90
|
| Rate for Payer: Cash Price |
$648.90
|
| Rate for Payer: Cigna Commercial |
$2,137.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$773.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$170.13
|
| Rate for Payer: Health EOS Commercial |
$2,047.06
|
| Rate for Payer: HFN Commercial |
$2,137.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$706.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$706.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$170.13
|
| Rate for Payer: Multiplan Commercial |
$1,799.62
|
| Rate for Payer: NAPHCARE Commercial |
$255.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,137.04
|
| Rate for Payer: Quartz Beloit One Network |
$989.79
|
| Rate for Payer: Quartz Commercial |
$1,282.23
|
| Rate for Payer: Quartz Medicare Advantage |
$170.13
|
| Rate for Payer: The Alliance Commercial |
$723.07
|
| Rate for Payer: United Healthcare Medicaid |
$773.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$170.13
|
| Rate for Payer: WEA Trust Commercial |
$1,237.24
|
| Rate for Payer: WPS Commercial |
$765.60
|
|
|
VERTEBROPLASTY CERVICAL/THORACIC
|
Facility
|
IP
|
$2,293.00
|
|
| Hospital Charge Code |
6180099
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,168.51 |
| Max. Negotiated Rate |
$2,193.94 |
| Rate for Payer: Aetna Commercial |
$2,146.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,050.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,263.90
|
| Rate for Payer: Cash Price |
$687.90
|
| Rate for Payer: Cigna Commercial |
$2,193.94
|
| Rate for Payer: Health EOS Commercial |
$2,122.40
|
| Rate for Payer: HFN Commercial |
$2,193.94
|
| Rate for Payer: Multiplan Commercial |
$1,907.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,193.94
|
| Rate for Payer: Quartz Beloit One Network |
$1,168.51
|
| Rate for Payer: Quartz Commercial |
$1,430.83
|
| Rate for Payer: WEA Trust Commercial |
$1,311.60
|
| Rate for Payer: WPS Commercial |
$1,766.30
|
|
|
VERTEBROPLASTY CERVICAL/THORACIC
|
Facility
|
OP
|
$2,293.00
|
|
| Hospital Charge Code |
6180099
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$667.72 |
| Max. Negotiated Rate |
$2,193.94 |
| Rate for Payer: Aetna Commercial |
$2,146.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,050.86
|
| Rate for Payer: Aetna Managed Medicare |
$667.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,550.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,192.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,144.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,263.90
|
| Rate for Payer: Cash Price |
$687.90
|
| Rate for Payer: Cigna Commercial |
$2,193.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,334.53
|
| Rate for Payer: Health EOS Commercial |
$2,122.40
|
| Rate for Payer: HFN Commercial |
$2,193.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,788.54
|
| Rate for Payer: Multiplan Commercial |
$1,907.78
|
| Rate for Payer: NAPHCARE Commercial |
$1,430.83
|
| Rate for Payer: Preferred Network Access Commercial |
$2,193.94
|
| Rate for Payer: Quartz Beloit One Network |
$1,168.51
|
| Rate for Payer: Quartz Commercial |
$1,550.07
|
| Rate for Payer: Quartz Medicare Advantage |
$1,430.83
|
| Rate for Payer: The Alliance Commercial |
$1,192.36
|
| Rate for Payer: WEA Trust Commercial |
$1,311.60
|
| Rate for Payer: WPS Commercial |
$1,766.30
|
|
|
VERTEBROPLASTY CERVICAL/THORACIC ADD LEVEL
|
Facility
|
IP
|
$1,165.00
|
|
| Hospital Charge Code |
6180097
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$593.68 |
| Max. Negotiated Rate |
$1,114.67 |
| Rate for Payer: Aetna Commercial |
$1,090.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,041.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$642.15
|
| Rate for Payer: Cash Price |
$349.50
|
| Rate for Payer: Cigna Commercial |
$1,114.67
|
| Rate for Payer: Health EOS Commercial |
$1,078.32
|
| Rate for Payer: HFN Commercial |
$1,114.67
|
| Rate for Payer: Multiplan Commercial |
$969.28
|
| Rate for Payer: Preferred Network Access Commercial |
$1,114.67
|
| Rate for Payer: Quartz Beloit One Network |
$593.68
|
| Rate for Payer: Quartz Commercial |
$726.96
|
| Rate for Payer: WEA Trust Commercial |
$666.38
|
| Rate for Payer: WPS Commercial |
$897.40
|
|
|
VERTEBROPLASTY CERVICAL/THORACIC ADD LEVEL
|
Facility
|
OP
|
$1,165.00
|
|
| Hospital Charge Code |
6180097
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$339.25 |
| Max. Negotiated Rate |
$1,114.67 |
| Rate for Payer: Aetna Commercial |
$1,090.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,041.98
|
| Rate for Payer: Aetna Managed Medicare |
$339.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$787.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$605.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$581.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$642.15
|
| Rate for Payer: Cash Price |
$349.50
|
| Rate for Payer: Cigna Commercial |
$1,114.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$678.03
|
| Rate for Payer: Health EOS Commercial |
$1,078.32
|
| Rate for Payer: HFN Commercial |
$1,114.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$908.70
|
| Rate for Payer: Multiplan Commercial |
$969.28
|
| Rate for Payer: NAPHCARE Commercial |
$726.96
|
| Rate for Payer: Preferred Network Access Commercial |
$1,114.67
|
| Rate for Payer: Quartz Beloit One Network |
$593.68
|
| Rate for Payer: Quartz Commercial |
$787.54
|
| Rate for Payer: Quartz Medicare Advantage |
$726.96
|
| Rate for Payer: The Alliance Commercial |
$605.80
|
| Rate for Payer: WEA Trust Commercial |
$666.38
|
| Rate for Payer: WPS Commercial |
$897.40
|
|
|
VERTEBROPLASTY LUMBAR/SACRAL
|
Facility
|
IP
|
$2,133.00
|
|
| Hospital Charge Code |
6180098
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,086.98 |
| Max. Negotiated Rate |
$2,040.85 |
| Rate for Payer: Aetna Commercial |
$1,996.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,907.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,175.71
|
| Rate for Payer: Cash Price |
$639.90
|
| Rate for Payer: Cigna Commercial |
$2,040.85
|
| Rate for Payer: Health EOS Commercial |
$1,974.30
|
| Rate for Payer: HFN Commercial |
$2,040.85
|
| Rate for Payer: Multiplan Commercial |
$1,774.66
|
| Rate for Payer: Preferred Network Access Commercial |
$2,040.85
|
| Rate for Payer: Quartz Beloit One Network |
$1,086.98
|
| Rate for Payer: Quartz Commercial |
$1,330.99
|
| Rate for Payer: WEA Trust Commercial |
$1,220.08
|
| Rate for Payer: WPS Commercial |
$1,643.05
|
|
|
VERTEBROPLASTY LUMBAR/SACRAL
|
Facility
|
OP
|
$2,133.00
|
|
| Hospital Charge Code |
6180098
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$621.13 |
| Max. Negotiated Rate |
$2,040.85 |
| Rate for Payer: Aetna Commercial |
$1,996.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,907.76
|
| Rate for Payer: Aetna Managed Medicare |
$621.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,441.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,109.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,064.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,175.71
|
| Rate for Payer: Cash Price |
$639.90
|
| Rate for Payer: Cigna Commercial |
$2,040.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,241.41
|
| Rate for Payer: Health EOS Commercial |
$1,974.30
|
| Rate for Payer: HFN Commercial |
$2,040.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,663.74
|
| Rate for Payer: Multiplan Commercial |
$1,774.66
|
| Rate for Payer: NAPHCARE Commercial |
$1,330.99
|
| Rate for Payer: Preferred Network Access Commercial |
$2,040.85
|
| Rate for Payer: Quartz Beloit One Network |
$1,086.98
|
| Rate for Payer: Quartz Commercial |
$1,441.91
|
| Rate for Payer: Quartz Medicare Advantage |
$1,330.99
|
| Rate for Payer: The Alliance Commercial |
$1,109.16
|
| Rate for Payer: WEA Trust Commercial |
$1,220.08
|
| Rate for Payer: WPS Commercial |
$1,643.05
|
|
|
VERTEBROPLASTY LUMBAR/SACRAL ADD LEVEL
|
Facility
|
OP
|
$1,165.00
|
|
| Hospital Charge Code |
6180096
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$339.25 |
| Max. Negotiated Rate |
$1,114.67 |
| Rate for Payer: Aetna Commercial |
$1,090.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,041.98
|
| Rate for Payer: Aetna Managed Medicare |
$339.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$787.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$605.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$581.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$642.15
|
| Rate for Payer: Cash Price |
$349.50
|
| Rate for Payer: Cigna Commercial |
$1,114.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$678.03
|
| Rate for Payer: Health EOS Commercial |
$1,078.32
|
| Rate for Payer: HFN Commercial |
$1,114.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$908.70
|
| Rate for Payer: Multiplan Commercial |
$969.28
|
| Rate for Payer: NAPHCARE Commercial |
$726.96
|
| Rate for Payer: Preferred Network Access Commercial |
$1,114.67
|
| Rate for Payer: Quartz Beloit One Network |
$593.68
|
| Rate for Payer: Quartz Commercial |
$787.54
|
| Rate for Payer: Quartz Medicare Advantage |
$726.96
|
| Rate for Payer: The Alliance Commercial |
$605.80
|
| Rate for Payer: WEA Trust Commercial |
$666.38
|
| Rate for Payer: WPS Commercial |
$897.40
|
|
|
VERTEBROPLASTY LUMBAR/SACRAL ADD LEVEL
|
Facility
|
IP
|
$1,165.00
|
|
| Hospital Charge Code |
6180096
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$593.68 |
| Max. Negotiated Rate |
$1,114.67 |
| Rate for Payer: Aetna Commercial |
$1,090.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,041.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$642.15
|
| Rate for Payer: Cash Price |
$349.50
|
| Rate for Payer: Cigna Commercial |
$1,114.67
|
| Rate for Payer: Health EOS Commercial |
$1,078.32
|
| Rate for Payer: HFN Commercial |
$1,114.67
|
| Rate for Payer: Multiplan Commercial |
$969.28
|
| Rate for Payer: Preferred Network Access Commercial |
$1,114.67
|
| Rate for Payer: Quartz Beloit One Network |
$593.68
|
| Rate for Payer: Quartz Commercial |
$726.96
|
| Rate for Payer: WEA Trust Commercial |
$666.38
|
| Rate for Payer: WPS Commercial |
$897.40
|
|
