|
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
|
|
|
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
|
$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
|
|
|
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
|
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 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 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
|
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 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
|
|
|
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
|
|
|
VERTIGINOUS DIAGNOSES EXCEPT FOR BENIGN VERTIGO
|
Facility
|
OP
|
$48.15
|
|
|
Service Code
|
EAPG 00561
|
| Min. Negotiated Rate |
$46.30 |
| Max. Negotiated Rate |
$48.15 |
| Rate for Payer: Anthem Medicaid |
$46.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$46.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$46.30
|
| Rate for Payer: Dean Health Medicaid |
$46.30
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$46.30
|
| Rate for Payer: Managed Health Services Medicaid |
$48.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$46.30
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$46.30
|
| Rate for Payer: United Healthcare Medicaid |
$46.30
|
|
|
VERTIGO AND OTHER LABYRINTH DISORDERS
|
Facility
|
IP
|
$5,874.77
|
|
|
Service Code
|
APR-DRG 1111
|
| Min. Negotiated Rate |
$5,218.34 |
| Max. Negotiated Rate |
$5,874.77 |
| Rate for Payer: Anthem Medicaid |
$5,625.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$5,625.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,625.41
|
| Rate for Payer: Dean Health Medicaid |
$5,625.41
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5,218.34
|
| Rate for Payer: Managed Health Services Medicaid |
$5,874.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,625.41
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5,625.41
|
| Rate for Payer: United Healthcare Medicaid |
$5,625.41
|
|
|
VERTIGO AND OTHER LABYRINTH DISORDERS
|
Facility
|
IP
|
$6,576.23
|
|
|
Service Code
|
APR-DRG 1112
|
| Min. Negotiated Rate |
$5,841.42 |
| Max. Negotiated Rate |
$6,576.23 |
| Rate for Payer: Anthem Medicaid |
$6,297.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$6,297.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,297.10
|
| Rate for Payer: Dean Health Medicaid |
$6,297.10
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5,841.42
|
| Rate for Payer: Managed Health Services Medicaid |
$6,576.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,297.10
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6,297.10
|
| Rate for Payer: United Healthcare Medicaid |
$6,297.10
|
|
|
VERTIGO AND OTHER LABYRINTH DISORDERS
|
Facility
|
IP
|
$14,906.13
|
|
|
Service Code
|
APR-DRG 1114
|
| Min. Negotiated Rate |
$13,240.55 |
| Max. Negotiated Rate |
$14,906.13 |
| Rate for Payer: Anthem Medicaid |
$14,273.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$14,273.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14,273.44
|
| Rate for Payer: Dean Health Medicaid |
$14,273.44
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13,240.55
|
| Rate for Payer: Managed Health Services Medicaid |
$14,906.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,273.44
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14,273.44
|
| Rate for Payer: United Healthcare Medicaid |
$14,273.44
|
|
|
VERTIGO AND OTHER LABYRINTH DISORDERS
|
Facility
|
IP
|
$8,592.94
|
|
|
Service Code
|
APR-DRG 1113
|
| Min. Negotiated Rate |
$7,632.79 |
| Max. Negotiated Rate |
$8,592.94 |
| Rate for Payer: Anthem Medicaid |
$8,228.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$8,228.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8,228.22
|
| Rate for Payer: Dean Health Medicaid |
$8,228.22
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$7,632.79
|
| Rate for Payer: Managed Health Services Medicaid |
$8,592.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,228.22
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8,228.22
|
| Rate for Payer: United Healthcare Medicaid |
$8,228.22
|
|
|
Very Long Chain Fatty Acids / 90559
|
Professional
|
Both
|
$404.00
|
|
|
Service Code
|
CPT 82726
|
| Hospital Charge Code |
4624618
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.54 |
| Max. Negotiated Rate |
$399.15 |
| Rate for Payer: Aetna Commercial |
$399.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$361.34
|
| Rate for Payer: Aetna Managed Medicare |
$20.54
|
| Rate for Payer: Anthem Medicare Advantage |
$20.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.54
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cigna Commercial |
$399.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$210.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.54
|
| Rate for Payer: Health EOS Commercial |
$382.35
|
| Rate for Payer: HFN Commercial |
$399.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$72.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.54
|
| Rate for Payer: Multiplan Commercial |
$336.13
|
| Rate for Payer: NAPHCARE Commercial |
$30.81
|
| Rate for Payer: Preferred Network Access Commercial |
$399.15
|
| Rate for Payer: Quartz Beloit One Network |
$184.87
|
| Rate for Payer: Quartz Commercial |
$239.49
|
| Rate for Payer: Quartz Medicare Advantage |
$20.54
|
| Rate for Payer: The Alliance Commercial |
$81.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.54
|
| Rate for Payer: WEA Trust Commercial |
$231.09
|
| Rate for Payer: WPS Commercial |
$90.38
|
|
|
Very Long Chain Fatty Acids / 90559
|
Facility
|
OP
|
$404.00
|
|
|
Service Code
|
CPT 82726
|
| Hospital Charge Code |
4624618
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.54 |
| Max. Negotiated Rate |
$386.55 |
| Rate for Payer: Aetna Commercial |
$378.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$361.34
|
| Rate for Payer: Aetna Managed Medicare |
$20.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$77.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$35.95
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34.10
|
| Rate for Payer: Anthem Medicare Advantage |
$20.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$222.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.54
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cigna Commercial |
$386.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$20.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$235.13
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$20.54
|
| Rate for Payer: Health EOS Commercial |
$373.94
|
| Rate for Payer: HFN Commercial |
$386.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$76.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.54
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$20.54
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$20.54
|
| Rate for Payer: Multiplan Commercial |
$336.13
|
| Rate for Payer: NAPHCARE Commercial |
$30.81
|
| Rate for Payer: Preferred Network Access Commercial |
$386.55
|
| Rate for Payer: Quartz Beloit One Network |
$205.88
|
| Rate for Payer: Quartz Commercial |
$273.10
|
| Rate for Payer: Quartz Medicare Advantage |
$20.54
|
| Rate for Payer: The Alliance Commercial |
$82.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.54
|
| Rate for Payer: United Healthcare PPO |
$315.12
|
| Rate for Payer: WEA Trust Commercial |
$231.09
|
| Rate for Payer: Wellcare Medicare |
$20.54
|
| Rate for Payer: WPS Commercial |
$311.20
|
|
|
Very Long Chain Fatty Acids / 90559
|
Facility
|
IP
|
$404.00
|
|
|
Service Code
|
CPT 82726
|
| Hospital Charge Code |
4624618
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$205.88 |
| Max. Negotiated Rate |
$386.55 |
| Rate for Payer: Aetna Commercial |
$378.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$361.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$222.68
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cigna Commercial |
$386.55
|
| Rate for Payer: Health EOS Commercial |
$373.94
|
| Rate for Payer: HFN Commercial |
$386.55
|
| Rate for Payer: Multiplan Commercial |
$336.13
|
| Rate for Payer: Preferred Network Access Commercial |
$386.55
|
| Rate for Payer: Quartz Beloit One Network |
$205.88
|
| Rate for Payer: Quartz Commercial |
$252.10
|
| Rate for Payer: WEA Trust Commercial |
$231.09
|
| Rate for Payer: WPS Commercial |
$311.20
|
|
|
VESICOVAGINAL FISTULA CLOSURE
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960501
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,005.28 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,455.44
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
VESICOVAGINAL FISTULA CLOSURE
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960501
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,145.87 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,145.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,660.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,046.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,964.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,290.17
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,069.30
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,455.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,660.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,455.44
|
| Rate for Payer: The Alliance Commercial |
$2,046.20
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
VESICULECTOMY
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960502
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,005.28 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,455.44
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
VESICULECTOMY
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960502
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,145.87 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,145.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,660.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,046.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,964.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,290.17
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,069.30
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,455.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,660.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,455.44
|
| Rate for Payer: The Alliance Commercial |
$2,046.20
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
VESSEL CLOSURE SYSTEM ANASTOCLIP LARGE 4008-07
|
Facility
|
IP
|
$6,077.00
|
|
| Hospital Charge Code |
5298748
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,096.84 |
| Max. Negotiated Rate |
$5,814.47 |
| Rate for Payer: Aetna Commercial |
$5,688.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,435.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,349.64
|
| Rate for Payer: Cash Price |
$1,823.10
|
| Rate for Payer: Cigna Commercial |
$5,814.47
|
| Rate for Payer: Health EOS Commercial |
$5,624.87
|
| Rate for Payer: HFN Commercial |
$5,814.47
|
| Rate for Payer: Multiplan Commercial |
$5,056.06
|
| Rate for Payer: Preferred Network Access Commercial |
$5,814.47
|
| Rate for Payer: Quartz Beloit One Network |
$3,096.84
|
| Rate for Payer: Quartz Commercial |
$3,792.05
|
| Rate for Payer: WEA Trust Commercial |
$3,476.04
|
| Rate for Payer: WPS Commercial |
$4,681.11
|
|
