|
EXTERNAL ECG REC>7D<15D RECORDING- 93246
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 93246
|
| Hospital Charge Code |
5727949
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$50.96 |
| Max. Negotiated Rate |
$95.68 |
| Rate for Payer: Aetna Commercial |
$93.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$89.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$55.12
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$95.68
|
| Rate for Payer: Health EOS Commercial |
$92.56
|
| Rate for Payer: HFN Commercial |
$95.68
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: Preferred Network Access Commercial |
$95.68
|
| Rate for Payer: Quartz Beloit One Network |
$50.96
|
| Rate for Payer: Quartz Commercial |
$62.40
|
| Rate for Payer: WEA Trust Commercial |
$57.20
|
| Rate for Payer: WPS Commercial |
$77.03
|
|
|
EXTERNAL ECG REC>7D<15D RECORDING- 93246
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 93246
|
| Hospital Charge Code |
5727949
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$39.31 |
| Max. Negotiated Rate |
$157.25 |
| Rate for Payer: Aetna Commercial |
$93.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$89.44
|
| Rate for Payer: Aetna Managed Medicare |
$39.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$52.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$49.92
|
| Rate for Payer: Anthem Medicare Advantage |
$39.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$55.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.31
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$95.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$39.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$58.20
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$39.31
|
| Rate for Payer: Health EOS Commercial |
$92.56
|
| Rate for Payer: HFN Commercial |
$95.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$146.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$39.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$39.31
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$39.31
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: NAPHCARE Commercial |
$58.97
|
| Rate for Payer: Preferred Network Access Commercial |
$95.68
|
| Rate for Payer: Quartz Beloit One Network |
$50.96
|
| Rate for Payer: Quartz Commercial |
$67.60
|
| Rate for Payer: Quartz Medicare Advantage |
$39.31
|
| Rate for Payer: The Alliance Commercial |
$157.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.31
|
| Rate for Payer: United Healthcare PPO |
$78.00
|
| Rate for Payer: WEA Trust Commercial |
$57.20
|
| Rate for Payer: Wellcare Medicare |
$39.31
|
| Rate for Payer: WPS Commercial |
$77.03
|
|
|
EXTERNAL HEART ASSIST DEVICES
|
Facility
|
IP
|
$53,574.37
|
|
|
Service Code
|
APR-DRG 1783
|
| Min. Negotiated Rate |
$47,588.10 |
| Max. Negotiated Rate |
$53,574.37 |
| Rate for Payer: Anthem Medicaid |
$51,300.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$51,300.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$51,300.42
|
| Rate for Payer: Dean Health Medicaid |
$51,300.42
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$47,588.10
|
| Rate for Payer: Managed Health Services Medicaid |
$53,574.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$51,300.42
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$51,300.42
|
| Rate for Payer: United Healthcare Medicaid |
$51,300.42
|
|
|
EXTERNAL HEART ASSIST DEVICES
|
Facility
|
IP
|
$43,666.18
|
|
|
Service Code
|
APR-DRG 1782
|
| Min. Negotiated Rate |
$38,787.03 |
| Max. Negotiated Rate |
$43,666.18 |
| Rate for Payer: Anthem Medicaid |
$41,812.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$41,812.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$41,812.78
|
| Rate for Payer: Dean Health Medicaid |
$41,812.78
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$38,787.03
|
| Rate for Payer: Managed Health Services Medicaid |
$43,666.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$41,812.78
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$41,812.78
|
| Rate for Payer: United Healthcare Medicaid |
$41,812.78
|
|
|
EXTERNAL HEART ASSIST DEVICES
|
Facility
|
IP
|
$66,376.11
|
|
|
Service Code
|
APR-DRG 1784
|
| Min. Negotiated Rate |
$58,959.40 |
| Max. Negotiated Rate |
$66,376.11 |
| Rate for Payer: Anthem Medicaid |
$63,558.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$63,558.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$63,558.78
|
| Rate for Payer: Dean Health Medicaid |
$63,558.78
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$58,959.40
|
| Rate for Payer: Managed Health Services Medicaid |
$66,376.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$63,558.78
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$63,558.78
|
| Rate for Payer: United Healthcare Medicaid |
$63,558.78
|
|
|
EXTERNAL HEART ASSIST DEVICES
|
Facility
|
IP
|
$39,282.03
|
|
|
Service Code
|
APR-DRG 1781
|
| Min. Negotiated Rate |
$34,892.75 |
| Max. Negotiated Rate |
$39,282.03 |
| Rate for Payer: Anthem Medicaid |
$37,614.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$37,614.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$37,614.71
|
| Rate for Payer: Dean Health Medicaid |
$37,614.71
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$34,892.75
|
| Rate for Payer: Managed Health Services Medicaid |
$39,282.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$37,614.71
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$37,614.71
|
| Rate for Payer: United Healthcare Medicaid |
$37,614.71
|
|
|
EXTERNAL NEUROSTIMULATOR INTERSTIM 353101
|
Facility
|
OP
|
$4,871.00
|
|
|
Service Code
|
HCPCS C1787
|
| Hospital Charge Code |
5349490
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,418.44 |
| Max. Negotiated Rate |
$4,660.57 |
| Rate for Payer: Aetna Commercial |
$4,559.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,356.62
|
| Rate for Payer: Aetna Managed Medicare |
$1,418.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,292.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,532.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,431.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,684.90
|
| Rate for Payer: Cash Price |
$1,461.30
|
| Rate for Payer: Cigna Commercial |
$4,660.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,834.92
|
| Rate for Payer: Health EOS Commercial |
$4,508.60
|
| Rate for Payer: HFN Commercial |
$4,660.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,799.38
|
| Rate for Payer: Multiplan Commercial |
$4,052.67
|
| Rate for Payer: NAPHCARE Commercial |
$3,039.50
|
| Rate for Payer: Preferred Network Access Commercial |
$4,660.57
|
| Rate for Payer: Quartz Beloit One Network |
$2,482.26
|
| Rate for Payer: Quartz Commercial |
$3,292.80
|
| Rate for Payer: Quartz Medicare Advantage |
$3,039.50
|
| Rate for Payer: The Alliance Commercial |
$2,532.92
|
| Rate for Payer: WEA Trust Commercial |
$2,786.21
|
| Rate for Payer: WPS Commercial |
$3,752.13
|
|
|
EXTERNAL NEUROSTIMULATOR INTERSTIM 353101
|
Facility
|
IP
|
$4,871.00
|
|
|
Service Code
|
HCPCS C1787
|
| Hospital Charge Code |
5349490
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,482.26 |
| Max. Negotiated Rate |
$4,660.57 |
| Rate for Payer: Aetna Commercial |
$4,559.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,356.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,684.90
|
| Rate for Payer: Cash Price |
$1,461.30
|
| Rate for Payer: Cigna Commercial |
$4,660.57
|
| Rate for Payer: Health EOS Commercial |
$4,508.60
|
| Rate for Payer: HFN Commercial |
$4,660.57
|
| Rate for Payer: Multiplan Commercial |
$4,052.67
|
| Rate for Payer: Preferred Network Access Commercial |
$4,660.57
|
| Rate for Payer: Quartz Beloit One Network |
$2,482.26
|
| Rate for Payer: Quartz Commercial |
$3,039.50
|
| Rate for Payer: WEA Trust Commercial |
$2,786.21
|
| Rate for Payer: WPS Commercial |
$3,752.13
|
|
|
External Pacemaker
|
Facility
|
IP
|
$814.00
|
|
| Hospital Charge Code |
3052550
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$414.81 |
| Max. Negotiated Rate |
$778.84 |
| Rate for Payer: Aetna Commercial |
$761.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$728.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$448.68
|
| Rate for Payer: Cash Price |
$244.20
|
| Rate for Payer: Cigna Commercial |
$778.84
|
| Rate for Payer: Health EOS Commercial |
$753.44
|
| Rate for Payer: HFN Commercial |
$778.84
|
| Rate for Payer: Multiplan Commercial |
$677.25
|
| Rate for Payer: Preferred Network Access Commercial |
$778.84
|
| Rate for Payer: Quartz Beloit One Network |
$414.81
|
| Rate for Payer: Quartz Commercial |
$507.94
|
| Rate for Payer: WEA Trust Commercial |
$465.61
|
| Rate for Payer: WPS Commercial |
$627.02
|
|
|
External Pacemaker
|
Facility
|
OP
|
$814.00
|
|
| Hospital Charge Code |
3052550
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$237.04 |
| Max. Negotiated Rate |
$778.84 |
| Rate for Payer: Aetna Commercial |
$761.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$728.04
|
| Rate for Payer: Aetna Managed Medicare |
$237.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$550.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$423.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$406.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$448.68
|
| Rate for Payer: Cash Price |
$244.20
|
| Rate for Payer: Cigna Commercial |
$778.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$473.75
|
| Rate for Payer: Health EOS Commercial |
$753.44
|
| Rate for Payer: HFN Commercial |
$778.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$634.92
|
| Rate for Payer: Multiplan Commercial |
$677.25
|
| Rate for Payer: NAPHCARE Commercial |
$507.94
|
| Rate for Payer: Preferred Network Access Commercial |
$778.84
|
| Rate for Payer: Quartz Beloit One Network |
$414.81
|
| Rate for Payer: Quartz Commercial |
$550.26
|
| Rate for Payer: Quartz Medicare Advantage |
$507.94
|
| Rate for Payer: The Alliance Commercial |
$423.28
|
| Rate for Payer: WEA Trust Commercial |
$465.61
|
| Rate for Payer: WPS Commercial |
$627.02
|
|
|
EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS (1-STAGE PROCEDURE), MANUAL OR MECHANICAL TECHNIQUE (EG, IRRIGATION AND ASPIRATION OR PHACOEMULSIFICATION), COMPLEX, REQUIRING DEVICES OR TECHNIQUES NOT GENERALLY USED IN ROUTINE CATARACT SURGERY (EG, IRIS EXPANSION DEVICE, SUTURE SUPPORT FOR INTRAOCULAR LENS, OR PRIMARY POSTERIOR CAPSULORRHEXIS) OR PERFORMED ON PATIENTS IN THE AMBLYOGENIC DEVELOPMENTAL STAGE; WITHOUT ENDOSCOPIC CYCLOPHOTOCOAGULATION
|
Facility
|
OP
|
$12,349.86
|
|
|
Service Code
|
CPT 66982
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,428.73 |
| Max. Negotiated Rate |
$12,349.86 |
| Rate for Payer: Aetna Managed Medicare |
$2,428.73
|
| 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 |
$2,428.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,428.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,428.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,428.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,428.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,034.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,428.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,428.73
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,428.73
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,428.73
|
| Rate for Payer: NAPHCARE Commercial |
$3,643.10
|
| Rate for Payer: Quartz Medicare Advantage |
$2,428.73
|
| Rate for Payer: The Alliance Commercial |
$9,714.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,428.73
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$2,428.73
|
|
|
EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS (1 STAGE PROCEDURE), MANUAL OR MECHANICAL TECHNIQUE (EG, IRRIGATION AND ASPIRATION OR PHACOEMULSIFICATION); WITH INSERTION OF INTRAOCULAR (EG, TRABECULAR MESHWORK, SUPRACILIARY, SUPRACHOROIDAL) ANTERIOR SEGMENT AQUEOUS DRAINAGE DEVICE, WITHOUT EXTRAOCULAR RESERVOIR, INTERNAL APPROACH, ONE OR MORE
|
Facility
|
OP
|
$22,400.35
|
|
|
Service Code
|
CPT 66991
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,600.09 |
| Max. Negotiated Rate |
$22,400.35 |
| Rate for Payer: Aetna Managed Medicare |
$5,600.09
|
| Rate for Payer: Anthem Medicare Advantage |
$5,600.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,600.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,600.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,600.09
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,600.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,832.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,600.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,600.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,600.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,600.09
|
| Rate for Payer: NAPHCARE Commercial |
$8,400.13
|
| Rate for Payer: Quartz Medicare Advantage |
$5,600.09
|
| Rate for Payer: The Alliance Commercial |
$22,400.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,600.09
|
| Rate for Payer: Wellcare Medicare |
$5,600.09
|
|
|
EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS (1 STAGE PROCEDURE), MANUAL OR MECHANICAL TECHNIQUE (EG, IRRIGATION AND ASPIRATION OR PHACOEMULSIFICATION); WITHOUT ENDOSCOPIC CYCLOPHOTOCOAGULATION
|
Facility
|
OP
|
$12,349.86
|
|
|
Service Code
|
CPT 66984
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,428.73 |
| Max. Negotiated Rate |
$12,349.86 |
| Rate for Payer: Aetna Managed Medicare |
$2,428.73
|
| 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 |
$2,428.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,428.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,428.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,428.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,428.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,034.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,428.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,428.73
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,428.73
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,428.73
|
| Rate for Payer: NAPHCARE Commercial |
$3,643.10
|
| Rate for Payer: Quartz Medicare Advantage |
$2,428.73
|
| Rate for Payer: The Alliance Commercial |
$9,714.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,428.73
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$2,428.73
|
|
|
EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)
|
Facility
|
IP
|
$68,392.82
|
|
|
Service Code
|
APR-DRG 0092
|
| Min. Negotiated Rate |
$60,750.77 |
| Max. Negotiated Rate |
$68,392.82 |
| Rate for Payer: Anthem Medicaid |
$65,489.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$65,489.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$65,489.89
|
| Rate for Payer: Dean Health Medicaid |
$65,489.89
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$60,750.77
|
| Rate for Payer: Managed Health Services Medicaid |
$68,392.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$65,489.89
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$65,489.89
|
| Rate for Payer: United Healthcare Medicaid |
$65,489.89
|
|
|
EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)
|
Facility
|
IP
|
$202,811.01
|
|
|
Service Code
|
APR-DRG 0094
|
| Min. Negotiated Rate |
$180,149.39 |
| Max. Negotiated Rate |
$202,811.01 |
| Rate for Payer: Anthem Medicaid |
$194,202.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$194,202.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$194,202.72
|
| Rate for Payer: Dean Health Medicaid |
$194,202.72
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$180,149.39
|
| Rate for Payer: Managed Health Services Medicaid |
$202,811.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$194,202.72
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$194,202.72
|
| Rate for Payer: United Healthcare Medicaid |
$194,202.72
|
|
|
EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)
|
Facility
|
IP
|
$50,067.05
|
|
|
Service Code
|
APR-DRG 0091
|
| Min. Negotiated Rate |
$44,472.68 |
| Max. Negotiated Rate |
$50,067.05 |
| Rate for Payer: Anthem Medicaid |
$47,941.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$47,941.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$47,941.96
|
| Rate for Payer: Dean Health Medicaid |
$47,941.96
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$44,472.68
|
| Rate for Payer: Managed Health Services Medicaid |
$50,067.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$47,941.96
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$47,941.96
|
| Rate for Payer: United Healthcare Medicaid |
$47,941.96
|
|
|
EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)
|
Facility
|
IP
|
$136,347.22
|
|
|
Service Code
|
APR-DRG 0093
|
| Min. Negotiated Rate |
$121,112.11 |
| Max. Negotiated Rate |
$136,347.22 |
| Rate for Payer: Anthem Medicaid |
$130,559.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$130,559.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$130,559.98
|
| Rate for Payer: Dean Health Medicaid |
$130,559.98
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$121,112.11
|
| Rate for Payer: Managed Health Services Medicaid |
$136,347.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$130,559.98
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$130,559.98
|
| Rate for Payer: United Healthcare Medicaid |
$130,559.98
|
|
|
EXTRACORPOREAL SHOCKWAVE LITHOTRIPTOR (ESWL)
|
Facility
|
OP
|
$40,002.00
|
|
| Hospital Charge Code |
2950489
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$11,648.58 |
| Max. Negotiated Rate |
$38,273.91 |
| Rate for Payer: Aetna Commercial |
$37,441.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$35,777.79
|
| Rate for Payer: Aetna Managed Medicare |
$11,648.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$27,041.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20,801.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19,969.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$22,049.10
|
| Rate for Payer: Cash Price |
$12,000.60
|
| Rate for Payer: Cigna Commercial |
$38,273.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23,281.16
|
| Rate for Payer: Health EOS Commercial |
$37,025.85
|
| Rate for Payer: HFN Commercial |
$38,273.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31,201.56
|
| Rate for Payer: Multiplan Commercial |
$33,281.66
|
| Rate for Payer: NAPHCARE Commercial |
$24,961.25
|
| Rate for Payer: Preferred Network Access Commercial |
$38,273.91
|
| Rate for Payer: Quartz Beloit One Network |
$20,385.02
|
| Rate for Payer: Quartz Commercial |
$27,041.35
|
| Rate for Payer: Quartz Medicare Advantage |
$24,961.25
|
| Rate for Payer: The Alliance Commercial |
$20,801.04
|
| Rate for Payer: WEA Trust Commercial |
$22,881.14
|
| Rate for Payer: WPS Commercial |
$30,813.54
|
|
|
EXTRACORPOREAL SHOCKWAVE LITHOTRIPTOR (ESWL)
|
Facility
|
IP
|
$40,002.00
|
|
| Hospital Charge Code |
2950489
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$20,385.02 |
| Max. Negotiated Rate |
$38,273.91 |
| Rate for Payer: Aetna Commercial |
$37,441.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$35,777.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$22,049.10
|
| Rate for Payer: Cash Price |
$12,000.60
|
| Rate for Payer: Cigna Commercial |
$38,273.91
|
| Rate for Payer: Health EOS Commercial |
$37,025.85
|
| Rate for Payer: HFN Commercial |
$38,273.91
|
| Rate for Payer: Multiplan Commercial |
$33,281.66
|
| Rate for Payer: Preferred Network Access Commercial |
$38,273.91
|
| Rate for Payer: Quartz Beloit One Network |
$20,385.02
|
| Rate for Payer: Quartz Commercial |
$24,961.25
|
| Rate for Payer: WEA Trust Commercial |
$22,881.14
|
| Rate for Payer: WPS Commercial |
$30,813.54
|
|
|
EXTRACRANIAL PROCEDURES WITH CC
|
Facility
|
IP
|
$44,569.20
|
|
|
Service Code
|
MSDRG 038
|
| Min. Negotiated Rate |
$12,932.97 |
| Max. Negotiated Rate |
$44,569.20 |
| Rate for Payer: Aetna Managed Medicare |
$12,932.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$35,403.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27,136.75
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25,781.69
|
| Rate for Payer: Anthem Medicare Advantage |
$12,932.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12,932.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12,932.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12,932.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28,620.04
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12,932.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32,445.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12,932.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12,932.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12,932.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12,932.97
|
| Rate for Payer: NAPHCARE Commercial |
$19,399.46
|
| Rate for Payer: Quartz Medicare Advantage |
$12,932.97
|
| Rate for Payer: The Alliance Commercial |
$44,569.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,932.97
|
| Rate for Payer: United Healthcare PPO |
$25,259.60
|
| Rate for Payer: Wellcare Medicare |
$12,932.97
|
|
|
EXTRACRANIAL PROCEDURES WITH MCC
|
Facility
|
IP
|
$93,666.56
|
|
|
Service Code
|
MSDRG 037
|
| Min. Negotiated Rate |
$25,718.33 |
| Max. Negotiated Rate |
$93,666.56 |
| Rate for Payer: Aetna Managed Medicare |
$25,718.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$71,830.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$55,057.87
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$52,308.57
|
| Rate for Payer: Anthem Medicare Advantage |
$25,718.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25,718.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25,718.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$25,718.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$58,067.31
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$25,718.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68,457.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$25,718.33
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25,718.33
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$25,718.33
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$25,718.33
|
| Rate for Payer: NAPHCARE Commercial |
$38,577.49
|
| Rate for Payer: Quartz Medicare Advantage |
$25,718.33
|
| Rate for Payer: The Alliance Commercial |
$93,666.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25,718.33
|
| Rate for Payer: United Healthcare PPO |
$53,294.78
|
| Rate for Payer: Wellcare Medicare |
$25,718.33
|
|
|
EXTRACRANIAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$31,881.20
|
|
|
Service Code
|
MSDRG 039
|
| Min. Negotiated Rate |
$9,508.99 |
| Max. Negotiated Rate |
$31,881.20 |
| Rate for Payer: Aetna Managed Medicare |
$9,508.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25,648.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,659.34
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18,677.66
|
| Rate for Payer: Anthem Medicare Advantage |
$9,508.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,508.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,508.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,508.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20,733.92
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,508.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23,139.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,508.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9,508.99
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9,508.99
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,508.99
|
| Rate for Payer: NAPHCARE Commercial |
$14,263.49
|
| Rate for Payer: Quartz Medicare Advantage |
$9,508.99
|
| Rate for Payer: The Alliance Commercial |
$31,881.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,508.99
|
| Rate for Payer: United Healthcare PPO |
$18,014.38
|
| Rate for Payer: Wellcare Medicare |
$9,508.99
|
|
|
EXTRACTOR ATLAS 2.8 4-WIRE G32788
|
Facility
|
OP
|
$2,412.00
|
|
| Hospital Charge Code |
2965857
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$702.37 |
| Max. Negotiated Rate |
$2,307.80 |
| Rate for Payer: Aetna Commercial |
$2,257.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,157.29
|
| Rate for Payer: Aetna Managed Medicare |
$702.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,630.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,254.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,204.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,329.49
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Cigna Commercial |
$2,307.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,403.78
|
| Rate for Payer: Health EOS Commercial |
$2,232.55
|
| Rate for Payer: HFN Commercial |
$2,307.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,881.36
|
| Rate for Payer: Multiplan Commercial |
$2,006.78
|
| Rate for Payer: NAPHCARE Commercial |
$1,505.09
|
| Rate for Payer: Preferred Network Access Commercial |
$2,307.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,229.16
|
| Rate for Payer: Quartz Commercial |
$1,630.51
|
| Rate for Payer: Quartz Medicare Advantage |
$1,505.09
|
| Rate for Payer: The Alliance Commercial |
$1,254.24
|
| Rate for Payer: WEA Trust Commercial |
$1,379.66
|
| Rate for Payer: WPS Commercial |
$1,857.96
|
|
|
EXTRACTOR ATLAS 2.8 4-WIRE G32788
|
Facility
|
IP
|
$2,412.00
|
|
| Hospital Charge Code |
2965857
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,229.16 |
| Max. Negotiated Rate |
$2,307.80 |
| Rate for Payer: Aetna Commercial |
$2,257.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,157.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,329.49
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Cigna Commercial |
$2,307.80
|
| Rate for Payer: Health EOS Commercial |
$2,232.55
|
| Rate for Payer: HFN Commercial |
$2,307.80
|
| Rate for Payer: Multiplan Commercial |
$2,006.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,307.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,229.16
|
| Rate for Payer: Quartz Commercial |
$1,505.09
|
| Rate for Payer: WEA Trust Commercial |
$1,379.66
|
| Rate for Payer: WPS Commercial |
$1,857.96
|
|
|
EXTRACTOR CAPTURA 2.8 3-WIRE G32757
|
Facility
|
IP
|
$2,412.00
|
|
| Hospital Charge Code |
2965858
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,229.16 |
| Max. Negotiated Rate |
$2,307.80 |
| Rate for Payer: Aetna Commercial |
$2,257.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,157.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,329.49
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Cigna Commercial |
$2,307.80
|
| Rate for Payer: Health EOS Commercial |
$2,232.55
|
| Rate for Payer: HFN Commercial |
$2,307.80
|
| Rate for Payer: Multiplan Commercial |
$2,006.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,307.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,229.16
|
| Rate for Payer: Quartz Commercial |
$1,505.09
|
| Rate for Payer: WEA Trust Commercial |
$1,379.66
|
| Rate for Payer: WPS Commercial |
$1,857.96
|
|
