|
Interrogation Eval F2F Implant Subq Lead Defib 9326126
|
Professional
|
Both
|
$926.00
|
|
|
Service Code
|
CPT 93261 26
|
| Hospital Charge Code |
5290774
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.94 |
| Max. Negotiated Rate |
$914.89 |
| Rate for Payer: Aetna Commercial |
$914.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$828.21
|
| Rate for Payer: Aetna Managed Medicare |
$35.65
|
| Rate for Payer: Anthem Medicare Advantage |
$35.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.65
|
| Rate for Payer: Cash Price |
$277.80
|
| Rate for Payer: Cash Price |
$277.80
|
| Rate for Payer: Cash Price |
$277.80
|
| Rate for Payer: Cigna Commercial |
$914.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$31.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35.65
|
| Rate for Payer: Health EOS Commercial |
$876.37
|
| Rate for Payer: HFN Commercial |
$914.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$131.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$131.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.65
|
| Rate for Payer: Multiplan Commercial |
$770.43
|
| Rate for Payer: NAPHCARE Commercial |
$53.48
|
| Rate for Payer: Preferred Network Access Commercial |
$914.89
|
| Rate for Payer: Quartz Beloit One Network |
$423.74
|
| Rate for Payer: Quartz Commercial |
$548.93
|
| Rate for Payer: Quartz Medicare Advantage |
$35.65
|
| Rate for Payer: The Alliance Commercial |
$135.47
|
| Rate for Payer: United Healthcare Medicaid |
$31.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.65
|
| Rate for Payer: WEA Trust Commercial |
$529.67
|
| Rate for Payer: WPS Commercial |
$142.60
|
|
|
INTERROG DEV EVAL ICPMS PHYS/QHP IN PERSON
|
Facility
|
IP
|
$565.00
|
|
|
Service Code
|
CPT 93290
|
| Hospital Charge Code |
6182855
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$287.92 |
| Max. Negotiated Rate |
$540.59 |
| Rate for Payer: Aetna Commercial |
$528.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$505.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$311.43
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cigna Commercial |
$540.59
|
| Rate for Payer: Health EOS Commercial |
$522.96
|
| Rate for Payer: HFN Commercial |
$540.59
|
| Rate for Payer: Multiplan Commercial |
$470.08
|
| Rate for Payer: Preferred Network Access Commercial |
$540.59
|
| Rate for Payer: Quartz Beloit One Network |
$287.92
|
| Rate for Payer: Quartz Commercial |
$352.56
|
| Rate for Payer: WEA Trust Commercial |
$323.18
|
| Rate for Payer: WPS Commercial |
$435.22
|
|
|
INTERROG DEV EVAL ICPMS PHYS/QHP IN PERSON
|
Facility
|
OP
|
$565.00
|
|
|
Service Code
|
CPT 93290
|
| Hospital Charge Code |
6182855
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$39.28 |
| Max. Negotiated Rate |
$540.59 |
| Rate for Payer: Aetna Commercial |
$528.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$505.34
|
| Rate for Payer: Aetna Managed Medicare |
$39.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$381.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$293.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$282.05
|
| Rate for Payer: Anthem Medicare Advantage |
$39.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$311.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.28
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cigna Commercial |
$540.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$39.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$328.83
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$39.28
|
| Rate for Payer: Health EOS Commercial |
$522.96
|
| Rate for Payer: HFN Commercial |
$540.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$146.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$39.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$39.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$39.28
|
| Rate for Payer: Multiplan Commercial |
$470.08
|
| Rate for Payer: NAPHCARE Commercial |
$58.92
|
| Rate for Payer: Preferred Network Access Commercial |
$540.59
|
| Rate for Payer: Quartz Beloit One Network |
$287.92
|
| Rate for Payer: Quartz Commercial |
$381.94
|
| Rate for Payer: Quartz Medicare Advantage |
$39.28
|
| Rate for Payer: The Alliance Commercial |
$157.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.28
|
| Rate for Payer: WEA Trust Commercial |
$323.18
|
| Rate for Payer: Wellcare Medicare |
$39.28
|
| Rate for Payer: WPS Commercial |
$435.22
|
|
|
INTERSTIM - REVISION/REMOVAL OF NEUROSTIMULATOR ELECTRODE
|
Facility
|
IP
|
$948.00
|
|
|
Service Code
|
CPT 64585
|
| Hospital Charge Code |
5432918
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$483.10 |
| Max. Negotiated Rate |
$907.05 |
| Rate for Payer: Aetna Commercial |
$887.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$847.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$522.54
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cigna Commercial |
$907.05
|
| Rate for Payer: Health EOS Commercial |
$877.47
|
| Rate for Payer: HFN Commercial |
$907.05
|
| Rate for Payer: Multiplan Commercial |
$788.74
|
| Rate for Payer: Preferred Network Access Commercial |
$907.05
|
| Rate for Payer: Quartz Beloit One Network |
$483.10
|
| Rate for Payer: Quartz Commercial |
$591.55
|
| Rate for Payer: WEA Trust Commercial |
$542.26
|
| Rate for Payer: WPS Commercial |
$730.24
|
|
|
INTERSTIM - REVISION/REMOVAL OF NEUROSTIMULATOR ELECTRODE
|
Facility
|
OP
|
$948.00
|
|
|
Service Code
|
CPT 64585
|
| Hospital Charge Code |
5432918
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$483.10 |
| Max. Negotiated Rate |
$14,717.04 |
| Rate for Payer: Aetna Commercial |
$887.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$847.89
|
| Rate for Payer: Aetna Managed Medicare |
$3,679.26
|
| 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 |
$3,679.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$522.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,679.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,679.26
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cigna Commercial |
$907.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,679.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,679.26
|
| Rate for Payer: Health EOS Commercial |
$877.47
|
| Rate for Payer: HFN Commercial |
$907.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,686.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,679.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,679.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,679.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,679.26
|
| Rate for Payer: Multiplan Commercial |
$788.74
|
| Rate for Payer: NAPHCARE Commercial |
$5,518.89
|
| Rate for Payer: Preferred Network Access Commercial |
$907.05
|
| Rate for Payer: Quartz Beloit One Network |
$483.10
|
| Rate for Payer: Quartz Commercial |
$640.85
|
| Rate for Payer: Quartz Medicare Advantage |
$3,679.26
|
| Rate for Payer: The Alliance Commercial |
$14,717.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,679.26
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: WEA Trust Commercial |
$542.26
|
| Rate for Payer: Wellcare Medicare |
$3,679.26
|
| Rate for Payer: WPS Commercial |
$730.24
|
|
|
INTERSTIM - STAGE 1 - PLACEMENT PERMANENT ELCTRODE
|
Facility
|
IP
|
$1,543.00
|
|
|
Service Code
|
CPT 64581
|
| Hospital Charge Code |
5388685
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$786.31 |
| Max. Negotiated Rate |
$1,476.34 |
| Rate for Payer: Aetna Commercial |
$1,444.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,380.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$850.50
|
| Rate for Payer: Cash Price |
$462.90
|
| Rate for Payer: Cigna Commercial |
$1,476.34
|
| Rate for Payer: Health EOS Commercial |
$1,428.20
|
| Rate for Payer: HFN Commercial |
$1,476.34
|
| Rate for Payer: Multiplan Commercial |
$1,283.78
|
| Rate for Payer: Preferred Network Access Commercial |
$1,476.34
|
| Rate for Payer: Quartz Beloit One Network |
$786.31
|
| Rate for Payer: Quartz Commercial |
$962.83
|
| Rate for Payer: WEA Trust Commercial |
$882.60
|
| Rate for Payer: WPS Commercial |
$1,188.57
|
|
|
INTERSTIM - STAGE 1 - PLACEMENT PERMANENT ELCTRODE
|
Facility
|
OP
|
$1,543.00
|
|
|
Service Code
|
CPT 64581
|
| Hospital Charge Code |
5388685
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$786.31 |
| Max. Negotiated Rate |
$26,827.47 |
| Rate for Payer: Aetna Commercial |
$1,444.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,380.06
|
| Rate for Payer: Aetna Managed Medicare |
$6,706.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,394.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,394.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,919.20
|
| Rate for Payer: Anthem Medicare Advantage |
$6,706.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$850.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,706.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,706.87
|
| Rate for Payer: Cash Price |
$462.90
|
| Rate for Payer: Cash Price |
$462.90
|
| Rate for Payer: Cash Price |
$462.90
|
| Rate for Payer: Cigna Commercial |
$1,476.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,706.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,706.87
|
| Rate for Payer: Health EOS Commercial |
$1,428.20
|
| Rate for Payer: HFN Commercial |
$1,476.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24,949.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,706.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,706.87
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,706.87
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,706.87
|
| Rate for Payer: Multiplan Commercial |
$1,283.78
|
| Rate for Payer: NAPHCARE Commercial |
$10,060.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,476.34
|
| Rate for Payer: Quartz Beloit One Network |
$786.31
|
| Rate for Payer: Quartz Commercial |
$1,043.07
|
| Rate for Payer: Quartz Medicare Advantage |
$6,706.87
|
| Rate for Payer: The Alliance Commercial |
$26,827.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,706.87
|
| Rate for Payer: United Healthcare PPO |
$9,979.84
|
| Rate for Payer: WEA Trust Commercial |
$882.60
|
| Rate for Payer: Wellcare Medicare |
$6,706.87
|
| Rate for Payer: WPS Commercial |
$1,188.57
|
|
|
INTERSTIM - STAGE 2 - PLACEMENT PERMANENT NEUROSTIMULATOR
|
Facility
|
OP
|
$6,034.00
|
|
|
Service Code
|
CPT 64590
|
| Hospital Charge Code |
5375879
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,074.93 |
| Max. Negotiated Rate |
$81,665.88 |
| Rate for Payer: Aetna Commercial |
$5,647.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,396.81
|
| Rate for Payer: Aetna Managed Medicare |
$20,416.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20,607.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,113.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18,158.40
|
| Rate for Payer: Anthem Medicare Advantage |
$20,416.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,325.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20,416.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20,416.47
|
| Rate for Payer: Cash Price |
$1,810.20
|
| Rate for Payer: Cash Price |
$1,810.20
|
| Rate for Payer: Cash Price |
$1,810.20
|
| Rate for Payer: Cigna Commercial |
$5,773.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$20,416.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$20,416.47
|
| Rate for Payer: Health EOS Commercial |
$5,585.07
|
| Rate for Payer: HFN Commercial |
$5,773.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$75,949.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20,416.47
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20,416.47
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$20,416.47
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$20,416.47
|
| Rate for Payer: Multiplan Commercial |
$5,020.29
|
| Rate for Payer: NAPHCARE Commercial |
$30,624.70
|
| Rate for Payer: Preferred Network Access Commercial |
$5,773.33
|
| Rate for Payer: Quartz Beloit One Network |
$3,074.93
|
| Rate for Payer: Quartz Commercial |
$4,078.98
|
| Rate for Payer: Quartz Medicare Advantage |
$20,416.47
|
| Rate for Payer: The Alliance Commercial |
$81,665.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20,416.47
|
| Rate for Payer: United Healthcare PPO |
$11,521.12
|
| Rate for Payer: WEA Trust Commercial |
$3,451.45
|
| Rate for Payer: Wellcare Medicare |
$20,416.47
|
| Rate for Payer: WPS Commercial |
$4,647.99
|
|
|
INTERSTIM - STAGE 2 - PLACEMENT PERMANENT NEUROSTIMULATOR
|
Facility
|
IP
|
$6,034.00
|
|
|
Service Code
|
CPT 64590
|
| Hospital Charge Code |
5375879
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,074.93 |
| Max. Negotiated Rate |
$5,773.33 |
| Rate for Payer: Aetna Commercial |
$5,647.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,396.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,325.94
|
| Rate for Payer: Cash Price |
$1,810.20
|
| Rate for Payer: Cigna Commercial |
$5,773.33
|
| Rate for Payer: Health EOS Commercial |
$5,585.07
|
| Rate for Payer: HFN Commercial |
$5,773.33
|
| Rate for Payer: Multiplan Commercial |
$5,020.29
|
| Rate for Payer: Preferred Network Access Commercial |
$5,773.33
|
| Rate for Payer: Quartz Beloit One Network |
$3,074.93
|
| Rate for Payer: Quartz Commercial |
$3,765.22
|
| Rate for Payer: WEA Trust Commercial |
$3,451.45
|
| Rate for Payer: WPS Commercial |
$4,647.99
|
|
|
INTERSTIM - TEST PHASE
|
Facility
|
OP
|
$1,258.00
|
|
|
Service Code
|
CPT 64561
|
| Hospital Charge Code |
5375878
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$641.08 |
| Max. Negotiated Rate |
$26,827.47 |
| Rate for Payer: Aetna Commercial |
$1,177.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,125.16
|
| Rate for Payer: Aetna Managed Medicare |
$6,706.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,394.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,394.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,919.20
|
| Rate for Payer: Anthem Medicare Advantage |
$6,706.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$693.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,706.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,706.87
|
| Rate for Payer: Cash Price |
$377.40
|
| Rate for Payer: Cash Price |
$377.40
|
| Rate for Payer: Cash Price |
$377.40
|
| Rate for Payer: Cigna Commercial |
$1,203.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,706.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,706.87
|
| Rate for Payer: Health EOS Commercial |
$1,164.40
|
| Rate for Payer: HFN Commercial |
$1,203.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24,949.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,706.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,706.87
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,706.87
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,706.87
|
| Rate for Payer: Multiplan Commercial |
$1,046.66
|
| Rate for Payer: NAPHCARE Commercial |
$10,060.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,203.65
|
| Rate for Payer: Quartz Beloit One Network |
$641.08
|
| Rate for Payer: Quartz Commercial |
$850.41
|
| Rate for Payer: Quartz Medicare Advantage |
$6,706.87
|
| Rate for Payer: The Alliance Commercial |
$26,827.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,706.87
|
| Rate for Payer: United Healthcare PPO |
$9,979.84
|
| Rate for Payer: WEA Trust Commercial |
$719.58
|
| Rate for Payer: Wellcare Medicare |
$6,706.87
|
| Rate for Payer: WPS Commercial |
$969.04
|
|
|
INTERSTIM - TEST PHASE
|
Facility
|
IP
|
$1,258.00
|
|
|
Service Code
|
CPT 64561
|
| Hospital Charge Code |
5375878
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$641.08 |
| Max. Negotiated Rate |
$1,203.65 |
| Rate for Payer: Aetna Commercial |
$1,177.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,125.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$693.41
|
| Rate for Payer: Cash Price |
$377.40
|
| Rate for Payer: Cigna Commercial |
$1,203.65
|
| Rate for Payer: Health EOS Commercial |
$1,164.40
|
| Rate for Payer: HFN Commercial |
$1,203.65
|
| Rate for Payer: Multiplan Commercial |
$1,046.66
|
| Rate for Payer: Preferred Network Access Commercial |
$1,203.65
|
| Rate for Payer: Quartz Beloit One Network |
$641.08
|
| Rate for Payer: Quartz Commercial |
$784.99
|
| Rate for Payer: WEA Trust Commercial |
$719.58
|
| Rate for Payer: WPS Commercial |
$969.04
|
|
|
INTERSTITIAL AND ALVEOLAR LUNG DIAGNOSES
|
Facility
|
OP
|
$121.86
|
|
|
Service Code
|
EAPG 00582
|
| Min. Negotiated Rate |
$117.17 |
| Max. Negotiated Rate |
$121.86 |
| Rate for Payer: Anthem Medicaid |
$117.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$117.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$117.17
|
| Rate for Payer: Dean Health Medicaid |
$117.17
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$117.17
|
| Rate for Payer: Managed Health Services Medicaid |
$121.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$117.17
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$117.17
|
| Rate for Payer: United Healthcare Medicaid |
$117.17
|
|
|
INTERSTITIAL AND ALVEOLAR LUNG DISEASES
|
Facility
|
IP
|
$6,050.13
|
|
|
Service Code
|
APR-DRG 1421
|
| Min. Negotiated Rate |
$5,374.11 |
| Max. Negotiated Rate |
$6,050.13 |
| Rate for Payer: Anthem Medicaid |
$5,793.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$5,793.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,793.34
|
| Rate for Payer: Dean Health Medicaid |
$5,793.34
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5,374.11
|
| Rate for Payer: Managed Health Services Medicaid |
$6,050.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,793.34
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5,793.34
|
| Rate for Payer: United Healthcare Medicaid |
$5,793.34
|
|
|
INTERSTITIAL AND ALVEOLAR LUNG DISEASES
|
Facility
|
IP
|
$11,837.22
|
|
|
Service Code
|
APR-DRG 1423
|
| Min. Negotiated Rate |
$10,514.56 |
| Max. Negotiated Rate |
$11,837.22 |
| Rate for Payer: Anthem Medicaid |
$11,334.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$11,334.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11,334.79
|
| Rate for Payer: Dean Health Medicaid |
$11,334.79
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$10,514.56
|
| Rate for Payer: Managed Health Services Medicaid |
$11,837.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,334.79
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11,334.79
|
| Rate for Payer: United Healthcare Medicaid |
$11,334.79
|
|
|
INTERSTITIAL AND ALVEOLAR LUNG DISEASES
|
Facility
|
IP
|
$7,803.80
|
|
|
Service Code
|
APR-DRG 1422
|
| Min. Negotiated Rate |
$6,931.82 |
| Max. Negotiated Rate |
$7,803.80 |
| Rate for Payer: Anthem Medicaid |
$7,472.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$7,472.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7,472.56
|
| Rate for Payer: Dean Health Medicaid |
$7,472.56
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6,931.82
|
| Rate for Payer: Managed Health Services Medicaid |
$7,803.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,472.56
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$7,472.56
|
| Rate for Payer: United Healthcare Medicaid |
$7,472.56
|
|
|
INTERSTITIAL AND ALVEOLAR LUNG DISEASES
|
Facility
|
IP
|
$18,413.45
|
|
|
Service Code
|
APR-DRG 1424
|
| Min. Negotiated Rate |
$16,355.98 |
| Max. Negotiated Rate |
$18,413.45 |
| Rate for Payer: Anthem Medicaid |
$17,631.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$17,631.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17,631.89
|
| Rate for Payer: Dean Health Medicaid |
$17,631.89
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$16,355.98
|
| Rate for Payer: Managed Health Services Medicaid |
$18,413.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$17,631.89
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17,631.89
|
| Rate for Payer: United Healthcare Medicaid |
$17,631.89
|
|
|
INTERSTITIAL LUNG DISEASE WITH CC
|
Facility
|
IP
|
$27,913.60
|
|
|
Service Code
|
MSDRG 197
|
| Min. Negotiated Rate |
$7,775.18 |
| Max. Negotiated Rate |
$27,913.60 |
| Rate for Payer: Aetna Managed Medicare |
$7,775.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20,708.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15,872.98
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,080.36
|
| Rate for Payer: Anthem Medicare Advantage |
$7,775.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,775.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,775.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,775.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16,740.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,775.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,229.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,775.18
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,775.18
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,775.18
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,775.18
|
| Rate for Payer: NAPHCARE Commercial |
$11,662.76
|
| Rate for Payer: Quartz Medicare Advantage |
$7,775.18
|
| Rate for Payer: The Alliance Commercial |
$27,913.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,775.18
|
| Rate for Payer: United Healthcare PPO |
$15,748.77
|
| Rate for Payer: Wellcare Medicare |
$7,775.18
|
|
|
INTERSTITIAL LUNG DISEASE WITH MCC
|
Facility
|
IP
|
$52,739.44
|
|
|
Service Code
|
MSDRG 196
|
| Min. Negotiated Rate |
$14,959.33 |
| Max. Negotiated Rate |
$52,739.44 |
| Rate for Payer: Aetna Managed Medicare |
$14,959.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$41,177.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31,561.99
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29,985.95
|
| Rate for Payer: Anthem Medicare Advantage |
$14,959.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14,959.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14,959.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14,959.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33,287.15
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14,959.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$38,438.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14,959.33
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14,959.33
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14,959.33
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14,959.33
|
| Rate for Payer: NAPHCARE Commercial |
$22,438.99
|
| Rate for Payer: Quartz Medicare Advantage |
$14,959.33
|
| Rate for Payer: The Alliance Commercial |
$52,739.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14,959.33
|
| Rate for Payer: United Healthcare PPO |
$29,925.03
|
| Rate for Payer: Wellcare Medicare |
$14,959.33
|
|
|
INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC
|
Facility
|
IP
|
$21,850.40
|
|
|
Service Code
|
MSDRG 198
|
| Min. Negotiated Rate |
$5,991.59 |
| Max. Negotiated Rate |
$21,850.40 |
| Rate for Payer: Aetna Managed Medicare |
$5,991.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,626.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,977.90
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,379.79
|
| Rate for Payer: Anthem Medicare Advantage |
$5,991.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,991.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,991.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,991.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,632.61
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,991.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,781.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,991.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,991.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,991.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,991.59
|
| Rate for Payer: NAPHCARE Commercial |
$8,987.38
|
| Rate for Payer: Quartz Medicare Advantage |
$5,991.59
|
| Rate for Payer: The Alliance Commercial |
$21,850.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,991.59
|
| Rate for Payer: United Healthcare PPO |
$12,286.40
|
| Rate for Payer: Wellcare Medicare |
$5,991.59
|
|
|
INTESTINAL OBSTRUCTION
|
Facility
|
IP
|
$4,296.47
|
|
|
Service Code
|
APR-DRG 2471
|
| Min. Negotiated Rate |
$3,816.39 |
| Max. Negotiated Rate |
$4,296.47 |
| Rate for Payer: Anthem Medicaid |
$4,114.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$4,114.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,114.11
|
| Rate for Payer: Dean Health Medicaid |
$4,114.11
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$3,816.39
|
| Rate for Payer: Managed Health Services Medicaid |
$4,296.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,114.11
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4,114.11
|
| Rate for Payer: United Healthcare Medicaid |
$4,114.11
|
|
|
INTESTINAL OBSTRUCTION
|
Facility
|
IP
|
$9,119.04
|
|
|
Service Code
|
APR-DRG 2473
|
| Min. Negotiated Rate |
$8,100.10 |
| Max. Negotiated Rate |
$9,119.04 |
| Rate for Payer: Anthem Medicaid |
$8,731.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$8,731.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8,731.99
|
| Rate for Payer: Dean Health Medicaid |
$8,731.99
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8,100.10
|
| Rate for Payer: Managed Health Services Medicaid |
$9,119.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,731.99
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8,731.99
|
| Rate for Payer: United Healthcare Medicaid |
$8,731.99
|
|
|
INTESTINAL OBSTRUCTION
|
Facility
|
IP
|
$5,699.40
|
|
|
Service Code
|
APR-DRG 2472
|
| Min. Negotiated Rate |
$5,062.56 |
| Max. Negotiated Rate |
$5,699.40 |
| Rate for Payer: Anthem Medicaid |
$5,457.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$5,457.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,457.49
|
| Rate for Payer: Dean Health Medicaid |
$5,457.49
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5,062.56
|
| Rate for Payer: Managed Health Services Medicaid |
$5,699.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,457.49
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5,457.49
|
| Rate for Payer: United Healthcare Medicaid |
$5,457.49
|
|
|
INTESTINAL OBSTRUCTION
|
Facility
|
IP
|
$16,396.74
|
|
|
Service Code
|
APR-DRG 2474
|
| Min. Negotiated Rate |
$14,564.61 |
| Max. Negotiated Rate |
$16,396.74 |
| Rate for Payer: Anthem Medicaid |
$15,700.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$15,700.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15,700.78
|
| Rate for Payer: Dean Health Medicaid |
$15,700.78
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14,564.61
|
| Rate for Payer: Managed Health Services Medicaid |
$16,396.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$15,700.78
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$15,700.78
|
| Rate for Payer: United Healthcare Medicaid |
$15,700.78
|
|
|
INTESTINAL OBSTRUCTION DIAGNOSES
|
Facility
|
OP
|
$98.27
|
|
|
Service Code
|
EAPG 00618
|
| Min. Negotiated Rate |
$94.49 |
| Max. Negotiated Rate |
$98.27 |
| Rate for Payer: Anthem Medicaid |
$94.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$94.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$94.49
|
| Rate for Payer: Dean Health Medicaid |
$94.49
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$94.49
|
| Rate for Payer: Managed Health Services Medicaid |
$98.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$94.49
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$94.49
|
| Rate for Payer: United Healthcare Medicaid |
$94.49
|
|
|
Int Peritoneal Dialysis
|
Facility
|
OP
|
$2,653.00
|
|
| Hospital Charge Code |
3603562
|
|
Hospital Revenue Code
|
831
|
| Min. Negotiated Rate |
$566.80 |
| Max. Negotiated Rate |
$2,538.39 |
| Rate for Payer: Aetna Commercial |
$2,483.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,372.84
|
| Rate for Payer: Aetna Managed Medicare |
$772.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$726.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$596.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$566.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,462.33
|
| Rate for Payer: Cash Price |
$795.90
|
| Rate for Payer: Cash Price |
$795.90
|
| Rate for Payer: Cigna Commercial |
$2,538.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,544.05
|
| Rate for Payer: Health EOS Commercial |
$2,455.62
|
| Rate for Payer: HFN Commercial |
$2,538.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,069.34
|
| Rate for Payer: Multiplan Commercial |
$2,207.30
|
| Rate for Payer: NAPHCARE Commercial |
$1,655.47
|
| Rate for Payer: Preferred Network Access Commercial |
$2,538.39
|
| Rate for Payer: Quartz Beloit One Network |
$1,351.97
|
| Rate for Payer: Quartz Commercial |
$1,793.43
|
| Rate for Payer: Quartz Medicare Advantage |
$1,655.47
|
| Rate for Payer: The Alliance Commercial |
$1,379.56
|
| Rate for Payer: United Healthcare PPO |
$2,069.34
|
| Rate for Payer: WEA Trust Commercial |
$1,517.52
|
| Rate for Payer: WPS Commercial |
$2,043.61
|
|
