|
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 |
$46.73 |
| Max. Negotiated Rate |
$879.70 |
| Rate for Payer: Aetna Commercial |
$879.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$796.36
|
| 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 |
$879.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$46.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$555.60
|
| Rate for Payer: Health EOS Commercial |
$842.66
|
| Rate for Payer: HFN Commercial |
$879.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$126.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$126.69
|
| Rate for Payer: Multiplan Commercial |
$740.80
|
| Rate for Payer: Preferred Network Access Commercial |
$879.70
|
| Rate for Payer: Quartz Beloit One Network |
$407.44
|
| Rate for Payer: Quartz Commercial |
$527.82
|
| Rate for Payer: The Alliance Commercial |
$463.00
|
| Rate for Payer: United Healthcare Medicaid |
$46.73
|
| Rate for Payer: WEA Trust Commercial |
$509.30
|
| Rate for Payer: WPS Commercial |
$685.89
|
|
|
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 |
$37.27 |
| Max. Negotiated Rate |
$519.80 |
| Rate for Payer: Aetna Commercial |
$508.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$485.90
|
| Rate for Payer: Aetna Managed Medicare |
$37.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$367.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$282.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$271.20
|
| Rate for Payer: Anthem Medicare Advantage |
$37.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$299.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$37.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$37.27
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cigna Commercial |
$519.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$37.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$316.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$37.27
|
| Rate for Payer: Health EOS Commercial |
$502.85
|
| Rate for Payer: HFN Commercial |
$519.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$138.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$37.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$37.27
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$37.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$37.27
|
| Rate for Payer: Multiplan Commercial |
$452.00
|
| Rate for Payer: NAPHCARE Commercial |
$55.90
|
| Rate for Payer: Preferred Network Access Commercial |
$519.80
|
| Rate for Payer: Quartz Beloit One Network |
$276.85
|
| Rate for Payer: Quartz Commercial |
$367.25
|
| Rate for Payer: Quartz Medicare Advantage |
$37.27
|
| Rate for Payer: The Alliance Commercial |
$149.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.27
|
| Rate for Payer: WEA Trust Commercial |
$310.75
|
| Rate for Payer: Wellcare Medicare |
$37.27
|
| Rate for Payer: WPS Commercial |
$418.50
|
|
|
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 |
$276.85 |
| Max. Negotiated Rate |
$519.80 |
| Rate for Payer: Aetna Commercial |
$508.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$485.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$299.45
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cigna Commercial |
$519.80
|
| Rate for Payer: Health EOS Commercial |
$502.85
|
| Rate for Payer: HFN Commercial |
$519.80
|
| Rate for Payer: Multiplan Commercial |
$452.00
|
| Rate for Payer: NAPHCARE Commercial |
$339.00
|
| Rate for Payer: Preferred Network Access Commercial |
$519.80
|
| Rate for Payer: Quartz Beloit One Network |
$276.85
|
| Rate for Payer: Quartz Commercial |
$339.00
|
| Rate for Payer: WEA Trust Commercial |
$310.75
|
| Rate for Payer: WPS Commercial |
$418.50
|
|
|
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 |
$464.52 |
| Max. Negotiated Rate |
$13,452.32 |
| Rate for Payer: Aetna Commercial |
$853.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$815.28
|
| Rate for Payer: Aetna Managed Medicare |
$3,363.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,363.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$502.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,363.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,363.08
|
| 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 |
$872.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,363.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,363.08
|
| Rate for Payer: Health EOS Commercial |
$843.72
|
| Rate for Payer: HFN Commercial |
$872.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,510.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,363.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,363.08
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,363.08
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,363.08
|
| Rate for Payer: Multiplan Commercial |
$758.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,044.62
|
| Rate for Payer: Preferred Network Access Commercial |
$872.16
|
| Rate for Payer: Quartz Beloit One Network |
$464.52
|
| Rate for Payer: Quartz Commercial |
$616.20
|
| Rate for Payer: Quartz Medicare Advantage |
$3,363.08
|
| Rate for Payer: The Alliance Commercial |
$13,452.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,363.08
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: WEA Trust Commercial |
$521.40
|
| Rate for Payer: Wellcare Medicare |
$3,363.08
|
| Rate for Payer: WPS Commercial |
$702.18
|
|
|
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 |
$464.52 |
| Max. Negotiated Rate |
$872.16 |
| Rate for Payer: Aetna Commercial |
$853.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$815.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$502.44
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cigna Commercial |
$872.16
|
| Rate for Payer: Health EOS Commercial |
$843.72
|
| Rate for Payer: HFN Commercial |
$872.16
|
| Rate for Payer: Multiplan Commercial |
$758.40
|
| Rate for Payer: NAPHCARE Commercial |
$568.80
|
| Rate for Payer: Preferred Network Access Commercial |
$872.16
|
| Rate for Payer: Quartz Beloit One Network |
$464.52
|
| Rate for Payer: Quartz Commercial |
$568.80
|
| Rate for Payer: WEA Trust Commercial |
$521.40
|
| Rate for Payer: WPS Commercial |
$702.18
|
|
|
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 |
$756.07 |
| Max. Negotiated Rate |
$27,039.44 |
| Rate for Payer: Aetna Commercial |
$1,388.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,326.98
|
| Rate for Payer: Aetna Managed Medicare |
$6,759.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,649.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,649.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,230.00
|
| Rate for Payer: Anthem Medicare Advantage |
$6,759.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$817.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,759.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,759.86
|
| 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 |
$1,419.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,759.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,759.86
|
| Rate for Payer: Health EOS Commercial |
$1,373.27
|
| Rate for Payer: HFN Commercial |
$1,419.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25,146.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,759.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,759.86
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,759.86
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,759.86
|
| Rate for Payer: Multiplan Commercial |
$1,234.40
|
| Rate for Payer: NAPHCARE Commercial |
$10,139.79
|
| Rate for Payer: Preferred Network Access Commercial |
$1,419.56
|
| Rate for Payer: Quartz Beloit One Network |
$756.07
|
| Rate for Payer: Quartz Commercial |
$1,002.95
|
| Rate for Payer: Quartz Medicare Advantage |
$6,759.86
|
| Rate for Payer: The Alliance Commercial |
$27,039.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,759.86
|
| Rate for Payer: United Healthcare PPO |
$9,596.00
|
| Rate for Payer: WEA Trust Commercial |
$848.65
|
| Rate for Payer: Wellcare Medicare |
$6,759.86
|
| Rate for Payer: WPS Commercial |
$1,142.90
|
|
|
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 |
$756.07 |
| Max. Negotiated Rate |
$1,419.56 |
| Rate for Payer: Aetna Commercial |
$1,388.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,326.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$817.79
|
| Rate for Payer: Cash Price |
$462.90
|
| Rate for Payer: Cigna Commercial |
$1,419.56
|
| Rate for Payer: Health EOS Commercial |
$1,373.27
|
| Rate for Payer: HFN Commercial |
$1,419.56
|
| Rate for Payer: Multiplan Commercial |
$1,234.40
|
| Rate for Payer: NAPHCARE Commercial |
$925.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,419.56
|
| Rate for Payer: Quartz Beloit One Network |
$756.07
|
| Rate for Payer: Quartz Commercial |
$925.80
|
| Rate for Payer: WEA Trust Commercial |
$848.65
|
| Rate for Payer: WPS Commercial |
$1,142.90
|
|
|
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 |
$2,956.66 |
| Max. Negotiated Rate |
$5,551.28 |
| Rate for Payer: Aetna Commercial |
$5,430.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,189.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,198.02
|
| Rate for Payer: Cash Price |
$1,810.20
|
| Rate for Payer: Cigna Commercial |
$5,551.28
|
| Rate for Payer: Health EOS Commercial |
$5,370.26
|
| Rate for Payer: HFN Commercial |
$5,551.28
|
| Rate for Payer: Multiplan Commercial |
$4,827.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,620.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,551.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,956.66
|
| Rate for Payer: Quartz Commercial |
$3,620.40
|
| Rate for Payer: WEA Trust Commercial |
$3,318.70
|
| Rate for Payer: WPS Commercial |
$4,469.38
|
|
|
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 |
$2,956.66 |
| Max. Negotiated Rate |
$86,487.80 |
| Rate for Payer: Aetna Commercial |
$5,430.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,189.24
|
| Rate for Payer: Aetna Managed Medicare |
$21,621.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,815.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,378.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,460.00
|
| Rate for Payer: Anthem Medicare Advantage |
$21,621.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,198.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21,621.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21,621.95
|
| 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 |
$5,551.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$21,621.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$21,621.95
|
| Rate for Payer: Health EOS Commercial |
$5,370.26
|
| Rate for Payer: HFN Commercial |
$5,551.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80,433.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21,621.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21,621.95
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$21,621.95
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$21,621.95
|
| Rate for Payer: Multiplan Commercial |
$4,827.20
|
| Rate for Payer: NAPHCARE Commercial |
$32,432.92
|
| Rate for Payer: Preferred Network Access Commercial |
$5,551.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,956.66
|
| Rate for Payer: Quartz Commercial |
$3,922.10
|
| Rate for Payer: Quartz Medicare Advantage |
$21,621.95
|
| Rate for Payer: The Alliance Commercial |
$86,487.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21,621.95
|
| Rate for Payer: United Healthcare PPO |
$11,078.00
|
| Rate for Payer: WEA Trust Commercial |
$3,318.70
|
| Rate for Payer: Wellcare Medicare |
$21,621.95
|
| Rate for Payer: WPS Commercial |
$4,469.38
|
|
|
INTERSTIM - TEST PHASE
|
Facility
|
OP
|
$1,258.00
|
|
|
Service Code
|
CPT 64561
|
| Hospital Charge Code |
5375878
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$616.42 |
| Max. Negotiated Rate |
$27,039.44 |
| Rate for Payer: Aetna Commercial |
$1,132.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,081.88
|
| Rate for Payer: Aetna Managed Medicare |
$6,759.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,649.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,649.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,230.00
|
| Rate for Payer: Anthem Medicare Advantage |
$6,759.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$666.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,759.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,759.86
|
| 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 |
$1,157.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,759.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,759.86
|
| Rate for Payer: Health EOS Commercial |
$1,119.62
|
| Rate for Payer: HFN Commercial |
$1,157.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25,146.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,759.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,759.86
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,759.86
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,759.86
|
| Rate for Payer: Multiplan Commercial |
$1,006.40
|
| Rate for Payer: NAPHCARE Commercial |
$10,139.79
|
| Rate for Payer: Preferred Network Access Commercial |
$1,157.36
|
| Rate for Payer: Quartz Beloit One Network |
$616.42
|
| Rate for Payer: Quartz Commercial |
$817.70
|
| Rate for Payer: Quartz Medicare Advantage |
$6,759.86
|
| Rate for Payer: The Alliance Commercial |
$27,039.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,759.86
|
| Rate for Payer: United Healthcare PPO |
$9,596.00
|
| Rate for Payer: WEA Trust Commercial |
$691.90
|
| Rate for Payer: Wellcare Medicare |
$6,759.86
|
| Rate for Payer: WPS Commercial |
$931.80
|
|
|
INTERSTIM - TEST PHASE
|
Facility
|
IP
|
$1,258.00
|
|
|
Service Code
|
CPT 64561
|
| Hospital Charge Code |
5375878
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$616.42 |
| Max. Negotiated Rate |
$1,157.36 |
| Rate for Payer: Aetna Commercial |
$1,132.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,081.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$666.74
|
| Rate for Payer: Cash Price |
$377.40
|
| Rate for Payer: Cigna Commercial |
$1,157.36
|
| Rate for Payer: Health EOS Commercial |
$1,119.62
|
| Rate for Payer: HFN Commercial |
$1,157.36
|
| Rate for Payer: Multiplan Commercial |
$1,006.40
|
| Rate for Payer: NAPHCARE Commercial |
$754.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,157.36
|
| Rate for Payer: Quartz Beloit One Network |
$616.42
|
| Rate for Payer: Quartz Commercial |
$754.80
|
| Rate for Payer: WEA Trust Commercial |
$691.90
|
| Rate for Payer: WPS Commercial |
$931.80
|
|
|
INTERSTITIAL LUNG DISEASE WITH CC
|
Facility
|
IP
|
$26,840.00
|
|
|
Service Code
|
MSDRG 197
|
| Min. Negotiated Rate |
$9,654.66 |
| Max. Negotiated Rate |
$26,840.00 |
| Rate for Payer: Aetna Managed Medicare |
$9,654.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20,980.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,081.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,278.00
|
| Rate for Payer: Anthem Medicare Advantage |
$9,654.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,654.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,654.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,654.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16,959.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,654.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19,451.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,654.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9,654.66
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9,654.66
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,654.66
|
| Rate for Payer: NAPHCARE Commercial |
$14,481.99
|
| Rate for Payer: Quartz Medicare Advantage |
$9,654.66
|
| Rate for Payer: The Alliance Commercial |
$26,840.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,654.66
|
| Rate for Payer: United Healthcare PPO |
$15,143.05
|
| Rate for Payer: Wellcare Medicare |
$9,654.66
|
|
|
INTERSTITIAL LUNG DISEASE WITH MCC
|
Facility
|
IP
|
$50,711.00
|
|
|
Service Code
|
MSDRG 196
|
| Min. Negotiated Rate |
$18,241.54 |
| Max. Negotiated Rate |
$50,711.00 |
| Rate for Payer: Aetna Managed Medicare |
$18,241.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39,862.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30,553.90
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29,028.20
|
| Rate for Payer: Anthem Medicare Advantage |
$18,241.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18,241.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18,241.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18,241.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32,223.96
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18,241.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36,960.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18,241.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18,241.54
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18,241.54
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18,241.54
|
| Rate for Payer: NAPHCARE Commercial |
$27,362.31
|
| Rate for Payer: Quartz Medicare Advantage |
$18,241.54
|
| Rate for Payer: The Alliance Commercial |
$50,711.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18,241.54
|
| Rate for Payer: United Healthcare PPO |
$28,774.07
|
| Rate for Payer: Wellcare Medicare |
$18,241.54
|
|
|
INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC
|
Facility
|
IP
|
$21,010.00
|
|
|
Service Code
|
MSDRG 198
|
| Min. Negotiated Rate |
$7,557.42 |
| Max. Negotiated Rate |
$21,010.00 |
| Rate for Payer: Aetna Managed Medicare |
$7,557.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,364.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,543.18
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,916.84
|
| Rate for Payer: Anthem Medicare Advantage |
$7,557.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,557.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,557.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,557.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13,228.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,557.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,174.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,557.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,557.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,557.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,557.42
|
| Rate for Payer: NAPHCARE Commercial |
$11,336.13
|
| Rate for Payer: Quartz Medicare Advantage |
$7,557.42
|
| Rate for Payer: The Alliance Commercial |
$21,010.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,557.42
|
| Rate for Payer: United Healthcare PPO |
$11,813.85
|
| Rate for Payer: Wellcare Medicare |
$7,557.42
|
|
|
Int Peritoneal Dialysis
|
Facility
|
IP
|
$2,653.00
|
|
| Hospital Charge Code |
3603562
|
|
Hospital Revenue Code
|
831
|
| Min. Negotiated Rate |
$1,299.97 |
| Max. Negotiated Rate |
$2,440.76 |
| Rate for Payer: Aetna Commercial |
$2,387.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,281.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,406.09
|
| Rate for Payer: Cash Price |
$795.90
|
| Rate for Payer: Cigna Commercial |
$2,440.76
|
| Rate for Payer: Health EOS Commercial |
$2,361.17
|
| Rate for Payer: HFN Commercial |
$2,440.76
|
| Rate for Payer: Multiplan Commercial |
$2,122.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,591.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,440.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,299.97
|
| Rate for Payer: Quartz Commercial |
$1,591.80
|
| Rate for Payer: WEA Trust Commercial |
$1,459.15
|
| Rate for Payer: WPS Commercial |
$1,965.08
|
|
|
Int Peritoneal Dialysis
|
Facility
|
OP
|
$2,653.00
|
|
| Hospital Charge Code |
3603562
|
|
Hospital Revenue Code
|
831
|
| Min. Negotiated Rate |
$545.00 |
| Max. Negotiated Rate |
$10,612.00 |
| Rate for Payer: Aetna Commercial |
$2,387.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,281.58
|
| Rate for Payer: Aetna Managed Medicare |
$742.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$699.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$574.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$545.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,406.09
|
| Rate for Payer: Cash Price |
$795.90
|
| Rate for Payer: Cash Price |
$795.90
|
| Rate for Payer: Cigna Commercial |
$2,440.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,484.62
|
| Rate for Payer: Health EOS Commercial |
$2,361.17
|
| Rate for Payer: HFN Commercial |
$2,440.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,989.75
|
| Rate for Payer: Multiplan Commercial |
$2,122.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,591.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,440.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,299.97
|
| Rate for Payer: Quartz Commercial |
$1,724.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,591.80
|
| Rate for Payer: The Alliance Commercial |
$10,612.00
|
| Rate for Payer: United Healthcare PPO |
$1,989.75
|
| Rate for Payer: WEA Trust Commercial |
$1,459.15
|
| Rate for Payer: WPS Commercial |
$1,965.08
|
|
|
(Intra)Abdominal Pressure (AP)
|
Facility
|
IP
|
$439.00
|
|
|
Service Code
|
CPT 51797
|
| Hospital Charge Code |
3005557
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$215.11 |
| Max. Negotiated Rate |
$403.88 |
| Rate for Payer: Aetna Commercial |
$395.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$377.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$232.67
|
| Rate for Payer: Cash Price |
$131.70
|
| Rate for Payer: Cigna Commercial |
$403.88
|
| Rate for Payer: Health EOS Commercial |
$390.71
|
| Rate for Payer: HFN Commercial |
$403.88
|
| Rate for Payer: Multiplan Commercial |
$351.20
|
| Rate for Payer: NAPHCARE Commercial |
$263.40
|
| Rate for Payer: Preferred Network Access Commercial |
$403.88
|
| Rate for Payer: Quartz Beloit One Network |
$215.11
|
| Rate for Payer: Quartz Commercial |
$263.40
|
| Rate for Payer: WEA Trust Commercial |
$241.45
|
| Rate for Payer: WPS Commercial |
$325.17
|
|
|
(Intra)Abdominal Pressure (AP)
|
Facility
|
OP
|
$439.00
|
|
|
Service Code
|
CPT 51797
|
| Hospital Charge Code |
3005557
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$122.92 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$395.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$377.54
|
| Rate for Payer: Aetna Managed Medicare |
$122.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$285.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$219.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$210.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$232.67
|
| Rate for Payer: Cash Price |
$131.70
|
| Rate for Payer: Cash Price |
$131.70
|
| Rate for Payer: Cigna Commercial |
$403.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Health EOS Commercial |
$390.71
|
| Rate for Payer: HFN Commercial |
$403.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$329.25
|
| Rate for Payer: Multiplan Commercial |
$351.20
|
| Rate for Payer: NAPHCARE Commercial |
$263.40
|
| Rate for Payer: Preferred Network Access Commercial |
$403.88
|
| Rate for Payer: Quartz Beloit One Network |
$215.11
|
| Rate for Payer: Quartz Commercial |
$285.35
|
| Rate for Payer: Quartz Medicare Advantage |
$263.40
|
| Rate for Payer: The Alliance Commercial |
$1,756.00
|
| Rate for Payer: United Healthcare PPO |
$329.25
|
| Rate for Payer: WEA Trust Commercial |
$241.45
|
| Rate for Payer: WPS Commercial |
$325.17
|
|
|
INTRA-ATRIAL PACING 93610
|
Professional
|
Both
|
$670.00
|
|
|
Service Code
|
CPT 93610
|
| Hospital Charge Code |
3015419
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$212.28 |
| Max. Negotiated Rate |
$729.19 |
| Rate for Payer: Aetna Commercial |
$636.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$576.20
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cigna Commercial |
$636.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$212.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$402.00
|
| Rate for Payer: Health EOS Commercial |
$609.70
|
| Rate for Payer: HFN Commercial |
$636.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$729.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$729.19
|
| Rate for Payer: Multiplan Commercial |
$536.00
|
| Rate for Payer: Preferred Network Access Commercial |
$636.50
|
| Rate for Payer: Quartz Beloit One Network |
$294.80
|
| Rate for Payer: Quartz Commercial |
$381.90
|
| Rate for Payer: The Alliance Commercial |
$335.00
|
| Rate for Payer: United Healthcare Medicaid |
$212.28
|
| Rate for Payer: WEA Trust Commercial |
$368.50
|
| Rate for Payer: WPS Commercial |
$496.27
|
|
|
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS
|
Facility
|
IP
|
$27,342.00
|
|
|
Service Code
|
MSDRG 065
|
| Min. Negotiated Rate |
$9,835.40 |
| Max. Negotiated Rate |
$27,342.00 |
| Rate for Payer: Aetna Managed Medicare |
$9,835.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21,399.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,402.62
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,583.56
|
| Rate for Payer: Anthem Medicare Advantage |
$9,835.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,835.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,835.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,835.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17,299.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,835.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19,819.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,835.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9,835.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9,835.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,835.40
|
| Rate for Payer: NAPHCARE Commercial |
$14,753.10
|
| Rate for Payer: Quartz Medicare Advantage |
$9,835.40
|
| Rate for Payer: The Alliance Commercial |
$27,342.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,835.40
|
| Rate for Payer: United Healthcare PPO |
$15,429.97
|
| Rate for Payer: Wellcare Medicare |
$9,835.40
|
|
|
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC
|
Facility
|
IP
|
$53,572.00
|
|
|
Service Code
|
MSDRG 064
|
| Min. Negotiated Rate |
$19,270.55 |
| Max. Negotiated Rate |
$53,572.00 |
| Rate for Payer: The Alliance Commercial |
$53,572.00
|
| Rate for Payer: Aetna Managed Medicare |
$19,270.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$41,960.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32,162.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30,556.00
|
| Rate for Payer: Anthem Medicare Advantage |
$19,270.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19,270.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19,270.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19,270.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33,919.96
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19,270.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39,058.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19,270.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19,270.55
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19,270.55
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19,270.55
|
| Rate for Payer: NAPHCARE Commercial |
$28,905.82
|
| Rate for Payer: Quartz Medicare Advantage |
$19,270.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19,270.55
|
| Rate for Payer: United Healthcare PPO |
$30,407.54
|
| Rate for Payer: Wellcare Medicare |
$19,270.55
|
|
|
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC
|
Facility
|
IP
|
$18,598.00
|
|
|
Service Code
|
MSDRG 066
|
| Min. Negotiated Rate |
$6,690.03 |
| Max. Negotiated Rate |
$18,598.00 |
| Rate for Payer: Aetna Managed Medicare |
$6,690.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14,476.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,095.89
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,541.82
|
| Rate for Payer: Anthem Medicare Advantage |
$6,690.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,690.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,690.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,690.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,702.39
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,690.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,406.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,690.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,690.03
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,690.03
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,690.03
|
| Rate for Payer: NAPHCARE Commercial |
$10,035.04
|
| Rate for Payer: Quartz Medicare Advantage |
$6,690.03
|
| Rate for Payer: The Alliance Commercial |
$18,598.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,690.03
|
| Rate for Payer: United Healthcare PPO |
$10,436.94
|
| Rate for Payer: Wellcare Medicare |
$6,690.03
|
|
|
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC
|
Facility
|
IP
|
$163,595.00
|
|
|
Service Code
|
MSDRG 021
|
| Min. Negotiated Rate |
$58,847.28 |
| Max. Negotiated Rate |
$163,595.00 |
| Rate for Payer: Aetna Managed Medicare |
$58,847.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$128,817.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$98,737.34
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$93,806.92
|
| Rate for Payer: Anthem Medicare Advantage |
$58,847.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$58,847.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$58,847.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$58,847.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$104,134.28
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$58,847.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$119,757.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$58,847.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$58,847.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$58,847.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$58,847.28
|
| Rate for Payer: NAPHCARE Commercial |
$88,270.92
|
| Rate for Payer: Quartz Medicare Advantage |
$58,847.28
|
| Rate for Payer: The Alliance Commercial |
$163,595.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$58,847.28
|
| Rate for Payer: United Healthcare PPO |
$93,232.59
|
| Rate for Payer: Wellcare Medicare |
$58,847.28
|
|
|
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC
|
Facility
|
IP
|
$225,036.00
|
|
|
Service Code
|
MSDRG 020
|
| Min. Negotiated Rate |
$80,948.06 |
| Max. Negotiated Rate |
$225,036.00 |
| Rate for Payer: Aetna Managed Medicare |
$80,948.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$177,281.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$135,884.45
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$129,099.10
|
| Rate for Payer: Anthem Medicare Advantage |
$80,948.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$80,948.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$80,948.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$80,948.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$143,311.83
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$80,948.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$164,821.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$80,948.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$80,948.06
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$80,948.06
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$80,948.06
|
| Rate for Payer: NAPHCARE Commercial |
$121,422.09
|
| Rate for Payer: Quartz Medicare Advantage |
$80,948.06
|
| Rate for Payer: The Alliance Commercial |
$225,036.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$80,948.06
|
| Rate for Payer: United Healthcare PPO |
$128,315.88
|
| Rate for Payer: Wellcare Medicare |
$80,948.06
|
|
|
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC
|
Facility
|
IP
|
$104,609.00
|
|
|
Service Code
|
MSDRG 022
|
| Min. Negotiated Rate |
$37,629.19 |
| Max. Negotiated Rate |
$104,609.00 |
| Rate for Payer: Aetna Managed Medicare |
$37,629.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$73,010.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$55,961.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$53,167.44
|
| Rate for Payer: Anthem Medicare Advantage |
$37,629.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$37,629.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$37,629.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$37,629.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$59,020.73
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$37,629.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$67,795.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$37,629.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$37,629.19
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$37,629.19
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$37,629.19
|
| Rate for Payer: NAPHCARE Commercial |
$56,443.78
|
| Rate for Payer: Quartz Medicare Advantage |
$37,629.19
|
| Rate for Payer: The Alliance Commercial |
$104,609.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37,629.19
|
| Rate for Payer: United Healthcare PPO |
$52,779.78
|
| Rate for Payer: Wellcare Medicare |
$37,629.19
|
|
