|
Int Peritoneal Dialysis
|
Facility
|
IP
|
$2,653.00
|
|
| Hospital Charge Code |
3603562
|
|
Hospital Revenue Code
|
831
|
| Min. Negotiated Rate |
$1,351.97 |
| 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: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,462.33
|
| Rate for Payer: Cash Price |
$795.90
|
| Rate for Payer: Cigna Commercial |
$2,538.39
|
| Rate for Payer: Health EOS Commercial |
$2,455.62
|
| Rate for Payer: HFN Commercial |
$2,538.39
|
| Rate for Payer: Multiplan Commercial |
$2,207.30
|
| 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 |
$1,655.47
|
| Rate for Payer: WEA Trust Commercial |
$1,517.52
|
| Rate for Payer: WPS Commercial |
$2,043.61
|
|
|
(Intra)Abdominal Pressure (AP)
|
Facility
|
IP
|
$439.00
|
|
|
Service Code
|
CPT 51797
|
| Hospital Charge Code |
3005557
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$223.71 |
| Max. Negotiated Rate |
$420.04 |
| Rate for Payer: Aetna Commercial |
$410.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$392.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$241.98
|
| Rate for Payer: Cash Price |
$131.70
|
| Rate for Payer: Cigna Commercial |
$420.04
|
| Rate for Payer: Health EOS Commercial |
$406.34
|
| Rate for Payer: HFN Commercial |
$420.04
|
| Rate for Payer: Multiplan Commercial |
$365.25
|
| Rate for Payer: Preferred Network Access Commercial |
$420.04
|
| Rate for Payer: Quartz Beloit One Network |
$223.71
|
| Rate for Payer: Quartz Commercial |
$273.94
|
| Rate for Payer: WEA Trust Commercial |
$251.11
|
| Rate for Payer: WPS Commercial |
$338.16
|
|
|
(Intra)Abdominal Pressure (AP)
|
Facility
|
OP
|
$439.00
|
|
|
Service Code
|
CPT 51797
|
| Hospital Charge Code |
3005557
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$127.84 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$410.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$392.64
|
| Rate for Payer: Aetna Managed Medicare |
$127.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$296.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$228.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$219.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$241.98
|
| Rate for Payer: Cash Price |
$131.70
|
| Rate for Payer: Cash Price |
$131.70
|
| Rate for Payer: Cigna Commercial |
$420.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$406.34
|
| Rate for Payer: HFN Commercial |
$420.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$342.42
|
| Rate for Payer: Multiplan Commercial |
$365.25
|
| Rate for Payer: NAPHCARE Commercial |
$273.94
|
| Rate for Payer: Preferred Network Access Commercial |
$420.04
|
| Rate for Payer: Quartz Beloit One Network |
$223.71
|
| Rate for Payer: Quartz Commercial |
$296.76
|
| Rate for Payer: Quartz Medicare Advantage |
$273.94
|
| Rate for Payer: The Alliance Commercial |
$615.89
|
| Rate for Payer: United Healthcare PPO |
$342.42
|
| Rate for Payer: WEA Trust Commercial |
$251.11
|
| Rate for Payer: WPS Commercial |
$338.16
|
|
|
INTRA-ATRIAL PACING 93610
|
Professional
|
Both
|
$670.00
|
|
|
Service Code
|
CPT 93610
|
| Hospital Charge Code |
3015419
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$220.77 |
| Max. Negotiated Rate |
$758.36 |
| Rate for Payer: Aetna Commercial |
$661.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$599.25
|
| 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 |
$661.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$220.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$418.08
|
| Rate for Payer: Health EOS Commercial |
$634.09
|
| Rate for Payer: HFN Commercial |
$661.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$758.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$758.36
|
| Rate for Payer: Multiplan Commercial |
$557.44
|
| Rate for Payer: Preferred Network Access Commercial |
$661.96
|
| Rate for Payer: Quartz Beloit One Network |
$306.59
|
| Rate for Payer: Quartz Commercial |
$397.18
|
| Rate for Payer: The Alliance Commercial |
$348.40
|
| Rate for Payer: United Healthcare Medicaid |
$220.77
|
| Rate for Payer: WEA Trust Commercial |
$383.24
|
| Rate for Payer: WPS Commercial |
$516.10
|
|
|
INTRACRANIAL HEMORRHAGE
|
Facility
|
IP
|
$7,628.43
|
|
|
Service Code
|
APR-DRG 0441
|
| Min. Negotiated Rate |
$6,776.05 |
| Max. Negotiated Rate |
$7,628.43 |
| Rate for Payer: Anthem Medicaid |
$7,304.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$7,304.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7,304.64
|
| Rate for Payer: Dean Health Medicaid |
$7,304.64
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6,776.05
|
| Rate for Payer: Managed Health Services Medicaid |
$7,628.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,304.64
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$7,304.64
|
| Rate for Payer: United Healthcare Medicaid |
$7,304.64
|
|
|
INTRACRANIAL HEMORRHAGE
|
Facility
|
OP
|
$99.58
|
|
|
Service Code
|
EAPG 00539
|
| Min. Negotiated Rate |
$95.75 |
| Max. Negotiated Rate |
$99.58 |
| Rate for Payer: Anthem Medicaid |
$95.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$95.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$95.75
|
| Rate for Payer: Dean Health Medicaid |
$95.75
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$95.75
|
| Rate for Payer: Managed Health Services Medicaid |
$99.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$95.75
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$95.75
|
| Rate for Payer: United Healthcare Medicaid |
$95.75
|
|
|
INTRACRANIAL HEMORRHAGE
|
Facility
|
IP
|
$21,570.04
|
|
|
Service Code
|
APR-DRG 0444
|
| Min. Negotiated Rate |
$19,159.86 |
| Max. Negotiated Rate |
$21,570.04 |
| Rate for Payer: Anthem Medicaid |
$20,654.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$20,654.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$20,654.50
|
| Rate for Payer: Dean Health Medicaid |
$20,654.50
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19,159.86
|
| Rate for Payer: Managed Health Services Medicaid |
$21,570.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$20,654.50
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$20,654.50
|
| Rate for Payer: United Healthcare Medicaid |
$20,654.50
|
|
|
INTRACRANIAL HEMORRHAGE
|
Facility
|
IP
|
$14,029.30
|
|
|
Service Code
|
APR-DRG 0443
|
| Min. Negotiated Rate |
$12,461.70 |
| Max. Negotiated Rate |
$14,029.30 |
| Rate for Payer: Anthem Medicaid |
$13,433.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$13,433.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13,433.82
|
| Rate for Payer: Dean Health Medicaid |
$13,433.82
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12,461.70
|
| Rate for Payer: Managed Health Services Medicaid |
$14,029.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,433.82
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13,433.82
|
| Rate for Payer: United Healthcare Medicaid |
$13,433.82
|
|
|
INTRACRANIAL HEMORRHAGE
|
Facility
|
IP
|
$9,908.19
|
|
|
Service Code
|
APR-DRG 0442
|
| Min. Negotiated Rate |
$8,801.07 |
| Max. Negotiated Rate |
$9,908.19 |
| Rate for Payer: Anthem Medicaid |
$9,487.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$9,487.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9,487.64
|
| Rate for Payer: Dean Health Medicaid |
$9,487.64
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8,801.07
|
| Rate for Payer: Managed Health Services Medicaid |
$9,908.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,487.64
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$9,487.64
|
| Rate for Payer: United Healthcare Medicaid |
$9,487.64
|
|
|
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS
|
Facility
|
IP
|
$28,435.68
|
|
|
Service Code
|
MSDRG 065
|
| Min. Negotiated Rate |
$8,243.85 |
| Max. Negotiated Rate |
$28,435.68 |
| Rate for Payer: Aetna Managed Medicare |
$8,243.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22,043.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,896.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16,052.78
|
| Rate for Payer: Anthem Medicare Advantage |
$8,243.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,243.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,243.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,243.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17,820.06
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,243.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,612.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,243.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,243.85
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,243.85
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,243.85
|
| Rate for Payer: NAPHCARE Commercial |
$12,365.78
|
| Rate for Payer: Quartz Medicare Advantage |
$8,243.85
|
| Rate for Payer: The Alliance Commercial |
$28,435.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,243.85
|
| Rate for Payer: United Healthcare PPO |
$16,047.17
|
| Rate for Payer: Wellcare Medicare |
$8,243.85
|
|
|
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC
|
Facility
|
IP
|
$55,714.88
|
|
|
Service Code
|
MSDRG 064
|
| Min. Negotiated Rate |
$15,907.41 |
| Max. Negotiated Rate |
$55,714.88 |
| Rate for Payer: Aetna Managed Medicare |
$15,907.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$43,878.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33,632.45
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31,953.02
|
| Rate for Payer: Anthem Medicare Advantage |
$15,907.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15,907.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15,907.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15,907.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35,470.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15,907.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40,620.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15,907.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15,907.41
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15,907.41
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15,907.41
|
| Rate for Payer: NAPHCARE Commercial |
$23,861.12
|
| Rate for Payer: Quartz Medicare Advantage |
$15,907.41
|
| Rate for Payer: The Alliance Commercial |
$55,714.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15,907.41
|
| Rate for Payer: United Healthcare PPO |
$31,623.84
|
| Rate for Payer: Wellcare Medicare |
$15,907.41
|
|
|
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC
|
Facility
|
IP
|
$19,341.92
|
|
|
Service Code
|
MSDRG 066
|
| Min. Negotiated Rate |
$5,748.05 |
| Max. Negotiated Rate |
$19,341.92 |
| Rate for Payer: Aetna Managed Medicare |
$5,748.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14,933.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,446.07
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,874.51
|
| Rate for Payer: Anthem Medicare Advantage |
$5,748.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,748.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,748.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,748.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,071.71
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,748.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,942.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,748.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,748.05
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,748.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,748.05
|
| Rate for Payer: NAPHCARE Commercial |
$8,622.07
|
| Rate for Payer: Quartz Medicare Advantage |
$5,748.05
|
| Rate for Payer: The Alliance Commercial |
$19,341.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,748.05
|
| Rate for Payer: United Healthcare PPO |
$10,854.42
|
| Rate for Payer: Wellcare Medicare |
$5,748.05
|
|
|
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC
|
Facility
|
IP
|
$170,138.80
|
|
|
Service Code
|
MSDRG 021
|
| Min. Negotiated Rate |
$42,160.01 |
| Max. Negotiated Rate |
$170,138.80 |
| Rate for Payer: Aetna Managed Medicare |
$42,160.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$115,506.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$88,534.78
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$84,113.82
|
| Rate for Payer: Anthem Medicare Advantage |
$42,160.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$42,160.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$42,160.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$42,160.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$93,374.06
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$42,160.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$124,547.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42,160.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$42,160.01
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$42,160.01
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$42,160.01
|
| Rate for Payer: NAPHCARE Commercial |
$63,240.01
|
| Rate for Payer: Quartz Medicare Advantage |
$42,160.01
|
| Rate for Payer: The Alliance Commercial |
$170,138.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42,160.01
|
| Rate for Payer: United Healthcare PPO |
$96,961.89
|
| Rate for Payer: Wellcare Medicare |
$42,160.01
|
|
|
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC
|
Facility
|
IP
|
$234,037.44
|
|
|
Service Code
|
MSDRG 020
|
| Min. Negotiated Rate |
$60,767.60 |
| Max. Negotiated Rate |
$234,037.44 |
| Rate for Payer: Aetna Managed Medicare |
$60,767.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$171,690.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$131,599.70
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$125,028.31
|
| Rate for Payer: Anthem Medicare Advantage |
$60,767.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$60,767.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$60,767.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$60,767.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$138,792.88
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$60,767.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$171,414.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60,767.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$60,767.60
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$60,767.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$60,767.60
|
| Rate for Payer: NAPHCARE Commercial |
$91,151.39
|
| Rate for Payer: Quartz Medicare Advantage |
$60,767.60
|
| Rate for Payer: The Alliance Commercial |
$234,037.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60,767.60
|
| Rate for Payer: United Healthcare PPO |
$133,448.52
|
| Rate for Payer: Wellcare Medicare |
$60,767.60
|
|
|
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC
|
Facility
|
IP
|
$108,793.36
|
|
|
Service Code
|
MSDRG 022
|
| Min. Negotiated Rate |
$24,839.93 |
| Max. Negotiated Rate |
$108,793.36 |
| Rate for Payer: Aetna Managed Medicare |
$24,839.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67,096.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$51,428.71
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$48,860.63
|
| Rate for Payer: Anthem Medicare Advantage |
$24,839.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24,839.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24,839.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$24,839.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54,239.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$24,839.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$70,507.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$24,839.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24,839.93
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$24,839.93
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$24,839.93
|
| Rate for Payer: NAPHCARE Commercial |
$37,259.90
|
| Rate for Payer: Quartz Medicare Advantage |
$24,839.93
|
| Rate for Payer: The Alliance Commercial |
$108,793.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24,839.93
|
| Rate for Payer: United Healthcare PPO |
$54,890.97
|
| Rate for Payer: Wellcare Medicare |
$24,839.93
|
|
|
INTRACUTANEOUS TESTS W/ALLERGENIC XTRCS AIRBORNE, IMMED TYPE 95027
|
Professional
|
Both
|
$3.00
|
|
|
Service Code
|
CPT 95027
|
| Hospital Charge Code |
6219189
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$17.80 |
| Rate for Payer: Aetna Commercial |
$2.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2.68
|
| Rate for Payer: Aetna Managed Medicare |
$4.45
|
| Rate for Payer: Anthem Medicare Advantage |
$4.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.45
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna Commercial |
$2.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.45
|
| Rate for Payer: Health EOS Commercial |
$2.84
|
| Rate for Payer: HFN Commercial |
$2.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.45
|
| Rate for Payer: Multiplan Commercial |
$2.50
|
| Rate for Payer: NAPHCARE Commercial |
$6.68
|
| Rate for Payer: Preferred Network Access Commercial |
$2.96
|
| Rate for Payer: Quartz Beloit One Network |
$1.37
|
| Rate for Payer: Quartz Commercial |
$1.78
|
| Rate for Payer: Quartz Medicare Advantage |
$4.45
|
| Rate for Payer: The Alliance Commercial |
$11.13
|
| Rate for Payer: United Healthcare Medicaid |
$5.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.45
|
| Rate for Payer: WEA Trust Commercial |
$1.72
|
| Rate for Payer: WPS Commercial |
$17.80
|
|
|
INTRANASAL BIOPSY 30100
|
Professional
|
Both
|
$303.00
|
|
|
Service Code
|
CPT 30100
|
| Hospital Charge Code |
3014350
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$46.99 |
| Max. Negotiated Rate |
$299.36 |
| Rate for Payer: Aetna Commercial |
$299.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$271.00
|
| Rate for Payer: Aetna Managed Medicare |
$59.30
|
| Rate for Payer: Anthem Medicare Advantage |
$59.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$59.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$59.30
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Cigna Commercial |
$299.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$46.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$59.30
|
| Rate for Payer: Health EOS Commercial |
$286.76
|
| Rate for Payer: HFN Commercial |
$299.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$231.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$231.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$59.30
|
| Rate for Payer: Multiplan Commercial |
$252.10
|
| Rate for Payer: NAPHCARE Commercial |
$88.95
|
| Rate for Payer: Preferred Network Access Commercial |
$299.36
|
| Rate for Payer: Quartz Beloit One Network |
$138.65
|
| Rate for Payer: Quartz Commercial |
$179.62
|
| Rate for Payer: Quartz Medicare Advantage |
$59.30
|
| Rate for Payer: The Alliance Commercial |
$252.03
|
| Rate for Payer: United Healthcare Medicaid |
$46.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$59.30
|
| Rate for Payer: WEA Trust Commercial |
$173.32
|
| Rate for Payer: WPS Commercial |
$266.85
|
|
|
INTRAOCULAR LENS IMPLANT, SECONDARY
|
Facility
|
IP
|
$5,256.00
|
|
| Hospital Charge Code |
2960367
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,678.46 |
| Max. Negotiated Rate |
$5,028.94 |
| Rate for Payer: Aetna Commercial |
$4,919.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,700.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,897.11
|
| Rate for Payer: Cash Price |
$1,576.80
|
| Rate for Payer: Cigna Commercial |
$5,028.94
|
| Rate for Payer: Health EOS Commercial |
$4,864.95
|
| Rate for Payer: HFN Commercial |
$5,028.94
|
| Rate for Payer: Multiplan Commercial |
$4,372.99
|
| Rate for Payer: Preferred Network Access Commercial |
$5,028.94
|
| Rate for Payer: Quartz Beloit One Network |
$2,678.46
|
| Rate for Payer: Quartz Commercial |
$3,279.74
|
| Rate for Payer: WEA Trust Commercial |
$3,006.43
|
| Rate for Payer: WPS Commercial |
$4,048.70
|
|
|
INTRAOCULAR LENS IMPLANT, SECONDARY
|
Facility
|
OP
|
$5,256.00
|
|
| Hospital Charge Code |
2960367
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,530.55 |
| Max. Negotiated Rate |
$5,028.94 |
| Rate for Payer: Aetna Commercial |
$4,919.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,700.97
|
| Rate for Payer: Aetna Managed Medicare |
$1,530.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,553.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,733.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,623.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,897.11
|
| Rate for Payer: Cash Price |
$1,576.80
|
| Rate for Payer: Cigna Commercial |
$5,028.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,058.99
|
| Rate for Payer: Health EOS Commercial |
$4,864.95
|
| Rate for Payer: HFN Commercial |
$5,028.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,099.68
|
| Rate for Payer: Multiplan Commercial |
$4,372.99
|
| Rate for Payer: NAPHCARE Commercial |
$3,279.74
|
| Rate for Payer: Preferred Network Access Commercial |
$5,028.94
|
| Rate for Payer: Quartz Beloit One Network |
$2,678.46
|
| Rate for Payer: Quartz Commercial |
$3,553.06
|
| Rate for Payer: Quartz Medicare Advantage |
$3,279.74
|
| Rate for Payer: The Alliance Commercial |
$2,733.12
|
| Rate for Payer: WEA Trust Commercial |
$3,006.43
|
| Rate for Payer: WPS Commercial |
$4,048.70
|
|
|
INTRAOCULAR LENS REPOSITIONING
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960344
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,005.28 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,455.44
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
INTRAOCULAR LENS REPOSITIONING
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960344
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,145.87 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,145.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,660.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,046.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,964.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,290.17
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,069.30
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,455.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,660.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,455.44
|
| Rate for Payer: The Alliance Commercial |
$2,046.20
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
INTRAOCULAR PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$50,953.76
|
|
|
Service Code
|
MSDRG 116
|
| Min. Negotiated Rate |
$14,353.56 |
| Max. Negotiated Rate |
$50,953.76 |
| Rate for Payer: Aetna Managed Medicare |
$14,353.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39,451.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30,239.10
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28,729.12
|
| Rate for Payer: Anthem Medicare Advantage |
$14,353.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14,353.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14,353.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14,353.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31,891.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14,353.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37,128.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14,353.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14,353.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14,353.56
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14,353.56
|
| Rate for Payer: NAPHCARE Commercial |
$21,530.34
|
| Rate for Payer: Quartz Medicare Advantage |
$14,353.56
|
| Rate for Payer: The Alliance Commercial |
$50,953.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14,353.56
|
| Rate for Payer: United Healthcare PPO |
$28,905.10
|
| Rate for Payer: Wellcare Medicare |
$14,353.56
|
|
|
INTRAOCULAR PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$33,468.24
|
|
|
Service Code
|
MSDRG 117
|
| Min. Negotiated Rate |
$8,815.18 |
| Max. Negotiated Rate |
$33,468.24 |
| Rate for Payer: Aetna Managed Medicare |
$8,815.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23,671.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,144.13
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,238.11
|
| Rate for Payer: Anthem Medicare Advantage |
$8,815.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,815.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,815.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,815.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19,135.88
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,815.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24,303.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,815.18
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,815.18
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,815.18
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,815.18
|
| Rate for Payer: NAPHCARE Commercial |
$13,222.76
|
| Rate for Payer: Quartz Medicare Advantage |
$8,815.18
|
| Rate for Payer: The Alliance Commercial |
$33,468.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,815.18
|
| Rate for Payer: United Healthcare PPO |
$18,920.63
|
| Rate for Payer: Wellcare Medicare |
$8,815.18
|
|
|
INTRAOCULAR RETINAL REPAIR
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960158
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,145.87 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,145.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,660.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,046.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,964.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,290.17
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,069.30
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,455.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,660.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,455.44
|
| Rate for Payer: The Alliance Commercial |
$2,046.20
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
INTRAOCULAR RETINAL REPAIR
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960158
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,005.28 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,455.44
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
