|
MURPHY RING SPLINT
|
Facility
|
IP
|
$1,076.00
|
|
| Hospital Charge Code |
2971403
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$548.33 |
| Max. Negotiated Rate |
$1,029.52 |
| Rate for Payer: Aetna Commercial |
$1,007.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$962.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$593.09
|
| Rate for Payer: Cash Price |
$322.80
|
| Rate for Payer: Cigna Commercial |
$1,029.52
|
| Rate for Payer: Health EOS Commercial |
$995.95
|
| Rate for Payer: HFN Commercial |
$1,029.52
|
| Rate for Payer: Multiplan Commercial |
$895.23
|
| Rate for Payer: Preferred Network Access Commercial |
$1,029.52
|
| Rate for Payer: Quartz Beloit One Network |
$548.33
|
| Rate for Payer: Quartz Commercial |
$671.42
|
| Rate for Payer: WEA Trust Commercial |
$615.47
|
| Rate for Payer: WPS Commercial |
$828.84
|
|
|
MUSCLE, MYOCUTANEOUS, OR FASCIOCUTANEOUS FLAP; TRUNK
|
Facility
|
OP
|
$14,917.51
|
|
|
Service Code
|
CPT 15734
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,729.38 |
| Max. Negotiated Rate |
$14,917.51 |
| Rate for Payer: Aetna Managed Medicare |
$3,729.38
|
| 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 |
$3,729.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,729.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,729.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,729.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,729.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,873.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,729.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,729.38
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,729.38
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,729.38
|
| Rate for Payer: NAPHCARE Commercial |
$5,594.07
|
| Rate for Payer: Quartz Medicare Advantage |
$3,729.38
|
| Rate for Payer: The Alliance Commercial |
$14,917.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,729.38
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$3,729.38
|
|
|
MUSCLE-SKIN GRAFT, TRUNK 15734
|
Professional
|
Both
|
$10,065.00
|
|
|
Service Code
|
CPT 15734
|
| Hospital Charge Code |
3013647
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,301.99 |
| Max. Negotiated Rate |
$9,944.22 |
| Rate for Payer: Aetna Commercial |
$9,944.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,002.14
|
| Rate for Payer: Aetna Managed Medicare |
$1,301.99
|
| Rate for Payer: Anthem Medicare Advantage |
$1,301.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,301.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,301.99
|
| Rate for Payer: Cash Price |
$3,019.50
|
| Rate for Payer: Cash Price |
$3,019.50
|
| Rate for Payer: Cash Price |
$3,019.50
|
| Rate for Payer: Cigna Commercial |
$9,944.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,315.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,301.99
|
| Rate for Payer: Health EOS Commercial |
$9,525.52
|
| Rate for Payer: HFN Commercial |
$9,944.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,111.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,111.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,301.99
|
| Rate for Payer: Multiplan Commercial |
$8,374.08
|
| Rate for Payer: NAPHCARE Commercial |
$1,952.98
|
| Rate for Payer: Preferred Network Access Commercial |
$9,944.22
|
| Rate for Payer: Quartz Beloit One Network |
$4,605.74
|
| Rate for Payer: Quartz Commercial |
$5,966.53
|
| Rate for Payer: Quartz Medicare Advantage |
$1,301.99
|
| Rate for Payer: The Alliance Commercial |
$5,533.44
|
| Rate for Payer: United Healthcare Medicaid |
$1,315.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,301.99
|
| Rate for Payer: WEA Trust Commercial |
$5,757.18
|
| Rate for Payer: WPS Commercial |
$5,858.94
|
|
|
MUSCLE-SKIN GRAFT, TRUNK, UNL 4999915734
|
Professional
|
Both
|
$10,064.00
|
|
|
Service Code
|
CPT 49999
|
| Hospital Charge Code |
6172052
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$4,605.29 |
| Max. Negotiated Rate |
$9,943.23 |
| Rate for Payer: Aetna Commercial |
$9,943.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,001.24
|
| Rate for Payer: Cash Price |
$3,019.20
|
| Rate for Payer: Cash Price |
$3,019.20
|
| Rate for Payer: Cigna Commercial |
$9,943.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,233.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,279.94
|
| Rate for Payer: Health EOS Commercial |
$9,524.57
|
| Rate for Payer: HFN Commercial |
$9,943.23
|
| Rate for Payer: Multiplan Commercial |
$8,373.25
|
| Rate for Payer: Preferred Network Access Commercial |
$9,943.23
|
| Rate for Payer: Quartz Beloit One Network |
$4,605.29
|
| Rate for Payer: Quartz Commercial |
$5,965.94
|
| Rate for Payer: The Alliance Commercial |
$5,233.28
|
| Rate for Payer: WEA Trust Commercial |
$5,756.61
|
| Rate for Payer: WPS Commercial |
$7,752.30
|
|
|
MUSCLE TEST, 2 LIMBS 95861
|
Professional
|
Both
|
$475.00
|
|
|
Service Code
|
CPT 95861
|
| Hospital Charge Code |
3015472
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$113.93 |
| Max. Negotiated Rate |
$647.13 |
| Rate for Payer: Aetna Commercial |
$469.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$424.84
|
| Rate for Payer: Aetna Managed Medicare |
$161.78
|
| Rate for Payer: Anthem Medicare Advantage |
$161.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$161.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$161.78
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cigna Commercial |
$469.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$113.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$161.78
|
| Rate for Payer: Health EOS Commercial |
$449.54
|
| Rate for Payer: HFN Commercial |
$469.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$613.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$613.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$161.78
|
| Rate for Payer: Multiplan Commercial |
$395.20
|
| Rate for Payer: NAPHCARE Commercial |
$242.67
|
| Rate for Payer: Preferred Network Access Commercial |
$469.30
|
| Rate for Payer: Quartz Beloit One Network |
$217.36
|
| Rate for Payer: Quartz Commercial |
$281.58
|
| Rate for Payer: Quartz Medicare Advantage |
$161.78
|
| Rate for Payer: The Alliance Commercial |
$404.46
|
| Rate for Payer: United Healthcare Medicaid |
$113.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$161.78
|
| Rate for Payer: WEA Trust Commercial |
$271.70
|
| Rate for Payer: WPS Commercial |
$647.13
|
|
|
MUSCLE TEST, 2 LIMBS 9586126
|
Professional
|
Both
|
$475.00
|
|
|
Service Code
|
CPT 95861 26
|
| Hospital Charge Code |
3015473
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$78.19 |
| Max. Negotiated Rate |
$469.30 |
| Rate for Payer: Aetna Commercial |
$469.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$424.84
|
| Rate for Payer: Aetna Managed Medicare |
$81.47
|
| Rate for Payer: Anthem Medicare Advantage |
$81.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$81.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$81.47
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cigna Commercial |
$469.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$78.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$81.47
|
| Rate for Payer: Health EOS Commercial |
$449.54
|
| Rate for Payer: HFN Commercial |
$469.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$292.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$292.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$81.47
|
| Rate for Payer: Multiplan Commercial |
$395.20
|
| Rate for Payer: NAPHCARE Commercial |
$122.21
|
| Rate for Payer: Preferred Network Access Commercial |
$469.30
|
| Rate for Payer: Quartz Beloit One Network |
$217.36
|
| Rate for Payer: Quartz Commercial |
$281.58
|
| Rate for Payer: Quartz Medicare Advantage |
$81.47
|
| Rate for Payer: The Alliance Commercial |
$203.68
|
| Rate for Payer: United Healthcare Medicaid |
$78.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$81.47
|
| Rate for Payer: WEA Trust Commercial |
$271.70
|
| Rate for Payer: WPS Commercial |
$325.89
|
|
|
MUSCLE TEST, 3 LIMBS 95863
|
Professional
|
Both
|
$1,350.00
|
|
|
Service Code
|
CPT 95863
|
| Hospital Charge Code |
3015475
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$130.64 |
| Max. Negotiated Rate |
$1,333.80 |
| Rate for Payer: Aetna Commercial |
$1,333.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,207.44
|
| Rate for Payer: Aetna Managed Medicare |
$220.26
|
| Rate for Payer: Anthem Medicare Advantage |
$220.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$220.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$220.26
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna Commercial |
$1,333.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$130.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$220.26
|
| Rate for Payer: Health EOS Commercial |
$1,277.64
|
| Rate for Payer: HFN Commercial |
$1,333.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$800.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$800.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$220.26
|
| Rate for Payer: Multiplan Commercial |
$1,123.20
|
| Rate for Payer: NAPHCARE Commercial |
$330.39
|
| Rate for Payer: Preferred Network Access Commercial |
$1,333.80
|
| Rate for Payer: Quartz Beloit One Network |
$617.76
|
| Rate for Payer: Quartz Commercial |
$800.28
|
| Rate for Payer: Quartz Medicare Advantage |
$220.26
|
| Rate for Payer: The Alliance Commercial |
$550.65
|
| Rate for Payer: United Healthcare Medicaid |
$130.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$220.26
|
| Rate for Payer: WEA Trust Commercial |
$772.20
|
| Rate for Payer: WPS Commercial |
$881.05
|
|
|
Muscle Test Cran Nerv Unilat 95867
|
Professional
|
Both
|
$308.00
|
|
|
Service Code
|
CPT 95867
|
| Hospital Charge Code |
5082940
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$70.74 |
| Max. Negotiated Rate |
$428.19 |
| Rate for Payer: Aetna Commercial |
$304.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$275.48
|
| Rate for Payer: Aetna Managed Medicare |
$107.05
|
| Rate for Payer: Anthem Medicare Advantage |
$107.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$107.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$107.05
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cigna Commercial |
$304.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$70.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$107.05
|
| Rate for Payer: Health EOS Commercial |
$291.49
|
| Rate for Payer: HFN Commercial |
$304.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$398.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$398.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$107.05
|
| Rate for Payer: Multiplan Commercial |
$256.26
|
| Rate for Payer: NAPHCARE Commercial |
$160.57
|
| Rate for Payer: Preferred Network Access Commercial |
$304.30
|
| Rate for Payer: Quartz Beloit One Network |
$140.94
|
| Rate for Payer: Quartz Commercial |
$182.58
|
| Rate for Payer: Quartz Medicare Advantage |
$107.05
|
| Rate for Payer: The Alliance Commercial |
$267.62
|
| Rate for Payer: United Healthcare Medicaid |
$70.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$107.05
|
| Rate for Payer: WEA Trust Commercial |
$176.18
|
| Rate for Payer: WPS Commercial |
$428.19
|
|
|
MUSCLE TEST CRAN NERV UNILAT 9586726
|
Professional
|
Both
|
$308.00
|
|
|
Service Code
|
CPT 95867 26
|
| Hospital Charge Code |
3015478
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$17.70 |
| Max. Negotiated Rate |
$304.30 |
| Rate for Payer: Aetna Commercial |
$304.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$275.48
|
| Rate for Payer: Aetna Managed Medicare |
$41.38
|
| Rate for Payer: Anthem Medicare Advantage |
$41.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$41.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$41.38
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cigna Commercial |
$304.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.38
|
| Rate for Payer: Health EOS Commercial |
$291.49
|
| Rate for Payer: HFN Commercial |
$304.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$149.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$149.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$41.38
|
| Rate for Payer: Multiplan Commercial |
$256.26
|
| Rate for Payer: NAPHCARE Commercial |
$62.07
|
| Rate for Payer: Preferred Network Access Commercial |
$304.30
|
| Rate for Payer: Quartz Beloit One Network |
$140.94
|
| Rate for Payer: Quartz Commercial |
$182.58
|
| Rate for Payer: Quartz Medicare Advantage |
$41.38
|
| Rate for Payer: The Alliance Commercial |
$103.45
|
| Rate for Payer: United Healthcare Medicaid |
$17.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$41.38
|
| Rate for Payer: WEA Trust Commercial |
$176.18
|
| Rate for Payer: WPS Commercial |
$165.53
|
|
|
MUSCLE TEST, NONPARASPINAL 95870
|
Professional
|
Both
|
$534.00
|
|
|
Service Code
|
CPT 95870
|
| Hospital Charge Code |
3015480
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$26.63 |
| Max. Negotiated Rate |
$527.59 |
| Rate for Payer: Aetna Commercial |
$527.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$477.61
|
| Rate for Payer: Aetna Managed Medicare |
$86.04
|
| Rate for Payer: Anthem Medicare Advantage |
$86.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$86.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$86.04
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cigna Commercial |
$527.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$26.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$86.04
|
| Rate for Payer: Health EOS Commercial |
$505.38
|
| Rate for Payer: HFN Commercial |
$527.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$323.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$323.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$86.04
|
| Rate for Payer: Multiplan Commercial |
$444.29
|
| Rate for Payer: NAPHCARE Commercial |
$129.06
|
| Rate for Payer: Preferred Network Access Commercial |
$527.59
|
| Rate for Payer: Quartz Beloit One Network |
$244.36
|
| Rate for Payer: Quartz Commercial |
$316.56
|
| Rate for Payer: Quartz Medicare Advantage |
$86.04
|
| Rate for Payer: The Alliance Commercial |
$215.10
|
| Rate for Payer: United Healthcare Medicaid |
$26.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$86.04
|
| Rate for Payer: WEA Trust Commercial |
$305.45
|
| Rate for Payer: WPS Commercial |
$344.16
|
|
|
MUSCLE TEST, NONPARASPINAL 9587026
|
Professional
|
Both
|
$534.00
|
|
|
Service Code
|
CPT 95870 26
|
| Hospital Charge Code |
3015481
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$19.13 |
| Max. Negotiated Rate |
$527.59 |
| Rate for Payer: Aetna Commercial |
$527.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$477.61
|
| Rate for Payer: Aetna Managed Medicare |
$19.71
|
| Rate for Payer: Anthem Medicare Advantage |
$19.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.71
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cigna Commercial |
$527.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.71
|
| Rate for Payer: Health EOS Commercial |
$505.38
|
| Rate for Payer: HFN Commercial |
$527.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$69.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.71
|
| Rate for Payer: Multiplan Commercial |
$444.29
|
| Rate for Payer: NAPHCARE Commercial |
$29.56
|
| Rate for Payer: Preferred Network Access Commercial |
$527.59
|
| Rate for Payer: Quartz Beloit One Network |
$244.36
|
| Rate for Payer: Quartz Commercial |
$316.56
|
| Rate for Payer: Quartz Medicare Advantage |
$19.71
|
| Rate for Payer: The Alliance Commercial |
$49.27
|
| Rate for Payer: United Healthcare Medicaid |
$19.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.71
|
| Rate for Payer: WEA Trust Commercial |
$305.45
|
| Rate for Payer: WPS Commercial |
$78.83
|
|
|
MUSCLE TEST, ONE LIMB 95860
|
Professional
|
Both
|
$946.00
|
|
|
Service Code
|
CPT 95860
|
| Hospital Charge Code |
3015470
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$77.77 |
| Max. Negotiated Rate |
$934.65 |
| Rate for Payer: Aetna Commercial |
$934.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$846.10
|
| Rate for Payer: Aetna Managed Medicare |
$119.38
|
| Rate for Payer: Anthem Medicare Advantage |
$119.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$119.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$119.38
|
| Rate for Payer: Cash Price |
$283.80
|
| Rate for Payer: Cash Price |
$283.80
|
| Rate for Payer: Cash Price |
$283.80
|
| Rate for Payer: Cigna Commercial |
$934.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$77.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$119.38
|
| Rate for Payer: Health EOS Commercial |
$895.29
|
| Rate for Payer: HFN Commercial |
$934.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$424.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$424.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$119.38
|
| Rate for Payer: Multiplan Commercial |
$787.07
|
| Rate for Payer: NAPHCARE Commercial |
$179.07
|
| Rate for Payer: Preferred Network Access Commercial |
$934.65
|
| Rate for Payer: Quartz Beloit One Network |
$432.89
|
| Rate for Payer: Quartz Commercial |
$560.79
|
| Rate for Payer: Quartz Medicare Advantage |
$119.38
|
| Rate for Payer: The Alliance Commercial |
$298.45
|
| Rate for Payer: United Healthcare Medicaid |
$77.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$119.38
|
| Rate for Payer: WEA Trust Commercial |
$541.11
|
| Rate for Payer: WPS Commercial |
$477.53
|
|
|
MUSCLE TEST, ONE LIMB 9586026
|
Professional
|
Both
|
$946.00
|
|
|
Service Code
|
CPT 95860 26
|
| Hospital Charge Code |
3015471
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$48.87 |
| Max. Negotiated Rate |
$934.65 |
| Rate for Payer: Aetna Commercial |
$934.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$846.10
|
| Rate for Payer: Aetna Managed Medicare |
$51.72
|
| Rate for Payer: Anthem Medicare Advantage |
$51.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$51.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$51.72
|
| Rate for Payer: Cash Price |
$283.80
|
| Rate for Payer: Cash Price |
$283.80
|
| Rate for Payer: Cash Price |
$283.80
|
| Rate for Payer: Cigna Commercial |
$934.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$48.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51.72
|
| Rate for Payer: Health EOS Commercial |
$895.29
|
| Rate for Payer: HFN Commercial |
$934.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$183.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$183.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$51.72
|
| Rate for Payer: Multiplan Commercial |
$787.07
|
| Rate for Payer: NAPHCARE Commercial |
$77.58
|
| Rate for Payer: Preferred Network Access Commercial |
$934.65
|
| Rate for Payer: Quartz Beloit One Network |
$432.89
|
| Rate for Payer: Quartz Commercial |
$560.79
|
| Rate for Payer: Quartz Medicare Advantage |
$51.72
|
| Rate for Payer: The Alliance Commercial |
$129.30
|
| Rate for Payer: United Healthcare Medicaid |
$48.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$51.72
|
| Rate for Payer: WEA Trust Commercial |
$541.11
|
| Rate for Payer: WPS Commercial |
$206.88
|
|
|
MUSCULOSKELETAL AND OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$52,697.54
|
|
|
Service Code
|
APR-DRG 9124
|
| Min. Negotiated Rate |
$46,809.25 |
| Max. Negotiated Rate |
$52,697.54 |
| Rate for Payer: Anthem Medicaid |
$50,460.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$50,460.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$50,460.80
|
| Rate for Payer: Dean Health Medicaid |
$50,460.80
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$46,809.25
|
| Rate for Payer: Managed Health Services Medicaid |
$52,697.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$50,460.80
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$50,460.80
|
| Rate for Payer: United Healthcare Medicaid |
$50,460.80
|
|
|
MUSCULOSKELETAL AND OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$23,849.80
|
|
|
Service Code
|
APR-DRG 9122
|
| Min. Negotiated Rate |
$21,184.88 |
| Max. Negotiated Rate |
$23,849.80 |
| Rate for Payer: Anthem Medicaid |
$22,837.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$22,837.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$22,837.50
|
| Rate for Payer: Dean Health Medicaid |
$22,837.50
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$21,184.88
|
| Rate for Payer: Managed Health Services Medicaid |
$23,849.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$22,837.50
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$22,837.50
|
| Rate for Payer: United Healthcare Medicaid |
$22,837.50
|
|
|
MUSCULOSKELETAL AND OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$33,407.26
|
|
|
Service Code
|
APR-DRG 9123
|
| Min. Negotiated Rate |
$29,674.41 |
| Max. Negotiated Rate |
$33,407.26 |
| Rate for Payer: Anthem Medicaid |
$31,989.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$31,989.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$31,989.29
|
| Rate for Payer: Dean Health Medicaid |
$31,989.29
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$29,674.41
|
| Rate for Payer: Managed Health Services Medicaid |
$33,407.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$31,989.29
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$31,989.29
|
| Rate for Payer: United Healthcare Medicaid |
$31,989.29
|
|
|
MUSCULOSKELETAL AND OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$17,711.99
|
|
|
Service Code
|
APR-DRG 9121
|
| Min. Negotiated Rate |
$15,732.89 |
| Max. Negotiated Rate |
$17,711.99 |
| Rate for Payer: Anthem Medicaid |
$16,960.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$16,960.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16,960.20
|
| Rate for Payer: Dean Health Medicaid |
$16,960.20
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15,732.89
|
| Rate for Payer: Managed Health Services Medicaid |
$17,711.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$16,960.20
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$16,960.20
|
| Rate for Payer: United Healthcare Medicaid |
$16,960.20
|
|
|
MUSCULOSKELETAL EXCISIONS, BIOPSIES, AND DRAINAGE PROCEDURES
|
Facility
|
OP
|
$767.84
|
|
|
Service Code
|
EAPG 00051
|
| Min. Negotiated Rate |
$738.30 |
| Max. Negotiated Rate |
$767.84 |
| Rate for Payer: Anthem Medicaid |
$738.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$738.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$738.30
|
| Rate for Payer: Dean Health Medicaid |
$738.30
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$738.30
|
| Rate for Payer: Managed Health Services Medicaid |
$767.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$738.30
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$738.30
|
| Rate for Payer: United Healthcare Medicaid |
$738.30
|
|
|
MUSCULOSKELETAL MALIGNANCY AND PATHOLOGICAL FRACTURE DUE TO MUSCULOSKELETAL MALIGNANCY
|
Facility
|
IP
|
$8,066.85
|
|
|
Service Code
|
APR-DRG 3431
|
| Min. Negotiated Rate |
$7,165.48 |
| Max. Negotiated Rate |
$8,066.85 |
| Rate for Payer: Anthem Medicaid |
$7,724.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$7,724.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7,724.45
|
| Rate for Payer: Dean Health Medicaid |
$7,724.45
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$7,165.48
|
| Rate for Payer: Managed Health Services Medicaid |
$8,066.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,724.45
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$7,724.45
|
| Rate for Payer: United Healthcare Medicaid |
$7,724.45
|
|
|
MUSCULOSKELETAL MALIGNANCY AND PATHOLOGICAL FRACTURE DUE TO MUSCULOSKELETAL MALIGNANCY
|
Facility
|
IP
|
$9,557.46
|
|
|
Service Code
|
APR-DRG 3432
|
| Min. Negotiated Rate |
$8,489.53 |
| Max. Negotiated Rate |
$9,557.46 |
| Rate for Payer: Anthem Medicaid |
$9,151.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$9,151.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9,151.79
|
| Rate for Payer: Dean Health Medicaid |
$9,151.79
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8,489.53
|
| Rate for Payer: Managed Health Services Medicaid |
$9,557.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,151.79
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$9,151.79
|
| Rate for Payer: United Healthcare Medicaid |
$9,151.79
|
|
|
MUSCULOSKELETAL MALIGNANCY AND PATHOLOGICAL FRACTURE DUE TO MUSCULOSKELETAL MALIGNANCY
|
Facility
|
IP
|
$14,467.71
|
|
|
Service Code
|
APR-DRG 3433
|
| Min. Negotiated Rate |
$12,851.12 |
| Max. Negotiated Rate |
$14,467.71 |
| Rate for Payer: Anthem Medicaid |
$13,853.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$13,853.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13,853.63
|
| Rate for Payer: Dean Health Medicaid |
$13,853.63
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12,851.12
|
| Rate for Payer: Managed Health Services Medicaid |
$14,467.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,853.63
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13,853.63
|
| Rate for Payer: United Healthcare Medicaid |
$13,853.63
|
|
|
MUSCULOSKELETAL MALIGNANCY AND PATHOLOGICAL FRACTURE DUE TO MUSCULOSKELETAL MALIGNANCY
|
Facility
|
IP
|
$22,534.56
|
|
|
Service Code
|
APR-DRG 3434
|
| Min. Negotiated Rate |
$20,016.60 |
| Max. Negotiated Rate |
$22,534.56 |
| Rate for Payer: Anthem Medicaid |
$21,578.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$21,578.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$21,578.08
|
| Rate for Payer: Dean Health Medicaid |
$21,578.08
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$20,016.60
|
| Rate for Payer: Managed Health Services Medicaid |
$22,534.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$21,578.08
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$21,578.08
|
| Rate for Payer: United Healthcare Medicaid |
$21,578.08
|
|
|
MUSCULOSKELETAL MALIGNANCY AND PATHOLOGICAL FX DUE TO MALIGNANCY
|
Facility
|
OP
|
$111.38
|
|
|
Service Code
|
EAPG 00653
|
| Min. Negotiated Rate |
$107.09 |
| Max. Negotiated Rate |
$111.38 |
| Rate for Payer: Anthem Medicaid |
$107.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$107.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$107.09
|
| Rate for Payer: Dean Health Medicaid |
$107.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$107.09
|
| Rate for Payer: Managed Health Services Medicaid |
$111.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$107.09
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$107.09
|
| Rate for Payer: United Healthcare Medicaid |
$107.09
|
|
|
Musk Antibody, Quant, Titer
|
Professional
|
Both
|
$1,613.00
|
|
|
Service Code
|
CPT 86366
|
| Hospital Charge Code |
983334
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.14 |
| Max. Negotiated Rate |
$1,593.64 |
| Rate for Payer: Aetna Commercial |
$1,593.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,442.67
|
| Rate for Payer: Aetna Managed Medicare |
$19.14
|
| Rate for Payer: Anthem Medicare Advantage |
$19.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.14
|
| Rate for Payer: Cash Price |
$483.90
|
| Rate for Payer: Cash Price |
$483.90
|
| Rate for Payer: Cigna Commercial |
$1,593.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$838.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.14
|
| Rate for Payer: Health EOS Commercial |
$1,526.54
|
| Rate for Payer: HFN Commercial |
$1,593.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.14
|
| Rate for Payer: Multiplan Commercial |
$1,342.02
|
| Rate for Payer: NAPHCARE Commercial |
$28.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,593.64
|
| Rate for Payer: Quartz Beloit One Network |
$738.11
|
| Rate for Payer: Quartz Commercial |
$956.19
|
| Rate for Payer: Quartz Medicare Advantage |
$19.14
|
| Rate for Payer: The Alliance Commercial |
$75.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.14
|
| Rate for Payer: WEA Trust Commercial |
$922.64
|
| Rate for Payer: WPS Commercial |
$84.20
|
|
|
Musk Antibody, Quant, Titer
|
Facility
|
OP
|
$1,613.00
|
|
|
Service Code
|
CPT 86366
|
| Hospital Charge Code |
983334
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.14 |
| Max. Negotiated Rate |
$1,543.32 |
| Rate for Payer: Aetna Commercial |
$1,509.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,442.67
|
| Rate for Payer: Aetna Managed Medicare |
$19.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,090.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$838.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$805.21
|
| Rate for Payer: Anthem Medicare Advantage |
$19.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$889.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.14
|
| Rate for Payer: Cash Price |
$483.90
|
| Rate for Payer: Cash Price |
$483.90
|
| Rate for Payer: Cigna Commercial |
$1,543.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$938.77
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.14
|
| Rate for Payer: Health EOS Commercial |
$1,492.99
|
| Rate for Payer: HFN Commercial |
$1,543.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$71.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.14
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.14
|
| Rate for Payer: Multiplan Commercial |
$1,342.02
|
| Rate for Payer: NAPHCARE Commercial |
$28.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,543.32
|
| Rate for Payer: Quartz Beloit One Network |
$821.98
|
| Rate for Payer: Quartz Commercial |
$1,090.39
|
| Rate for Payer: Quartz Medicare Advantage |
$19.14
|
| Rate for Payer: The Alliance Commercial |
$76.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.14
|
| Rate for Payer: United Healthcare PPO |
$1,258.14
|
| Rate for Payer: WEA Trust Commercial |
$922.64
|
| Rate for Payer: Wellcare Medicare |
$19.14
|
| Rate for Payer: WPS Commercial |
$1,242.49
|
|
