|
APPENDECTOMY, OPEN
|
Facility
|
IP
|
$4,238.00
|
|
| Hospital Charge Code |
2959811
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,159.68 |
| Max. Negotiated Rate |
$4,054.92 |
| Rate for Payer: Aetna Commercial |
$3,966.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,790.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,335.99
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$4,054.92
|
| Rate for Payer: Health EOS Commercial |
$3,922.69
|
| Rate for Payer: HFN Commercial |
$4,054.92
|
| Rate for Payer: Multiplan Commercial |
$3,526.02
|
| Rate for Payer: Preferred Network Access Commercial |
$4,054.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,159.68
|
| Rate for Payer: Quartz Commercial |
$2,644.51
|
| Rate for Payer: WEA Trust Commercial |
$2,424.14
|
| Rate for Payer: WPS Commercial |
$3,264.53
|
|
|
APPENDECTOMY, OPEN, PEDIATRIC
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2950472
|
|
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
|
|
|
APPENDECTOMY, OPEN, PEDIATRIC
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2950472
|
|
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
|
|
|
APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$26,655.66
|
|
|
Service Code
|
APR-DRG 2334
|
| Min. Negotiated Rate |
$23,677.22 |
| Max. Negotiated Rate |
$26,655.66 |
| Rate for Payer: Anthem Medicaid |
$25,524.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$25,524.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$25,524.27
|
| Rate for Payer: Dean Health Medicaid |
$25,524.27
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$23,677.22
|
| Rate for Payer: Managed Health Services Medicaid |
$26,655.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,524.27
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$25,524.27
|
| Rate for Payer: United Healthcare Medicaid |
$25,524.27
|
|
|
APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$12,100.27
|
|
|
Service Code
|
APR-DRG 2332
|
| Min. Negotiated Rate |
$10,748.21 |
| Max. Negotiated Rate |
$12,100.27 |
| Rate for Payer: Anthem Medicaid |
$11,586.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$11,586.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11,586.67
|
| Rate for Payer: Dean Health Medicaid |
$11,586.67
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$10,748.21
|
| Rate for Payer: Managed Health Services Medicaid |
$12,100.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,586.67
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11,586.67
|
| Rate for Payer: United Healthcare Medicaid |
$11,586.67
|
|
|
APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$9,382.09
|
|
|
Service Code
|
APR-DRG 2331
|
| Min. Negotiated Rate |
$8,333.76 |
| Max. Negotiated Rate |
$9,382.09 |
| Rate for Payer: Anthem Medicaid |
$8,983.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$8,983.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8,983.87
|
| Rate for Payer: Dean Health Medicaid |
$8,983.87
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8,333.76
|
| Rate for Payer: Managed Health Services Medicaid |
$9,382.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,983.87
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8,983.87
|
| Rate for Payer: United Healthcare Medicaid |
$8,983.87
|
|
|
APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$17,010.52
|
|
|
Service Code
|
APR-DRG 2333
|
| Min. Negotiated Rate |
$15,109.81 |
| Max. Negotiated Rate |
$17,010.52 |
| Rate for Payer: Anthem Medicaid |
$16,288.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$16,288.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16,288.51
|
| Rate for Payer: Dean Health Medicaid |
$16,288.51
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15,109.81
|
| Rate for Payer: Managed Health Services Medicaid |
$17,010.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$16,288.51
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$16,288.51
|
| Rate for Payer: United Healthcare Medicaid |
$16,288.51
|
|
|
APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$8,768.31
|
|
|
Service Code
|
APR-DRG 2341
|
| Min. Negotiated Rate |
$7,788.56 |
| Max. Negotiated Rate |
$8,768.31 |
| Rate for Payer: Anthem Medicaid |
$8,396.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$8,396.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8,396.14
|
| Rate for Payer: Dean Health Medicaid |
$8,396.14
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$7,788.56
|
| Rate for Payer: Managed Health Services Medicaid |
$8,768.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,396.14
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8,396.14
|
| Rate for Payer: United Healthcare Medicaid |
$8,396.14
|
|
|
APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$10,697.34
|
|
|
Service Code
|
APR-DRG 2342
|
| Min. Negotiated Rate |
$9,502.04 |
| Max. Negotiated Rate |
$10,697.34 |
| Rate for Payer: Anthem Medicaid |
$10,243.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$10,243.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10,243.29
|
| Rate for Payer: Dean Health Medicaid |
$10,243.29
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9,502.04
|
| Rate for Payer: Managed Health Services Medicaid |
$10,697.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,243.29
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$10,243.29
|
| Rate for Payer: United Healthcare Medicaid |
$10,243.29
|
|
|
APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$23,674.44
|
|
|
Service Code
|
APR-DRG 2344
|
| Min. Negotiated Rate |
$21,029.11 |
| Max. Negotiated Rate |
$23,674.44 |
| Rate for Payer: Anthem Medicaid |
$22,669.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$22,669.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$22,669.58
|
| Rate for Payer: Dean Health Medicaid |
$22,669.58
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$21,029.11
|
| Rate for Payer: Managed Health Services Medicaid |
$23,674.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$22,669.58
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$22,669.58
|
| Rate for Payer: United Healthcare Medicaid |
$22,669.58
|
|
|
APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$16,396.74
|
|
|
Service Code
|
APR-DRG 2343
|
| Min. Negotiated Rate |
$14,564.61 |
| Max. Negotiated Rate |
$16,396.74 |
| Rate for Payer: Anthem Medicaid |
$15,700.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$15,700.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15,700.78
|
| Rate for Payer: Dean Health Medicaid |
$15,700.78
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14,564.61
|
| Rate for Payer: Managed Health Services Medicaid |
$16,396.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$15,700.78
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$15,700.78
|
| Rate for Payer: United Healthcare Medicaid |
$15,700.78
|
|
|
APPENDIX PROCEDURES WITH CC
|
Facility
|
IP
|
$42,175.12
|
|
|
Service Code
|
MSDRG 398
|
| Min. Negotiated Rate |
$12,098.23 |
| Max. Negotiated Rate |
$42,175.12 |
| Rate for Payer: Aetna Managed Medicare |
$12,098.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33,025.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25,313.81
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24,049.77
|
| Rate for Payer: Anthem Medicare Advantage |
$12,098.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12,098.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12,098.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12,098.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26,697.45
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12,098.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30,689.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12,098.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12,098.23
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12,098.23
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12,098.23
|
| Rate for Payer: NAPHCARE Commercial |
$18,147.34
|
| Rate for Payer: Quartz Medicare Advantage |
$12,098.23
|
| Rate for Payer: The Alliance Commercial |
$42,175.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,098.23
|
| Rate for Payer: United Healthcare PPO |
$23,892.35
|
| Rate for Payer: Wellcare Medicare |
$12,098.23
|
|
|
APPENDIX PROCEDURES WITH MCC
|
Facility
|
IP
|
$62,449.92
|
|
|
Service Code
|
MSDRG 397
|
| Min. Negotiated Rate |
$18,847.39 |
| Max. Negotiated Rate |
$62,449.92 |
| Rate for Payer: Aetna Managed Medicare |
$18,847.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$52,254.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$40,052.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$38,052.85
|
| Rate for Payer: Anthem Medicare Advantage |
$18,847.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18,847.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18,847.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18,847.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$42,242.16
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18,847.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45,561.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18,847.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18,847.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18,847.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18,847.39
|
| Rate for Payer: NAPHCARE Commercial |
$28,271.08
|
| Rate for Payer: Quartz Medicare Advantage |
$18,847.39
|
| Rate for Payer: The Alliance Commercial |
$62,449.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18,847.39
|
| Rate for Payer: United Healthcare PPO |
$35,469.86
|
| Rate for Payer: Wellcare Medicare |
$18,847.39
|
|
|
APPENDIX PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$31,109.52
|
|
|
Service Code
|
MSDRG 399
|
| Min. Negotiated Rate |
$9,273.13 |
| Max. Negotiated Rate |
$31,109.52 |
| Rate for Payer: Aetna Managed Medicare |
$9,273.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$24,976.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,144.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18,188.28
|
| Rate for Payer: Anthem Medicare Advantage |
$9,273.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,273.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,273.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,273.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20,190.65
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,273.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22,573.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,273.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9,273.13
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9,273.13
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,273.13
|
| Rate for Payer: NAPHCARE Commercial |
$13,909.69
|
| Rate for Payer: Quartz Medicare Advantage |
$9,273.13
|
| Rate for Payer: The Alliance Commercial |
$31,109.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,273.13
|
| Rate for Payer: United Healthcare PPO |
$17,573.89
|
| Rate for Payer: Wellcare Medicare |
$9,273.13
|
|
|
APPLICATION OF FINGER SPLINT 29130
|
Professional
|
Both
|
$154.00
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
3014295
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$10.51 |
| Max. Negotiated Rate |
$152.15 |
| Rate for Payer: Aetna Commercial |
$152.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$137.74
|
| Rate for Payer: Aetna Managed Medicare |
$24.53
|
| Rate for Payer: Anthem Medicare Advantage |
$24.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24.53
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cigna Commercial |
$152.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24.53
|
| Rate for Payer: Health EOS Commercial |
$145.75
|
| Rate for Payer: HFN Commercial |
$152.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$98.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$98.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24.53
|
| Rate for Payer: Multiplan Commercial |
$128.13
|
| Rate for Payer: NAPHCARE Commercial |
$36.80
|
| Rate for Payer: Preferred Network Access Commercial |
$152.15
|
| Rate for Payer: Quartz Beloit One Network |
$70.47
|
| Rate for Payer: Quartz Commercial |
$91.29
|
| Rate for Payer: Quartz Medicare Advantage |
$24.53
|
| Rate for Payer: The Alliance Commercial |
$104.27
|
| Rate for Payer: United Healthcare Medicaid |
$10.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.53
|
| Rate for Payer: WEA Trust Commercial |
$88.09
|
| Rate for Payer: WPS Commercial |
$110.40
|
|
|
APPLICATION OF FINGER SPLINT 29131
|
Professional
|
Both
|
$248.00
|
|
|
Service Code
|
CPT 29131
|
| Hospital Charge Code |
3014296
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.49 |
| Max. Negotiated Rate |
$245.02 |
| Rate for Payer: Aetna Commercial |
$245.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$221.81
|
| Rate for Payer: Aetna Managed Medicare |
$29.93
|
| Rate for Payer: Anthem Medicare Advantage |
$29.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$29.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$29.93
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$245.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$23.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.93
|
| Rate for Payer: Health EOS Commercial |
$234.71
|
| Rate for Payer: HFN Commercial |
$245.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$117.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$117.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$29.93
|
| Rate for Payer: Multiplan Commercial |
$206.34
|
| Rate for Payer: NAPHCARE Commercial |
$44.90
|
| Rate for Payer: Preferred Network Access Commercial |
$245.02
|
| Rate for Payer: Quartz Beloit One Network |
$113.48
|
| Rate for Payer: Quartz Commercial |
$147.01
|
| Rate for Payer: Quartz Medicare Advantage |
$29.93
|
| Rate for Payer: The Alliance Commercial |
$127.21
|
| Rate for Payer: United Healthcare Medicaid |
$23.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.93
|
| Rate for Payer: WEA Trust Commercial |
$141.86
|
| Rate for Payer: WPS Commercial |
$134.69
|
|
|
APPLICATION OF FOREARM CAST 29075
|
Professional
|
Both
|
$242.00
|
|
|
Service Code
|
CPT 29075
|
| Hospital Charge Code |
3014290
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$56.50 |
| Max. Negotiated Rate |
$254.26 |
| Rate for Payer: Aetna Commercial |
$239.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$216.44
|
| Rate for Payer: Aetna Managed Medicare |
$56.50
|
| Rate for Payer: Anthem Medicare Advantage |
$56.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$56.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$56.50
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cigna Commercial |
$239.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$58.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$56.50
|
| Rate for Payer: Health EOS Commercial |
$229.03
|
| Rate for Payer: HFN Commercial |
$239.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$212.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$212.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$56.50
|
| Rate for Payer: Multiplan Commercial |
$201.34
|
| Rate for Payer: NAPHCARE Commercial |
$84.75
|
| Rate for Payer: Preferred Network Access Commercial |
$239.10
|
| Rate for Payer: Quartz Beloit One Network |
$110.74
|
| Rate for Payer: Quartz Commercial |
$143.46
|
| Rate for Payer: Quartz Medicare Advantage |
$56.50
|
| Rate for Payer: The Alliance Commercial |
$240.14
|
| Rate for Payer: United Healthcare Medicaid |
$58.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.50
|
| Rate for Payer: WEA Trust Commercial |
$138.42
|
| Rate for Payer: WPS Commercial |
$254.26
|
|
|
APPLICATION OF HIP CASTS 29325
|
Professional
|
Both
|
$855.00
|
|
|
Service Code
|
CPT 29325
|
| Hospital Charge Code |
3014298
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$160.41 |
| Max. Negotiated Rate |
$844.74 |
| Rate for Payer: Aetna Commercial |
$844.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$764.71
|
| Rate for Payer: Aetna Managed Medicare |
$160.41
|
| Rate for Payer: Anthem Medicare Advantage |
$160.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$160.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$160.41
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cigna Commercial |
$844.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$297.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$160.41
|
| Rate for Payer: Health EOS Commercial |
$809.17
|
| Rate for Payer: HFN Commercial |
$844.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$601.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$601.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$160.41
|
| Rate for Payer: Multiplan Commercial |
$711.36
|
| Rate for Payer: NAPHCARE Commercial |
$240.61
|
| Rate for Payer: Preferred Network Access Commercial |
$844.74
|
| Rate for Payer: Quartz Beloit One Network |
$391.25
|
| Rate for Payer: Quartz Commercial |
$506.84
|
| Rate for Payer: Quartz Medicare Advantage |
$160.41
|
| Rate for Payer: The Alliance Commercial |
$681.74
|
| Rate for Payer: United Healthcare Medicaid |
$297.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$160.41
|
| Rate for Payer: WEA Trust Commercial |
$489.06
|
| Rate for Payer: WPS Commercial |
$721.84
|
|
|
APPLICATION OF LEG CAST 29450
|
Professional
|
Both
|
$331.00
|
|
|
Service Code
|
CPT 29450
|
| Hospital Charge Code |
3014302
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$57.45 |
| Max. Negotiated Rate |
$439.73 |
| Rate for Payer: Aetna Commercial |
$327.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$296.05
|
| Rate for Payer: Aetna Managed Medicare |
$97.72
|
| Rate for Payer: Anthem Medicare Advantage |
$97.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$97.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$97.72
|
| Rate for Payer: Cash Price |
$99.30
|
| Rate for Payer: Cash Price |
$99.30
|
| Rate for Payer: Cash Price |
$99.30
|
| Rate for Payer: Cigna Commercial |
$327.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$57.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$97.72
|
| Rate for Payer: Health EOS Commercial |
$313.26
|
| Rate for Payer: HFN Commercial |
$327.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$392.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$392.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$97.72
|
| Rate for Payer: Multiplan Commercial |
$275.39
|
| Rate for Payer: NAPHCARE Commercial |
$146.58
|
| Rate for Payer: Preferred Network Access Commercial |
$327.03
|
| Rate for Payer: Quartz Beloit One Network |
$151.47
|
| Rate for Payer: Quartz Commercial |
$196.22
|
| Rate for Payer: Quartz Medicare Advantage |
$97.72
|
| Rate for Payer: The Alliance Commercial |
$415.30
|
| Rate for Payer: United Healthcare Medicaid |
$57.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$97.72
|
| Rate for Payer: WEA Trust Commercial |
$189.33
|
| Rate for Payer: WPS Commercial |
$439.73
|
|
|
Application of Long Arm Cast 29065
|
Professional
|
Both
|
$245.00
|
|
|
Service Code
|
CPT 29065
|
| Hospital Charge Code |
3014289
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$61.63 |
| Max. Negotiated Rate |
$277.34 |
| Rate for Payer: Aetna Commercial |
$242.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$219.13
|
| Rate for Payer: Aetna Managed Medicare |
$61.63
|
| Rate for Payer: Anthem Medicare Advantage |
$61.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$61.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$61.63
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$242.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$84.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$61.63
|
| Rate for Payer: Health EOS Commercial |
$231.87
|
| Rate for Payer: HFN Commercial |
$242.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$232.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$232.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$61.63
|
| Rate for Payer: Multiplan Commercial |
$203.84
|
| Rate for Payer: NAPHCARE Commercial |
$92.45
|
| Rate for Payer: Preferred Network Access Commercial |
$242.06
|
| Rate for Payer: Quartz Beloit One Network |
$112.11
|
| Rate for Payer: Quartz Commercial |
$145.24
|
| Rate for Payer: Quartz Medicare Advantage |
$61.63
|
| Rate for Payer: The Alliance Commercial |
$261.93
|
| Rate for Payer: United Healthcare Medicaid |
$84.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$61.63
|
| Rate for Payer: WEA Trust Commercial |
$140.14
|
| Rate for Payer: WPS Commercial |
$277.34
|
|
|
APPLICATION OF LONG LEG CAST 29345
|
Professional
|
Both
|
$364.00
|
|
|
Service Code
|
CPT 29345
|
| Hospital Charge Code |
3014299
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$87.31 |
| Max. Negotiated Rate |
$392.89 |
| Rate for Payer: Aetna Commercial |
$359.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$325.56
|
| Rate for Payer: Aetna Managed Medicare |
$87.31
|
| Rate for Payer: Anthem Medicare Advantage |
$87.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$87.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$87.31
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cigna Commercial |
$359.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$118.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$87.31
|
| Rate for Payer: Health EOS Commercial |
$344.49
|
| Rate for Payer: HFN Commercial |
$359.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$340.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$340.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$87.31
|
| Rate for Payer: Multiplan Commercial |
$302.85
|
| Rate for Payer: NAPHCARE Commercial |
$130.96
|
| Rate for Payer: Preferred Network Access Commercial |
$359.63
|
| Rate for Payer: Quartz Beloit One Network |
$166.57
|
| Rate for Payer: Quartz Commercial |
$215.78
|
| Rate for Payer: Quartz Medicare Advantage |
$87.31
|
| Rate for Payer: The Alliance Commercial |
$371.06
|
| Rate for Payer: United Healthcare Medicaid |
$118.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$87.31
|
| Rate for Payer: WEA Trust Commercial |
$208.21
|
| Rate for Payer: WPS Commercial |
$392.89
|
|
|
Application of Long Leg Cast /Walking 29355
|
Professional
|
Both
|
$410.00
|
|
|
Service Code
|
CPT 29355
|
| Hospital Charge Code |
4125292
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$92.36 |
| Max. Negotiated Rate |
$415.63 |
| Rate for Payer: Aetna Commercial |
$405.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$366.70
|
| Rate for Payer: Aetna Managed Medicare |
$92.36
|
| Rate for Payer: Anthem Medicare Advantage |
$92.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$92.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$92.36
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cigna Commercial |
$405.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$94.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$92.36
|
| Rate for Payer: Health EOS Commercial |
$388.02
|
| Rate for Payer: HFN Commercial |
$405.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$365.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$365.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$92.36
|
| Rate for Payer: Multiplan Commercial |
$341.12
|
| Rate for Payer: NAPHCARE Commercial |
$138.54
|
| Rate for Payer: Preferred Network Access Commercial |
$405.08
|
| Rate for Payer: Quartz Beloit One Network |
$187.62
|
| Rate for Payer: Quartz Commercial |
$243.05
|
| Rate for Payer: Quartz Medicare Advantage |
$92.36
|
| Rate for Payer: The Alliance Commercial |
$392.54
|
| Rate for Payer: United Healthcare Medicaid |
$94.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$92.36
|
| Rate for Payer: WEA Trust Commercial |
$234.52
|
| Rate for Payer: WPS Commercial |
$415.63
|
|
|
Application of Long Leg Splint 29505
|
Professional
|
Both
|
$207.00
|
|
|
Service Code
|
CPT 29505
|
| Hospital Charge Code |
3014303
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$46.99 |
| Max. Negotiated Rate |
$236.76 |
| Rate for Payer: Aetna Commercial |
$204.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$185.14
|
| Rate for Payer: Aetna Managed Medicare |
$52.61
|
| Rate for Payer: Anthem Medicare Advantage |
$52.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$52.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$52.61
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cigna Commercial |
$204.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$46.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$52.61
|
| Rate for Payer: Health EOS Commercial |
$195.90
|
| Rate for Payer: HFN Commercial |
$204.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$176.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$176.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$52.61
|
| Rate for Payer: Multiplan Commercial |
$172.22
|
| Rate for Payer: NAPHCARE Commercial |
$78.92
|
| Rate for Payer: Preferred Network Access Commercial |
$204.52
|
| Rate for Payer: Quartz Beloit One Network |
$94.72
|
| Rate for Payer: Quartz Commercial |
$122.71
|
| Rate for Payer: Quartz Medicare Advantage |
$52.61
|
| Rate for Payer: The Alliance Commercial |
$223.61
|
| Rate for Payer: United Healthcare Medicaid |
$46.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$52.61
|
| Rate for Payer: WEA Trust Commercial |
$118.40
|
| Rate for Payer: WPS Commercial |
$236.76
|
|
|
Application Of Modality, Mechanical Traction
|
Professional
|
Both
|
$57.00
|
|
|
Service Code
|
CPT 97012
|
| Hospital Charge Code |
1188843
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$14.44 |
| Max. Negotiated Rate |
$57.74 |
| Rate for Payer: Aetna Commercial |
$56.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.98
|
| Rate for Payer: Aetna Managed Medicare |
$14.44
|
| Rate for Payer: Anthem Medicare Advantage |
$14.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.44
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna Commercial |
$56.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$29.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.44
|
| Rate for Payer: Health EOS Commercial |
$53.94
|
| Rate for Payer: HFN Commercial |
$56.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$52.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$52.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.44
|
| Rate for Payer: Multiplan Commercial |
$47.42
|
| Rate for Payer: NAPHCARE Commercial |
$21.65
|
| Rate for Payer: Preferred Network Access Commercial |
$56.32
|
| Rate for Payer: Quartz Beloit One Network |
$26.08
|
| Rate for Payer: Quartz Commercial |
$33.79
|
| Rate for Payer: Quartz Medicare Advantage |
$14.44
|
| Rate for Payer: The Alliance Commercial |
$36.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.44
|
| Rate for Payer: WEA Trust Commercial |
$32.60
|
| Rate for Payer: WPS Commercial |
$57.74
|
|
|
Application of multi-layer venous wound compression system, below knee 29581
|
Professional
|
Both
|
$209.00
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
3014306
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.60 |
| Max. Negotiated Rate |
$206.49 |
| Rate for Payer: Aetna Commercial |
$206.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$186.93
|
| Rate for Payer: Aetna Managed Medicare |
$23.60
|
| Rate for Payer: Anthem Medicare Advantage |
$23.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23.60
|
| Rate for Payer: Cash Price |
$62.70
|
| Rate for Payer: Cash Price |
$62.70
|
| Rate for Payer: Cash Price |
$62.70
|
| Rate for Payer: Cigna Commercial |
$206.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$74.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23.60
|
| Rate for Payer: Health EOS Commercial |
$197.80
|
| Rate for Payer: HFN Commercial |
$206.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$99.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$99.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23.60
|
| Rate for Payer: Multiplan Commercial |
$173.89
|
| Rate for Payer: NAPHCARE Commercial |
$35.40
|
| Rate for Payer: Preferred Network Access Commercial |
$206.49
|
| Rate for Payer: Quartz Beloit One Network |
$95.64
|
| Rate for Payer: Quartz Commercial |
$123.90
|
| Rate for Payer: Quartz Medicare Advantage |
$23.60
|
| Rate for Payer: The Alliance Commercial |
$100.29
|
| Rate for Payer: United Healthcare Medicaid |
$74.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.60
|
| Rate for Payer: WEA Trust Commercial |
$119.55
|
| Rate for Payer: WPS Commercial |
$106.19
|
|
