|
OSTEOMYELITIS, SEPTIC ARTHRITIS AND OTHER MUSCULOSKELETAL INFECTIONS
|
Facility
|
IP
|
$12,889.42
|
|
|
Service Code
|
APR-DRG 3443
|
| Min. Negotiated Rate |
$11,449.18 |
| Max. Negotiated Rate |
$12,889.42 |
| Rate for Payer: Anthem Medicaid |
$12,342.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$12,342.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12,342.33
|
| Rate for Payer: Dean Health Medicaid |
$12,342.33
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11,449.18
|
| Rate for Payer: Managed Health Services Medicaid |
$12,889.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,342.33
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12,342.33
|
| Rate for Payer: United Healthcare Medicaid |
$12,342.33
|
|
|
OSTEOMYELITIS WITH CC
|
Facility
|
IP
|
$36,227.36
|
|
|
Service Code
|
MSDRG 540
|
| Min. Negotiated Rate |
$10,434.10 |
| Max. Negotiated Rate |
$36,227.36 |
| Rate for Payer: Aetna Managed Medicare |
$10,434.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$28,284.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21,679.63
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20,597.07
|
| Rate for Payer: Anthem Medicare Advantage |
$10,434.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,434.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,434.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,434.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22,864.63
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,434.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26,327.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,434.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,434.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,434.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,434.10
|
| Rate for Payer: NAPHCARE Commercial |
$15,651.15
|
| Rate for Payer: Quartz Medicare Advantage |
$10,434.10
|
| Rate for Payer: The Alliance Commercial |
$36,227.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,434.10
|
| Rate for Payer: United Healthcare PPO |
$20,496.29
|
| Rate for Payer: Wellcare Medicare |
$10,434.10
|
|
|
OSTEOMYELITIS WITH MCC
|
Facility
|
IP
|
$55,201.12
|
|
|
Service Code
|
MSDRG 539
|
| Min. Negotiated Rate |
$15,591.13 |
| Max. Negotiated Rate |
$55,201.12 |
| Rate for Payer: Aetna Managed Medicare |
$15,591.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$42,977.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32,941.74
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31,296.80
|
| Rate for Payer: Anthem Medicare Advantage |
$15,591.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15,591.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15,591.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15,591.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34,742.32
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15,591.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40,243.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15,591.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15,591.13
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15,591.13
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15,591.13
|
| Rate for Payer: NAPHCARE Commercial |
$23,386.69
|
| Rate for Payer: Quartz Medicare Advantage |
$15,591.13
|
| Rate for Payer: The Alliance Commercial |
$55,201.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15,591.13
|
| Rate for Payer: United Healthcare PPO |
$31,330.19
|
| Rate for Payer: Wellcare Medicare |
$15,591.13
|
|
|
OSTEOMYELITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$24,054.16
|
|
|
Service Code
|
MSDRG 541
|
| Min. Negotiated Rate |
$6,536.85 |
| Max. Negotiated Rate |
$24,054.16 |
| Rate for Payer: Aetna Managed Medicare |
$6,536.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,833.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,902.75
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,258.46
|
| Rate for Payer: Anthem Medicare Advantage |
$6,536.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,536.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,536.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,536.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13,608.01
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,536.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17,398.21
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,536.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,536.85
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,536.85
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,536.85
|
| Rate for Payer: NAPHCARE Commercial |
$9,805.27
|
| Rate for Payer: Quartz Medicare Advantage |
$6,536.85
|
| Rate for Payer: The Alliance Commercial |
$24,054.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,536.85
|
| Rate for Payer: United Healthcare PPO |
$13,544.73
|
| Rate for Payer: Wellcare Medicare |
$6,536.85
|
|
|
Osteopathic Manip Txmt 1-2 Regions 98925
|
Professional
|
Both
|
$126.00
|
|
|
Service Code
|
CPT 98925
|
| Hospital Charge Code |
5517227
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$16.43 |
| Max. Negotiated Rate |
$124.49 |
| Rate for Payer: Aetna Commercial |
$124.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$112.69
|
| Rate for Payer: Aetna Managed Medicare |
$19.61
|
| Rate for Payer: Anthem Medicare Advantage |
$19.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.61
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna Commercial |
$124.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.61
|
| Rate for Payer: Health EOS Commercial |
$119.25
|
| Rate for Payer: HFN Commercial |
$124.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$84.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$84.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.61
|
| Rate for Payer: Multiplan Commercial |
$104.83
|
| Rate for Payer: NAPHCARE Commercial |
$29.42
|
| Rate for Payer: Preferred Network Access Commercial |
$124.49
|
| Rate for Payer: Quartz Beloit One Network |
$57.66
|
| Rate for Payer: Quartz Commercial |
$74.69
|
| Rate for Payer: Quartz Medicare Advantage |
$19.61
|
| Rate for Payer: The Alliance Commercial |
$49.04
|
| Rate for Payer: United Healthcare Medicaid |
$16.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.61
|
| Rate for Payer: WEA Trust Commercial |
$72.07
|
| Rate for Payer: WPS Commercial |
$78.46
|
|
|
Osteopathic Manip Txmt 3-4 Regions 98926
|
Professional
|
Both
|
$181.00
|
|
|
Service Code
|
CPT 98926
|
| Hospital Charge Code |
5517228
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$29.72 |
| Max. Negotiated Rate |
$178.83 |
| Rate for Payer: Aetna Commercial |
$178.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$161.89
|
| Rate for Payer: Aetna Managed Medicare |
$29.72
|
| Rate for Payer: Anthem Medicare Advantage |
$29.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$29.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$29.72
|
| Rate for Payer: Cash Price |
$54.30
|
| Rate for Payer: Cash Price |
$54.30
|
| Rate for Payer: Cigna Commercial |
$178.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$30.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.72
|
| Rate for Payer: Health EOS Commercial |
$171.30
|
| Rate for Payer: HFN Commercial |
$178.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$126.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$126.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$29.72
|
| Rate for Payer: Multiplan Commercial |
$150.59
|
| Rate for Payer: NAPHCARE Commercial |
$44.58
|
| Rate for Payer: Preferred Network Access Commercial |
$178.83
|
| Rate for Payer: Quartz Beloit One Network |
$82.83
|
| Rate for Payer: Quartz Commercial |
$107.30
|
| Rate for Payer: Quartz Medicare Advantage |
$29.72
|
| Rate for Payer: The Alliance Commercial |
$74.31
|
| Rate for Payer: United Healthcare Medicaid |
$30.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.72
|
| Rate for Payer: WEA Trust Commercial |
$103.53
|
| Rate for Payer: WPS Commercial |
$118.89
|
|
|
Osteopathic Manip Txmt 5-6 Regions 98927
|
Professional
|
Both
|
$237.00
|
|
|
Service Code
|
CPT 98927
|
| Hospital Charge Code |
5517229
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$39.95 |
| Max. Negotiated Rate |
$234.16 |
| Rate for Payer: Aetna Commercial |
$234.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$211.97
|
| Rate for Payer: Aetna Managed Medicare |
$39.95
|
| Rate for Payer: Anthem Medicare Advantage |
$39.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.95
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cigna Commercial |
$234.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$48.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$39.95
|
| Rate for Payer: Health EOS Commercial |
$224.30
|
| Rate for Payer: HFN Commercial |
$234.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$167.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$167.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.95
|
| Rate for Payer: Multiplan Commercial |
$197.18
|
| Rate for Payer: NAPHCARE Commercial |
$59.92
|
| Rate for Payer: Preferred Network Access Commercial |
$234.16
|
| Rate for Payer: Quartz Beloit One Network |
$108.45
|
| Rate for Payer: Quartz Commercial |
$140.49
|
| Rate for Payer: Quartz Medicare Advantage |
$39.95
|
| Rate for Payer: The Alliance Commercial |
$99.87
|
| Rate for Payer: United Healthcare Medicaid |
$48.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.95
|
| Rate for Payer: WEA Trust Commercial |
$135.56
|
| Rate for Payer: WPS Commercial |
$159.79
|
|
|
Osteopathic Manip Txmt 7-8 Regions 98928
|
Professional
|
Both
|
$292.00
|
|
|
Service Code
|
CPT 98928
|
| Hospital Charge Code |
5517230
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$50.06 |
| Max. Negotiated Rate |
$288.50 |
| Rate for Payer: Aetna Commercial |
$288.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$261.16
|
| Rate for Payer: Aetna Managed Medicare |
$50.06
|
| Rate for Payer: Anthem Medicare Advantage |
$50.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$50.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$50.06
|
| Rate for Payer: Cash Price |
$87.60
|
| Rate for Payer: Cash Price |
$87.60
|
| Rate for Payer: Cigna Commercial |
$288.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$57.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50.06
|
| Rate for Payer: Health EOS Commercial |
$276.35
|
| Rate for Payer: HFN Commercial |
$288.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$210.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$50.06
|
| Rate for Payer: Multiplan Commercial |
$242.94
|
| Rate for Payer: NAPHCARE Commercial |
$75.08
|
| Rate for Payer: Preferred Network Access Commercial |
$288.50
|
| Rate for Payer: Quartz Beloit One Network |
$133.62
|
| Rate for Payer: Quartz Commercial |
$173.10
|
| Rate for Payer: Quartz Medicare Advantage |
$50.06
|
| Rate for Payer: The Alliance Commercial |
$125.14
|
| Rate for Payer: United Healthcare Medicaid |
$57.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$50.06
|
| Rate for Payer: WEA Trust Commercial |
$167.02
|
| Rate for Payer: WPS Commercial |
$200.22
|
|
|
Osteopathic Manip Txmt 9-10 Regions 98929
|
Professional
|
Both
|
$356.00
|
|
|
Service Code
|
CPT 98929
|
| Hospital Charge Code |
5517231
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$59.73 |
| Max. Negotiated Rate |
$351.73 |
| Rate for Payer: Aetna Commercial |
$351.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$318.41
|
| Rate for Payer: Aetna Managed Medicare |
$59.73
|
| Rate for Payer: Anthem Medicare Advantage |
$59.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$59.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$59.73
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$351.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$66.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$59.73
|
| Rate for Payer: Health EOS Commercial |
$336.92
|
| Rate for Payer: HFN Commercial |
$351.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$254.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$254.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$59.73
|
| Rate for Payer: Multiplan Commercial |
$296.19
|
| Rate for Payer: NAPHCARE Commercial |
$89.59
|
| Rate for Payer: Preferred Network Access Commercial |
$351.73
|
| Rate for Payer: Quartz Beloit One Network |
$162.91
|
| Rate for Payer: Quartz Commercial |
$211.04
|
| Rate for Payer: Quartz Medicare Advantage |
$59.73
|
| Rate for Payer: The Alliance Commercial |
$149.32
|
| Rate for Payer: United Healthcare Medicaid |
$66.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$59.73
|
| Rate for Payer: WEA Trust Commercial |
$203.63
|
| Rate for Payer: WPS Commercial |
$238.91
|
|
|
Osteopathic Manipulative Treatment 1-2 body regions
|
Professional
|
Both
|
$105.00
|
|
|
Service Code
|
CPT 98925
|
| Hospital Charge Code |
1188988
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$16.43 |
| Max. Negotiated Rate |
$103.74 |
| Rate for Payer: Aetna Commercial |
$103.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.91
|
| Rate for Payer: Aetna Managed Medicare |
$19.61
|
| Rate for Payer: Anthem Medicare Advantage |
$19.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.61
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$103.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.61
|
| Rate for Payer: Health EOS Commercial |
$99.37
|
| Rate for Payer: HFN Commercial |
$103.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$84.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$84.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.61
|
| Rate for Payer: Multiplan Commercial |
$87.36
|
| Rate for Payer: NAPHCARE Commercial |
$29.42
|
| Rate for Payer: Preferred Network Access Commercial |
$103.74
|
| Rate for Payer: Quartz Beloit One Network |
$48.05
|
| Rate for Payer: Quartz Commercial |
$62.24
|
| Rate for Payer: Quartz Medicare Advantage |
$19.61
|
| Rate for Payer: The Alliance Commercial |
$49.04
|
| Rate for Payer: United Healthcare Medicaid |
$16.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.61
|
| Rate for Payer: WEA Trust Commercial |
$60.06
|
| Rate for Payer: WPS Commercial |
$78.46
|
|
|
OSTEOPLASTY, RADIUS OR ULNA; SHORTENING
|
Facility
|
OP
|
$30,545.47
|
|
|
Service Code
|
CPT 25390
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,807.99 |
| Max. Negotiated Rate |
$30,545.47 |
| Rate for Payer: Aetna Managed Medicare |
$7,636.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,182.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,724.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,889.12
|
| Rate for Payer: Anthem Medicare Advantage |
$7,636.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,636.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,636.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,636.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,636.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28,407.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,636.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,636.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,636.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,636.37
|
| Rate for Payer: NAPHCARE Commercial |
$11,454.55
|
| Rate for Payer: Quartz Medicare Advantage |
$7,636.37
|
| Rate for Payer: The Alliance Commercial |
$30,545.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,636.37
|
| Rate for Payer: United Healthcare PPO |
$8,790.08
|
| Rate for Payer: Wellcare Medicare |
$7,636.37
|
|
|
OSTEOPOROSIS
|
Facility
|
OP
|
$28.22
|
|
|
Service Code
|
EAPG 00662
|
| Min. Negotiated Rate |
$27.14 |
| Max. Negotiated Rate |
$28.22 |
| Rate for Payer: Anthem Medicaid |
$27.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$27.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$27.14
|
| Rate for Payer: Dean Health Medicaid |
$27.14
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$27.14
|
| Rate for Payer: Managed Health Services Medicaid |
$28.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.14
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$27.14
|
| Rate for Payer: United Healthcare Medicaid |
$27.14
|
|
|
OSTEOTOMY; CALCANEUS (EG, DWYER OR CHAMBERS TYPE PROCEDURE), WITH OR WITHOUT INTERNAL FIXATION
|
Facility
|
OP
|
$30,545.47
|
|
|
Service Code
|
CPT 28300
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,947.89 |
| Max. Negotiated Rate |
$30,545.47 |
| Rate for Payer: Aetna Managed Medicare |
$7,636.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,182.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,724.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,889.12
|
| Rate for Payer: Anthem Medicare Advantage |
$7,636.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,636.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,636.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,636.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,636.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28,407.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,636.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,636.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,636.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,636.37
|
| Rate for Payer: NAPHCARE Commercial |
$11,454.55
|
| Rate for Payer: Quartz Medicare Advantage |
$7,636.37
|
| Rate for Payer: The Alliance Commercial |
$30,545.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,636.37
|
| Rate for Payer: United Healthcare PPO |
$8,790.08
|
| Rate for Payer: Wellcare Medicare |
$7,636.37
|
|
|
OSTEOTOMY, SHORTENING, ANGULAR OR ROTATIONAL CORRECTION; OTHER PHALANGES, ANY TOE
|
Facility
|
OP
|
$13,773.68
|
|
|
Service Code
|
CPT 28312
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,443.42 |
| Max. Negotiated Rate |
$13,773.68 |
| Rate for Payer: Aetna Managed Medicare |
$3,443.42
|
| 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 |
$3,443.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,443.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,443.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,443.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,443.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,809.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,443.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,443.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,443.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,443.42
|
| Rate for Payer: NAPHCARE Commercial |
$5,165.13
|
| Rate for Payer: Quartz Medicare Advantage |
$3,443.42
|
| Rate for Payer: The Alliance Commercial |
$13,773.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,443.42
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$3,443.42
|
|
|
OSTEOTOMY, SHORTENING, ANGULAR OR ROTATIONAL CORRECTION; PROXIMAL PHALANX, FIRST TOE (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$30,545.47
|
|
|
Service Code
|
CPT 28310
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,267.12 |
| Max. Negotiated Rate |
$30,545.47 |
| Rate for Payer: Aetna Managed Medicare |
$7,636.37
|
| 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 |
$7,636.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,636.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,636.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,636.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,636.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28,407.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,636.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,636.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,636.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,636.37
|
| Rate for Payer: NAPHCARE Commercial |
$11,454.55
|
| Rate for Payer: Quartz Medicare Advantage |
$7,636.37
|
| Rate for Payer: The Alliance Commercial |
$30,545.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,636.37
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$7,636.37
|
|
|
OSTEOTOMY, TARSAL BONES, OTHER THAN CALCANEUS OR TALUS;
|
Facility
|
OP
|
$30,545.47
|
|
|
Service Code
|
CPT 28304
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,947.89 |
| Max. Negotiated Rate |
$30,545.47 |
| Rate for Payer: Aetna Managed Medicare |
$7,636.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,182.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,724.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,889.12
|
| Rate for Payer: Anthem Medicare Advantage |
$7,636.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,636.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,636.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,636.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,636.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28,407.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,636.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,636.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,636.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,636.37
|
| Rate for Payer: NAPHCARE Commercial |
$11,454.55
|
| Rate for Payer: Quartz Medicare Advantage |
$7,636.37
|
| Rate for Payer: The Alliance Commercial |
$30,545.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,636.37
|
| Rate for Payer: United Healthcare PPO |
$8,790.08
|
| Rate for Payer: Wellcare Medicare |
$7,636.37
|
|
|
OSTEOTOMY, TARSAL BONES, OTHER THAN CALCANEUS OR TALUS; WITH AUTOGRAFT (INCLUDES OBTAINING GRAFT) (EG, FOWLER TYPE)
|
Facility
|
OP
|
$30,545.47
|
|
|
Service Code
|
CPT 28305
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,807.99 |
| Max. Negotiated Rate |
$30,545.47 |
| Rate for Payer: Aetna Managed Medicare |
$7,636.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,182.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,724.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,889.12
|
| Rate for Payer: Anthem Medicare Advantage |
$7,636.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,636.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,636.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,636.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,636.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28,407.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,636.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,636.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,636.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,636.37
|
| Rate for Payer: NAPHCARE Commercial |
$11,454.55
|
| Rate for Payer: Quartz Medicare Advantage |
$7,636.37
|
| Rate for Payer: The Alliance Commercial |
$30,545.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,636.37
|
| Rate for Payer: United Healthcare PPO |
$8,790.08
|
| Rate for Payer: Wellcare Medicare |
$7,636.37
|
|
|
OSTEOTOMY; TIBIA
|
Facility
|
OP
|
$30,545.47
|
|
|
Service Code
|
CPT 27705
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,947.89 |
| Max. Negotiated Rate |
$30,545.47 |
| Rate for Payer: Aetna Managed Medicare |
$7,636.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,182.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,724.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,889.12
|
| Rate for Payer: Anthem Medicare Advantage |
$7,636.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,636.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,636.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,636.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,636.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28,407.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,636.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,636.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,636.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,636.37
|
| Rate for Payer: NAPHCARE Commercial |
$11,454.55
|
| Rate for Payer: Quartz Medicare Advantage |
$7,636.37
|
| Rate for Payer: The Alliance Commercial |
$30,545.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,636.37
|
| Rate for Payer: United Healthcare PPO |
$8,790.08
|
| Rate for Payer: Wellcare Medicare |
$7,636.37
|
|
|
OSTEOTOMY; ULNA
|
Facility
|
OP
|
$30,545.47
|
|
|
Service Code
|
CPT 25360
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,807.99 |
| Max. Negotiated Rate |
$30,545.47 |
| Rate for Payer: Aetna Managed Medicare |
$7,636.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,182.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,724.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,889.12
|
| Rate for Payer: Anthem Medicare Advantage |
$7,636.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,636.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,636.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,636.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,636.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28,407.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,636.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,636.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,636.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,636.37
|
| Rate for Payer: NAPHCARE Commercial |
$11,454.55
|
| Rate for Payer: Quartz Medicare Advantage |
$7,636.37
|
| Rate for Payer: The Alliance Commercial |
$30,545.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,636.37
|
| Rate for Payer: United Healthcare PPO |
$8,790.08
|
| Rate for Payer: Wellcare Medicare |
$7,636.37
|
|
|
OSTEOTOMY, WITH OR WITHOUT LENGTHENING, SHORTENING OR ANGULAR CORRECTION, METATARSAL; FIRST METATARSAL
|
Facility
|
OP
|
$30,545.47
|
|
|
Service Code
|
CPT 28306
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,636.37 |
| Max. Negotiated Rate |
$30,545.47 |
| Rate for Payer: Aetna Managed Medicare |
$7,636.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,182.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,724.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,889.12
|
| Rate for Payer: Anthem Medicare Advantage |
$7,636.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,636.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,636.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,636.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,107.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,636.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28,407.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,636.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,636.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,636.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,636.37
|
| Rate for Payer: NAPHCARE Commercial |
$11,454.55
|
| Rate for Payer: Quartz Medicare Advantage |
$7,636.37
|
| Rate for Payer: The Alliance Commercial |
$30,545.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,636.37
|
| Rate for Payer: United Healthcare PPO |
$8,790.08
|
| Rate for Payer: Wellcare Medicare |
$7,636.37
|
|
|
OSTEOTOMY, WITH OR WITHOUT LENGTHENING, SHORTENING OR ANGULAR CORRECTION, METATARSAL; MULTIPLE (EG, SWANSON TYPE CAVUS FOOT PROCEDURE)
|
Facility
|
OP
|
$30,545.47
|
|
|
Service Code
|
CPT 28309
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,636.37 |
| Max. Negotiated Rate |
$30,545.47 |
| Rate for Payer: Aetna Managed Medicare |
$7,636.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,182.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,724.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,889.12
|
| Rate for Payer: Anthem Medicare Advantage |
$7,636.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,636.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,636.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,636.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,107.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,636.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28,407.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,636.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,636.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,636.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,636.37
|
| Rate for Payer: NAPHCARE Commercial |
$11,454.55
|
| Rate for Payer: Quartz Medicare Advantage |
$7,636.37
|
| Rate for Payer: The Alliance Commercial |
$30,545.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,636.37
|
| Rate for Payer: United Healthcare PPO |
$8,790.08
|
| Rate for Payer: Wellcare Medicare |
$7,636.37
|
|
|
Osteotomy, with or without lengthening, shortening or angular correction, metatarsal; other than first metatarsal, each
|
Facility
|
OP
|
$13,773.68
|
|
|
Service Code
|
CPT 28308
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,443.42 |
| Max. Negotiated Rate |
$13,773.68 |
| Rate for Payer: Aetna Managed Medicare |
$3,443.42
|
| 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 |
$3,443.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,443.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,443.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,443.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,443.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,809.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,443.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,443.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,443.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,443.42
|
| Rate for Payer: NAPHCARE Commercial |
$5,165.13
|
| Rate for Payer: Quartz Medicare Advantage |
$3,443.42
|
| Rate for Payer: The Alliance Commercial |
$13,773.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,443.42
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$3,443.42
|
|
|
OSTEOT SHRT CORRJ OTH PHALANGES ANY TOE 28312
|
Professional
|
Both
|
$1,576.00
|
|
|
Service Code
|
CPT 28312
|
| Hospital Charge Code |
6178952
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$288.49 |
| Max. Negotiated Rate |
$1,557.09 |
| Rate for Payer: Aetna Commercial |
$1,557.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,409.57
|
| Rate for Payer: Aetna Managed Medicare |
$335.84
|
| Rate for Payer: Anthem Medicare Advantage |
$335.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$335.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$335.84
|
| Rate for Payer: Cash Price |
$472.80
|
| Rate for Payer: Cash Price |
$472.80
|
| Rate for Payer: Cash Price |
$472.80
|
| Rate for Payer: Cigna Commercial |
$1,557.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$288.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$335.84
|
| Rate for Payer: Health EOS Commercial |
$1,491.53
|
| Rate for Payer: HFN Commercial |
$1,557.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,127.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,127.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$335.84
|
| Rate for Payer: Multiplan Commercial |
$1,311.23
|
| Rate for Payer: NAPHCARE Commercial |
$503.76
|
| Rate for Payer: Preferred Network Access Commercial |
$1,557.09
|
| Rate for Payer: Quartz Beloit One Network |
$721.18
|
| Rate for Payer: Quartz Commercial |
$934.25
|
| Rate for Payer: Quartz Medicare Advantage |
$335.84
|
| Rate for Payer: The Alliance Commercial |
$1,427.31
|
| Rate for Payer: United Healthcare Medicaid |
$288.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$335.84
|
| Rate for Payer: WEA Trust Commercial |
$901.47
|
| Rate for Payer: WPS Commercial |
$1,511.27
|
|
|
OSTOMY BELT LARGE 34 - 65 7299"
|
Facility
|
OP
|
$142.00
|
|
| Hospital Charge Code |
2963719
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$41.35 |
| Max. Negotiated Rate |
$135.87 |
| Rate for Payer: Aetna Commercial |
$132.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$127.00
|
| Rate for Payer: Aetna Managed Medicare |
$41.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$95.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$73.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$70.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$78.27
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cigna Commercial |
$135.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$82.64
|
| Rate for Payer: Health EOS Commercial |
$131.44
|
| Rate for Payer: HFN Commercial |
$135.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$110.76
|
| Rate for Payer: Multiplan Commercial |
$118.14
|
| Rate for Payer: NAPHCARE Commercial |
$88.61
|
| Rate for Payer: Preferred Network Access Commercial |
$135.87
|
| Rate for Payer: Quartz Beloit One Network |
$72.36
|
| Rate for Payer: Quartz Commercial |
$95.99
|
| Rate for Payer: Quartz Medicare Advantage |
$88.61
|
| Rate for Payer: The Alliance Commercial |
$73.84
|
| Rate for Payer: WEA Trust Commercial |
$81.22
|
| Rate for Payer: WPS Commercial |
$109.38
|
|
|
OSTOMY BELT LARGE 34 - 65 7299"
|
Facility
|
IP
|
$142.00
|
|
| Hospital Charge Code |
2963719
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$72.36 |
| Max. Negotiated Rate |
$135.87 |
| Rate for Payer: Aetna Commercial |
$132.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$127.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$78.27
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cigna Commercial |
$135.87
|
| Rate for Payer: Health EOS Commercial |
$131.44
|
| Rate for Payer: HFN Commercial |
$135.87
|
| Rate for Payer: Multiplan Commercial |
$118.14
|
| Rate for Payer: Preferred Network Access Commercial |
$135.87
|
| Rate for Payer: Quartz Beloit One Network |
$72.36
|
| Rate for Payer: Quartz Commercial |
$88.61
|
| Rate for Payer: WEA Trust Commercial |
$81.22
|
| Rate for Payer: WPS Commercial |
$109.38
|
|
