|
Parsabiv 5.0 mg dose
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
HCPCS J0606
|
| Hospital Charge Code |
5412962
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.59 |
| Max. Negotiated Rate |
$8.61 |
| Rate for Payer: Aetna Commercial |
$8.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.96
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna Commercial |
$8.61
|
| Rate for Payer: Health EOS Commercial |
$8.33
|
| Rate for Payer: HFN Commercial |
$8.61
|
| Rate for Payer: Multiplan Commercial |
$7.49
|
| Rate for Payer: Preferred Network Access Commercial |
$8.61
|
| Rate for Payer: Quartz Beloit One Network |
$4.59
|
| Rate for Payer: Quartz Commercial |
$5.62
|
| Rate for Payer: WEA Trust Commercial |
$5.15
|
| Rate for Payer: WPS Commercial |
$6.93
|
|
|
Parsabiv 5.0 mg dose
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
HCPCS J0606
|
| Hospital Charge Code |
5412962
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$9.57 |
| Rate for Payer: Aetna Commercial |
$8.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.05
|
| Rate for Payer: Aetna Managed Medicare |
$2.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4.49
|
| Rate for Payer: Anthem Medicare Advantage |
$2.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2.39
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna Commercial |
$8.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.24
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2.39
|
| Rate for Payer: Health EOS Commercial |
$8.33
|
| Rate for Payer: HFN Commercial |
$8.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2.39
|
| Rate for Payer: Multiplan Commercial |
$7.49
|
| Rate for Payer: NAPHCARE Commercial |
$3.59
|
| Rate for Payer: Preferred Network Access Commercial |
$8.61
|
| Rate for Payer: Quartz Beloit One Network |
$4.59
|
| Rate for Payer: Quartz Commercial |
$6.08
|
| Rate for Payer: Quartz Medicare Advantage |
$2.39
|
| Rate for Payer: The Alliance Commercial |
$9.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.39
|
| Rate for Payer: WEA Trust Commercial |
$5.15
|
| Rate for Payer: Wellcare Medicare |
$2.39
|
| Rate for Payer: WPS Commercial |
$6.93
|
|
|
Parsabiv 7.5 mg dose
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
HCPCS J0606
|
| Hospital Charge Code |
5412963
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$9.57 |
| Rate for Payer: Aetna Commercial |
$8.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.05
|
| Rate for Payer: Aetna Managed Medicare |
$2.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4.49
|
| Rate for Payer: Anthem Medicare Advantage |
$2.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2.39
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna Commercial |
$8.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.24
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2.39
|
| Rate for Payer: Health EOS Commercial |
$8.33
|
| Rate for Payer: HFN Commercial |
$8.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2.39
|
| Rate for Payer: Multiplan Commercial |
$7.49
|
| Rate for Payer: NAPHCARE Commercial |
$3.59
|
| Rate for Payer: Preferred Network Access Commercial |
$8.61
|
| Rate for Payer: Quartz Beloit One Network |
$4.59
|
| Rate for Payer: Quartz Commercial |
$6.08
|
| Rate for Payer: Quartz Medicare Advantage |
$2.39
|
| Rate for Payer: The Alliance Commercial |
$9.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.39
|
| Rate for Payer: WEA Trust Commercial |
$5.15
|
| Rate for Payer: Wellcare Medicare |
$2.39
|
| Rate for Payer: WPS Commercial |
$6.93
|
|
|
Parsabiv 7.5 mg dose
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
HCPCS J0606
|
| Hospital Charge Code |
5412963
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.59 |
| Max. Negotiated Rate |
$8.61 |
| Rate for Payer: Aetna Commercial |
$8.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.96
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna Commercial |
$8.61
|
| Rate for Payer: Health EOS Commercial |
$8.33
|
| Rate for Payer: HFN Commercial |
$8.61
|
| Rate for Payer: Multiplan Commercial |
$7.49
|
| Rate for Payer: Preferred Network Access Commercial |
$8.61
|
| Rate for Payer: Quartz Beloit One Network |
$4.59
|
| Rate for Payer: Quartz Commercial |
$5.62
|
| Rate for Payer: WEA Trust Commercial |
$5.15
|
| Rate for Payer: WPS Commercial |
$6.93
|
|
|
PARTIAL AMPUTATION OF TOE 28825
|
Professional
|
Both
|
$1,504.00
|
|
|
Service Code
|
CPT 28825
|
| Hospital Charge Code |
3014286
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$151.78 |
| Max. Negotiated Rate |
$1,485.95 |
| Rate for Payer: Aetna Commercial |
$1,485.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,345.18
|
| Rate for Payer: Aetna Managed Medicare |
$151.78
|
| Rate for Payer: Anthem Medicare Advantage |
$151.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$151.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$151.78
|
| Rate for Payer: Cash Price |
$451.20
|
| Rate for Payer: Cash Price |
$451.20
|
| Rate for Payer: Cash Price |
$451.20
|
| Rate for Payer: Cigna Commercial |
$1,485.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$156.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$151.78
|
| Rate for Payer: Health EOS Commercial |
$1,423.39
|
| Rate for Payer: HFN Commercial |
$1,485.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$609.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$609.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$151.78
|
| Rate for Payer: Multiplan Commercial |
$1,251.33
|
| Rate for Payer: NAPHCARE Commercial |
$227.67
|
| Rate for Payer: Preferred Network Access Commercial |
$1,485.95
|
| Rate for Payer: Quartz Beloit One Network |
$688.23
|
| Rate for Payer: Quartz Commercial |
$891.57
|
| Rate for Payer: Quartz Medicare Advantage |
$151.78
|
| Rate for Payer: The Alliance Commercial |
$645.05
|
| Rate for Payer: United Healthcare Medicaid |
$156.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$151.78
|
| Rate for Payer: WEA Trust Commercial |
$860.29
|
| Rate for Payer: WPS Commercial |
$683.00
|
|
|
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) BONE (EG, OSTEOMYELITIS); DISTAL PHALANX OF FINGER
|
Facility
|
OP
|
$6,807.99
|
|
|
Service Code
|
CPT 26236
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,692.24 |
| Max. Negotiated Rate |
$6,807.99 |
| Rate for Payer: Aetna Managed Medicare |
$1,692.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$1,692.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,692.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,692.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,692.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,692.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,295.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,692.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,692.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,692.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,692.24
|
| Rate for Payer: NAPHCARE Commercial |
$2,538.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,692.24
|
| Rate for Payer: The Alliance Commercial |
$2,876.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,692.24
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$1,692.24
|
|
|
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) BONE, FEMUR, PROXIMAL TIBIA AND/OR FIBULA (EG, OSTEOMYELITIS OR BONE ABSCESS)
|
Facility
|
OP
|
$12,809.52
|
|
|
Service Code
|
CPT 27360
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,443.42 |
| Max. Negotiated Rate |
$12,809.52 |
| 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 |
$8,673.35
|
| 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 |
$5,853.81
|
| 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
|
|
|
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, SEQUESTRECTOMY, OR DIAPHYSECTOMY) BONE (EG, OSTEOMYELITIS OR BOSSING); PHALANX OF TOE
|
Facility
|
OP
|
$12,809.52
|
|
|
Service Code
|
CPT 28124
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,443.42 |
| Max. Negotiated Rate |
$12,809.52 |
| 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 |
$5,853.81
|
| 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
|
|
|
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, SEQUESTRECTOMY, OR DIAPHYSECTOMY) BONE (EG, OSTEOMYELITIS OR BOSSING); TALUS OR CALCANEUS
|
Facility
|
OP
|
$12,809.52
|
|
|
Service Code
|
CPT 28120
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,443.42 |
| Max. Negotiated Rate |
$12,809.52 |
| 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 |
$12,105.14
|
| 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 |
$5,853.81
|
| 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
|
|
|
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, SEQUESTRECTOMY, OR DIAPHYSECTOMY) BONE (EG, OSTEOMYELITIS OR BOSSING); TARSAL OR METATARSAL BONE, EXCEPT TALUS OR CALCANEUS
|
Facility
|
OP
|
$12,809.52
|
|
|
Service Code
|
CPT 28122
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,443.42 |
| Max. Negotiated Rate |
$12,809.52 |
| 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 |
$5,853.81
|
| 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
|
|
|
PARTIAL EXCISION OF LIP 40510
|
Professional
|
Both
|
$3,338.00
|
|
|
Service Code
|
CPT 40510
|
| Hospital Charge Code |
3014601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$307.41 |
| Max. Negotiated Rate |
$3,297.94 |
| Rate for Payer: Aetna Commercial |
$3,297.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,985.51
|
| Rate for Payer: Aetna Managed Medicare |
$307.41
|
| Rate for Payer: Anthem Medicare Advantage |
$307.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$307.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$307.41
|
| Rate for Payer: Cash Price |
$1,001.40
|
| Rate for Payer: Cash Price |
$1,001.40
|
| Rate for Payer: Cash Price |
$1,001.40
|
| Rate for Payer: Cigna Commercial |
$3,297.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$457.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$307.41
|
| Rate for Payer: Health EOS Commercial |
$3,159.08
|
| Rate for Payer: HFN Commercial |
$3,297.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,213.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,213.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$307.41
|
| Rate for Payer: Multiplan Commercial |
$2,777.22
|
| Rate for Payer: NAPHCARE Commercial |
$461.12
|
| Rate for Payer: Preferred Network Access Commercial |
$3,297.94
|
| Rate for Payer: Quartz Beloit One Network |
$1,527.47
|
| Rate for Payer: Quartz Commercial |
$1,978.77
|
| Rate for Payer: Quartz Medicare Advantage |
$307.41
|
| Rate for Payer: The Alliance Commercial |
$1,306.51
|
| Rate for Payer: United Healthcare Medicaid |
$457.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$307.41
|
| Rate for Payer: WEA Trust Commercial |
$1,909.34
|
| Rate for Payer: WPS Commercial |
$1,383.36
|
|
|
PARTIAL EXCISION OF LIP 40520
|
Professional
|
Both
|
$1,964.00
|
|
|
Service Code
|
CPT 40520
|
| Hospital Charge Code |
3014602
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$316.35 |
| Max. Negotiated Rate |
$1,940.43 |
| Rate for Payer: Aetna Commercial |
$1,940.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,756.60
|
| Rate for Payer: Aetna Managed Medicare |
$316.35
|
| Rate for Payer: Anthem Medicare Advantage |
$316.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$316.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$316.35
|
| Rate for Payer: Cash Price |
$589.20
|
| Rate for Payer: Cash Price |
$589.20
|
| Rate for Payer: Cash Price |
$589.20
|
| Rate for Payer: Cigna Commercial |
$1,940.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$419.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$316.35
|
| Rate for Payer: Health EOS Commercial |
$1,858.73
|
| Rate for Payer: HFN Commercial |
$1,940.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,233.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,233.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$316.35
|
| Rate for Payer: Multiplan Commercial |
$1,634.05
|
| Rate for Payer: NAPHCARE Commercial |
$474.52
|
| Rate for Payer: Preferred Network Access Commercial |
$1,940.43
|
| Rate for Payer: Quartz Beloit One Network |
$898.73
|
| Rate for Payer: Quartz Commercial |
$1,164.26
|
| Rate for Payer: Quartz Medicare Advantage |
$316.35
|
| Rate for Payer: The Alliance Commercial |
$1,344.48
|
| Rate for Payer: United Healthcare Medicaid |
$419.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$316.35
|
| Rate for Payer: WEA Trust Commercial |
$1,123.41
|
| Rate for Payer: WPS Commercial |
$1,423.56
|
|
|
PARTIAL REMOVAL, FOOT FASCIA 28060
|
Professional
|
Both
|
$1,953.00
|
|
|
Service Code
|
CPT 28060
|
| Hospital Charge Code |
3014191
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$336.35 |
| Max. Negotiated Rate |
$1,929.56 |
| Rate for Payer: Aetna Commercial |
$1,929.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,746.76
|
| Rate for Payer: Aetna Managed Medicare |
$336.35
|
| Rate for Payer: Anthem Medicare Advantage |
$336.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$336.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$336.35
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cigna Commercial |
$1,929.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$391.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$336.35
|
| Rate for Payer: Health EOS Commercial |
$1,848.32
|
| Rate for Payer: HFN Commercial |
$1,929.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,265.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,265.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$336.35
|
| Rate for Payer: Multiplan Commercial |
$1,624.90
|
| Rate for Payer: NAPHCARE Commercial |
$504.52
|
| Rate for Payer: Preferred Network Access Commercial |
$1,929.56
|
| Rate for Payer: Quartz Beloit One Network |
$893.69
|
| Rate for Payer: Quartz Commercial |
$1,157.74
|
| Rate for Payer: Quartz Medicare Advantage |
$336.35
|
| Rate for Payer: The Alliance Commercial |
$1,429.47
|
| Rate for Payer: United Healthcare Medicaid |
$391.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$336.35
|
| Rate for Payer: WEA Trust Commercial |
$1,117.12
|
| Rate for Payer: WPS Commercial |
$1,513.56
|
|
|
PARTIAL REMOVAL OF FOOT BONE 28122
|
Professional
|
Both
|
$1,824.00
|
|
|
Service Code
|
CPT 28122
|
| Hospital Charge Code |
3014207
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$391.73 |
| Max. Negotiated Rate |
$1,834.47 |
| Rate for Payer: Aetna Commercial |
$1,802.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,631.39
|
| Rate for Payer: Aetna Managed Medicare |
$407.66
|
| Rate for Payer: Anthem Medicare Advantage |
$407.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$407.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$407.66
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cigna Commercial |
$1,802.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$391.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$407.66
|
| Rate for Payer: Health EOS Commercial |
$1,726.23
|
| Rate for Payer: HFN Commercial |
$1,802.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,532.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,532.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$407.66
|
| Rate for Payer: Multiplan Commercial |
$1,517.57
|
| Rate for Payer: NAPHCARE Commercial |
$611.49
|
| Rate for Payer: Preferred Network Access Commercial |
$1,802.11
|
| Rate for Payer: Quartz Beloit One Network |
$834.66
|
| Rate for Payer: Quartz Commercial |
$1,081.27
|
| Rate for Payer: Quartz Medicare Advantage |
$407.66
|
| Rate for Payer: The Alliance Commercial |
$1,732.55
|
| Rate for Payer: United Healthcare Medicaid |
$391.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$407.66
|
| Rate for Payer: WEA Trust Commercial |
$1,043.33
|
| Rate for Payer: WPS Commercial |
$1,834.47
|
|
|
Partial Removal of Foot Bone 2812250
|
Professional
|
Both
|
$3,649.00
|
|
|
Service Code
|
CPT 28122 50
|
| Hospital Charge Code |
5096727
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$391.73 |
| Max. Negotiated Rate |
$3,605.21 |
| Rate for Payer: Aetna Commercial |
$3,605.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,263.67
|
| Rate for Payer: Cash Price |
$1,094.70
|
| Rate for Payer: Cash Price |
$1,094.70
|
| Rate for Payer: Cash Price |
$1,094.70
|
| Rate for Payer: Cigna Commercial |
$3,605.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$391.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,276.98
|
| Rate for Payer: Health EOS Commercial |
$3,453.41
|
| Rate for Payer: HFN Commercial |
$3,605.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,532.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,532.43
|
| Rate for Payer: Multiplan Commercial |
$3,035.97
|
| Rate for Payer: Preferred Network Access Commercial |
$3,605.21
|
| Rate for Payer: Quartz Beloit One Network |
$1,669.78
|
| Rate for Payer: Quartz Commercial |
$2,163.13
|
| Rate for Payer: The Alliance Commercial |
$1,897.48
|
| Rate for Payer: United Healthcare Medicaid |
$391.73
|
| Rate for Payer: WEA Trust Commercial |
$2,087.23
|
| Rate for Payer: WPS Commercial |
$2,810.82
|
|
|
PARTIAL REMOVAL OF FOOT BONE 28288
|
Professional
|
Both
|
$2,261.00
|
|
|
Service Code
|
CPT 28288
|
| Hospital Charge Code |
3014231
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$277.50 |
| Max. Negotiated Rate |
$2,233.87 |
| Rate for Payer: Aetna Commercial |
$2,233.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,022.24
|
| Rate for Payer: Aetna Managed Medicare |
$408.19
|
| Rate for Payer: Anthem Medicare Advantage |
$408.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$408.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$408.19
|
| Rate for Payer: Cash Price |
$678.30
|
| Rate for Payer: Cash Price |
$678.30
|
| Rate for Payer: Cash Price |
$678.30
|
| Rate for Payer: Cigna Commercial |
$2,233.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$277.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$408.19
|
| Rate for Payer: Health EOS Commercial |
$2,139.81
|
| Rate for Payer: HFN Commercial |
$2,233.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,519.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,519.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$408.19
|
| Rate for Payer: Multiplan Commercial |
$1,881.15
|
| Rate for Payer: NAPHCARE Commercial |
$612.28
|
| Rate for Payer: Preferred Network Access Commercial |
$2,233.87
|
| Rate for Payer: Quartz Beloit One Network |
$1,034.63
|
| Rate for Payer: Quartz Commercial |
$1,340.32
|
| Rate for Payer: Quartz Medicare Advantage |
$408.19
|
| Rate for Payer: The Alliance Commercial |
$1,734.81
|
| Rate for Payer: United Healthcare Medicaid |
$277.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$408.19
|
| Rate for Payer: WEA Trust Commercial |
$1,293.29
|
| Rate for Payer: WPS Commercial |
$1,836.85
|
|
|
Partial Removal of Foot Bone 2828850
|
Professional
|
Both
|
$4,523.00
|
|
|
Service Code
|
CPT 28288 50
|
| Hospital Charge Code |
5220624
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$277.50 |
| Max. Negotiated Rate |
$4,468.72 |
| Rate for Payer: Aetna Commercial |
$4,468.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,045.37
|
| Rate for Payer: Cash Price |
$1,356.90
|
| Rate for Payer: Cash Price |
$1,356.90
|
| Rate for Payer: Cash Price |
$1,356.90
|
| Rate for Payer: Cigna Commercial |
$4,468.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$277.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,822.35
|
| Rate for Payer: Health EOS Commercial |
$4,280.57
|
| Rate for Payer: HFN Commercial |
$4,468.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,519.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,519.84
|
| Rate for Payer: Multiplan Commercial |
$3,763.14
|
| Rate for Payer: Preferred Network Access Commercial |
$4,468.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,069.72
|
| Rate for Payer: Quartz Commercial |
$2,681.23
|
| Rate for Payer: The Alliance Commercial |
$2,351.96
|
| Rate for Payer: United Healthcare Medicaid |
$277.50
|
| Rate for Payer: WEA Trust Commercial |
$2,587.16
|
| Rate for Payer: WPS Commercial |
$3,484.07
|
|
|
PARTIAL REMOVAL OF TOE 28124
|
Professional
|
Both
|
$1,927.00
|
|
|
Service Code
|
CPT 28124
|
| Hospital Charge Code |
3014208
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$235.04 |
| Max. Negotiated Rate |
$1,903.88 |
| Rate for Payer: Aetna Commercial |
$1,903.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,723.51
|
| Rate for Payer: Aetna Managed Medicare |
$313.31
|
| Rate for Payer: Anthem Medicare Advantage |
$313.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$313.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$313.31
|
| Rate for Payer: Cash Price |
$578.10
|
| Rate for Payer: Cash Price |
$578.10
|
| Rate for Payer: Cash Price |
$578.10
|
| Rate for Payer: Cigna Commercial |
$1,903.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$235.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$313.31
|
| Rate for Payer: Health EOS Commercial |
$1,823.71
|
| Rate for Payer: HFN Commercial |
$1,903.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,170.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,170.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$313.31
|
| Rate for Payer: Multiplan Commercial |
$1,603.26
|
| Rate for Payer: NAPHCARE Commercial |
$469.97
|
| Rate for Payer: Preferred Network Access Commercial |
$1,903.88
|
| Rate for Payer: Quartz Beloit One Network |
$881.80
|
| Rate for Payer: Quartz Commercial |
$1,142.33
|
| Rate for Payer: Quartz Medicare Advantage |
$313.31
|
| Rate for Payer: The Alliance Commercial |
$1,331.57
|
| Rate for Payer: United Healthcare Medicaid |
$235.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$313.31
|
| Rate for Payer: WEA Trust Commercial |
$1,102.24
|
| Rate for Payer: WPS Commercial |
$1,409.90
|
|
|
PARTIAL REMOVAL OF TOE 28126
|
Professional
|
Both
|
$1,349.00
|
|
|
Service Code
|
CPT 28126
|
| Hospital Charge Code |
3014209
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$233.88 |
| Max. Negotiated Rate |
$1,332.81 |
| Rate for Payer: Aetna Commercial |
$1,332.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,206.55
|
| Rate for Payer: Aetna Managed Medicare |
$233.88
|
| Rate for Payer: Anthem Medicare Advantage |
$233.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$233.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$233.88
|
| Rate for Payer: Cash Price |
$404.70
|
| Rate for Payer: Cash Price |
$404.70
|
| Rate for Payer: Cash Price |
$404.70
|
| Rate for Payer: Cigna Commercial |
$1,332.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$280.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$233.88
|
| Rate for Payer: Health EOS Commercial |
$1,276.69
|
| Rate for Payer: HFN Commercial |
$1,332.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$865.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$865.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$233.88
|
| Rate for Payer: Multiplan Commercial |
$1,122.37
|
| Rate for Payer: NAPHCARE Commercial |
$350.81
|
| Rate for Payer: Preferred Network Access Commercial |
$1,332.81
|
| Rate for Payer: Quartz Beloit One Network |
$617.30
|
| Rate for Payer: Quartz Commercial |
$799.69
|
| Rate for Payer: Quartz Medicare Advantage |
$233.88
|
| Rate for Payer: The Alliance Commercial |
$993.97
|
| Rate for Payer: United Healthcare Medicaid |
$280.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$233.88
|
| Rate for Payer: WEA Trust Commercial |
$771.63
|
| Rate for Payer: WPS Commercial |
$1,052.44
|
|
|
PARTIAL REMOVAL OF TOE 28153
|
Professional
|
Both
|
$1,643.00
|
|
|
Service Code
|
CPT 28153
|
| Hospital Charge Code |
3014211
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$107.71 |
| Max. Negotiated Rate |
$1,623.28 |
| Rate for Payer: Aetna Commercial |
$1,623.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,469.50
|
| Rate for Payer: Aetna Managed Medicare |
$247.20
|
| Rate for Payer: Anthem Medicare Advantage |
$247.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$247.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$247.20
|
| Rate for Payer: Cash Price |
$492.90
|
| Rate for Payer: Cash Price |
$492.90
|
| Rate for Payer: Cash Price |
$492.90
|
| Rate for Payer: Cigna Commercial |
$1,623.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$107.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$247.20
|
| Rate for Payer: Health EOS Commercial |
$1,554.94
|
| Rate for Payer: HFN Commercial |
$1,623.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$927.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$927.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$247.20
|
| Rate for Payer: Multiplan Commercial |
$1,366.98
|
| Rate for Payer: NAPHCARE Commercial |
$370.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,623.28
|
| Rate for Payer: Quartz Beloit One Network |
$751.84
|
| Rate for Payer: Quartz Commercial |
$973.97
|
| Rate for Payer: Quartz Medicare Advantage |
$247.20
|
| Rate for Payer: The Alliance Commercial |
$1,050.59
|
| Rate for Payer: United Healthcare Medicaid |
$107.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$247.20
|
| Rate for Payer: WEA Trust Commercial |
$939.80
|
| Rate for Payer: WPS Commercial |
$1,112.39
|
|
|
PARTIAL THICKNESS BURNS WITHOUT SKIN GRAFT
|
Facility
|
IP
|
$4,734.89
|
|
|
Service Code
|
APR-DRG 8441
|
| Min. Negotiated Rate |
$4,205.82 |
| Max. Negotiated Rate |
$4,734.89 |
| Rate for Payer: Anthem Medicaid |
$4,533.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$4,533.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,533.92
|
| Rate for Payer: Dean Health Medicaid |
$4,533.92
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4,205.82
|
| Rate for Payer: Managed Health Services Medicaid |
$4,734.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,533.92
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4,533.92
|
| Rate for Payer: United Healthcare Medicaid |
$4,533.92
|
|
|
PARTIAL THICKNESS BURNS WITHOUT SKIN GRAFT
|
Facility
|
IP
|
$7,979.16
|
|
|
Service Code
|
APR-DRG 8442
|
| Min. Negotiated Rate |
$7,087.59 |
| Max. Negotiated Rate |
$7,979.16 |
| Rate for Payer: Anthem Medicaid |
$7,640.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$7,640.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7,640.49
|
| Rate for Payer: Dean Health Medicaid |
$7,640.49
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$7,087.59
|
| Rate for Payer: Managed Health Services Medicaid |
$7,979.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,640.49
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$7,640.49
|
| Rate for Payer: United Healthcare Medicaid |
$7,640.49
|
|
|
PARTIAL THICKNESS BURNS WITHOUT SKIN GRAFT
|
Facility
|
IP
|
$22,271.51
|
|
|
Service Code
|
APR-DRG 8444
|
| Min. Negotiated Rate |
$19,782.94 |
| Max. Negotiated Rate |
$22,271.51 |
| Rate for Payer: Anthem Medicaid |
$21,326.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$21,326.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$21,326.20
|
| Rate for Payer: Dean Health Medicaid |
$21,326.20
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19,782.94
|
| Rate for Payer: Managed Health Services Medicaid |
$22,271.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$21,326.20
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$21,326.20
|
| Rate for Payer: United Healthcare Medicaid |
$21,326.20
|
|
|
PARTIAL THICKNESS BURNS WITHOUT SKIN GRAFT
|
Facility
|
IP
|
$12,451.00
|
|
|
Service Code
|
APR-DRG 8443
|
| Min. Negotiated Rate |
$11,059.76 |
| Max. Negotiated Rate |
$12,451.00 |
| Rate for Payer: Anthem Medicaid |
$11,922.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$11,922.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11,922.52
|
| Rate for Payer: Dean Health Medicaid |
$11,922.52
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11,059.76
|
| Rate for Payer: Managed Health Services Medicaid |
$12,451.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,922.52
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11,922.52
|
| Rate for Payer: United Healthcare Medicaid |
$11,922.52
|
|
|
PARTIAL THICKNESS BURNS W OR W/O SKIN GRAFT
|
Facility
|
OP
|
$112.69
|
|
|
Service Code
|
EAPG 00861
|
| Min. Negotiated Rate |
$108.35 |
| Max. Negotiated Rate |
$112.69 |
| Rate for Payer: Anthem Medicaid |
$108.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$108.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$108.35
|
| Rate for Payer: Dean Health Medicaid |
$108.35
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$108.35
|
| Rate for Payer: Managed Health Services Medicaid |
$112.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$108.35
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$108.35
|
| Rate for Payer: United Healthcare Medicaid |
$108.35
|
|
