|
POST HOFFMANN 3 LARGE 30 DEG 4922-2-140
|
Facility
|
IP
|
$1,479.00
|
|
| Hospital Charge Code |
5685710
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$753.70 |
| Max. Negotiated Rate |
$1,415.11 |
| Rate for Payer: Aetna Commercial |
$1,384.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,322.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$815.22
|
| Rate for Payer: Cash Price |
$443.70
|
| Rate for Payer: Cigna Commercial |
$1,415.11
|
| Rate for Payer: Health EOS Commercial |
$1,368.96
|
| Rate for Payer: HFN Commercial |
$1,415.11
|
| Rate for Payer: Multiplan Commercial |
$1,230.53
|
| Rate for Payer: Preferred Network Access Commercial |
$1,415.11
|
| Rate for Payer: Quartz Beloit One Network |
$753.70
|
| Rate for Payer: Quartz Commercial |
$922.90
|
| Rate for Payer: WEA Trust Commercial |
$845.99
|
| Rate for Payer: WPS Commercial |
$1,139.27
|
|
|
POST HOFFMANN 3 LARGE 30 DEG 4922-2-140
|
Facility
|
OP
|
$1,479.00
|
|
| Hospital Charge Code |
5685710
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$430.68 |
| Max. Negotiated Rate |
$1,415.11 |
| Rate for Payer: Aetna Commercial |
$1,384.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,322.82
|
| Rate for Payer: Aetna Managed Medicare |
$430.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$999.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$769.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$738.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$815.22
|
| Rate for Payer: Cash Price |
$443.70
|
| Rate for Payer: Cigna Commercial |
$1,415.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$860.78
|
| Rate for Payer: Health EOS Commercial |
$1,368.96
|
| Rate for Payer: HFN Commercial |
$1,415.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,153.62
|
| Rate for Payer: Multiplan Commercial |
$1,230.53
|
| Rate for Payer: NAPHCARE Commercial |
$922.90
|
| Rate for Payer: Preferred Network Access Commercial |
$1,415.11
|
| Rate for Payer: Quartz Beloit One Network |
$753.70
|
| Rate for Payer: Quartz Commercial |
$999.80
|
| Rate for Payer: Quartz Medicare Advantage |
$922.90
|
| Rate for Payer: The Alliance Commercial |
$769.08
|
| Rate for Payer: WEA Trust Commercial |
$845.99
|
| Rate for Payer: WPS Commercial |
$1,139.27
|
|
|
POST MODULAR 20MM AR-9582-20
|
Facility
|
IP
|
$7,415.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5831633
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,778.68 |
| Max. Negotiated Rate |
$7,094.67 |
| Rate for Payer: Aetna Commercial |
$6,940.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,631.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,087.15
|
| Rate for Payer: Cash Price |
$2,224.50
|
| Rate for Payer: Cigna Commercial |
$7,094.67
|
| Rate for Payer: Health EOS Commercial |
$6,863.32
|
| Rate for Payer: HFN Commercial |
$7,094.67
|
| Rate for Payer: Multiplan Commercial |
$6,169.28
|
| Rate for Payer: Preferred Network Access Commercial |
$7,094.67
|
| Rate for Payer: Quartz Beloit One Network |
$3,778.68
|
| Rate for Payer: Quartz Commercial |
$4,626.96
|
| Rate for Payer: WEA Trust Commercial |
$4,241.38
|
| Rate for Payer: WPS Commercial |
$5,711.77
|
|
|
POST MODULAR 20MM AR-9582-20
|
Facility
|
OP
|
$7,415.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5831633
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,159.25 |
| Max. Negotiated Rate |
$7,094.67 |
| Rate for Payer: Aetna Commercial |
$6,940.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,631.98
|
| Rate for Payer: Aetna Managed Medicare |
$2,159.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,012.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,855.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,701.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,087.15
|
| Rate for Payer: Cash Price |
$2,224.50
|
| Rate for Payer: Cigna Commercial |
$7,094.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,315.53
|
| Rate for Payer: Health EOS Commercial |
$6,863.32
|
| Rate for Payer: HFN Commercial |
$7,094.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,783.70
|
| Rate for Payer: Multiplan Commercial |
$6,169.28
|
| Rate for Payer: NAPHCARE Commercial |
$4,626.96
|
| Rate for Payer: Preferred Network Access Commercial |
$7,094.67
|
| Rate for Payer: Quartz Beloit One Network |
$3,778.68
|
| Rate for Payer: Quartz Commercial |
$5,012.54
|
| Rate for Payer: Quartz Medicare Advantage |
$4,626.96
|
| Rate for Payer: The Alliance Commercial |
$3,855.80
|
| Rate for Payer: WEA Trust Commercial |
$4,241.38
|
| Rate for Payer: WPS Commercial |
$5,711.77
|
|
|
POST MODULAR 25MM AR-9582-25
|
Facility
|
OP
|
$7,415.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5659647
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,159.25 |
| Max. Negotiated Rate |
$7,094.67 |
| Rate for Payer: Aetna Commercial |
$6,940.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,631.98
|
| Rate for Payer: Aetna Managed Medicare |
$2,159.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,012.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,855.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,701.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,087.15
|
| Rate for Payer: Cash Price |
$2,224.50
|
| Rate for Payer: Cigna Commercial |
$7,094.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,315.53
|
| Rate for Payer: Health EOS Commercial |
$6,863.32
|
| Rate for Payer: HFN Commercial |
$7,094.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,783.70
|
| Rate for Payer: Multiplan Commercial |
$6,169.28
|
| Rate for Payer: NAPHCARE Commercial |
$4,626.96
|
| Rate for Payer: Preferred Network Access Commercial |
$7,094.67
|
| Rate for Payer: Quartz Beloit One Network |
$3,778.68
|
| Rate for Payer: Quartz Commercial |
$5,012.54
|
| Rate for Payer: Quartz Medicare Advantage |
$4,626.96
|
| Rate for Payer: The Alliance Commercial |
$3,855.80
|
| Rate for Payer: WEA Trust Commercial |
$4,241.38
|
| Rate for Payer: WPS Commercial |
$5,711.77
|
|
|
POST MODULAR 25MM AR-9582-25
|
Facility
|
IP
|
$7,415.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5659647
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,778.68 |
| Max. Negotiated Rate |
$7,094.67 |
| Rate for Payer: Aetna Commercial |
$6,940.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,631.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,087.15
|
| Rate for Payer: Cash Price |
$2,224.50
|
| Rate for Payer: Cigna Commercial |
$7,094.67
|
| Rate for Payer: Health EOS Commercial |
$6,863.32
|
| Rate for Payer: HFN Commercial |
$7,094.67
|
| Rate for Payer: Multiplan Commercial |
$6,169.28
|
| Rate for Payer: Preferred Network Access Commercial |
$7,094.67
|
| Rate for Payer: Quartz Beloit One Network |
$3,778.68
|
| Rate for Payer: Quartz Commercial |
$4,626.96
|
| Rate for Payer: WEA Trust Commercial |
$4,241.38
|
| Rate for Payer: WPS Commercial |
$5,711.77
|
|
|
POST MODULAR 30MM AR-9582-30
|
Facility
|
IP
|
$7,130.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6065655
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,633.45 |
| Max. Negotiated Rate |
$6,821.98 |
| Rate for Payer: Aetna Commercial |
$6,673.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,377.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,930.06
|
| Rate for Payer: Cash Price |
$2,139.00
|
| Rate for Payer: Cigna Commercial |
$6,821.98
|
| Rate for Payer: Health EOS Commercial |
$6,599.53
|
| Rate for Payer: HFN Commercial |
$6,821.98
|
| Rate for Payer: Multiplan Commercial |
$5,932.16
|
| Rate for Payer: Preferred Network Access Commercial |
$6,821.98
|
| Rate for Payer: Quartz Beloit One Network |
$3,633.45
|
| Rate for Payer: Quartz Commercial |
$4,449.12
|
| Rate for Payer: WEA Trust Commercial |
$4,078.36
|
| Rate for Payer: WPS Commercial |
$5,492.24
|
|
|
POST MODULAR 30MM AR-9582-30
|
Facility
|
OP
|
$7,130.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6065655
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,076.26 |
| Max. Negotiated Rate |
$6,821.98 |
| Rate for Payer: Aetna Commercial |
$6,673.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,377.07
|
| Rate for Payer: Aetna Managed Medicare |
$2,076.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,819.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,707.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,559.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,930.06
|
| Rate for Payer: Cash Price |
$2,139.00
|
| Rate for Payer: Cigna Commercial |
$6,821.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,149.66
|
| Rate for Payer: Health EOS Commercial |
$6,599.53
|
| Rate for Payer: HFN Commercial |
$6,821.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,561.40
|
| Rate for Payer: Multiplan Commercial |
$5,932.16
|
| Rate for Payer: NAPHCARE Commercial |
$4,449.12
|
| Rate for Payer: Preferred Network Access Commercial |
$6,821.98
|
| Rate for Payer: Quartz Beloit One Network |
$3,633.45
|
| Rate for Payer: Quartz Commercial |
$4,819.88
|
| Rate for Payer: Quartz Medicare Advantage |
$4,449.12
|
| Rate for Payer: The Alliance Commercial |
$3,707.60
|
| Rate for Payer: WEA Trust Commercial |
$4,078.36
|
| Rate for Payer: WPS Commercial |
$5,492.24
|
|
|
POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC
|
Facility
|
IP
|
$51,263.68
|
|
|
Service Code
|
MSDRG 862
|
| Min. Negotiated Rate |
$14,473.05 |
| Max. Negotiated Rate |
$51,263.68 |
| Rate for Payer: Aetna Managed Medicare |
$14,473.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39,791.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30,500.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28,976.99
|
| Rate for Payer: Anthem Medicare Advantage |
$14,473.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14,473.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14,473.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14,473.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32,167.11
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14,473.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37,355.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14,473.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14,473.05
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14,473.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14,473.05
|
| Rate for Payer: NAPHCARE Commercial |
$21,709.57
|
| Rate for Payer: Quartz Medicare Advantage |
$14,473.05
|
| Rate for Payer: The Alliance Commercial |
$51,263.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14,473.05
|
| Rate for Payer: United Healthcare PPO |
$29,081.94
|
| Rate for Payer: Wellcare Medicare |
$14,473.05
|
|
|
POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC
|
Facility
|
IP
|
$28,135.12
|
|
|
Service Code
|
MSDRG 863
|
| Min. Negotiated Rate |
$8,148.90 |
| Max. Negotiated Rate |
$28,135.12 |
| Rate for Payer: Aetna Managed Medicare |
$8,148.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21,773.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,689.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,855.75
|
| Rate for Payer: Anthem Medicare Advantage |
$8,148.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,148.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,148.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,148.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17,601.34
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,148.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,391.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,148.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,148.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,148.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,148.90
|
| Rate for Payer: NAPHCARE Commercial |
$12,223.35
|
| Rate for Payer: Quartz Medicare Advantage |
$8,148.90
|
| Rate for Payer: The Alliance Commercial |
$28,135.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,148.90
|
| Rate for Payer: United Healthcare PPO |
$15,875.08
|
| Rate for Payer: Wellcare Medicare |
$8,148.90
|
|
|
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC
|
Facility
|
IP
|
$59,384.00
|
|
|
Service Code
|
MSDRG 857
|
| Min. Negotiated Rate |
$16,906.81 |
| Max. Negotiated Rate |
$59,384.00 |
| Rate for Payer: Aetna Managed Medicare |
$16,906.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46,725.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$35,814.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34,026.55
|
| Rate for Payer: Anthem Medicare Advantage |
$16,906.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16,906.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16,906.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16,906.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37,772.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16,906.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43,312.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16,906.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16,906.81
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16,906.81
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16,906.81
|
| Rate for Payer: NAPHCARE Commercial |
$25,360.22
|
| Rate for Payer: Quartz Medicare Advantage |
$16,906.81
|
| Rate for Payer: The Alliance Commercial |
$59,384.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16,906.81
|
| Rate for Payer: United Healthcare PPO |
$33,718.94
|
| Rate for Payer: Wellcare Medicare |
$16,906.81
|
|
|
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$122,776.16
|
|
|
Service Code
|
MSDRG 856
|
| Min. Negotiated Rate |
$35,341.62 |
| Max. Negotiated Rate |
$122,776.16 |
| Rate for Payer: Aetna Managed Medicare |
$35,341.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$99,249.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$76,073.55
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$72,274.84
|
| Rate for Payer: Anthem Medicare Advantage |
$35,341.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35,341.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35,341.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$35,341.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$80,231.70
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$35,341.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$89,807.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35,341.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35,341.62
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$35,341.62
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$35,341.62
|
| Rate for Payer: NAPHCARE Commercial |
$53,012.43
|
| Rate for Payer: Quartz Medicare Advantage |
$35,341.62
|
| Rate for Payer: The Alliance Commercial |
$122,776.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35,341.62
|
| Rate for Payer: United Healthcare PPO |
$69,916.64
|
| Rate for Payer: Wellcare Medicare |
$35,341.62
|
|
|
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$35,818.64
|
|
|
Service Code
|
MSDRG 858
|
| Min. Negotiated Rate |
$11,173.88 |
| Max. Negotiated Rate |
$35,818.64 |
| Rate for Payer: Aetna Managed Medicare |
$11,173.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30,391.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23,295.19
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22,131.96
|
| Rate for Payer: Anthem Medicare Advantage |
$11,173.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,173.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,173.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,173.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24,568.50
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,173.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26,027.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,173.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,173.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,173.88
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,173.88
|
| Rate for Payer: NAPHCARE Commercial |
$16,760.83
|
| Rate for Payer: Quartz Medicare Advantage |
$11,173.88
|
| Rate for Payer: The Alliance Commercial |
$35,818.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,173.88
|
| Rate for Payer: United Healthcare PPO |
$20,262.63
|
| Rate for Payer: Wellcare Medicare |
$11,173.88
|
|
|
POST-OPERATIVE, POST-TRAUMA, OTHER DEVICE INFECTIONS WITH O.R. PROCEDURE
|
Facility
|
IP
|
$9,995.87
|
|
|
Service Code
|
APR-DRG 7111
|
| Min. Negotiated Rate |
$8,878.96 |
| Max. Negotiated Rate |
$9,995.87 |
| Rate for Payer: Anthem Medicaid |
$9,571.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$9,571.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9,571.60
|
| Rate for Payer: Dean Health Medicaid |
$9,571.60
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8,878.96
|
| Rate for Payer: Managed Health Services Medicaid |
$9,995.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,571.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$9,571.60
|
| Rate for Payer: United Healthcare Medicaid |
$9,571.60
|
|
|
POST-OPERATIVE, POST-TRAUMA, OTHER DEVICE INFECTIONS WITH O.R. PROCEDURE
|
Facility
|
IP
|
$23,060.66
|
|
|
Service Code
|
APR-DRG 7113
|
| Min. Negotiated Rate |
$20,483.91 |
| Max. Negotiated Rate |
$23,060.66 |
| Rate for Payer: Anthem Medicaid |
$22,081.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$22,081.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$22,081.85
|
| Rate for Payer: Dean Health Medicaid |
$22,081.85
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$20,483.91
|
| Rate for Payer: Managed Health Services Medicaid |
$23,060.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$22,081.85
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$22,081.85
|
| Rate for Payer: United Healthcare Medicaid |
$22,081.85
|
|
|
POST-OPERATIVE, POST-TRAUMA, OTHER DEVICE INFECTIONS WITH O.R. PROCEDURE
|
Facility
|
IP
|
$38,755.93
|
|
|
Service Code
|
APR-DRG 7114
|
| Min. Negotiated Rate |
$34,425.44 |
| Max. Negotiated Rate |
$38,755.93 |
| Rate for Payer: Anthem Medicaid |
$37,110.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$37,110.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$37,110.94
|
| Rate for Payer: Dean Health Medicaid |
$37,110.94
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$34,425.44
|
| Rate for Payer: Managed Health Services Medicaid |
$38,755.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$37,110.94
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$37,110.94
|
| Rate for Payer: United Healthcare Medicaid |
$37,110.94
|
|
|
POST-OPERATIVE, POST-TRAUMA, OTHER DEVICE INFECTIONS WITH O.R. PROCEDURE
|
Facility
|
IP
|
$14,292.35
|
|
|
Service Code
|
APR-DRG 7112
|
| Min. Negotiated Rate |
$12,695.35 |
| Max. Negotiated Rate |
$14,292.35 |
| Rate for Payer: Anthem Medicaid |
$13,685.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$13,685.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13,685.71
|
| Rate for Payer: Dean Health Medicaid |
$13,685.71
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12,695.35
|
| Rate for Payer: Managed Health Services Medicaid |
$14,292.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,685.71
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13,685.71
|
| Rate for Payer: United Healthcare Medicaid |
$13,685.71
|
|
|
POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS
|
Facility
|
IP
|
$5,699.40
|
|
|
Service Code
|
APR-DRG 7211
|
| Min. Negotiated Rate |
$5,062.56 |
| Max. Negotiated Rate |
$5,699.40 |
| Rate for Payer: Anthem Medicaid |
$5,457.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$5,457.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,457.49
|
| Rate for Payer: Dean Health Medicaid |
$5,457.49
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5,062.56
|
| Rate for Payer: Managed Health Services Medicaid |
$5,699.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,457.49
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5,457.49
|
| Rate for Payer: United Healthcare Medicaid |
$5,457.49
|
|
|
POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS
|
Facility
|
IP
|
$13,152.47
|
|
|
Service Code
|
APR-DRG 7213
|
| Min. Negotiated Rate |
$11,682.84 |
| Max. Negotiated Rate |
$13,152.47 |
| Rate for Payer: Anthem Medicaid |
$12,594.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$12,594.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12,594.21
|
| Rate for Payer: Dean Health Medicaid |
$12,594.21
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11,682.84
|
| Rate for Payer: Managed Health Services Medicaid |
$13,152.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,594.21
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12,594.21
|
| Rate for Payer: United Healthcare Medicaid |
$12,594.21
|
|
|
POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS
|
Facility
|
IP
|
$7,979.16
|
|
|
Service Code
|
APR-DRG 7212
|
| 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
|
|
|
POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS
|
Facility
|
IP
|
$22,446.87
|
|
|
Service Code
|
APR-DRG 7214
|
| Min. Negotiated Rate |
$19,938.71 |
| Max. Negotiated Rate |
$22,446.87 |
| Rate for Payer: Anthem Medicaid |
$21,494.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$21,494.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$21,494.12
|
| Rate for Payer: Dean Health Medicaid |
$21,494.12
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19,938.71
|
| Rate for Payer: Managed Health Services Medicaid |
$22,446.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$21,494.12
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$21,494.12
|
| Rate for Payer: United Healthcare Medicaid |
$21,494.12
|
|
|
POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS AND COMPLICATIONS
|
Facility
|
OP
|
$102.20
|
|
|
Service Code
|
EAPG 00806
|
| Min. Negotiated Rate |
$98.27 |
| Max. Negotiated Rate |
$102.20 |
| Rate for Payer: Anthem Medicaid |
$98.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$98.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$98.27
|
| Rate for Payer: Dean Health Medicaid |
$98.27
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$98.27
|
| Rate for Payer: Managed Health Services Medicaid |
$102.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$98.27
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$98.27
|
| Rate for Payer: United Healthcare Medicaid |
$98.27
|
|
|
Post Op Ostomy Follow Up
|
Facility
|
IP
|
$214.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
3005548
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$109.05 |
| Max. Negotiated Rate |
$204.76 |
| Rate for Payer: Aetna Commercial |
$200.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$191.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$117.96
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cigna Commercial |
$204.76
|
| Rate for Payer: Health EOS Commercial |
$198.08
|
| Rate for Payer: HFN Commercial |
$204.76
|
| Rate for Payer: Multiplan Commercial |
$178.05
|
| Rate for Payer: Preferred Network Access Commercial |
$204.76
|
| Rate for Payer: Quartz Beloit One Network |
$109.05
|
| Rate for Payer: Quartz Commercial |
$133.54
|
| Rate for Payer: WEA Trust Commercial |
$122.41
|
| Rate for Payer: WPS Commercial |
$164.84
|
|
|
Post Op Ostomy Follow Up
|
Facility
|
OP
|
$214.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
3005548
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.74 |
| Max. Negotiated Rate |
$204.76 |
| Rate for Payer: Aetna Commercial |
$200.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$191.40
|
| Rate for Payer: Aetna Managed Medicare |
$62.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$144.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$111.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$106.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$117.96
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cigna Commercial |
$204.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$124.55
|
| Rate for Payer: Health EOS Commercial |
$198.08
|
| Rate for Payer: HFN Commercial |
$204.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$166.92
|
| Rate for Payer: Multiplan Commercial |
$178.05
|
| Rate for Payer: NAPHCARE Commercial |
$133.54
|
| Rate for Payer: Preferred Network Access Commercial |
$204.76
|
| Rate for Payer: Quartz Beloit One Network |
$109.05
|
| Rate for Payer: Quartz Commercial |
$144.66
|
| Rate for Payer: Quartz Medicare Advantage |
$133.54
|
| Rate for Payer: The Alliance Commercial |
$30.74
|
| Rate for Payer: WEA Trust Commercial |
$122.41
|
| Rate for Payer: WPS Commercial |
$164.84
|
|
|
Post op shoe applied - Treatments Done
|
Facility
|
OP
|
$210.00
|
|
| Hospital Charge Code |
3149555
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$61.15 |
| Max. Negotiated Rate |
$200.93 |
| Rate for Payer: Aetna Commercial |
$196.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$187.82
|
| Rate for Payer: Aetna Managed Medicare |
$61.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$141.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$109.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$104.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.75
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$200.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$122.22
|
| Rate for Payer: Health EOS Commercial |
$194.38
|
| Rate for Payer: HFN Commercial |
$200.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$163.80
|
| Rate for Payer: Multiplan Commercial |
$174.72
|
| Rate for Payer: NAPHCARE Commercial |
$131.04
|
| Rate for Payer: Preferred Network Access Commercial |
$200.93
|
| Rate for Payer: Quartz Beloit One Network |
$107.02
|
| Rate for Payer: Quartz Commercial |
$141.96
|
| Rate for Payer: Quartz Medicare Advantage |
$131.04
|
| Rate for Payer: The Alliance Commercial |
$109.20
|
| Rate for Payer: WEA Trust Commercial |
$120.12
|
| Rate for Payer: WPS Commercial |
$161.76
|
|
