|
SKIN CLOSURE DEVICE ZIPLINE ZIP16 PS1160
|
Facility
|
IP
|
$691.00
|
|
| Hospital Charge Code |
4493817
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$352.13 |
| Max. Negotiated Rate |
$661.15 |
| Rate for Payer: Aetna Commercial |
$646.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$618.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$380.88
|
| Rate for Payer: Cash Price |
$207.30
|
| Rate for Payer: Cigna Commercial |
$661.15
|
| Rate for Payer: Health EOS Commercial |
$639.59
|
| Rate for Payer: HFN Commercial |
$661.15
|
| Rate for Payer: Multiplan Commercial |
$574.91
|
| Rate for Payer: Preferred Network Access Commercial |
$661.15
|
| Rate for Payer: Quartz Beloit One Network |
$352.13
|
| Rate for Payer: Quartz Commercial |
$431.18
|
| Rate for Payer: WEA Trust Commercial |
$395.25
|
| Rate for Payer: WPS Commercial |
$532.28
|
|
|
SKIN CLOSURE DEVICE ZIPLINE ZIP4 PS2040
|
Facility
|
IP
|
$339.00
|
|
| Hospital Charge Code |
5106665
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$172.75 |
| Max. Negotiated Rate |
$324.36 |
| Rate for Payer: Aetna Commercial |
$317.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$303.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$186.86
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cigna Commercial |
$324.36
|
| Rate for Payer: Health EOS Commercial |
$313.78
|
| Rate for Payer: HFN Commercial |
$324.36
|
| Rate for Payer: Multiplan Commercial |
$282.05
|
| Rate for Payer: Preferred Network Access Commercial |
$324.36
|
| Rate for Payer: Quartz Beloit One Network |
$172.75
|
| Rate for Payer: Quartz Commercial |
$211.54
|
| Rate for Payer: WEA Trust Commercial |
$193.91
|
| Rate for Payer: WPS Commercial |
$261.13
|
|
|
SKIN CLOSURE DEVICE ZIPLINE ZIP4 PS2040
|
Facility
|
OP
|
$339.00
|
|
| Hospital Charge Code |
5106665
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.72 |
| Max. Negotiated Rate |
$324.36 |
| Rate for Payer: Aetna Commercial |
$317.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$303.20
|
| Rate for Payer: Aetna Managed Medicare |
$98.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$229.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$176.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$169.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$186.86
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cigna Commercial |
$324.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$197.30
|
| Rate for Payer: Health EOS Commercial |
$313.78
|
| Rate for Payer: HFN Commercial |
$324.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$264.42
|
| Rate for Payer: Multiplan Commercial |
$282.05
|
| Rate for Payer: NAPHCARE Commercial |
$211.54
|
| Rate for Payer: Preferred Network Access Commercial |
$324.36
|
| Rate for Payer: Quartz Beloit One Network |
$172.75
|
| Rate for Payer: Quartz Commercial |
$229.16
|
| Rate for Payer: Quartz Medicare Advantage |
$211.54
|
| Rate for Payer: The Alliance Commercial |
$176.28
|
| Rate for Payer: WEA Trust Commercial |
$193.91
|
| Rate for Payer: WPS Commercial |
$261.13
|
|
|
SKIN CLOSURE DEVICE ZIPLINE ZIP8 PS2080
|
Facility
|
OP
|
$678.00
|
|
| Hospital Charge Code |
4493818
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$197.43 |
| Max. Negotiated Rate |
$648.71 |
| Rate for Payer: Aetna Commercial |
$634.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$606.40
|
| Rate for Payer: Aetna Managed Medicare |
$197.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$458.33
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$352.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$338.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$373.71
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cigna Commercial |
$648.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$394.60
|
| Rate for Payer: Health EOS Commercial |
$627.56
|
| Rate for Payer: HFN Commercial |
$648.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$528.84
|
| Rate for Payer: Multiplan Commercial |
$564.10
|
| Rate for Payer: NAPHCARE Commercial |
$423.07
|
| Rate for Payer: Preferred Network Access Commercial |
$648.71
|
| Rate for Payer: Quartz Beloit One Network |
$345.51
|
| Rate for Payer: Quartz Commercial |
$458.33
|
| Rate for Payer: Quartz Medicare Advantage |
$423.07
|
| Rate for Payer: The Alliance Commercial |
$352.56
|
| Rate for Payer: WEA Trust Commercial |
$387.82
|
| Rate for Payer: WPS Commercial |
$522.26
|
|
|
SKIN CLOSURE DEVICE ZIPLINE ZIP8 PS2080
|
Facility
|
IP
|
$678.00
|
|
| Hospital Charge Code |
4493818
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$345.51 |
| Max. Negotiated Rate |
$648.71 |
| Rate for Payer: Aetna Commercial |
$634.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$606.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$373.71
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cigna Commercial |
$648.71
|
| Rate for Payer: Health EOS Commercial |
$627.56
|
| Rate for Payer: HFN Commercial |
$648.71
|
| Rate for Payer: Multiplan Commercial |
$564.10
|
| Rate for Payer: Preferred Network Access Commercial |
$648.71
|
| Rate for Payer: Quartz Beloit One Network |
$345.51
|
| Rate for Payer: Quartz Commercial |
$423.07
|
| Rate for Payer: WEA Trust Commercial |
$387.82
|
| Rate for Payer: WPS Commercial |
$522.26
|
|
|
SKIN DEBRIDEMENT WITH CC
|
Facility
|
IP
|
$47,113.04
|
|
|
Service Code
|
MSDRG 571
|
| Min. Negotiated Rate |
$13,445.30 |
| Max. Negotiated Rate |
$47,113.04 |
| Rate for Payer: Aetna Managed Medicare |
$13,445.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$36,863.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28,255.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26,844.67
|
| Rate for Payer: Anthem Medicare Advantage |
$13,445.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,445.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,445.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,445.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29,800.04
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,445.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34,311.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,445.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,445.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,445.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,445.30
|
| Rate for Payer: NAPHCARE Commercial |
$20,167.95
|
| Rate for Payer: Quartz Medicare Advantage |
$13,445.30
|
| Rate for Payer: The Alliance Commercial |
$47,113.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,445.30
|
| Rate for Payer: United Healthcare PPO |
$26,712.12
|
| Rate for Payer: Wellcare Medicare |
$13,445.30
|
|
|
SKIN DEBRIDEMENT WITH MCC
|
Facility
|
IP
|
$81,130.40
|
|
|
Service Code
|
MSDRG 570
|
| Min. Negotiated Rate |
$23,030.30 |
| Max. Negotiated Rate |
$81,130.40 |
| Rate for Payer: Aetna Managed Medicare |
$23,030.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$64,172.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$49,187.66
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46,731.49
|
| Rate for Payer: Anthem Medicare Advantage |
$23,030.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23,030.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23,030.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$23,030.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51,876.24
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$23,030.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59,262.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$23,030.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23,030.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$23,030.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$23,030.30
|
| Rate for Payer: NAPHCARE Commercial |
$34,545.45
|
| Rate for Payer: Quartz Medicare Advantage |
$23,030.30
|
| Rate for Payer: The Alliance Commercial |
$81,130.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23,030.30
|
| Rate for Payer: United Healthcare PPO |
$46,136.40
|
| Rate for Payer: Wellcare Medicare |
$23,030.30
|
|
|
SKIN DEBRIDEMENT WITHOUT CC/MCC
|
Facility
|
IP
|
$31,842.72
|
|
|
Service Code
|
MSDRG 572
|
| Min. Negotiated Rate |
$9,285.38 |
| Max. Negotiated Rate |
$31,842.72 |
| Rate for Payer: Aetna Managed Medicare |
$9,285.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25,011.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,171.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18,213.70
|
| Rate for Payer: Anthem Medicare Advantage |
$9,285.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,285.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,285.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,285.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20,218.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,285.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23,111.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,285.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9,285.38
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9,285.38
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,285.38
|
| Rate for Payer: NAPHCARE Commercial |
$13,928.07
|
| Rate for Payer: Quartz Medicare Advantage |
$9,285.38
|
| Rate for Payer: The Alliance Commercial |
$31,842.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,285.38
|
| Rate for Payer: United Healthcare PPO |
$17,992.28
|
| Rate for Payer: Wellcare Medicare |
$9,285.38
|
|
|
SKIN FULL GRAFT ADD-ON 15221
|
Professional
|
Both
|
$854.00
|
|
|
Service Code
|
CPT 15221
|
| Hospital Charge Code |
3013642
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$54.75 |
| Max. Negotiated Rate |
$843.75 |
| Rate for Payer: Aetna Commercial |
$843.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$763.82
|
| Rate for Payer: Aetna Managed Medicare |
$54.75
|
| Rate for Payer: Anthem Medicare Advantage |
$54.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$54.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$54.75
|
| Rate for Payer: Cash Price |
$256.20
|
| Rate for Payer: Cash Price |
$256.20
|
| Rate for Payer: Cash Price |
$256.20
|
| Rate for Payer: Cigna Commercial |
$843.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$221.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.75
|
| Rate for Payer: Health EOS Commercial |
$808.23
|
| Rate for Payer: HFN Commercial |
$843.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$237.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$237.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$54.75
|
| Rate for Payer: Multiplan Commercial |
$710.53
|
| Rate for Payer: NAPHCARE Commercial |
$82.12
|
| Rate for Payer: Preferred Network Access Commercial |
$843.75
|
| Rate for Payer: Quartz Beloit One Network |
$390.79
|
| Rate for Payer: Quartz Commercial |
$506.25
|
| Rate for Payer: Quartz Medicare Advantage |
$54.75
|
| Rate for Payer: The Alliance Commercial |
$232.67
|
| Rate for Payer: United Healthcare Medicaid |
$221.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54.75
|
| Rate for Payer: WEA Trust Commercial |
$488.49
|
| Rate for Payer: WPS Commercial |
$246.36
|
|
|
SKIN FULL GRAFT EEN AND LIPS 15260
|
Professional
|
Both
|
$3,308.00
|
|
|
Service Code
|
CPT 15260
|
| Hospital Charge Code |
3013644
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$711.78 |
| Max. Negotiated Rate |
$3,268.30 |
| Rate for Payer: Aetna Commercial |
$3,268.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,958.68
|
| Rate for Payer: Aetna Managed Medicare |
$711.78
|
| Rate for Payer: Anthem Medicare Advantage |
$711.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$711.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$711.78
|
| Rate for Payer: Cash Price |
$992.40
|
| Rate for Payer: Cash Price |
$992.40
|
| Rate for Payer: Cash Price |
$992.40
|
| Rate for Payer: Cigna Commercial |
$3,268.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$783.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$711.78
|
| Rate for Payer: Health EOS Commercial |
$3,130.69
|
| Rate for Payer: HFN Commercial |
$3,268.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,932.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,932.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$711.78
|
| Rate for Payer: Multiplan Commercial |
$2,752.26
|
| Rate for Payer: NAPHCARE Commercial |
$1,067.66
|
| Rate for Payer: Preferred Network Access Commercial |
$3,268.30
|
| Rate for Payer: Quartz Beloit One Network |
$1,513.74
|
| Rate for Payer: Quartz Commercial |
$1,960.98
|
| Rate for Payer: Quartz Medicare Advantage |
$711.78
|
| Rate for Payer: The Alliance Commercial |
$3,025.05
|
| Rate for Payer: United Healthcare Medicaid |
$783.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$711.78
|
| Rate for Payer: WEA Trust Commercial |
$1,892.18
|
| Rate for Payer: WPS Commercial |
$3,202.99
|
|
|
SKIN FULL GRAFT SCLP/ARM/LEG 15220
|
Professional
|
Both
|
$3,097.00
|
|
|
Service Code
|
CPT 15220
|
| Hospital Charge Code |
3013641
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$470.08 |
| Max. Negotiated Rate |
$3,059.84 |
| Rate for Payer: Aetna Commercial |
$3,059.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,769.96
|
| Rate for Payer: Aetna Managed Medicare |
$522.00
|
| Rate for Payer: Anthem Medicare Advantage |
$522.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$522.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$522.00
|
| Rate for Payer: Cash Price |
$929.10
|
| Rate for Payer: Cash Price |
$929.10
|
| Rate for Payer: Cash Price |
$929.10
|
| Rate for Payer: Cigna Commercial |
$3,059.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$470.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$522.00
|
| Rate for Payer: Health EOS Commercial |
$2,931.00
|
| Rate for Payer: HFN Commercial |
$3,059.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,107.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,107.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$522.00
|
| Rate for Payer: Multiplan Commercial |
$2,576.70
|
| Rate for Payer: NAPHCARE Commercial |
$783.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,059.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,417.19
|
| Rate for Payer: Quartz Commercial |
$1,835.90
|
| Rate for Payer: Quartz Medicare Advantage |
$522.00
|
| Rate for Payer: The Alliance Commercial |
$2,218.49
|
| Rate for Payer: United Healthcare Medicaid |
$470.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$522.00
|
| Rate for Payer: WEA Trust Commercial |
$1,771.48
|
| Rate for Payer: WPS Commercial |
$2,348.99
|
|
|
SKIN FULL GRAFT, TRUNK 15200
|
Professional
|
Both
|
$3,459.00
|
|
|
Service Code
|
CPT 15200
|
| Hospital Charge Code |
3013640
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$378.41 |
| Max. Negotiated Rate |
$3,417.49 |
| Rate for Payer: Aetna Commercial |
$3,417.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,093.73
|
| Rate for Payer: Aetna Managed Medicare |
$582.14
|
| Rate for Payer: Anthem Medicare Advantage |
$582.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$582.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$582.14
|
| Rate for Payer: Cash Price |
$1,037.70
|
| Rate for Payer: Cash Price |
$1,037.70
|
| Rate for Payer: Cash Price |
$1,037.70
|
| Rate for Payer: Cigna Commercial |
$3,417.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$378.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$582.14
|
| Rate for Payer: Health EOS Commercial |
$3,273.60
|
| Rate for Payer: HFN Commercial |
$3,417.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,306.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,306.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$582.14
|
| Rate for Payer: Multiplan Commercial |
$2,877.89
|
| Rate for Payer: NAPHCARE Commercial |
$873.21
|
| Rate for Payer: Preferred Network Access Commercial |
$3,417.49
|
| Rate for Payer: Quartz Beloit One Network |
$1,582.84
|
| Rate for Payer: Quartz Commercial |
$2,050.50
|
| Rate for Payer: Quartz Medicare Advantage |
$582.14
|
| Rate for Payer: The Alliance Commercial |
$2,474.09
|
| Rate for Payer: United Healthcare Medicaid |
$378.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$582.14
|
| Rate for Payer: WEA Trust Commercial |
$1,978.55
|
| Rate for Payer: WPS Commercial |
$2,619.63
|
|
|
SKIN FULL GRFT ADD-ON =EA ADDL 20CM -FACE/GENIT/HF 15241
|
Professional
|
Both
|
$573.00
|
|
|
Service Code
|
CPT 15241
|
| Hospital Charge Code |
5837662
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$85.28 |
| Max. Negotiated Rate |
$566.12 |
| Rate for Payer: Aetna Commercial |
$566.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$512.49
|
| Rate for Payer: Aetna Managed Medicare |
$85.28
|
| Rate for Payer: Anthem Medicare Advantage |
$85.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$85.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$85.28
|
| Rate for Payer: Cash Price |
$171.90
|
| Rate for Payer: Cash Price |
$171.90
|
| Rate for Payer: Cash Price |
$171.90
|
| Rate for Payer: Cigna Commercial |
$566.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$322.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$85.28
|
| Rate for Payer: Health EOS Commercial |
$542.29
|
| Rate for Payer: HFN Commercial |
$566.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$364.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$364.33
|
| Rate for Payer: Independent Care Health Plan Medicare |
$85.28
|
| Rate for Payer: Multiplan Commercial |
$476.74
|
| Rate for Payer: NAPHCARE Commercial |
$127.92
|
| Rate for Payer: Preferred Network Access Commercial |
$566.12
|
| Rate for Payer: Quartz Beloit One Network |
$262.20
|
| Rate for Payer: Quartz Commercial |
$339.67
|
| Rate for Payer: Quartz Medicare Advantage |
$85.28
|
| Rate for Payer: The Alliance Commercial |
$362.44
|
| Rate for Payer: United Healthcare Medicaid |
$322.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$85.28
|
| Rate for Payer: WEA Trust Commercial |
$327.76
|
| Rate for Payer: WPS Commercial |
$383.76
|
|
|
SKIN FULL GRFT ADD-ON = EA ADDL 20 SQ CM -EEN & LIPS 15261
|
Professional
|
Both
|
$661.00
|
|
|
Service Code
|
CPT 15261
|
| Hospital Charge Code |
5837663
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$108.53 |
| Max. Negotiated Rate |
$653.07 |
| Rate for Payer: Aetna Commercial |
$653.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$591.20
|
| Rate for Payer: Aetna Managed Medicare |
$108.53
|
| Rate for Payer: Anthem Medicare Advantage |
$108.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.53
|
| Rate for Payer: Cash Price |
$198.30
|
| Rate for Payer: Cash Price |
$198.30
|
| Rate for Payer: Cash Price |
$198.30
|
| Rate for Payer: Cigna Commercial |
$653.07
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$375.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$108.53
|
| Rate for Payer: Health EOS Commercial |
$625.57
|
| Rate for Payer: HFN Commercial |
$653.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$473.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$473.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.53
|
| Rate for Payer: Multiplan Commercial |
$549.95
|
| Rate for Payer: NAPHCARE Commercial |
$162.80
|
| Rate for Payer: Preferred Network Access Commercial |
$653.07
|
| Rate for Payer: Quartz Beloit One Network |
$302.47
|
| Rate for Payer: Quartz Commercial |
$391.84
|
| Rate for Payer: Quartz Medicare Advantage |
$108.53
|
| Rate for Payer: The Alliance Commercial |
$461.27
|
| Rate for Payer: United Healthcare Medicaid |
$375.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.53
|
| Rate for Payer: WEA Trust Commercial |
$378.09
|
| Rate for Payer: WPS Commercial |
$488.40
|
|
|
SKIN FULL GRFT FACE/GENIT/HF 15240
|
Professional
|
Both
|
$2,628.00
|
|
|
Service Code
|
CPT 15240
|
| Hospital Charge Code |
3013643
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$680.28 |
| Max. Negotiated Rate |
$3,061.28 |
| Rate for Payer: Aetna Commercial |
$2,596.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,350.48
|
| Rate for Payer: Aetna Managed Medicare |
$680.28
|
| Rate for Payer: Anthem Medicare Advantage |
$680.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$680.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$680.28
|
| Rate for Payer: Cash Price |
$788.40
|
| Rate for Payer: Cash Price |
$788.40
|
| Rate for Payer: Cash Price |
$788.40
|
| Rate for Payer: Cigna Commercial |
$2,596.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$868.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$680.28
|
| Rate for Payer: Health EOS Commercial |
$2,487.14
|
| Rate for Payer: HFN Commercial |
$2,596.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,748.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,748.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$680.28
|
| Rate for Payer: Multiplan Commercial |
$2,186.50
|
| Rate for Payer: NAPHCARE Commercial |
$1,020.43
|
| Rate for Payer: Preferred Network Access Commercial |
$2,596.46
|
| Rate for Payer: Quartz Beloit One Network |
$1,202.57
|
| Rate for Payer: Quartz Commercial |
$1,557.88
|
| Rate for Payer: Quartz Medicare Advantage |
$680.28
|
| Rate for Payer: The Alliance Commercial |
$2,891.21
|
| Rate for Payer: United Healthcare Medicaid |
$868.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$680.28
|
| Rate for Payer: WEA Trust Commercial |
$1,503.22
|
| Rate for Payer: WPS Commercial |
$3,061.28
|
|
|
Skin Fungi Culture 87101PP
|
Professional
|
Both
|
$264.00
|
|
|
Service Code
|
CPT 87101
|
| Hospital Charge Code |
3137591
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.02 |
| Max. Negotiated Rate |
$260.83 |
| Rate for Payer: Aetna Commercial |
$260.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$236.12
|
| Rate for Payer: Aetna Managed Medicare |
$8.02
|
| Rate for Payer: Anthem Medicare Advantage |
$8.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.02
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cigna Commercial |
$260.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$137.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.02
|
| Rate for Payer: Health EOS Commercial |
$249.85
|
| Rate for Payer: HFN Commercial |
$260.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$28.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.02
|
| Rate for Payer: Multiplan Commercial |
$219.65
|
| Rate for Payer: NAPHCARE Commercial |
$12.03
|
| Rate for Payer: Preferred Network Access Commercial |
$260.83
|
| Rate for Payer: Quartz Beloit One Network |
$120.81
|
| Rate for Payer: Quartz Commercial |
$156.50
|
| Rate for Payer: Quartz Medicare Advantage |
$8.02
|
| Rate for Payer: The Alliance Commercial |
$31.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.02
|
| Rate for Payer: WEA Trust Commercial |
$151.01
|
| Rate for Payer: WPS Commercial |
$35.28
|
|
|
SKIN GRAFT 15620
|
Professional
|
Both
|
$2,625.00
|
|
|
Service Code
|
CPT 15620
|
| Hospital Charge Code |
3013645
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$295.73 |
| Max. Negotiated Rate |
$2,593.50 |
| Rate for Payer: Aetna Commercial |
$2,593.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,347.80
|
| Rate for Payer: Aetna Managed Medicare |
$295.73
|
| Rate for Payer: Anthem Medicare Advantage |
$295.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$295.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$295.73
|
| Rate for Payer: Cash Price |
$787.50
|
| Rate for Payer: Cash Price |
$787.50
|
| Rate for Payer: Cash Price |
$787.50
|
| Rate for Payer: Cigna Commercial |
$2,593.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$331.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$295.73
|
| Rate for Payer: Health EOS Commercial |
$2,484.30
|
| Rate for Payer: HFN Commercial |
$2,593.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,123.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,123.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$295.73
|
| Rate for Payer: Multiplan Commercial |
$2,184.00
|
| Rate for Payer: NAPHCARE Commercial |
$443.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,593.50
|
| Rate for Payer: Quartz Beloit One Network |
$1,201.20
|
| Rate for Payer: Quartz Commercial |
$1,556.10
|
| Rate for Payer: Quartz Medicare Advantage |
$295.73
|
| Rate for Payer: The Alliance Commercial |
$1,256.87
|
| Rate for Payer: United Healthcare Medicaid |
$331.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$295.73
|
| Rate for Payer: WEA Trust Commercial |
$1,501.50
|
| Rate for Payer: WPS Commercial |
$1,330.80
|
|
|
SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC
|
Facility
|
IP
|
$73,578.96
|
|
|
Service Code
|
MSDRG 577
|
| Min. Negotiated Rate |
$21,395.58 |
| Max. Negotiated Rate |
$73,578.96 |
| Rate for Payer: Aetna Managed Medicare |
$21,395.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$57,836.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$44,330.94
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$42,117.29
|
| Rate for Payer: Anthem Medicare Advantage |
$21,395.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21,395.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21,395.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$21,395.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$46,754.05
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$21,395.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53,723.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21,395.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21,395.58
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$21,395.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$21,395.58
|
| Rate for Payer: NAPHCARE Commercial |
$32,093.37
|
| Rate for Payer: Quartz Medicare Advantage |
$21,395.58
|
| Rate for Payer: The Alliance Commercial |
$73,578.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21,395.58
|
| Rate for Payer: United Healthcare PPO |
$41,824.63
|
| Rate for Payer: Wellcare Medicare |
$21,395.58
|
|
|
SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC
|
Facility
|
IP
|
$157,467.44
|
|
|
Service Code
|
MSDRG 576
|
| Min. Negotiated Rate |
$38,041.13 |
| Max. Negotiated Rate |
$157,467.44 |
| Rate for Payer: Aetna Managed Medicare |
$38,041.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$106,940.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$81,968.85
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$77,875.75
|
| Rate for Payer: Anthem Medicare Advantage |
$38,041.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$38,041.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$38,041.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$38,041.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$86,449.23
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$38,041.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$115,253.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$38,041.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$38,041.13
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$38,041.13
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$38,041.13
|
| Rate for Payer: NAPHCARE Commercial |
$57,061.70
|
| Rate for Payer: Quartz Medicare Advantage |
$38,041.13
|
| Rate for Payer: The Alliance Commercial |
$157,467.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38,041.13
|
| Rate for Payer: United Healthcare PPO |
$89,726.15
|
| Rate for Payer: Wellcare Medicare |
$38,041.13
|
|
|
SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$44,862.48
|
|
|
Service Code
|
MSDRG 578
|
| Min. Negotiated Rate |
$12,808.90 |
| Max. Negotiated Rate |
$44,862.48 |
| Rate for Payer: Aetna Managed Medicare |
$12,808.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$35,050.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26,865.82
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25,524.28
|
| Rate for Payer: Anthem Medicare Advantage |
$12,808.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12,808.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12,808.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12,808.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28,334.29
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12,808.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32,660.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12,808.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12,808.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12,808.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12,808.90
|
| Rate for Payer: NAPHCARE Commercial |
$19,213.35
|
| Rate for Payer: Quartz Medicare Advantage |
$12,808.90
|
| Rate for Payer: The Alliance Commercial |
$44,862.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,808.90
|
| Rate for Payer: United Healthcare PPO |
$25,426.96
|
| Rate for Payer: Wellcare Medicare |
$12,808.90
|
|
|
SKIN GRAFT FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DIAGNOSES
|
Facility
|
IP
|
$29,724.57
|
|
|
Service Code
|
APR-DRG 3123
|
| Min. Negotiated Rate |
$26,403.22 |
| Max. Negotiated Rate |
$29,724.57 |
| Rate for Payer: Anthem Medicaid |
$28,462.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$28,462.91
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$28,462.91
|
| Rate for Payer: Dean Health Medicaid |
$28,462.91
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$26,403.22
|
| Rate for Payer: Managed Health Services Medicaid |
$29,724.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,462.91
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$28,462.91
|
| Rate for Payer: United Healthcare Medicaid |
$28,462.91
|
|
|
SKIN GRAFT FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DIAGNOSES
|
Facility
|
IP
|
$19,377.97
|
|
|
Service Code
|
APR-DRG 3122
|
| Min. Negotiated Rate |
$17,212.72 |
| Max. Negotiated Rate |
$19,377.97 |
| Rate for Payer: Anthem Medicaid |
$18,555.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$18,555.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18,555.47
|
| Rate for Payer: Dean Health Medicaid |
$18,555.47
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17,212.72
|
| Rate for Payer: Managed Health Services Medicaid |
$19,377.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$18,555.47
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$18,555.47
|
| Rate for Payer: United Healthcare Medicaid |
$18,555.47
|
|
|
SKIN GRAFT FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DIAGNOSES
|
Facility
|
IP
|
$13,503.20
|
|
|
Service Code
|
APR-DRG 3121
|
| Min. Negotiated Rate |
$11,994.38 |
| Max. Negotiated Rate |
$13,503.20 |
| Rate for Payer: Anthem Medicaid |
$12,930.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$12,930.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12,930.06
|
| Rate for Payer: Dean Health Medicaid |
$12,930.06
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11,994.38
|
| Rate for Payer: Managed Health Services Medicaid |
$13,503.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,930.06
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12,930.06
|
| Rate for Payer: United Healthcare Medicaid |
$12,930.06
|
|
|
SKIN GRAFT FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DIAGNOSES
|
Facility
|
IP
|
$48,401.07
|
|
|
Service Code
|
APR-DRG 3124
|
| Min. Negotiated Rate |
$42,992.85 |
| Max. Negotiated Rate |
$48,401.07 |
| Rate for Payer: Anthem Medicaid |
$46,346.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$46,346.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$46,346.69
|
| Rate for Payer: Dean Health Medicaid |
$46,346.69
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$42,992.85
|
| Rate for Payer: Managed Health Services Medicaid |
$48,401.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$46,346.69
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$46,346.69
|
| Rate for Payer: United Healthcare Medicaid |
$46,346.69
|
|
|
SKIN GRAFT FOR SKIN AND SUBCUTANEOUS TISSUE DIAGNOSES
|
Facility
|
IP
|
$14,467.71
|
|
|
Service Code
|
APR-DRG 3611
|
| Min. Negotiated Rate |
$12,851.12 |
| Max. Negotiated Rate |
$14,467.71 |
| Rate for Payer: Anthem Medicaid |
$13,853.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$13,853.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13,853.63
|
| Rate for Payer: Dean Health Medicaid |
$13,853.63
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12,851.12
|
| Rate for Payer: Managed Health Services Medicaid |
$14,467.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,853.63
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13,853.63
|
| Rate for Payer: United Healthcare Medicaid |
$13,853.63
|
|
