|
SKIN GRAFT FOR SKIN AND SUBCUTANEOUS TISSUE DIAGNOSES
|
Facility
|
IP
|
$47,085.82
|
|
|
Service Code
|
APR-DRG 3614
|
| Min. Negotiated Rate |
$41,824.57 |
| Max. Negotiated Rate |
$47,085.82 |
| Rate for Payer: Anthem Medicaid |
$45,087.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$45,087.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$45,087.27
|
| Rate for Payer: Dean Health Medicaid |
$45,087.27
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$41,824.57
|
| Rate for Payer: Managed Health Services Medicaid |
$47,085.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$45,087.27
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$45,087.27
|
| Rate for Payer: United Healthcare Medicaid |
$45,087.27
|
|
|
SKIN GRAFT FOR SKIN AND SUBCUTANEOUS TISSUE DIAGNOSES
|
Facility
|
IP
|
$26,480.30
|
|
|
Service Code
|
APR-DRG 3613
|
| Min. Negotiated Rate |
$23,521.45 |
| Max. Negotiated Rate |
$26,480.30 |
| Rate for Payer: Anthem Medicaid |
$25,356.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$25,356.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$25,356.34
|
| Rate for Payer: Dean Health Medicaid |
$25,356.34
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$23,521.45
|
| Rate for Payer: Managed Health Services Medicaid |
$26,480.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,356.34
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$25,356.34
|
| Rate for Payer: United Healthcare Medicaid |
$25,356.34
|
|
|
SKIN GRAFT FOR SKIN AND SUBCUTANEOUS TISSUE DIAGNOSES
|
Facility
|
IP
|
$19,202.60
|
|
|
Service Code
|
APR-DRG 3612
|
| Min. Negotiated Rate |
$17,056.95 |
| Max. Negotiated Rate |
$19,202.60 |
| Rate for Payer: Anthem Medicaid |
$18,387.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$18,387.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18,387.55
|
| Rate for Payer: Dean Health Medicaid |
$18,387.55
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17,056.95
|
| Rate for Payer: Managed Health Services Medicaid |
$19,202.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$18,387.55
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$18,387.55
|
| Rate for Payer: United Healthcare Medicaid |
$18,387.55
|
|
|
SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC
|
Facility
|
IP
|
$94,501.68
|
|
|
Service Code
|
MSDRG 574
|
| Min. Negotiated Rate |
$27,091.44 |
| Max. Negotiated Rate |
$94,501.68 |
| Rate for Payer: Aetna Managed Medicare |
$27,091.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$75,743.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$58,056.53
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$55,157.49
|
| Rate for Payer: Anthem Medicare Advantage |
$27,091.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27,091.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27,091.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$27,091.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$61,229.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$27,091.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69,069.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$27,091.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27,091.44
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$27,091.44
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$27,091.44
|
| Rate for Payer: NAPHCARE Commercial |
$40,637.16
|
| Rate for Payer: Quartz Medicare Advantage |
$27,091.44
|
| Rate for Payer: The Alliance Commercial |
$94,501.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27,091.44
|
| Rate for Payer: United Healthcare PPO |
$53,771.59
|
| Rate for Payer: Wellcare Medicare |
$27,091.44
|
|
|
SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC
|
Facility
|
IP
|
$172,260.40
|
|
|
Service Code
|
MSDRG 573
|
| Min. Negotiated Rate |
$50,678.69 |
| Max. Negotiated Rate |
$172,260.40 |
| Rate for Payer: Aetna Managed Medicare |
$50,678.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$142,946.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$109,567.19
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$104,095.98
|
| Rate for Payer: Anthem Medicare Advantage |
$50,678.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$50,678.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$50,678.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$50,678.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$115,556.08
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$50,678.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$126,103.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$50,678.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$50,678.69
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$50,678.69
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$50,678.69
|
| Rate for Payer: NAPHCARE Commercial |
$76,018.04
|
| Rate for Payer: Quartz Medicare Advantage |
$50,678.69
|
| Rate for Payer: The Alliance Commercial |
$172,260.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$50,678.69
|
| Rate for Payer: United Healthcare PPO |
$98,172.86
|
| Rate for Payer: Wellcare Medicare |
$50,678.69
|
|
|
SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$56,903.60
|
|
|
Service Code
|
MSDRG 575
|
| Min. Negotiated Rate |
$14,268.57 |
| Max. Negotiated Rate |
$56,903.60 |
| Rate for Payer: Aetna Managed Medicare |
$14,268.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$35,643.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27,320.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25,956.47
|
| Rate for Payer: Anthem Medicare Advantage |
$14,268.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14,268.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14,268.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14,268.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28,814.06
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14,268.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$41,492.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14,268.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14,268.57
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14,268.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14,268.57
|
| Rate for Payer: NAPHCARE Commercial |
$21,402.86
|
| Rate for Payer: Quartz Medicare Advantage |
$14,268.57
|
| Rate for Payer: The Alliance Commercial |
$56,903.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14,268.57
|
| Rate for Payer: United Healthcare PPO |
$32,302.74
|
| Rate for Payer: Wellcare Medicare |
$14,268.57
|
|
|
SKIN GRAFT, FULL THICKNESS
|
Facility
|
IP
|
$1,397.00
|
|
| Hospital Charge Code |
2960377
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$711.91 |
| Max. Negotiated Rate |
$1,336.65 |
| Rate for Payer: Aetna Commercial |
$1,307.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,249.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$770.03
|
| Rate for Payer: Cash Price |
$419.10
|
| Rate for Payer: Cigna Commercial |
$1,336.65
|
| Rate for Payer: Health EOS Commercial |
$1,293.06
|
| Rate for Payer: HFN Commercial |
$1,336.65
|
| Rate for Payer: Multiplan Commercial |
$1,162.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,336.65
|
| Rate for Payer: Quartz Beloit One Network |
$711.91
|
| Rate for Payer: Quartz Commercial |
$871.73
|
| Rate for Payer: WEA Trust Commercial |
$799.08
|
| Rate for Payer: WPS Commercial |
$1,076.11
|
|
|
SKIN GRAFT, FULL THICKNESS
|
Facility
|
OP
|
$1,397.00
|
|
| Hospital Charge Code |
2960377
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$406.81 |
| Max. Negotiated Rate |
$1,336.65 |
| Rate for Payer: Aetna Commercial |
$1,307.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,249.48
|
| Rate for Payer: Aetna Managed Medicare |
$406.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$944.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$726.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$697.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$770.03
|
| Rate for Payer: Cash Price |
$419.10
|
| Rate for Payer: Cigna Commercial |
$1,336.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$813.05
|
| Rate for Payer: Health EOS Commercial |
$1,293.06
|
| Rate for Payer: HFN Commercial |
$1,336.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,089.66
|
| Rate for Payer: Multiplan Commercial |
$1,162.30
|
| Rate for Payer: NAPHCARE Commercial |
$871.73
|
| Rate for Payer: Preferred Network Access Commercial |
$1,336.65
|
| Rate for Payer: Quartz Beloit One Network |
$711.91
|
| Rate for Payer: Quartz Commercial |
$944.37
|
| Rate for Payer: Quartz Medicare Advantage |
$871.73
|
| Rate for Payer: The Alliance Commercial |
$726.44
|
| Rate for Payer: WEA Trust Commercial |
$799.08
|
| Rate for Payer: WPS Commercial |
$1,076.11
|
|
|
SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC
|
Facility
|
IP
|
$51,800.32
|
|
|
Service Code
|
MSDRG 623
|
| Min. Negotiated Rate |
$14,664.48 |
| Max. Negotiated Rate |
$51,800.32 |
| Rate for Payer: Aetna Managed Medicare |
$14,664.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39,141.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30,001.61
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28,503.49
|
| Rate for Payer: Anthem Medicare Advantage |
$14,664.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14,664.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14,664.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14,664.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31,641.49
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14,664.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37,749.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14,664.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14,664.48
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14,664.48
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14,664.48
|
| Rate for Payer: NAPHCARE Commercial |
$21,996.72
|
| Rate for Payer: Quartz Medicare Advantage |
$14,664.48
|
| Rate for Payer: The Alliance Commercial |
$51,800.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14,664.48
|
| Rate for Payer: United Healthcare PPO |
$29,388.23
|
| Rate for Payer: Wellcare Medicare |
$14,664.48
|
|
|
SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC
|
Facility
|
IP
|
$106,109.12
|
|
|
Service Code
|
MSDRG 622
|
| Min. Negotiated Rate |
$27,763.83 |
| Max. Negotiated Rate |
$106,109.12 |
| Rate for Payer: Aetna Managed Medicare |
$27,763.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$77,658.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$59,524.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$56,552.56
|
| Rate for Payer: Anthem Medicare Advantage |
$27,763.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27,763.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27,763.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$27,763.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$62,778.52
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$27,763.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$77,583.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$27,763.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27,763.83
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$27,763.83
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$27,763.83
|
| Rate for Payer: NAPHCARE Commercial |
$41,645.74
|
| Rate for Payer: Quartz Medicare Advantage |
$27,763.83
|
| Rate for Payer: The Alliance Commercial |
$106,109.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27,763.83
|
| Rate for Payer: United Healthcare PPO |
$60,399.49
|
| Rate for Payer: Wellcare Medicare |
$27,763.83
|
|
|
SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$31,148.00
|
|
|
Service Code
|
MSDRG 624
|
| Min. Negotiated Rate |
$10,094.08 |
| Max. Negotiated Rate |
$31,148.00 |
| Rate for Payer: Aetna Managed Medicare |
$10,094.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$27,315.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20,937.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19,891.59
|
| Rate for Payer: Anthem Medicare Advantage |
$10,094.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,094.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,094.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,094.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22,081.49
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,094.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22,602.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,094.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,094.08
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,094.08
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,094.08
|
| Rate for Payer: NAPHCARE Commercial |
$15,141.13
|
| Rate for Payer: Quartz Medicare Advantage |
$10,094.08
|
| Rate for Payer: The Alliance Commercial |
$31,148.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,094.08
|
| Rate for Payer: United Healthcare PPO |
$17,595.99
|
| Rate for Payer: Wellcare Medicare |
$10,094.08
|
|
|
SKIN GRAFTS FOR INJURIES WITH CC/MCC
|
Facility
|
IP
|
$90,365.60
|
|
|
Service Code
|
MSDRG 904
|
| Min. Negotiated Rate |
$28,636.10 |
| Max. Negotiated Rate |
$90,365.60 |
| Rate for Payer: Aetna Managed Medicare |
$28,636.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$80,144.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$61,429.81
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$58,362.33
|
| Rate for Payer: Anthem Medicare Advantage |
$28,636.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28,636.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28,636.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$28,636.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64,787.53
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$28,636.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66,035.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$28,636.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28,636.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$28,636.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$28,636.10
|
| Rate for Payer: NAPHCARE Commercial |
$42,954.15
|
| Rate for Payer: Quartz Medicare Advantage |
$28,636.10
|
| Rate for Payer: The Alliance Commercial |
$90,365.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28,636.10
|
| Rate for Payer: United Healthcare PPO |
$51,409.66
|
| Rate for Payer: Wellcare Medicare |
$28,636.10
|
|
|
SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC
|
Facility
|
IP
|
$44,122.00
|
|
|
Service Code
|
MSDRG 905
|
| Min. Negotiated Rate |
$11,866.94 |
| Max. Negotiated Rate |
$44,122.00 |
| Rate for Payer: Aetna Managed Medicare |
$11,866.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31,240.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23,945.77
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22,750.04
|
| Rate for Payer: Anthem Medicare Advantage |
$11,866.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,866.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,866.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,866.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25,254.63
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,866.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32,117.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,866.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,866.94
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,866.94
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,866.94
|
| Rate for Payer: NAPHCARE Commercial |
$17,800.41
|
| Rate for Payer: Quartz Medicare Advantage |
$11,866.94
|
| Rate for Payer: The Alliance Commercial |
$44,122.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,866.94
|
| Rate for Payer: United Healthcare PPO |
$25,003.84
|
| Rate for Payer: Wellcare Medicare |
$11,866.94
|
|
|
SKIN GRAFT, SPLIT THICKNESS
|
Facility
|
OP
|
$1,503.00
|
|
| Hospital Charge Code |
2960538
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$437.67 |
| Max. Negotiated Rate |
$1,438.07 |
| Rate for Payer: Aetna Commercial |
$1,406.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,344.28
|
| Rate for Payer: Aetna Managed Medicare |
$437.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,016.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$781.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$750.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$828.45
|
| Rate for Payer: Cash Price |
$450.90
|
| Rate for Payer: Cigna Commercial |
$1,438.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$874.75
|
| Rate for Payer: Health EOS Commercial |
$1,391.18
|
| Rate for Payer: HFN Commercial |
$1,438.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,172.34
|
| Rate for Payer: Multiplan Commercial |
$1,250.50
|
| Rate for Payer: NAPHCARE Commercial |
$937.87
|
| Rate for Payer: Preferred Network Access Commercial |
$1,438.07
|
| Rate for Payer: Quartz Beloit One Network |
$765.93
|
| Rate for Payer: Quartz Commercial |
$1,016.03
|
| Rate for Payer: Quartz Medicare Advantage |
$937.87
|
| Rate for Payer: The Alliance Commercial |
$781.56
|
| Rate for Payer: WEA Trust Commercial |
$859.72
|
| Rate for Payer: WPS Commercial |
$1,157.76
|
|
|
SKIN GRAFT, SPLIT THICKNESS
|
Facility
|
IP
|
$1,503.00
|
|
| Hospital Charge Code |
2960538
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$765.93 |
| Max. Negotiated Rate |
$1,438.07 |
| Rate for Payer: Aetna Commercial |
$1,406.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,344.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$828.45
|
| Rate for Payer: Cash Price |
$450.90
|
| Rate for Payer: Cigna Commercial |
$1,438.07
|
| Rate for Payer: Health EOS Commercial |
$1,391.18
|
| Rate for Payer: HFN Commercial |
$1,438.07
|
| Rate for Payer: Multiplan Commercial |
$1,250.50
|
| Rate for Payer: Preferred Network Access Commercial |
$1,438.07
|
| Rate for Payer: Quartz Beloit One Network |
$765.93
|
| Rate for Payer: Quartz Commercial |
$937.87
|
| Rate for Payer: WEA Trust Commercial |
$859.72
|
| Rate for Payer: WPS Commercial |
$1,157.76
|
|
|
SKIN MARKER DEVON FINE DUAL TIP WITH RULER CAP & LABEL 31145868
|
Facility
|
OP
|
$51.00
|
|
| Hospital Charge Code |
3065498
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.85 |
| Max. Negotiated Rate |
$48.80 |
| Rate for Payer: Aetna Commercial |
$47.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$45.61
|
| Rate for Payer: Aetna Managed Medicare |
$14.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$34.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.11
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna Commercial |
$48.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.68
|
| Rate for Payer: Health EOS Commercial |
$47.21
|
| Rate for Payer: HFN Commercial |
$48.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39.78
|
| Rate for Payer: Multiplan Commercial |
$42.43
|
| Rate for Payer: NAPHCARE Commercial |
$31.82
|
| Rate for Payer: Preferred Network Access Commercial |
$48.80
|
| Rate for Payer: Quartz Beloit One Network |
$25.99
|
| Rate for Payer: Quartz Commercial |
$34.48
|
| Rate for Payer: Quartz Medicare Advantage |
$31.82
|
| Rate for Payer: The Alliance Commercial |
$26.52
|
| Rate for Payer: WEA Trust Commercial |
$29.17
|
| Rate for Payer: WPS Commercial |
$39.29
|
|
|
SKIN MARKER DEVON FINE DUAL TIP WITH RULER CAP & LABEL 31145868
|
Facility
|
IP
|
$51.00
|
|
| Hospital Charge Code |
3065498
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.99 |
| Max. Negotiated Rate |
$48.80 |
| Rate for Payer: Aetna Commercial |
$47.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$45.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.11
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna Commercial |
$48.80
|
| Rate for Payer: Health EOS Commercial |
$47.21
|
| Rate for Payer: HFN Commercial |
$48.80
|
| Rate for Payer: Multiplan Commercial |
$42.43
|
| Rate for Payer: Preferred Network Access Commercial |
$48.80
|
| Rate for Payer: Quartz Beloit One Network |
$25.99
|
| Rate for Payer: Quartz Commercial |
$31.82
|
| Rate for Payer: WEA Trust Commercial |
$29.17
|
| Rate for Payer: WPS Commercial |
$39.29
|
|
|
SKIN MARKERS FINE TIP STERILE DYNJSM03
|
Facility
|
IP
|
$19.00
|
|
| Hospital Charge Code |
3231470
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.68 |
| Max. Negotiated Rate |
$18.18 |
| Rate for Payer: Aetna Commercial |
$17.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10.47
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cigna Commercial |
$18.18
|
| Rate for Payer: Health EOS Commercial |
$17.59
|
| Rate for Payer: HFN Commercial |
$18.18
|
| Rate for Payer: Multiplan Commercial |
$15.81
|
| Rate for Payer: Preferred Network Access Commercial |
$18.18
|
| Rate for Payer: Quartz Beloit One Network |
$9.68
|
| Rate for Payer: Quartz Commercial |
$11.86
|
| Rate for Payer: WEA Trust Commercial |
$10.87
|
| Rate for Payer: WPS Commercial |
$14.64
|
|
|
SKIN MARKERS FINE TIP STERILE DYNJSM03
|
Facility
|
OP
|
$19.00
|
|
| Hospital Charge Code |
3231470
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.53 |
| Max. Negotiated Rate |
$18.18 |
| Rate for Payer: Aetna Commercial |
$17.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16.99
|
| Rate for Payer: Aetna Managed Medicare |
$5.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10.47
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cigna Commercial |
$18.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.06
|
| Rate for Payer: Health EOS Commercial |
$17.59
|
| Rate for Payer: HFN Commercial |
$18.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.82
|
| Rate for Payer: Multiplan Commercial |
$15.81
|
| Rate for Payer: NAPHCARE Commercial |
$11.86
|
| Rate for Payer: Preferred Network Access Commercial |
$18.18
|
| Rate for Payer: Quartz Beloit One Network |
$9.68
|
| Rate for Payer: Quartz Commercial |
$12.84
|
| Rate for Payer: Quartz Medicare Advantage |
$11.86
|
| Rate for Payer: The Alliance Commercial |
$9.88
|
| Rate for Payer: WEA Trust Commercial |
$10.87
|
| Rate for Payer: WPS Commercial |
$14.64
|
|
|
Skin Sensor
|
Facility
|
OP
|
$78.00
|
|
| Hospital Charge Code |
3101744
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$22.71 |
| Max. Negotiated Rate |
$74.63 |
| Rate for Payer: Aetna Commercial |
$73.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.76
|
| Rate for Payer: Aetna Managed Medicare |
$22.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$52.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$40.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$38.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.99
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna Commercial |
$74.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.40
|
| Rate for Payer: Health EOS Commercial |
$72.20
|
| Rate for Payer: HFN Commercial |
$74.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.84
|
| Rate for Payer: Multiplan Commercial |
$64.90
|
| Rate for Payer: NAPHCARE Commercial |
$48.67
|
| Rate for Payer: Preferred Network Access Commercial |
$74.63
|
| Rate for Payer: Quartz Beloit One Network |
$39.75
|
| Rate for Payer: Quartz Commercial |
$52.73
|
| Rate for Payer: Quartz Medicare Advantage |
$48.67
|
| Rate for Payer: The Alliance Commercial |
$40.56
|
| Rate for Payer: WEA Trust Commercial |
$44.62
|
| Rate for Payer: WPS Commercial |
$60.08
|
|
|
Skin Sensor
|
Facility
|
IP
|
$78.00
|
|
| Hospital Charge Code |
3101744
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$39.75 |
| Max. Negotiated Rate |
$74.63 |
| Rate for Payer: Aetna Commercial |
$73.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.99
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna Commercial |
$74.63
|
| Rate for Payer: Health EOS Commercial |
$72.20
|
| Rate for Payer: HFN Commercial |
$74.63
|
| Rate for Payer: Multiplan Commercial |
$64.90
|
| Rate for Payer: Preferred Network Access Commercial |
$74.63
|
| Rate for Payer: Quartz Beloit One Network |
$39.75
|
| Rate for Payer: Quartz Commercial |
$48.67
|
| Rate for Payer: WEA Trust Commercial |
$44.62
|
| Rate for Payer: WPS Commercial |
$60.08
|
|
|
SKIN SPLT GRFT T/A/L, ADD-ON 15101
|
Professional
|
Both
|
$795.00
|
|
|
Service Code
|
CPT 15101
|
| Hospital Charge Code |
3013634
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$94.04 |
| Max. Negotiated Rate |
$785.46 |
| Rate for Payer: Aetna Commercial |
$785.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$711.05
|
| Rate for Payer: Aetna Managed Medicare |
$94.04
|
| Rate for Payer: Anthem Medicare Advantage |
$94.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$94.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$94.04
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Cigna Commercial |
$785.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$223.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$94.04
|
| Rate for Payer: Health EOS Commercial |
$752.39
|
| Rate for Payer: HFN Commercial |
$785.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$382.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$382.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$94.04
|
| Rate for Payer: Multiplan Commercial |
$661.44
|
| Rate for Payer: NAPHCARE Commercial |
$141.06
|
| Rate for Payer: Preferred Network Access Commercial |
$785.46
|
| Rate for Payer: Quartz Beloit One Network |
$363.79
|
| Rate for Payer: Quartz Commercial |
$471.28
|
| Rate for Payer: Quartz Medicare Advantage |
$94.04
|
| Rate for Payer: The Alliance Commercial |
$399.66
|
| Rate for Payer: United Healthcare Medicaid |
$223.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$94.04
|
| Rate for Payer: WEA Trust Commercial |
$454.74
|
| Rate for Payer: WPS Commercial |
$423.17
|
|
|
SKIN SPLT GRFT, TRNK/ARM/LEG 15100
|
Professional
|
Both
|
$2,445.00
|
|
|
Service Code
|
CPT 15100
|
| Hospital Charge Code |
3013633
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$532.59 |
| Max. Negotiated Rate |
$2,829.86 |
| Rate for Payer: Aetna Commercial |
$2,415.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,186.81
|
| Rate for Payer: Aetna Managed Medicare |
$628.86
|
| Rate for Payer: Anthem Medicare Advantage |
$628.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$628.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$628.86
|
| Rate for Payer: Cash Price |
$733.50
|
| Rate for Payer: Cash Price |
$733.50
|
| Rate for Payer: Cash Price |
$733.50
|
| Rate for Payer: Cigna Commercial |
$2,415.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$532.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$628.86
|
| Rate for Payer: Health EOS Commercial |
$2,313.95
|
| Rate for Payer: HFN Commercial |
$2,415.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,444.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,444.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$628.86
|
| Rate for Payer: Multiplan Commercial |
$2,034.24
|
| Rate for Payer: NAPHCARE Commercial |
$943.29
|
| Rate for Payer: Preferred Network Access Commercial |
$2,415.66
|
| Rate for Payer: Quartz Beloit One Network |
$1,118.83
|
| Rate for Payer: Quartz Commercial |
$1,449.40
|
| Rate for Payer: Quartz Medicare Advantage |
$628.86
|
| Rate for Payer: The Alliance Commercial |
$2,672.64
|
| Rate for Payer: United Healthcare Medicaid |
$532.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$628.86
|
| Rate for Payer: WEA Trust Commercial |
$1,398.54
|
| Rate for Payer: WPS Commercial |
$2,829.86
|
|
|
Skin Substitute Apligraft 1 Sq Cm Q4101
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
HCPCS Q4101
|
| Hospital Charge Code |
3542168
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.13 |
| Max. Negotiated Rate |
$523.87 |
| Rate for Payer: Aetna Commercial |
$161.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$154.73
|
| Rate for Payer: Aetna Managed Medicare |
$130.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$116.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$89.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$86.36
|
| Rate for Payer: Anthem Medicare Advantage |
$130.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$95.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$130.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$130.97
|
| Rate for Payer: Cash Price |
$51.90
|
| Rate for Payer: Cash Price |
$51.90
|
| Rate for Payer: Cigna Commercial |
$165.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$130.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$42.13
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$130.97
|
| Rate for Payer: Health EOS Commercial |
$160.13
|
| Rate for Payer: HFN Commercial |
$165.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$487.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$130.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$130.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$130.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$130.97
|
| Rate for Payer: Multiplan Commercial |
$143.94
|
| Rate for Payer: NAPHCARE Commercial |
$196.45
|
| Rate for Payer: Preferred Network Access Commercial |
$165.53
|
| Rate for Payer: Quartz Beloit One Network |
$88.16
|
| Rate for Payer: Quartz Commercial |
$116.95
|
| Rate for Payer: Quartz Medicare Advantage |
$130.97
|
| Rate for Payer: The Alliance Commercial |
$523.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$130.97
|
| Rate for Payer: WEA Trust Commercial |
$98.96
|
| Rate for Payer: Wellcare Medicare |
$130.97
|
| Rate for Payer: WPS Commercial |
$79.61
|
|
|
Skin Substitute Apligraft 1 Sq Cm Q4101
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
HCPCS Q4101
|
| Hospital Charge Code |
3542168
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$88.16 |
| Max. Negotiated Rate |
$165.53 |
| Rate for Payer: Aetna Commercial |
$161.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$154.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$95.36
|
| Rate for Payer: Cash Price |
$51.90
|
| Rate for Payer: Cigna Commercial |
$165.53
|
| Rate for Payer: Health EOS Commercial |
$160.13
|
| Rate for Payer: HFN Commercial |
$165.53
|
| Rate for Payer: Multiplan Commercial |
$143.94
|
| Rate for Payer: Preferred Network Access Commercial |
$165.53
|
| Rate for Payer: Quartz Beloit One Network |
$88.16
|
| Rate for Payer: Quartz Commercial |
$107.95
|
| Rate for Payer: WEA Trust Commercial |
$98.96
|
| Rate for Payer: WPS Commercial |
$133.26
|
|
