|
US Upper Extremity Non-Vascular Bilat
|
Facility
|
OP
|
$1,103.00
|
|
|
Service Code
|
CPT 76882 LT,TC
|
| Hospital Charge Code |
2544987
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$321.19 |
| Max. Negotiated Rate |
$1,055.35 |
| Rate for Payer: Aetna Commercial |
$1,032.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$986.52
|
| Rate for Payer: Aetna Managed Medicare |
$321.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$848.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$716.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$681.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$607.97
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cigna Commercial |
$1,055.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$641.95
|
| Rate for Payer: Health EOS Commercial |
$1,020.94
|
| Rate for Payer: HFN Commercial |
$1,055.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$860.34
|
| Rate for Payer: Multiplan Commercial |
$917.70
|
| Rate for Payer: NAPHCARE Commercial |
$688.27
|
| Rate for Payer: Preferred Network Access Commercial |
$1,055.35
|
| Rate for Payer: Quartz Beloit One Network |
$562.09
|
| Rate for Payer: Quartz Commercial |
$745.63
|
| Rate for Payer: Quartz Medicare Advantage |
$688.27
|
| Rate for Payer: The Alliance Commercial |
$573.56
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$630.92
|
| Rate for Payer: WPS Commercial |
$849.64
|
|
|
US Upper Extremity Non-Vascular Bilat
|
Professional
|
Both
|
$1,103.00
|
|
|
Service Code
|
CPT 76882 LT,TC
|
| Hospital Charge Code |
2544987
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$200.26 |
| Max. Negotiated Rate |
$1,089.76 |
| Rate for Payer: Aetna Commercial |
$1,089.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$986.52
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cigna Commercial |
$1,089.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$573.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$688.27
|
| Rate for Payer: Health EOS Commercial |
$1,043.88
|
| Rate for Payer: HFN Commercial |
$1,089.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$200.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$200.26
|
| Rate for Payer: Multiplan Commercial |
$917.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,089.76
|
| Rate for Payer: Quartz Beloit One Network |
$504.73
|
| Rate for Payer: Quartz Commercial |
$653.86
|
| Rate for Payer: The Alliance Commercial |
$573.56
|
| Rate for Payer: WEA Trust Commercial |
$630.92
|
| Rate for Payer: WPS Commercial |
$849.64
|
|
|
US Upper Extremity Non-Vascular Left
|
Facility
|
IP
|
$1,103.00
|
|
|
Service Code
|
CPT 76882 TC,LT
|
| Hospital Charge Code |
2544990
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$562.09 |
| Max. Negotiated Rate |
$1,055.35 |
| Rate for Payer: Aetna Commercial |
$1,032.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$986.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$607.97
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cigna Commercial |
$1,055.35
|
| Rate for Payer: Health EOS Commercial |
$1,020.94
|
| Rate for Payer: HFN Commercial |
$1,055.35
|
| Rate for Payer: Multiplan Commercial |
$917.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,055.35
|
| Rate for Payer: Quartz Beloit One Network |
$562.09
|
| Rate for Payer: Quartz Commercial |
$688.27
|
| Rate for Payer: WEA Trust Commercial |
$630.92
|
| Rate for Payer: WPS Commercial |
$849.64
|
|
|
US Upper Extremity Non-Vascular Left
|
Facility
|
OP
|
$971.00
|
|
|
Service Code
|
CPT 76881 TC,LT
|
| Hospital Charge Code |
4406577
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$282.76 |
| Max. Negotiated Rate |
$929.05 |
| Rate for Payer: Aetna Commercial |
$908.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$868.46
|
| Rate for Payer: Aetna Managed Medicare |
$282.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$848.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$716.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$681.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$535.22
|
| Rate for Payer: Cash Price |
$291.30
|
| Rate for Payer: Cash Price |
$291.30
|
| Rate for Payer: Cash Price |
$291.30
|
| Rate for Payer: Cigna Commercial |
$929.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$565.12
|
| Rate for Payer: Health EOS Commercial |
$898.76
|
| Rate for Payer: HFN Commercial |
$929.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$757.38
|
| Rate for Payer: Multiplan Commercial |
$807.87
|
| Rate for Payer: NAPHCARE Commercial |
$605.90
|
| Rate for Payer: Preferred Network Access Commercial |
$929.05
|
| Rate for Payer: Quartz Beloit One Network |
$494.82
|
| Rate for Payer: Quartz Commercial |
$656.40
|
| Rate for Payer: Quartz Medicare Advantage |
$605.90
|
| Rate for Payer: The Alliance Commercial |
$504.92
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$555.41
|
| Rate for Payer: WPS Commercial |
$747.96
|
|
|
US Upper Extremity Non-Vascular Left
|
Professional
|
Both
|
$971.00
|
|
|
Service Code
|
CPT 76881 TC,LT
|
| Hospital Charge Code |
4406577
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$236.32 |
| Max. Negotiated Rate |
$959.35 |
| Rate for Payer: Aetna Commercial |
$959.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$868.46
|
| Rate for Payer: Cash Price |
$291.30
|
| Rate for Payer: Cash Price |
$291.30
|
| Rate for Payer: Cash Price |
$291.30
|
| Rate for Payer: Cigna Commercial |
$959.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$504.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$605.90
|
| Rate for Payer: Health EOS Commercial |
$918.95
|
| Rate for Payer: HFN Commercial |
$959.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$236.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$236.32
|
| Rate for Payer: Multiplan Commercial |
$807.87
|
| Rate for Payer: Preferred Network Access Commercial |
$959.35
|
| Rate for Payer: Quartz Beloit One Network |
$444.33
|
| Rate for Payer: Quartz Commercial |
$575.61
|
| Rate for Payer: The Alliance Commercial |
$504.92
|
| Rate for Payer: WEA Trust Commercial |
$555.41
|
| Rate for Payer: WPS Commercial |
$747.96
|
|
|
US Upper Extremity Non-Vascular Left
|
Facility
|
IP
|
$971.00
|
|
|
Service Code
|
CPT 76881 TC,LT
|
| Hospital Charge Code |
4406577
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$494.82 |
| Max. Negotiated Rate |
$929.05 |
| Rate for Payer: Aetna Commercial |
$908.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$868.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$535.22
|
| Rate for Payer: Cash Price |
$291.30
|
| Rate for Payer: Cigna Commercial |
$929.05
|
| Rate for Payer: Health EOS Commercial |
$898.76
|
| Rate for Payer: HFN Commercial |
$929.05
|
| Rate for Payer: Multiplan Commercial |
$807.87
|
| Rate for Payer: Preferred Network Access Commercial |
$929.05
|
| Rate for Payer: Quartz Beloit One Network |
$494.82
|
| Rate for Payer: Quartz Commercial |
$605.90
|
| Rate for Payer: WEA Trust Commercial |
$555.41
|
| Rate for Payer: WPS Commercial |
$747.96
|
|
|
US Upper Extremity Non-Vascular Left
|
Facility
|
OP
|
$1,103.00
|
|
|
Service Code
|
CPT 76882 TC,LT
|
| Hospital Charge Code |
2544990
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$321.19 |
| Max. Negotiated Rate |
$1,055.35 |
| Rate for Payer: Aetna Commercial |
$1,032.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$986.52
|
| Rate for Payer: Aetna Managed Medicare |
$321.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$848.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$716.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$681.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$607.97
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cigna Commercial |
$1,055.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$641.95
|
| Rate for Payer: Health EOS Commercial |
$1,020.94
|
| Rate for Payer: HFN Commercial |
$1,055.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$860.34
|
| Rate for Payer: Multiplan Commercial |
$917.70
|
| Rate for Payer: NAPHCARE Commercial |
$688.27
|
| Rate for Payer: Preferred Network Access Commercial |
$1,055.35
|
| Rate for Payer: Quartz Beloit One Network |
$562.09
|
| Rate for Payer: Quartz Commercial |
$745.63
|
| Rate for Payer: Quartz Medicare Advantage |
$688.27
|
| Rate for Payer: The Alliance Commercial |
$573.56
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$630.92
|
| Rate for Payer: WPS Commercial |
$849.64
|
|
|
US Upper Extremity Non-Vascular Left
|
Professional
|
Both
|
$1,103.00
|
|
|
Service Code
|
CPT 76882 TC,LT
|
| Hospital Charge Code |
2544990
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$200.26 |
| Max. Negotiated Rate |
$1,089.76 |
| Rate for Payer: Aetna Commercial |
$1,089.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$986.52
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cigna Commercial |
$1,089.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$573.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$688.27
|
| Rate for Payer: Health EOS Commercial |
$1,043.88
|
| Rate for Payer: HFN Commercial |
$1,089.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$200.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$200.26
|
| Rate for Payer: Multiplan Commercial |
$917.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,089.76
|
| Rate for Payer: Quartz Beloit One Network |
$504.73
|
| Rate for Payer: Quartz Commercial |
$653.86
|
| Rate for Payer: The Alliance Commercial |
$573.56
|
| Rate for Payer: WEA Trust Commercial |
$630.92
|
| Rate for Payer: WPS Commercial |
$849.64
|
|
|
US Upper Extremity Non-Vascular Right
|
Facility
|
OP
|
$1,103.00
|
|
|
Service Code
|
CPT 76882 RT,TC
|
| Hospital Charge Code |
2544993
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$321.19 |
| Max. Negotiated Rate |
$1,055.35 |
| Rate for Payer: Aetna Commercial |
$1,032.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$986.52
|
| Rate for Payer: Aetna Managed Medicare |
$321.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$848.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$716.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$681.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$607.97
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cigna Commercial |
$1,055.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$641.95
|
| Rate for Payer: Health EOS Commercial |
$1,020.94
|
| Rate for Payer: HFN Commercial |
$1,055.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$860.34
|
| Rate for Payer: Multiplan Commercial |
$917.70
|
| Rate for Payer: NAPHCARE Commercial |
$688.27
|
| Rate for Payer: Preferred Network Access Commercial |
$1,055.35
|
| Rate for Payer: Quartz Beloit One Network |
$562.09
|
| Rate for Payer: Quartz Commercial |
$745.63
|
| Rate for Payer: Quartz Medicare Advantage |
$688.27
|
| Rate for Payer: The Alliance Commercial |
$573.56
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$630.92
|
| Rate for Payer: WPS Commercial |
$849.64
|
|
|
US Upper Extremity Non-Vascular Right
|
Professional
|
Both
|
$1,103.00
|
|
|
Service Code
|
CPT 76882 RT,TC
|
| Hospital Charge Code |
2544993
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$200.26 |
| Max. Negotiated Rate |
$1,089.76 |
| Rate for Payer: Aetna Commercial |
$1,089.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$986.52
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cigna Commercial |
$1,089.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$573.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$688.27
|
| Rate for Payer: Health EOS Commercial |
$1,043.88
|
| Rate for Payer: HFN Commercial |
$1,089.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$200.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$200.26
|
| Rate for Payer: Multiplan Commercial |
$917.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,089.76
|
| Rate for Payer: Quartz Beloit One Network |
$504.73
|
| Rate for Payer: Quartz Commercial |
$653.86
|
| Rate for Payer: The Alliance Commercial |
$573.56
|
| Rate for Payer: WEA Trust Commercial |
$630.92
|
| Rate for Payer: WPS Commercial |
$849.64
|
|
|
US Upper Extremity Non-Vascular Right
|
Facility
|
IP
|
$1,103.00
|
|
|
Service Code
|
CPT 76882 TC,RT
|
| Hospital Charge Code |
4330578
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$562.09 |
| Max. Negotiated Rate |
$1,055.35 |
| Rate for Payer: Aetna Commercial |
$1,032.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$986.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$607.97
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cigna Commercial |
$1,055.35
|
| Rate for Payer: Health EOS Commercial |
$1,020.94
|
| Rate for Payer: HFN Commercial |
$1,055.35
|
| Rate for Payer: Multiplan Commercial |
$917.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,055.35
|
| Rate for Payer: Quartz Beloit One Network |
$562.09
|
| Rate for Payer: Quartz Commercial |
$688.27
|
| Rate for Payer: WEA Trust Commercial |
$630.92
|
| Rate for Payer: WPS Commercial |
$849.64
|
|
|
US Upper Extremity Non-Vascular Right
|
Facility
|
IP
|
$1,103.00
|
|
|
Service Code
|
CPT 76882 RT,TC
|
| Hospital Charge Code |
2544993
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$562.09 |
| Max. Negotiated Rate |
$1,055.35 |
| Rate for Payer: Aetna Commercial |
$1,032.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$986.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$607.97
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cigna Commercial |
$1,055.35
|
| Rate for Payer: Health EOS Commercial |
$1,020.94
|
| Rate for Payer: HFN Commercial |
$1,055.35
|
| Rate for Payer: Multiplan Commercial |
$917.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,055.35
|
| Rate for Payer: Quartz Beloit One Network |
$562.09
|
| Rate for Payer: Quartz Commercial |
$688.27
|
| Rate for Payer: WEA Trust Commercial |
$630.92
|
| Rate for Payer: WPS Commercial |
$849.64
|
|
|
US Upper Extremity Non-Vascular Right
|
Professional
|
Both
|
$1,103.00
|
|
|
Service Code
|
CPT 76882 TC,RT
|
| Hospital Charge Code |
4330578
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$200.26 |
| Max. Negotiated Rate |
$1,089.76 |
| Rate for Payer: Aetna Commercial |
$1,089.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$986.52
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cigna Commercial |
$1,089.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$573.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$688.27
|
| Rate for Payer: Health EOS Commercial |
$1,043.88
|
| Rate for Payer: HFN Commercial |
$1,089.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$200.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$200.26
|
| Rate for Payer: Multiplan Commercial |
$917.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,089.76
|
| Rate for Payer: Quartz Beloit One Network |
$504.73
|
| Rate for Payer: Quartz Commercial |
$653.86
|
| Rate for Payer: The Alliance Commercial |
$573.56
|
| Rate for Payer: WEA Trust Commercial |
$630.92
|
| Rate for Payer: WPS Commercial |
$849.64
|
|
|
US Upper Extremity Non-Vascular Right
|
Facility
|
OP
|
$1,103.00
|
|
|
Service Code
|
CPT 76882 TC,RT
|
| Hospital Charge Code |
4330578
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$321.19 |
| Max. Negotiated Rate |
$1,055.35 |
| Rate for Payer: Aetna Commercial |
$1,032.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$986.52
|
| Rate for Payer: Aetna Managed Medicare |
$321.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$848.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$716.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$681.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$607.97
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cigna Commercial |
$1,055.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$641.95
|
| Rate for Payer: Health EOS Commercial |
$1,020.94
|
| Rate for Payer: HFN Commercial |
$1,055.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$860.34
|
| Rate for Payer: Multiplan Commercial |
$917.70
|
| Rate for Payer: NAPHCARE Commercial |
$688.27
|
| Rate for Payer: Preferred Network Access Commercial |
$1,055.35
|
| Rate for Payer: Quartz Beloit One Network |
$562.09
|
| Rate for Payer: Quartz Commercial |
$745.63
|
| Rate for Payer: Quartz Medicare Advantage |
$688.27
|
| Rate for Payer: The Alliance Commercial |
$573.56
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$630.92
|
| Rate for Payer: WPS Commercial |
$849.64
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR LEIOMYOMA
|
Facility
|
IP
|
$8,680.63
|
|
|
Service Code
|
APR-DRG 5191
|
| Min. Negotiated Rate |
$7,710.67 |
| Max. Negotiated Rate |
$8,680.63 |
| Rate for Payer: Anthem Medicaid |
$8,312.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$8,312.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8,312.18
|
| Rate for Payer: Dean Health Medicaid |
$8,312.18
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$7,710.67
|
| Rate for Payer: Managed Health Services Medicaid |
$8,680.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,312.18
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8,312.18
|
| Rate for Payer: United Healthcare Medicaid |
$8,312.18
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR LEIOMYOMA
|
Facility
|
IP
|
$34,459.46
|
|
|
Service Code
|
APR-DRG 5194
|
| Min. Negotiated Rate |
$30,609.04 |
| Max. Negotiated Rate |
$34,459.46 |
| Rate for Payer: Anthem Medicaid |
$32,996.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$32,996.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$32,996.83
|
| Rate for Payer: Dean Health Medicaid |
$32,996.83
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$30,609.04
|
| Rate for Payer: Managed Health Services Medicaid |
$34,459.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$32,996.83
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$32,996.83
|
| Rate for Payer: United Healthcare Medicaid |
$32,996.83
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR LEIOMYOMA
|
Facility
|
IP
|
$20,780.89
|
|
|
Service Code
|
APR-DRG 5193
|
| Min. Negotiated Rate |
$18,458.89 |
| Max. Negotiated Rate |
$20,780.89 |
| Rate for Payer: Anthem Medicaid |
$19,898.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$19,898.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19,898.85
|
| Rate for Payer: Dean Health Medicaid |
$19,898.85
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18,458.89
|
| Rate for Payer: Managed Health Services Medicaid |
$20,780.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$19,898.85
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19,898.85
|
| Rate for Payer: United Healthcare Medicaid |
$19,898.85
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR LEIOMYOMA
|
Facility
|
IP
|
$11,486.49
|
|
|
Service Code
|
APR-DRG 5192
|
| Min. Negotiated Rate |
$10,203.01 |
| Max. Negotiated Rate |
$11,486.49 |
| Rate for Payer: Anthem Medicaid |
$10,998.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$10,998.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10,998.94
|
| Rate for Payer: Dean Health Medicaid |
$10,998.94
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$10,203.01
|
| Rate for Payer: Managed Health Services Medicaid |
$11,486.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,998.94
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$10,998.94
|
| Rate for Payer: United Healthcare Medicaid |
$10,998.94
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA
|
Facility
|
IP
|
$9,382.09
|
|
|
Service Code
|
APR-DRG 5131
|
| Min. Negotiated Rate |
$8,333.76 |
| Max. Negotiated Rate |
$9,382.09 |
| Rate for Payer: Anthem Medicaid |
$8,983.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$8,983.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8,983.87
|
| Rate for Payer: Dean Health Medicaid |
$8,983.87
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8,333.76
|
| Rate for Payer: Managed Health Services Medicaid |
$9,382.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,983.87
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8,983.87
|
| Rate for Payer: United Healthcare Medicaid |
$8,983.87
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA
|
Facility
|
IP
|
$19,027.23
|
|
|
Service Code
|
APR-DRG 5133
|
| Min. Negotiated Rate |
$16,901.18 |
| Max. Negotiated Rate |
$19,027.23 |
| Rate for Payer: Anthem Medicaid |
$18,219.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$18,219.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18,219.62
|
| Rate for Payer: Dean Health Medicaid |
$18,219.62
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$16,901.18
|
| Rate for Payer: Managed Health Services Medicaid |
$19,027.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$18,219.62
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$18,219.62
|
| Rate for Payer: United Healthcare Medicaid |
$18,219.62
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA
|
Facility
|
IP
|
$34,284.09
|
|
|
Service Code
|
APR-DRG 5134
|
| Min. Negotiated Rate |
$30,453.27 |
| Max. Negotiated Rate |
$34,284.09 |
| Rate for Payer: Anthem Medicaid |
$32,828.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$32,828.91
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$32,828.91
|
| Rate for Payer: Dean Health Medicaid |
$32,828.91
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$30,453.27
|
| Rate for Payer: Managed Health Services Medicaid |
$34,284.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$32,828.91
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$32,828.91
|
| Rate for Payer: United Healthcare Medicaid |
$32,828.91
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA
|
Facility
|
IP
|
$11,574.17
|
|
|
Service Code
|
APR-DRG 5132
|
| Min. Negotiated Rate |
$10,280.90 |
| Max. Negotiated Rate |
$11,574.17 |
| Rate for Payer: Anthem Medicaid |
$11,082.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$11,082.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11,082.90
|
| Rate for Payer: Dean Health Medicaid |
$11,082.90
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$10,280.90
|
| Rate for Payer: Managed Health Services Medicaid |
$11,574.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,082.90
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11,082.90
|
| Rate for Payer: United Healthcare Medicaid |
$11,082.90
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC
|
Facility
|
IP
|
$49,601.76
|
|
|
Service Code
|
MSDRG 742
|
| Min. Negotiated Rate |
$14,558.04 |
| Max. Negotiated Rate |
$49,601.76 |
| Rate for Payer: Aetna Managed Medicare |
$14,558.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$40,033.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30,685.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29,153.36
|
| Rate for Payer: Anthem Medicare Advantage |
$14,558.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14,558.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14,558.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14,558.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32,362.90
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14,558.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36,136.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14,558.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14,558.04
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14,558.04
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14,558.04
|
| Rate for Payer: NAPHCARE Commercial |
$21,837.07
|
| Rate for Payer: Quartz Medicare Advantage |
$14,558.04
|
| Rate for Payer: The Alliance Commercial |
$49,601.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14,558.04
|
| Rate for Payer: United Healthcare PPO |
$28,133.06
|
| Rate for Payer: Wellcare Medicare |
$14,558.04
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC
|
Facility
|
IP
|
$32,461.52
|
|
|
Service Code
|
MSDRG 743
|
| Min. Negotiated Rate |
$10,008.30 |
| Max. Negotiated Rate |
$32,461.52 |
| Rate for Payer: Aetna Managed Medicare |
$10,008.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$27,071.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20,749.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19,713.63
|
| Rate for Payer: Anthem Medicare Advantage |
$10,008.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,008.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,008.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,008.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21,883.94
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,008.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23,565.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,008.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,008.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,008.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,008.30
|
| Rate for Payer: NAPHCARE Commercial |
$15,012.46
|
| Rate for Payer: Quartz Medicare Advantage |
$10,008.30
|
| Rate for Payer: The Alliance Commercial |
$32,461.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,008.30
|
| Rate for Payer: United Healthcare PPO |
$18,345.93
|
| Rate for Payer: Wellcare Medicare |
$10,008.30
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY
|
Facility
|
IP
|
$40,684.96
|
|
|
Service Code
|
APR-DRG 5124
|
| Min. Negotiated Rate |
$36,138.92 |
| Max. Negotiated Rate |
$40,684.96 |
| Rate for Payer: Anthem Medicaid |
$38,958.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$38,958.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$38,958.09
|
| Rate for Payer: Dean Health Medicaid |
$38,958.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$36,138.92
|
| Rate for Payer: Managed Health Services Medicaid |
$40,684.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$38,958.09
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$38,958.09
|
| Rate for Payer: United Healthcare Medicaid |
$38,958.09
|
|
