|
BUR CARBIDE 1.8 #31-55639
|
Facility
|
OP
|
$2,195.00
|
|
| Hospital Charge Code |
2965327
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$639.18 |
| Max. Negotiated Rate |
$2,100.18 |
| Rate for Payer: Aetna Commercial |
$2,054.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,963.21
|
| Rate for Payer: Aetna Managed Medicare |
$639.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,483.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,141.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,095.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,209.88
|
| Rate for Payer: Cash Price |
$658.50
|
| Rate for Payer: Cigna Commercial |
$2,100.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,277.49
|
| Rate for Payer: Health EOS Commercial |
$2,031.69
|
| Rate for Payer: HFN Commercial |
$2,100.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,712.10
|
| Rate for Payer: Multiplan Commercial |
$1,826.24
|
| Rate for Payer: NAPHCARE Commercial |
$1,369.68
|
| Rate for Payer: Preferred Network Access Commercial |
$2,100.18
|
| Rate for Payer: Quartz Beloit One Network |
$1,118.57
|
| Rate for Payer: Quartz Commercial |
$1,483.82
|
| Rate for Payer: Quartz Medicare Advantage |
$1,369.68
|
| Rate for Payer: The Alliance Commercial |
$1,141.40
|
| Rate for Payer: WEA Trust Commercial |
$1,255.54
|
| Rate for Payer: WPS Commercial |
$1,690.81
|
|
|
BUR CARBIDE 1.8 #31-55639
|
Facility
|
IP
|
$2,195.00
|
|
| Hospital Charge Code |
2965327
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,118.57 |
| Max. Negotiated Rate |
$2,100.18 |
| Rate for Payer: Aetna Commercial |
$2,054.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,963.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,209.88
|
| Rate for Payer: Cash Price |
$658.50
|
| Rate for Payer: Cigna Commercial |
$2,100.18
|
| Rate for Payer: Health EOS Commercial |
$2,031.69
|
| Rate for Payer: HFN Commercial |
$2,100.18
|
| Rate for Payer: Multiplan Commercial |
$1,826.24
|
| Rate for Payer: Preferred Network Access Commercial |
$2,100.18
|
| Rate for Payer: Quartz Beloit One Network |
$1,118.57
|
| Rate for Payer: Quartz Commercial |
$1,369.68
|
| Rate for Payer: WEA Trust Commercial |
$1,255.54
|
| Rate for Payer: WPS Commercial |
$1,690.81
|
|
|
BUR DIAMOND 0.6 #31-55646
|
Facility
|
OP
|
$2,183.00
|
|
| Hospital Charge Code |
2965328
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$635.69 |
| Max. Negotiated Rate |
$2,088.69 |
| Rate for Payer: Aetna Commercial |
$2,043.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,952.48
|
| Rate for Payer: Aetna Managed Medicare |
$635.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,475.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,135.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,089.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,203.27
|
| Rate for Payer: Cash Price |
$654.90
|
| Rate for Payer: Cigna Commercial |
$2,088.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,270.51
|
| Rate for Payer: Health EOS Commercial |
$2,020.58
|
| Rate for Payer: HFN Commercial |
$2,088.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,702.74
|
| Rate for Payer: Multiplan Commercial |
$1,816.26
|
| Rate for Payer: NAPHCARE Commercial |
$1,362.19
|
| Rate for Payer: Preferred Network Access Commercial |
$2,088.69
|
| Rate for Payer: Quartz Beloit One Network |
$1,112.46
|
| Rate for Payer: Quartz Commercial |
$1,475.71
|
| Rate for Payer: Quartz Medicare Advantage |
$1,362.19
|
| Rate for Payer: The Alliance Commercial |
$1,135.16
|
| Rate for Payer: WEA Trust Commercial |
$1,248.68
|
| Rate for Payer: WPS Commercial |
$1,681.56
|
|
|
BUR DIAMOND 0.6 #31-55646
|
Facility
|
IP
|
$2,183.00
|
|
| Hospital Charge Code |
2965328
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,112.46 |
| Max. Negotiated Rate |
$2,088.69 |
| Rate for Payer: Aetna Commercial |
$2,043.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,952.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,203.27
|
| Rate for Payer: Cash Price |
$654.90
|
| Rate for Payer: Cigna Commercial |
$2,088.69
|
| Rate for Payer: Health EOS Commercial |
$2,020.58
|
| Rate for Payer: HFN Commercial |
$2,088.69
|
| Rate for Payer: Multiplan Commercial |
$1,816.26
|
| Rate for Payer: Preferred Network Access Commercial |
$2,088.69
|
| Rate for Payer: Quartz Beloit One Network |
$1,112.46
|
| Rate for Payer: Quartz Commercial |
$1,362.19
|
| Rate for Payer: WEA Trust Commercial |
$1,248.68
|
| Rate for Payer: WPS Commercial |
$1,681.56
|
|
|
BUR DIAMOND 0.7 #31-55347
|
Facility
|
OP
|
$2,183.00
|
|
| Hospital Charge Code |
2965329
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$635.69 |
| Max. Negotiated Rate |
$2,088.69 |
| Rate for Payer: Aetna Commercial |
$2,043.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,952.48
|
| Rate for Payer: Aetna Managed Medicare |
$635.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,475.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,135.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,089.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,203.27
|
| Rate for Payer: Cash Price |
$654.90
|
| Rate for Payer: Cigna Commercial |
$2,088.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,270.51
|
| Rate for Payer: Health EOS Commercial |
$2,020.58
|
| Rate for Payer: HFN Commercial |
$2,088.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,702.74
|
| Rate for Payer: Multiplan Commercial |
$1,816.26
|
| Rate for Payer: NAPHCARE Commercial |
$1,362.19
|
| Rate for Payer: Preferred Network Access Commercial |
$2,088.69
|
| Rate for Payer: Quartz Beloit One Network |
$1,112.46
|
| Rate for Payer: Quartz Commercial |
$1,475.71
|
| Rate for Payer: Quartz Medicare Advantage |
$1,362.19
|
| Rate for Payer: The Alliance Commercial |
$1,135.16
|
| Rate for Payer: WEA Trust Commercial |
$1,248.68
|
| Rate for Payer: WPS Commercial |
$1,681.56
|
|
|
BUR DIAMOND 0.7 #31-55347
|
Facility
|
IP
|
$2,183.00
|
|
| Hospital Charge Code |
2965329
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,112.46 |
| Max. Negotiated Rate |
$2,088.69 |
| Rate for Payer: Aetna Commercial |
$2,043.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,952.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,203.27
|
| Rate for Payer: Cash Price |
$654.90
|
| Rate for Payer: Cigna Commercial |
$2,088.69
|
| Rate for Payer: Health EOS Commercial |
$2,020.58
|
| Rate for Payer: HFN Commercial |
$2,088.69
|
| Rate for Payer: Multiplan Commercial |
$1,816.26
|
| Rate for Payer: Preferred Network Access Commercial |
$2,088.69
|
| Rate for Payer: Quartz Beloit One Network |
$1,112.46
|
| Rate for Payer: Quartz Commercial |
$1,362.19
|
| Rate for Payer: WEA Trust Commercial |
$1,248.68
|
| Rate for Payer: WPS Commercial |
$1,681.56
|
|
|
BUR DIAMOND 0.8MM ROUND 3155648
|
Facility
|
OP
|
$2,470.00
|
|
| Hospital Charge Code |
2965330
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$719.26 |
| Max. Negotiated Rate |
$2,363.30 |
| Rate for Payer: Aetna Commercial |
$2,311.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,209.17
|
| Rate for Payer: Aetna Managed Medicare |
$719.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,669.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,284.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,233.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,361.46
|
| Rate for Payer: Cash Price |
$741.00
|
| Rate for Payer: Cigna Commercial |
$2,363.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,437.54
|
| Rate for Payer: Health EOS Commercial |
$2,286.23
|
| Rate for Payer: HFN Commercial |
$2,363.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,926.60
|
| Rate for Payer: Multiplan Commercial |
$2,055.04
|
| Rate for Payer: NAPHCARE Commercial |
$1,541.28
|
| Rate for Payer: Preferred Network Access Commercial |
$2,363.30
|
| Rate for Payer: Quartz Beloit One Network |
$1,258.71
|
| Rate for Payer: Quartz Commercial |
$1,669.72
|
| Rate for Payer: Quartz Medicare Advantage |
$1,541.28
|
| Rate for Payer: The Alliance Commercial |
$1,284.40
|
| Rate for Payer: WEA Trust Commercial |
$1,412.84
|
| Rate for Payer: WPS Commercial |
$1,902.64
|
|
|
BUR DIAMOND 0.8MM ROUND 3155648
|
Facility
|
IP
|
$2,470.00
|
|
| Hospital Charge Code |
2965330
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,258.71 |
| Max. Negotiated Rate |
$2,363.30 |
| Rate for Payer: Aetna Commercial |
$2,311.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,209.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,361.46
|
| Rate for Payer: Cash Price |
$741.00
|
| Rate for Payer: Cigna Commercial |
$2,363.30
|
| Rate for Payer: Health EOS Commercial |
$2,286.23
|
| Rate for Payer: HFN Commercial |
$2,363.30
|
| Rate for Payer: Multiplan Commercial |
$2,055.04
|
| Rate for Payer: Preferred Network Access Commercial |
$2,363.30
|
| Rate for Payer: Quartz Beloit One Network |
$1,258.71
|
| Rate for Payer: Quartz Commercial |
$1,541.28
|
| Rate for Payer: WEA Trust Commercial |
$1,412.84
|
| Rate for Payer: WPS Commercial |
$1,902.64
|
|
|
BUR DIAMOND 1.4 31-55643
|
Facility
|
IP
|
$2,105.00
|
|
| Hospital Charge Code |
2965331
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,072.71 |
| Max. Negotiated Rate |
$2,014.06 |
| Rate for Payer: Aetna Commercial |
$1,970.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,882.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,160.28
|
| Rate for Payer: Cash Price |
$631.50
|
| Rate for Payer: Cigna Commercial |
$2,014.06
|
| Rate for Payer: Health EOS Commercial |
$1,948.39
|
| Rate for Payer: HFN Commercial |
$2,014.06
|
| Rate for Payer: Multiplan Commercial |
$1,751.36
|
| Rate for Payer: Preferred Network Access Commercial |
$2,014.06
|
| Rate for Payer: Quartz Beloit One Network |
$1,072.71
|
| Rate for Payer: Quartz Commercial |
$1,313.52
|
| Rate for Payer: WEA Trust Commercial |
$1,204.06
|
| Rate for Payer: WPS Commercial |
$1,621.48
|
|
|
BUR DIAMOND 1.4 31-55643
|
Facility
|
OP
|
$2,105.00
|
|
| Hospital Charge Code |
2965331
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$612.98 |
| Max. Negotiated Rate |
$2,014.06 |
| Rate for Payer: Aetna Commercial |
$1,970.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,882.71
|
| Rate for Payer: Aetna Managed Medicare |
$612.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,422.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,094.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,050.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,160.28
|
| Rate for Payer: Cash Price |
$631.50
|
| Rate for Payer: Cigna Commercial |
$2,014.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,225.11
|
| Rate for Payer: Health EOS Commercial |
$1,948.39
|
| Rate for Payer: HFN Commercial |
$2,014.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,641.90
|
| Rate for Payer: Multiplan Commercial |
$1,751.36
|
| Rate for Payer: NAPHCARE Commercial |
$1,313.52
|
| Rate for Payer: Preferred Network Access Commercial |
$2,014.06
|
| Rate for Payer: Quartz Beloit One Network |
$1,072.71
|
| Rate for Payer: Quartz Commercial |
$1,422.98
|
| Rate for Payer: Quartz Medicare Advantage |
$1,313.52
|
| Rate for Payer: The Alliance Commercial |
$1,094.60
|
| Rate for Payer: WEA Trust Commercial |
$1,204.06
|
| Rate for Payer: WPS Commercial |
$1,621.48
|
|
|
BUR FULL RADIUS 3.5 C9942
|
Facility
|
IP
|
$915.00
|
|
| Hospital Charge Code |
3072546
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$466.28 |
| Max. Negotiated Rate |
$875.47 |
| Rate for Payer: Aetna Commercial |
$856.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$818.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$504.35
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cigna Commercial |
$875.47
|
| Rate for Payer: Health EOS Commercial |
$846.92
|
| Rate for Payer: HFN Commercial |
$875.47
|
| Rate for Payer: Multiplan Commercial |
$761.28
|
| Rate for Payer: Preferred Network Access Commercial |
$875.47
|
| Rate for Payer: Quartz Beloit One Network |
$466.28
|
| Rate for Payer: Quartz Commercial |
$570.96
|
| Rate for Payer: WEA Trust Commercial |
$523.38
|
| Rate for Payer: WPS Commercial |
$704.82
|
|
|
BUR FULL RADIUS 3.5 C9942
|
Facility
|
OP
|
$915.00
|
|
| Hospital Charge Code |
3072546
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$266.45 |
| Max. Negotiated Rate |
$875.47 |
| Rate for Payer: Aetna Commercial |
$856.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$818.38
|
| Rate for Payer: Aetna Managed Medicare |
$266.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$618.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$475.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$456.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$504.35
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cigna Commercial |
$875.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$532.53
|
| Rate for Payer: Health EOS Commercial |
$846.92
|
| Rate for Payer: HFN Commercial |
$875.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$713.70
|
| Rate for Payer: Multiplan Commercial |
$761.28
|
| Rate for Payer: NAPHCARE Commercial |
$570.96
|
| Rate for Payer: Preferred Network Access Commercial |
$875.47
|
| Rate for Payer: Quartz Beloit One Network |
$466.28
|
| Rate for Payer: Quartz Commercial |
$618.54
|
| Rate for Payer: Quartz Medicare Advantage |
$570.96
|
| Rate for Payer: The Alliance Commercial |
$475.80
|
| Rate for Payer: WEA Trust Commercial |
$523.38
|
| Rate for Payer: WPS Commercial |
$704.82
|
|
|
BURN DEBRIDEMENT
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2959991
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$512.66 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$627.74
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
BURN DEBRIDEMENT
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2959991
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$292.95 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Aetna Managed Medicare |
$292.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$680.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$523.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$502.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$585.49
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.68
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: NAPHCARE Commercial |
$627.74
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$680.06
|
| Rate for Payer: Quartz Medicare Advantage |
$627.74
|
| Rate for Payer: The Alliance Commercial |
$523.12
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
BURNS WITH SKIN GRAFT EXCEPT EXTENSIVE THIRD DEGREE BURNS
|
Facility
|
IP
|
$14,818.44
|
|
|
Service Code
|
APR-DRG 8421
|
| Min. Negotiated Rate |
$13,162.67 |
| Max. Negotiated Rate |
$14,818.44 |
| Rate for Payer: Anthem Medicaid |
$14,189.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$14,189.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14,189.48
|
| Rate for Payer: Dean Health Medicaid |
$14,189.48
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13,162.67
|
| Rate for Payer: Managed Health Services Medicaid |
$14,818.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,189.48
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14,189.48
|
| Rate for Payer: United Healthcare Medicaid |
$14,189.48
|
|
|
BURNS WITH SKIN GRAFT EXCEPT EXTENSIVE THIRD DEGREE BURNS
|
Facility
|
IP
|
$103,027.64
|
|
|
Service Code
|
APR-DRG 8424
|
| Min. Negotiated Rate |
$91,515.58 |
| Max. Negotiated Rate |
$103,027.64 |
| Rate for Payer: Anthem Medicaid |
$98,654.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$98,654.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$98,654.65
|
| Rate for Payer: Dean Health Medicaid |
$98,654.65
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$91,515.58
|
| Rate for Payer: Managed Health Services Medicaid |
$103,027.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$98,654.65
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$98,654.65
|
| Rate for Payer: United Healthcare Medicaid |
$98,654.65
|
|
|
BURNS WITH SKIN GRAFT EXCEPT EXTENSIVE THIRD DEGREE BURNS
|
Facility
|
IP
|
$22,359.19
|
|
|
Service Code
|
APR-DRG 8422
|
| Min. Negotiated Rate |
$19,860.83 |
| Max. Negotiated Rate |
$22,359.19 |
| Rate for Payer: Anthem Medicaid |
$21,410.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$21,410.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$21,410.16
|
| Rate for Payer: Dean Health Medicaid |
$21,410.16
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19,860.83
|
| Rate for Payer: Managed Health Services Medicaid |
$22,359.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$21,410.16
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$21,410.16
|
| Rate for Payer: United Healthcare Medicaid |
$21,410.16
|
|
|
BURNS WITH SKIN GRAFT EXCEPT EXTENSIVE THIRD DEGREE BURNS
|
Facility
|
IP
|
$41,649.47
|
|
|
Service Code
|
APR-DRG 8423
|
| Min. Negotiated Rate |
$36,995.66 |
| Max. Negotiated Rate |
$41,649.47 |
| Rate for Payer: Anthem Medicaid |
$39,881.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$39,881.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$39,881.67
|
| Rate for Payer: Dean Health Medicaid |
$39,881.67
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$36,995.66
|
| Rate for Payer: Managed Health Services Medicaid |
$41,649.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$39,881.67
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$39,881.67
|
| Rate for Payer: United Healthcare Medicaid |
$39,881.67
|
|
|
BUR OVAL 8 FLUTED 4.0MM X 13CM AR-8400OBE
|
Facility
|
OP
|
$959.00
|
|
| Hospital Charge Code |
5106619
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$279.26 |
| Max. Negotiated Rate |
$917.57 |
| Rate for Payer: Aetna Commercial |
$897.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$857.73
|
| Rate for Payer: Aetna Managed Medicare |
$279.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$648.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$498.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$478.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$528.60
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cigna Commercial |
$917.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$558.14
|
| Rate for Payer: Health EOS Commercial |
$887.65
|
| Rate for Payer: HFN Commercial |
$917.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$748.02
|
| Rate for Payer: Multiplan Commercial |
$797.89
|
| Rate for Payer: NAPHCARE Commercial |
$598.42
|
| Rate for Payer: Preferred Network Access Commercial |
$917.57
|
| Rate for Payer: Quartz Beloit One Network |
$488.71
|
| Rate for Payer: Quartz Commercial |
$648.28
|
| Rate for Payer: Quartz Medicare Advantage |
$598.42
|
| Rate for Payer: The Alliance Commercial |
$498.68
|
| Rate for Payer: WEA Trust Commercial |
$548.55
|
| Rate for Payer: WPS Commercial |
$738.72
|
|
|
BUR OVAL 8 FLUTED 4.0MM X 13CM AR-8400OBE
|
Facility
|
IP
|
$959.00
|
|
| Hospital Charge Code |
5106619
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$488.71 |
| Max. Negotiated Rate |
$917.57 |
| Rate for Payer: Aetna Commercial |
$897.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$857.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$528.60
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cigna Commercial |
$917.57
|
| Rate for Payer: Health EOS Commercial |
$887.65
|
| Rate for Payer: HFN Commercial |
$917.57
|
| Rate for Payer: Multiplan Commercial |
$797.89
|
| Rate for Payer: Preferred Network Access Commercial |
$917.57
|
| Rate for Payer: Quartz Beloit One Network |
$488.71
|
| Rate for Payer: Quartz Commercial |
$598.42
|
| Rate for Payer: WEA Trust Commercial |
$548.55
|
| Rate for Payer: WPS Commercial |
$738.72
|
|
|
BUR OVAL 8 FLUTED 5.0MM AR-8500OBE
|
Facility
|
OP
|
$959.00
|
|
| Hospital Charge Code |
5206677
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$279.26 |
| Max. Negotiated Rate |
$917.57 |
| Rate for Payer: Aetna Commercial |
$897.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$857.73
|
| Rate for Payer: Aetna Managed Medicare |
$279.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$648.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$498.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$478.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$528.60
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cigna Commercial |
$917.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$558.14
|
| Rate for Payer: Health EOS Commercial |
$887.65
|
| Rate for Payer: HFN Commercial |
$917.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$748.02
|
| Rate for Payer: Multiplan Commercial |
$797.89
|
| Rate for Payer: NAPHCARE Commercial |
$598.42
|
| Rate for Payer: Preferred Network Access Commercial |
$917.57
|
| Rate for Payer: Quartz Beloit One Network |
$488.71
|
| Rate for Payer: Quartz Commercial |
$648.28
|
| Rate for Payer: Quartz Medicare Advantage |
$598.42
|
| Rate for Payer: The Alliance Commercial |
$498.68
|
| Rate for Payer: WEA Trust Commercial |
$548.55
|
| Rate for Payer: WPS Commercial |
$738.72
|
|
|
BUR OVAL 8 FLUTED 5.0MM AR-8500OBE
|
Facility
|
IP
|
$959.00
|
|
| Hospital Charge Code |
5206677
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$488.71 |
| Max. Negotiated Rate |
$917.57 |
| Rate for Payer: Aetna Commercial |
$897.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$857.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$528.60
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cigna Commercial |
$917.57
|
| Rate for Payer: Health EOS Commercial |
$887.65
|
| Rate for Payer: HFN Commercial |
$917.57
|
| Rate for Payer: Multiplan Commercial |
$797.89
|
| Rate for Payer: Preferred Network Access Commercial |
$917.57
|
| Rate for Payer: Quartz Beloit One Network |
$488.71
|
| Rate for Payer: Quartz Commercial |
$598.42
|
| Rate for Payer: WEA Trust Commercial |
$548.55
|
| Rate for Payer: WPS Commercial |
$738.72
|
|
|
BURR 20MM 3.1MM STRAIGHT AR-300-B202
|
Facility
|
OP
|
$3,580.00
|
|
| Hospital Charge Code |
5787769
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,042.50 |
| Max. Negotiated Rate |
$3,425.34 |
| Rate for Payer: Aetna Commercial |
$3,350.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,201.95
|
| Rate for Payer: Aetna Managed Medicare |
$1,042.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,420.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,861.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,787.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,973.30
|
| Rate for Payer: Cash Price |
$1,074.00
|
| Rate for Payer: Cigna Commercial |
$3,425.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,083.56
|
| Rate for Payer: Health EOS Commercial |
$3,313.65
|
| Rate for Payer: HFN Commercial |
$3,425.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,792.40
|
| Rate for Payer: Multiplan Commercial |
$2,978.56
|
| Rate for Payer: NAPHCARE Commercial |
$2,233.92
|
| Rate for Payer: Preferred Network Access Commercial |
$3,425.34
|
| Rate for Payer: Quartz Beloit One Network |
$1,824.37
|
| Rate for Payer: Quartz Commercial |
$2,420.08
|
| Rate for Payer: Quartz Medicare Advantage |
$2,233.92
|
| Rate for Payer: The Alliance Commercial |
$1,861.60
|
| Rate for Payer: WEA Trust Commercial |
$2,047.76
|
| Rate for Payer: WPS Commercial |
$2,757.67
|
|
|
BURR 20MM 3.1MM STRAIGHT AR-300-B202
|
Facility
|
IP
|
$3,580.00
|
|
| Hospital Charge Code |
5787769
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,824.37 |
| Max. Negotiated Rate |
$3,425.34 |
| Rate for Payer: Aetna Commercial |
$3,350.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,201.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,973.30
|
| Rate for Payer: Cash Price |
$1,074.00
|
| Rate for Payer: Cigna Commercial |
$3,425.34
|
| Rate for Payer: Health EOS Commercial |
$3,313.65
|
| Rate for Payer: HFN Commercial |
$3,425.34
|
| Rate for Payer: Multiplan Commercial |
$2,978.56
|
| Rate for Payer: Preferred Network Access Commercial |
$3,425.34
|
| Rate for Payer: Quartz Beloit One Network |
$1,824.37
|
| Rate for Payer: Quartz Commercial |
$2,233.92
|
| Rate for Payer: WEA Trust Commercial |
$2,047.76
|
| Rate for Payer: WPS Commercial |
$2,757.67
|
|
|
BURR CARTILAGE 2MM X 8MM CYLINDER SS 58CC2008
|
Facility
|
OP
|
$5,625.00
|
|
| Hospital Charge Code |
6180079
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,638.00 |
| Max. Negotiated Rate |
$5,382.00 |
| Rate for Payer: Aetna Commercial |
$5,265.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,031.00
|
| Rate for Payer: Aetna Managed Medicare |
$1,638.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,802.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,925.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,808.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,100.50
|
| Rate for Payer: Cash Price |
$1,687.50
|
| Rate for Payer: Cigna Commercial |
$5,382.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,273.75
|
| Rate for Payer: Health EOS Commercial |
$5,206.50
|
| Rate for Payer: HFN Commercial |
$5,382.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,387.50
|
| Rate for Payer: Multiplan Commercial |
$4,680.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,510.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,382.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,866.50
|
| Rate for Payer: Quartz Commercial |
$3,802.50
|
| Rate for Payer: Quartz Medicare Advantage |
$3,510.00
|
| Rate for Payer: The Alliance Commercial |
$2,925.00
|
| Rate for Payer: WEA Trust Commercial |
$3,217.50
|
| Rate for Payer: WPS Commercial |
$4,332.94
|
|
