|
Afo sing solid stirrup calf L1980
|
Facility
|
IP
|
$974.00
|
|
|
Service Code
|
HCPCS L1980
|
| Hospital Charge Code |
4526616
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$496.35 |
| Max. Negotiated Rate |
$931.92 |
| Rate for Payer: Aetna Commercial |
$911.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$871.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$536.87
|
| Rate for Payer: Cash Price |
$292.20
|
| Rate for Payer: Cigna Commercial |
$931.92
|
| Rate for Payer: Health EOS Commercial |
$901.53
|
| Rate for Payer: HFN Commercial |
$931.92
|
| Rate for Payer: Multiplan Commercial |
$810.37
|
| Rate for Payer: Preferred Network Access Commercial |
$931.92
|
| Rate for Payer: Quartz Beloit One Network |
$496.35
|
| Rate for Payer: Quartz Commercial |
$607.78
|
| Rate for Payer: WEA Trust Commercial |
$557.13
|
| Rate for Payer: WPS Commercial |
$750.27
|
|
|
Afo sing upright w/adjust s L1920
|
Facility
|
OP
|
$1,104.00
|
|
|
Service Code
|
HCPCS L1920
|
| Hospital Charge Code |
4308927
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$221.25 |
| Max. Negotiated Rate |
$2,100.22 |
| Rate for Payer: Aetna Commercial |
$1,033.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$987.42
|
| Rate for Payer: Aetna Managed Medicare |
$321.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$221.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$221.25
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$221.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$608.52
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cigna Commercial |
$1,056.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$642.53
|
| Rate for Payer: Health EOS Commercial |
$1,021.86
|
| Rate for Payer: HFN Commercial |
$1,056.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$861.12
|
| Rate for Payer: Multiplan Commercial |
$918.53
|
| Rate for Payer: NAPHCARE Commercial |
$688.90
|
| Rate for Payer: Preferred Network Access Commercial |
$1,056.31
|
| Rate for Payer: Quartz Beloit One Network |
$562.60
|
| Rate for Payer: Quartz Commercial |
$746.30
|
| Rate for Payer: Quartz Medicare Advantage |
$688.90
|
| Rate for Payer: The Alliance Commercial |
$2,100.22
|
| Rate for Payer: WEA Trust Commercial |
$631.49
|
| Rate for Payer: WPS Commercial |
$850.41
|
|
|
Afo sing upright w/adjust s L1920
|
Professional
|
Both
|
$1,104.00
|
|
|
Service Code
|
HCPCS L1920
|
| Hospital Charge Code |
4308927
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$505.19 |
| Max. Negotiated Rate |
$1,513.90 |
| Rate for Payer: Aetna Commercial |
$1,090.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$987.42
|
| Rate for Payer: Aetna Managed Medicare |
$525.05
|
| Rate for Payer: Anthem Medicare Advantage |
$525.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$525.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$525.05
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cigna Commercial |
$1,090.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$574.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$525.05
|
| Rate for Payer: Health EOS Commercial |
$1,044.83
|
| Rate for Payer: HFN Commercial |
$1,090.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,513.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,513.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$525.05
|
| Rate for Payer: Multiplan Commercial |
$918.53
|
| Rate for Payer: NAPHCARE Commercial |
$787.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,090.75
|
| Rate for Payer: Quartz Beloit One Network |
$505.19
|
| Rate for Payer: Quartz Commercial |
$654.45
|
| Rate for Payer: Quartz Medicare Advantage |
$525.05
|
| Rate for Payer: The Alliance Commercial |
$1,443.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$525.05
|
| Rate for Payer: WEA Trust Commercial |
$631.49
|
| Rate for Payer: WPS Commercial |
$918.85
|
|
|
Afo sing upright w/adjust s L1920
|
Facility
|
IP
|
$1,104.00
|
|
|
Service Code
|
HCPCS L1920
|
| Hospital Charge Code |
4308927
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$562.60 |
| Max. Negotiated Rate |
$1,056.31 |
| Rate for Payer: Aetna Commercial |
$1,033.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$987.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$608.52
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cigna Commercial |
$1,056.31
|
| Rate for Payer: Health EOS Commercial |
$1,021.86
|
| Rate for Payer: HFN Commercial |
$1,056.31
|
| Rate for Payer: Multiplan Commercial |
$918.53
|
| Rate for Payer: Preferred Network Access Commercial |
$1,056.31
|
| Rate for Payer: Quartz Beloit One Network |
$562.60
|
| Rate for Payer: Quartz Commercial |
$688.90
|
| Rate for Payer: WEA Trust Commercial |
$631.49
|
| Rate for Payer: WPS Commercial |
$850.41
|
|
|
Afo w/ankle joint, prefab L1971
|
Facility
|
IP
|
$1,181.00
|
|
|
Service Code
|
HCPCS L1971
|
| Hospital Charge Code |
5288724
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$601.84 |
| Max. Negotiated Rate |
$1,129.98 |
| Rate for Payer: Aetna Commercial |
$1,105.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,056.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$650.97
|
| Rate for Payer: Cash Price |
$354.30
|
| Rate for Payer: Cigna Commercial |
$1,129.98
|
| Rate for Payer: Health EOS Commercial |
$1,093.13
|
| Rate for Payer: HFN Commercial |
$1,129.98
|
| Rate for Payer: Multiplan Commercial |
$982.59
|
| Rate for Payer: Preferred Network Access Commercial |
$1,129.98
|
| Rate for Payer: Quartz Beloit One Network |
$601.84
|
| Rate for Payer: Quartz Commercial |
$736.94
|
| Rate for Payer: WEA Trust Commercial |
$675.53
|
| Rate for Payer: WPS Commercial |
$909.72
|
|
|
Afo w/ankle joint, prefab L1971
|
Facility
|
OP
|
$1,181.00
|
|
|
Service Code
|
HCPCS L1971
|
| Hospital Charge Code |
5288724
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$343.91 |
| Max. Negotiated Rate |
$2,396.58 |
| Rate for Payer: Aetna Commercial |
$1,105.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,056.29
|
| Rate for Payer: Aetna Managed Medicare |
$343.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$383.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$383.82
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$383.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$650.97
|
| Rate for Payer: Cash Price |
$354.30
|
| Rate for Payer: Cash Price |
$354.30
|
| Rate for Payer: Cigna Commercial |
$1,129.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$687.34
|
| Rate for Payer: Health EOS Commercial |
$1,093.13
|
| Rate for Payer: HFN Commercial |
$1,129.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$921.18
|
| Rate for Payer: Multiplan Commercial |
$982.59
|
| Rate for Payer: NAPHCARE Commercial |
$736.94
|
| Rate for Payer: Preferred Network Access Commercial |
$1,129.98
|
| Rate for Payer: Quartz Beloit One Network |
$601.84
|
| Rate for Payer: Quartz Commercial |
$798.36
|
| Rate for Payer: Quartz Medicare Advantage |
$736.94
|
| Rate for Payer: The Alliance Commercial |
$2,396.58
|
| Rate for Payer: WEA Trust Commercial |
$675.53
|
| Rate for Payer: WPS Commercial |
$909.72
|
|
|
Afo w/ankle joint, prefab L1971
|
Professional
|
Both
|
$1,181.00
|
|
|
Service Code
|
HCPCS L1971
|
| Hospital Charge Code |
5288724
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$540.43 |
| Max. Negotiated Rate |
$1,727.48 |
| Rate for Payer: Aetna Commercial |
$1,166.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,056.29
|
| Rate for Payer: Aetna Managed Medicare |
$599.14
|
| Rate for Payer: Anthem Medicare Advantage |
$599.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$599.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$599.14
|
| Rate for Payer: Cash Price |
$354.30
|
| Rate for Payer: Cash Price |
$354.30
|
| Rate for Payer: Cigna Commercial |
$1,166.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$614.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$599.14
|
| Rate for Payer: Health EOS Commercial |
$1,117.70
|
| Rate for Payer: HFN Commercial |
$1,166.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,727.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,727.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$599.14
|
| Rate for Payer: Multiplan Commercial |
$982.59
|
| Rate for Payer: NAPHCARE Commercial |
$898.72
|
| Rate for Payer: Preferred Network Access Commercial |
$1,166.83
|
| Rate for Payer: Quartz Beloit One Network |
$540.43
|
| Rate for Payer: Quartz Commercial |
$700.10
|
| Rate for Payer: Quartz Medicare Advantage |
$599.14
|
| Rate for Payer: The Alliance Commercial |
$1,647.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$599.14
|
| Rate for Payer: WEA Trust Commercial |
$675.53
|
| Rate for Payer: WPS Commercial |
$1,048.50
|
|
|
AFP Maternal / 5059
|
Professional
|
Both
|
$245.00
|
|
|
Service Code
|
CPT 82105
|
| Hospital Charge Code |
977774
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.44 |
| Max. Negotiated Rate |
$242.06 |
| Rate for Payer: Aetna Commercial |
$242.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$219.13
|
| Rate for Payer: Aetna Managed Medicare |
$17.44
|
| Rate for Payer: Anthem Medicare Advantage |
$17.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.44
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$242.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$127.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.44
|
| Rate for Payer: Health EOS Commercial |
$231.87
|
| Rate for Payer: HFN Commercial |
$242.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$61.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$61.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.44
|
| Rate for Payer: Multiplan Commercial |
$203.84
|
| Rate for Payer: NAPHCARE Commercial |
$26.16
|
| Rate for Payer: Preferred Network Access Commercial |
$242.06
|
| Rate for Payer: Quartz Beloit One Network |
$112.11
|
| Rate for Payer: Quartz Commercial |
$145.24
|
| Rate for Payer: Quartz Medicare Advantage |
$17.44
|
| Rate for Payer: The Alliance Commercial |
$68.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.44
|
| Rate for Payer: WEA Trust Commercial |
$140.14
|
| Rate for Payer: WPS Commercial |
$76.74
|
|
|
AFP Maternal / 5059
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 82105
|
| Hospital Charge Code |
977774
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$124.85 |
| Max. Negotiated Rate |
$234.42 |
| Rate for Payer: Aetna Commercial |
$229.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$219.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$135.04
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$234.42
|
| Rate for Payer: Health EOS Commercial |
$226.77
|
| Rate for Payer: HFN Commercial |
$234.42
|
| Rate for Payer: Multiplan Commercial |
$203.84
|
| Rate for Payer: Preferred Network Access Commercial |
$234.42
|
| Rate for Payer: Quartz Beloit One Network |
$124.85
|
| Rate for Payer: Quartz Commercial |
$152.88
|
| Rate for Payer: WEA Trust Commercial |
$140.14
|
| Rate for Payer: WPS Commercial |
$188.72
|
|
|
AFP Maternal / 5059
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 82105
|
| Hospital Charge Code |
977774
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.44 |
| Max. Negotiated Rate |
$234.42 |
| Rate for Payer: Aetna Commercial |
$229.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$219.13
|
| Rate for Payer: Aetna Managed Medicare |
$17.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$65.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.95
|
| Rate for Payer: Anthem Medicare Advantage |
$17.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$135.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.44
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$234.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$142.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.44
|
| Rate for Payer: Health EOS Commercial |
$226.77
|
| Rate for Payer: HFN Commercial |
$234.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.44
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.44
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.44
|
| Rate for Payer: Multiplan Commercial |
$203.84
|
| Rate for Payer: NAPHCARE Commercial |
$26.16
|
| Rate for Payer: Preferred Network Access Commercial |
$234.42
|
| Rate for Payer: Quartz Beloit One Network |
$124.85
|
| Rate for Payer: Quartz Commercial |
$165.62
|
| Rate for Payer: Quartz Medicare Advantage |
$17.44
|
| Rate for Payer: The Alliance Commercial |
$69.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.44
|
| Rate for Payer: United Healthcare PPO |
$191.10
|
| Rate for Payer: WEA Trust Commercial |
$140.14
|
| Rate for Payer: Wellcare Medicare |
$17.44
|
| Rate for Payer: WPS Commercial |
$188.72
|
|
|
AFTERCARE, BURNS, CORROSIONS, OTHER INJURIES RELATED TO THE SKIN AND SUB TIS
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
EAPG 00787
|
| Min. Negotiated Rate |
$109.61 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Anthem Medicaid |
$109.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$109.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$109.61
|
| Rate for Payer: Dean Health Medicaid |
$109.61
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$109.61
|
| Rate for Payer: Managed Health Services Medicaid |
$114.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$109.61
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$109.61
|
| Rate for Payer: United Healthcare Medicaid |
$109.61
|
|
|
AFTERCARE FOR JOINT REPLACEMENT
|
Facility
|
OP
|
$85.17
|
|
|
Service Code
|
EAPG 00874
|
| Min. Negotiated Rate |
$81.89 |
| Max. Negotiated Rate |
$85.17 |
| Rate for Payer: Anthem Medicaid |
$81.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$81.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$81.89
|
| Rate for Payer: Dean Health Medicaid |
$81.89
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$81.89
|
| Rate for Payer: Managed Health Services Medicaid |
$85.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$81.89
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$81.89
|
| Rate for Payer: United Healthcare Medicaid |
$81.89
|
|
|
AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE INJURIES
|
Facility
|
OP
|
$96.96
|
|
|
Service Code
|
EAPG 00869
|
| Min. Negotiated Rate |
$93.23 |
| Max. Negotiated Rate |
$96.96 |
| Rate for Payer: Anthem Medicaid |
$93.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$93.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$93.23
|
| Rate for Payer: Dean Health Medicaid |
$93.23
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$93.23
|
| Rate for Payer: Managed Health Services Medicaid |
$96.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$93.23
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$93.23
|
| Rate for Payer: United Healthcare Medicaid |
$93.23
|
|
|
AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC
|
Facility
|
IP
|
$31,634.72
|
|
|
Service Code
|
MSDRG 560
|
| Min. Negotiated Rate |
$9,130.68 |
| Max. Negotiated Rate |
$31,634.72 |
| Rate for Payer: Aetna Managed Medicare |
$9,130.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$24,570.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,833.17
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,892.74
|
| Rate for Payer: Anthem Medicare Advantage |
$9,130.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,130.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,130.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,130.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19,862.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,130.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22,958.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,130.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9,130.68
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9,130.68
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,130.68
|
| Rate for Payer: NAPHCARE Commercial |
$13,696.02
|
| Rate for Payer: Quartz Medicare Advantage |
$9,130.68
|
| Rate for Payer: The Alliance Commercial |
$31,634.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,130.68
|
| Rate for Payer: United Healthcare PPO |
$17,873.87
|
| Rate for Payer: Wellcare Medicare |
$9,130.68
|
|
|
AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC
|
Facility
|
IP
|
$51,498.72
|
|
|
Service Code
|
MSDRG 559
|
| Min. Negotiated Rate |
$15,222.26 |
| Max. Negotiated Rate |
$51,498.72 |
| Rate for Payer: Aetna Managed Medicare |
$15,222.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$40,690.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31,189.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29,631.62
|
| Rate for Payer: Anthem Medicare Advantage |
$15,222.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15,222.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15,222.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15,222.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32,893.81
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15,222.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37,528.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15,222.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15,222.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15,222.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15,222.26
|
| Rate for Payer: NAPHCARE Commercial |
$22,833.39
|
| Rate for Payer: Quartz Medicare Advantage |
$15,222.26
|
| Rate for Payer: The Alliance Commercial |
$51,498.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15,222.26
|
| Rate for Payer: United Healthcare PPO |
$29,216.14
|
| Rate for Payer: Wellcare Medicare |
$15,222.26
|
|
|
AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC
|
Facility
|
IP
|
$21,905.52
|
|
|
Service Code
|
MSDRG 561
|
| Min. Negotiated Rate |
$6,663.21 |
| Max. Negotiated Rate |
$21,905.52 |
| Rate for Payer: Aetna Managed Medicare |
$6,663.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17,540.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,444.62
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,773.26
|
| Rate for Payer: Anthem Medicare Advantage |
$6,663.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,663.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,663.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,663.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14,179.49
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,663.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,822.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,663.21
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,663.21
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,663.21
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,663.21
|
| Rate for Payer: NAPHCARE Commercial |
$9,994.81
|
| Rate for Payer: Quartz Medicare Advantage |
$6,663.21
|
| Rate for Payer: The Alliance Commercial |
$21,905.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,663.21
|
| Rate for Payer: United Healthcare PPO |
$12,317.99
|
| Rate for Payer: Wellcare Medicare |
$6,663.21
|
|
|
AFTERCARE, OPEN WOUNDS AND OTHER TRAUMATIC INJURIES
|
Facility
|
OP
|
$112.69
|
|
|
Service Code
|
EAPG 00585
|
| Min. Negotiated Rate |
$108.35 |
| Max. Negotiated Rate |
$112.69 |
| Rate for Payer: Anthem Medicaid |
$108.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$108.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$108.35
|
| Rate for Payer: Dean Health Medicaid |
$108.35
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$108.35
|
| Rate for Payer: Managed Health Services Medicaid |
$112.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$108.35
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$108.35
|
| Rate for Payer: United Healthcare Medicaid |
$108.35
|
|
|
AFTERCARE WITH CC/MCC
|
Facility
|
IP
|
$29,995.68
|
|
|
Service Code
|
MSDRG 949
|
| Min. Negotiated Rate |
$9,617.74 |
| Max. Negotiated Rate |
$29,995.68 |
| Rate for Payer: Aetna Managed Medicare |
$9,617.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25,958.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,896.83
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18,903.29
|
| Rate for Payer: Anthem Medicare Advantage |
$9,617.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,617.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,617.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,617.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20,984.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,617.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21,012.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,617.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9,617.74
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9,617.74
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,617.74
|
| Rate for Payer: NAPHCARE Commercial |
$14,426.61
|
| Rate for Payer: Quartz Medicare Advantage |
$9,617.74
|
| Rate for Payer: The Alliance Commercial |
$29,995.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,617.74
|
| Rate for Payer: United Healthcare PPO |
$16,358.19
|
| Rate for Payer: Wellcare Medicare |
$9,617.74
|
|
|
AFTERCARE WITHOUT CC/MCC
|
Facility
|
IP
|
$17,989.92
|
|
|
Service Code
|
MSDRG 950
|
| Min. Negotiated Rate |
$5,313.83 |
| Max. Negotiated Rate |
$17,989.92 |
| Rate for Payer: Aetna Managed Medicare |
$5,313.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,695.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,497.81
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,973.60
|
| Rate for Payer: Anthem Medicare Advantage |
$5,313.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,313.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,313.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,313.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,071.61
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,313.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,739.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,313.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,313.83
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,313.83
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,313.83
|
| Rate for Payer: NAPHCARE Commercial |
$7,970.74
|
| Rate for Payer: Quartz Medicare Advantage |
$5,313.83
|
| Rate for Payer: The Alliance Commercial |
$17,989.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,313.83
|
| Rate for Payer: United Healthcare PPO |
$9,918.17
|
| Rate for Payer: Wellcare Medicare |
$5,313.83
|
|
|
AFTEREFFECTS OF CEREBROVASCULAR ACCIDENT
|
Facility
|
OP
|
$90.41
|
|
|
Service Code
|
EAPG 00533
|
| Min. Negotiated Rate |
$86.93 |
| Max. Negotiated Rate |
$90.41 |
| Rate for Payer: Anthem Medicaid |
$86.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$86.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$86.93
|
| Rate for Payer: Dean Health Medicaid |
$86.93
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$86.93
|
| Rate for Payer: Managed Health Services Medicaid |
$90.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$86.93
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$86.93
|
| Rate for Payer: United Healthcare Medicaid |
$86.93
|
|
|
AGNA 1
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
2942953
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.53 |
| Max. Negotiated Rate |
$84.20 |
| Rate for Payer: Aetna Commercial |
$82.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$78.71
|
| Rate for Payer: Aetna Managed Medicare |
$12.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.93
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.80
|
| Rate for Payer: Anthem Medicare Advantage |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$48.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.53
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$84.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.53
|
| Rate for Payer: Health EOS Commercial |
$81.45
|
| Rate for Payer: HFN Commercial |
$84.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.53
|
| Rate for Payer: Multiplan Commercial |
$73.22
|
| Rate for Payer: NAPHCARE Commercial |
$18.80
|
| Rate for Payer: Preferred Network Access Commercial |
$84.20
|
| Rate for Payer: Quartz Beloit One Network |
$44.84
|
| Rate for Payer: Quartz Commercial |
$59.49
|
| Rate for Payer: Quartz Medicare Advantage |
$12.53
|
| Rate for Payer: The Alliance Commercial |
$50.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.53
|
| Rate for Payer: United Healthcare PPO |
$68.64
|
| Rate for Payer: WEA Trust Commercial |
$50.34
|
| Rate for Payer: Wellcare Medicare |
$12.53
|
| Rate for Payer: WPS Commercial |
$67.79
|
|
|
AGNA 1
|
Professional
|
Both
|
$88.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
2942953
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.53 |
| Max. Negotiated Rate |
$86.94 |
| Rate for Payer: Aetna Commercial |
$86.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$78.71
|
| Rate for Payer: Aetna Managed Medicare |
$12.53
|
| Rate for Payer: Anthem Commercial |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.53
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$86.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$45.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.53
|
| Rate for Payer: Health EOS Commercial |
$83.28
|
| Rate for Payer: HFN Commercial |
$86.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$44.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.53
|
| Rate for Payer: Multiplan Commercial |
$73.22
|
| Rate for Payer: NAPHCARE Commercial |
$18.80
|
| Rate for Payer: Preferred Network Access Commercial |
$86.94
|
| Rate for Payer: Quartz Beloit One Network |
$40.27
|
| Rate for Payer: Quartz Commercial |
$52.17
|
| Rate for Payer: Quartz Medicare Advantage |
$12.53
|
| Rate for Payer: The Alliance Commercial |
$49.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.53
|
| Rate for Payer: WEA Trust Commercial |
$50.34
|
| Rate for Payer: WPS Commercial |
$55.14
|
|
|
AGNA 1
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
2942953
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.84 |
| Max. Negotiated Rate |
$84.20 |
| Rate for Payer: Aetna Commercial |
$82.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$78.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$48.51
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$84.20
|
| Rate for Payer: Health EOS Commercial |
$81.45
|
| Rate for Payer: HFN Commercial |
$84.20
|
| Rate for Payer: Multiplan Commercial |
$73.22
|
| Rate for Payer: Preferred Network Access Commercial |
$84.20
|
| Rate for Payer: Quartz Beloit One Network |
$44.84
|
| Rate for Payer: Quartz Commercial |
$54.91
|
| Rate for Payer: WEA Trust Commercial |
$50.34
|
| Rate for Payer: WPS Commercial |
$67.79
|
|
|
AICD AND RELATED CARDIAC DEVICE INSERTION OR REPLACEMENT
|
Facility
|
OP
|
$10,792.94
|
|
|
Service Code
|
EAPG 00097
|
| Min. Negotiated Rate |
$10,377.80 |
| Max. Negotiated Rate |
$10,792.94 |
| Rate for Payer: Anthem Medicaid |
$10,377.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$10,377.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10,377.80
|
| Rate for Payer: Dean Health Medicaid |
$10,377.80
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$10,377.80
|
| Rate for Payer: Managed Health Services Medicaid |
$10,792.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,377.80
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$10,377.80
|
| Rate for Payer: United Healthcare Medicaid |
$10,377.80
|
|
|
AICD GENERATOR PROCEDURES
|
Facility
|
IP
|
$125,623.68
|
|
|
Service Code
|
MSDRG 245
|
| Min. Negotiated Rate |
$35,446.54 |
| Max. Negotiated Rate |
$125,623.68 |
| Rate for Payer: Aetna Managed Medicare |
$35,446.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$99,547.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$76,302.67
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$72,492.52
|
| Rate for Payer: Anthem Medicare Advantage |
$35,446.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35,446.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35,446.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$35,446.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$80,473.34
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$35,446.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$91,896.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35,446.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35,446.54
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$35,446.54
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$35,446.54
|
| Rate for Payer: NAPHCARE Commercial |
$53,169.81
|
| Rate for Payer: Quartz Medicare Advantage |
$35,446.54
|
| Rate for Payer: The Alliance Commercial |
$125,623.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35,446.54
|
| Rate for Payer: United Healthcare PPO |
$71,542.83
|
| Rate for Payer: Wellcare Medicare |
$35,446.54
|
|
