|
EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT
|
Facility
|
IP
|
$42,087.89
|
|
|
Service Code
|
APR-DRG 7924
|
| Min. Negotiated Rate |
$37,385.09 |
| Max. Negotiated Rate |
$42,087.89 |
| Rate for Payer: Anthem Medicaid |
$40,301.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$40,301.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$40,301.47
|
| Rate for Payer: Dean Health Medicaid |
$40,301.47
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$37,385.09
|
| Rate for Payer: Managed Health Services Medicaid |
$42,087.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$40,301.47
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$40,301.47
|
| Rate for Payer: United Healthcare Medicaid |
$40,301.47
|
|
|
EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT
|
Facility
|
IP
|
$13,327.83
|
|
|
Service Code
|
APR-DRG 7921
|
| Min. Negotiated Rate |
$11,838.61 |
| Max. Negotiated Rate |
$13,327.83 |
| Rate for Payer: Anthem Medicaid |
$12,762.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$12,762.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12,762.13
|
| Rate for Payer: Dean Health Medicaid |
$12,762.13
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11,838.61
|
| Rate for Payer: Managed Health Services Medicaid |
$13,327.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,762.13
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12,762.13
|
| Rate for Payer: United Healthcare Medicaid |
$12,762.13
|
|
|
EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT
|
Facility
|
IP
|
$16,922.84
|
|
|
Service Code
|
APR-DRG 7922
|
| Min. Negotiated Rate |
$15,031.92 |
| Max. Negotiated Rate |
$16,922.84 |
| Rate for Payer: Anthem Medicaid |
$16,204.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$16,204.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16,204.55
|
| Rate for Payer: Dean Health Medicaid |
$16,204.55
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15,031.92
|
| Rate for Payer: Managed Health Services Medicaid |
$16,922.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$16,204.55
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$16,204.55
|
| Rate for Payer: United Healthcare Medicaid |
$16,204.55
|
|
|
EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT
|
Facility
|
IP
|
$24,814.32
|
|
|
Service Code
|
APR-DRG 7923
|
| Min. Negotiated Rate |
$22,041.62 |
| Max. Negotiated Rate |
$24,814.32 |
| Rate for Payer: Anthem Medicaid |
$23,761.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$23,761.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$23,761.08
|
| Rate for Payer: Dean Health Medicaid |
$23,761.08
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$22,041.62
|
| Rate for Payer: Managed Health Services Medicaid |
$24,814.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$23,761.08
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$23,761.08
|
| Rate for Payer: United Healthcare Medicaid |
$23,761.08
|
|
|
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC
|
Facility
|
IP
|
$69,069.52
|
|
|
Service Code
|
MSDRG 982
|
| Min. Negotiated Rate |
$19,334.46 |
| Max. Negotiated Rate |
$69,069.52 |
| Rate for Payer: Aetna Managed Medicare |
$19,334.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$53,642.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$41,116.54
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$39,063.40
|
| Rate for Payer: Anthem Medicare Advantage |
$19,334.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19,334.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19,334.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19,334.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43,363.96
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19,334.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50,416.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19,334.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19,334.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19,334.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19,334.46
|
| Rate for Payer: NAPHCARE Commercial |
$29,001.69
|
| Rate for Payer: Quartz Medicare Advantage |
$19,334.46
|
| Rate for Payer: The Alliance Commercial |
$69,069.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19,334.46
|
| Rate for Payer: United Healthcare PPO |
$39,249.57
|
| Rate for Payer: Wellcare Medicare |
$19,334.46
|
|
|
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC
|
Facility
|
IP
|
$131,402.96
|
|
|
Service Code
|
MSDRG 981
|
| Min. Negotiated Rate |
$36,437.51 |
| Max. Negotiated Rate |
$131,402.96 |
| Rate for Payer: Aetna Managed Medicare |
$36,437.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$102,371.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$78,466.79
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$74,548.57
|
| Rate for Payer: Anthem Medicare Advantage |
$36,437.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36,437.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36,437.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$36,437.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$82,755.75
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$36,437.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$96,135.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$36,437.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36,437.51
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$36,437.51
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$36,437.51
|
| Rate for Payer: NAPHCARE Commercial |
$54,656.27
|
| Rate for Payer: Quartz Medicare Advantage |
$36,437.51
|
| Rate for Payer: The Alliance Commercial |
$131,402.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36,437.51
|
| Rate for Payer: United Healthcare PPO |
$74,842.57
|
| Rate for Payer: Wellcare Medicare |
$36,437.51
|
|
|
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC
|
Facility
|
IP
|
$45,545.76
|
|
|
Service Code
|
MSDRG 983
|
| Min. Negotiated Rate |
$13,632.93 |
| Max. Negotiated Rate |
$45,545.76 |
| Rate for Payer: Aetna Managed Medicare |
$13,632.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$37,398.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28,665.35
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27,233.95
|
| Rate for Payer: Anthem Medicare Advantage |
$13,632.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,632.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,632.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,632.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30,232.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,632.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33,161.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,632.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,632.93
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,632.93
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,632.93
|
| Rate for Payer: NAPHCARE Commercial |
$20,449.40
|
| Rate for Payer: Quartz Medicare Advantage |
$13,632.93
|
| Rate for Payer: The Alliance Commercial |
$45,545.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,632.93
|
| Rate for Payer: United Healthcare PPO |
$25,816.93
|
| Rate for Payer: Wellcare Medicare |
$13,632.93
|
|
|
EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$13,941.61
|
|
|
Service Code
|
APR-DRG 9501
|
| Min. Negotiated Rate |
$12,383.81 |
| Max. Negotiated Rate |
$13,941.61 |
| Rate for Payer: Anthem Medicaid |
$13,349.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$13,349.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13,349.86
|
| Rate for Payer: Dean Health Medicaid |
$13,349.86
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12,383.81
|
| Rate for Payer: Managed Health Services Medicaid |
$13,941.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,349.86
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13,349.86
|
| Rate for Payer: United Healthcare Medicaid |
$13,349.86
|
|
|
EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$28,146.28
|
|
|
Service Code
|
APR-DRG 9503
|
| Min. Negotiated Rate |
$25,001.28 |
| Max. Negotiated Rate |
$28,146.28 |
| Rate for Payer: Anthem Medicaid |
$26,951.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$26,951.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$26,951.61
|
| Rate for Payer: Dean Health Medicaid |
$26,951.61
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$25,001.28
|
| Rate for Payer: Managed Health Services Medicaid |
$28,146.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,951.61
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$26,951.61
|
| Rate for Payer: United Healthcare Medicaid |
$26,951.61
|
|
|
EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$46,822.78
|
|
|
Service Code
|
APR-DRG 9504
|
| Min. Negotiated Rate |
$41,590.91 |
| Max. Negotiated Rate |
$46,822.78 |
| Rate for Payer: Anthem Medicaid |
$44,835.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$44,835.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$44,835.39
|
| Rate for Payer: Dean Health Medicaid |
$44,835.39
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$41,590.91
|
| Rate for Payer: Managed Health Services Medicaid |
$46,822.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$44,835.39
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$44,835.39
|
| Rate for Payer: United Healthcare Medicaid |
$44,835.39
|
|
|
EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$18,150.40
|
|
|
Service Code
|
APR-DRG 9502
|
| Min. Negotiated Rate |
$16,122.32 |
| Max. Negotiated Rate |
$18,150.40 |
| Rate for Payer: Anthem Medicaid |
$17,380.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$17,380.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17,380.01
|
| Rate for Payer: Dean Health Medicaid |
$17,380.01
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$16,122.32
|
| Rate for Payer: Managed Health Services Medicaid |
$18,150.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$17,380.01
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17,380.01
|
| Rate for Payer: United Healthcare Medicaid |
$17,380.01
|
|
|
EXTENSIVE THIRD DEGREE BURNS WITHOUT SKIN GRAFT
|
Facility
|
IP
|
$23,586.75
|
|
|
Service Code
|
APR-DRG 8434
|
| Min. Negotiated Rate |
$20,951.23 |
| Max. Negotiated Rate |
$23,586.75 |
| Rate for Payer: Anthem Medicaid |
$22,585.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$22,585.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$22,585.62
|
| Rate for Payer: Dean Health Medicaid |
$22,585.62
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$20,951.23
|
| Rate for Payer: Managed Health Services Medicaid |
$23,586.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$22,585.62
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$22,585.62
|
| Rate for Payer: United Healthcare Medicaid |
$22,585.62
|
|
|
EXTENSIVE THIRD DEGREE BURNS WITHOUT SKIN GRAFT
|
Facility
|
IP
|
$9,119.04
|
|
|
Service Code
|
APR-DRG 8432
|
| Min. Negotiated Rate |
$8,100.10 |
| Max. Negotiated Rate |
$9,119.04 |
| Rate for Payer: Anthem Medicaid |
$8,731.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$8,731.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8,731.99
|
| Rate for Payer: Dean Health Medicaid |
$8,731.99
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8,100.10
|
| Rate for Payer: Managed Health Services Medicaid |
$9,119.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,731.99
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8,731.99
|
| Rate for Payer: United Healthcare Medicaid |
$8,731.99
|
|
|
EXTENSIVE THIRD DEGREE BURNS WITHOUT SKIN GRAFT
|
Facility
|
IP
|
$16,309.06
|
|
|
Service Code
|
APR-DRG 8433
|
| Min. Negotiated Rate |
$14,486.72 |
| Max. Negotiated Rate |
$16,309.06 |
| Rate for Payer: Anthem Medicaid |
$15,616.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$15,616.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15,616.82
|
| Rate for Payer: Dean Health Medicaid |
$15,616.82
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14,486.72
|
| Rate for Payer: Managed Health Services Medicaid |
$16,309.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$15,616.82
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$15,616.82
|
| Rate for Payer: United Healthcare Medicaid |
$15,616.82
|
|
|
EXTENSIVE THIRD DEGREE BURNS WITHOUT SKIN GRAFT
|
Facility
|
IP
|
$6,400.87
|
|
|
Service Code
|
APR-DRG 8431
|
| Min. Negotiated Rate |
$5,685.65 |
| Max. Negotiated Rate |
$6,400.87 |
| Rate for Payer: Anthem Medicaid |
$6,129.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$6,129.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,129.18
|
| Rate for Payer: Dean Health Medicaid |
$6,129.18
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5,685.65
|
| Rate for Payer: Managed Health Services Medicaid |
$6,400.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,129.18
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6,129.18
|
| Rate for Payer: United Healthcare Medicaid |
$6,129.18
|
|
|
EXTENSIVE THIRD DEGREE BURNS WITH SKIN GRAFT
|
Facility
|
IP
|
$59,887.56
|
|
|
Service Code
|
APR-DRG 8413
|
| Min. Negotiated Rate |
$53,195.86 |
| Max. Negotiated Rate |
$59,887.56 |
| Rate for Payer: Anthem Medicaid |
$57,345.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$57,345.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$57,345.64
|
| Rate for Payer: Dean Health Medicaid |
$57,345.64
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$53,195.86
|
| Rate for Payer: Managed Health Services Medicaid |
$59,887.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$57,345.64
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$57,345.64
|
| Rate for Payer: United Healthcare Medicaid |
$57,345.64
|
|
|
EXTENSIVE THIRD DEGREE BURNS WITH SKIN GRAFT
|
Facility
|
IP
|
$39,194.35
|
|
|
Service Code
|
APR-DRG 8411
|
| Min. Negotiated Rate |
$34,814.86 |
| Max. Negotiated Rate |
$39,194.35 |
| Rate for Payer: Anthem Medicaid |
$37,530.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$37,530.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$37,530.75
|
| Rate for Payer: Dean Health Medicaid |
$37,530.75
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$34,814.86
|
| Rate for Payer: Managed Health Services Medicaid |
$39,194.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$37,530.75
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$37,530.75
|
| Rate for Payer: United Healthcare Medicaid |
$37,530.75
|
|
|
EXTENSIVE THIRD DEGREE BURNS WITH SKIN GRAFT
|
Facility
|
IP
|
$184,046.83
|
|
|
Service Code
|
APR-DRG 8414
|
| Min. Negotiated Rate |
$163,481.87 |
| Max. Negotiated Rate |
$184,046.83 |
| Rate for Payer: Anthem Medicaid |
$176,234.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$176,234.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$176,234.98
|
| Rate for Payer: Dean Health Medicaid |
$176,234.98
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$163,481.87
|
| Rate for Payer: Managed Health Services Medicaid |
$184,046.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$176,234.98
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$176,234.98
|
| Rate for Payer: United Healthcare Medicaid |
$176,234.98
|
|
|
EXTENSIVE THIRD DEGREE BURNS WITH SKIN GRAFT
|
Facility
|
IP
|
$39,194.35
|
|
|
Service Code
|
APR-DRG 8412
|
| Min. Negotiated Rate |
$34,814.86 |
| Max. Negotiated Rate |
$39,194.35 |
| Rate for Payer: Anthem Medicaid |
$37,530.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$37,530.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$37,530.75
|
| Rate for Payer: Dean Health Medicaid |
$37,530.75
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$34,814.86
|
| Rate for Payer: Managed Health Services Medicaid |
$39,194.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$37,530.75
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$37,530.75
|
| Rate for Payer: United Healthcare Medicaid |
$37,530.75
|
|
|
EXTENSOR/FLEXOR TENDON REPAIR
|
Facility
|
OP
|
$1,337.00
|
|
| Hospital Charge Code |
2960414
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$389.33 |
| Max. Negotiated Rate |
$1,279.24 |
| Rate for Payer: Aetna Commercial |
$1,251.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,195.81
|
| Rate for Payer: Aetna Managed Medicare |
$389.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$903.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$695.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$667.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$736.95
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: Cigna Commercial |
$1,279.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$778.13
|
| Rate for Payer: Health EOS Commercial |
$1,237.53
|
| Rate for Payer: HFN Commercial |
$1,279.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,042.86
|
| Rate for Payer: Multiplan Commercial |
$1,112.38
|
| Rate for Payer: NAPHCARE Commercial |
$834.29
|
| Rate for Payer: Preferred Network Access Commercial |
$1,279.24
|
| Rate for Payer: Quartz Beloit One Network |
$681.34
|
| Rate for Payer: Quartz Commercial |
$903.81
|
| Rate for Payer: Quartz Medicare Advantage |
$834.29
|
| Rate for Payer: The Alliance Commercial |
$695.24
|
| Rate for Payer: WEA Trust Commercial |
$764.76
|
| Rate for Payer: WPS Commercial |
$1,029.89
|
|
|
EXTENSOR/FLEXOR TENDON REPAIR
|
Facility
|
IP
|
$1,337.00
|
|
| Hospital Charge Code |
2960414
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$681.34 |
| Max. Negotiated Rate |
$1,279.24 |
| Rate for Payer: Aetna Commercial |
$1,251.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,195.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$736.95
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: Cigna Commercial |
$1,279.24
|
| Rate for Payer: Health EOS Commercial |
$1,237.53
|
| Rate for Payer: HFN Commercial |
$1,279.24
|
| Rate for Payer: Multiplan Commercial |
$1,112.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,279.24
|
| Rate for Payer: Quartz Beloit One Network |
$681.34
|
| Rate for Payer: Quartz Commercial |
$834.29
|
| Rate for Payer: WEA Trust Commercial |
$764.76
|
| Rate for Payer: WPS Commercial |
$1,029.89
|
|
|
EXTENTION HOSE WITH CONNECTOR TOURNIQUET DUAL STERILE 60-1812-101-00
|
Facility
|
IP
|
$243.00
|
|
| Hospital Charge Code |
5729897
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$123.83 |
| Max. Negotiated Rate |
$232.50 |
| Rate for Payer: Aetna Commercial |
$227.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$217.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$133.94
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cigna Commercial |
$232.50
|
| Rate for Payer: Health EOS Commercial |
$224.92
|
| Rate for Payer: HFN Commercial |
$232.50
|
| Rate for Payer: Multiplan Commercial |
$202.18
|
| Rate for Payer: Preferred Network Access Commercial |
$232.50
|
| Rate for Payer: Quartz Beloit One Network |
$123.83
|
| Rate for Payer: Quartz Commercial |
$151.63
|
| Rate for Payer: WEA Trust Commercial |
$139.00
|
| Rate for Payer: WPS Commercial |
$187.18
|
|
|
EXTENTION HOSE WITH CONNECTOR TOURNIQUET DUAL STERILE 60-1812-101-00
|
Facility
|
OP
|
$243.00
|
|
| Hospital Charge Code |
5729897
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.76 |
| Max. Negotiated Rate |
$232.50 |
| Rate for Payer: Aetna Commercial |
$227.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$217.34
|
| Rate for Payer: Aetna Managed Medicare |
$70.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$164.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$126.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$121.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$133.94
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cigna Commercial |
$232.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$141.43
|
| Rate for Payer: Health EOS Commercial |
$224.92
|
| Rate for Payer: HFN Commercial |
$232.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$189.54
|
| Rate for Payer: Multiplan Commercial |
$202.18
|
| Rate for Payer: NAPHCARE Commercial |
$151.63
|
| Rate for Payer: Preferred Network Access Commercial |
$232.50
|
| Rate for Payer: Quartz Beloit One Network |
$123.83
|
| Rate for Payer: Quartz Commercial |
$164.27
|
| Rate for Payer: Quartz Medicare Advantage |
$151.63
|
| Rate for Payer: The Alliance Commercial |
$126.36
|
| Rate for Payer: WEA Trust Commercial |
$139.00
|
| Rate for Payer: WPS Commercial |
$187.18
|
|
|
EXTERNAL ECG REC>48HR<7D RECORDING- 93242
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 93242
|
| Hospital Charge Code |
5727950
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$39.31 |
| Max. Negotiated Rate |
$157.25 |
| Rate for Payer: Aetna Commercial |
$93.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$89.44
|
| Rate for Payer: Aetna Managed Medicare |
$39.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$52.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$49.92
|
| Rate for Payer: Anthem Medicare Advantage |
$39.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$55.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.31
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$95.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$39.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$58.20
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$39.31
|
| Rate for Payer: Health EOS Commercial |
$92.56
|
| Rate for Payer: HFN Commercial |
$95.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$146.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$39.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$39.31
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$39.31
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: NAPHCARE Commercial |
$58.97
|
| Rate for Payer: Preferred Network Access Commercial |
$95.68
|
| Rate for Payer: Quartz Beloit One Network |
$50.96
|
| Rate for Payer: Quartz Commercial |
$67.60
|
| Rate for Payer: Quartz Medicare Advantage |
$39.31
|
| Rate for Payer: The Alliance Commercial |
$157.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.31
|
| Rate for Payer: United Healthcare PPO |
$78.00
|
| Rate for Payer: WEA Trust Commercial |
$57.20
|
| Rate for Payer: Wellcare Medicare |
$39.31
|
| Rate for Payer: WPS Commercial |
$77.03
|
|
|
EXTERNAL ECG REC>48HR<7D RECORDING- 93242
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 93242
|
| Hospital Charge Code |
5727950
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$50.96 |
| Max. Negotiated Rate |
$95.68 |
| Rate for Payer: Aetna Commercial |
$93.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$89.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$55.12
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$95.68
|
| Rate for Payer: Health EOS Commercial |
$92.56
|
| Rate for Payer: HFN Commercial |
$95.68
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: Preferred Network Access Commercial |
$95.68
|
| Rate for Payer: Quartz Beloit One Network |
$50.96
|
| Rate for Payer: Quartz Commercial |
$62.40
|
| Rate for Payer: WEA Trust Commercial |
$57.20
|
| Rate for Payer: WPS Commercial |
$77.03
|
|
