|
FOREIGN BODY REMOVAL, HAND
|
Facility
|
IP
|
$1,337.00
|
|
| Hospital Charge Code |
2960061
|
|
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
|
|
|
FOREIGN BODY REMOVAL, HAND
|
Facility
|
OP
|
$1,337.00
|
|
| Hospital Charge Code |
2960061
|
|
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
|
|
|
FOREIGN BODY REMOVAL, NOSE
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960062
|
|
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
|
|
|
FOREIGN BODY REMOVAL, NOSE
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960062
|
|
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
|
|
|
FOREIGN BODY REMOVAL, OTHER
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960064
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$552.41 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$676.42
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
FOREIGN BODY REMOVAL, OTHER
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960064
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$315.66 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Aetna Managed Medicare |
$315.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$732.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$563.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$541.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$630.89
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.52
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: NAPHCARE Commercial |
$676.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$732.78
|
| Rate for Payer: Quartz Medicare Advantage |
$676.42
|
| Rate for Payer: The Alliance Commercial |
$563.68
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
FOREIGN BODY REMOVAL, PENIS
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960063
|
|
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
|
|
|
FOREIGN BODY REMOVAL, PENIS
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960063
|
|
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
|
|
|
Foreign Body Retrieval
|
Facility
|
IP
|
$4,689.00
|
|
|
Service Code
|
CPT 37197
|
| Hospital Charge Code |
3052433
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,389.51 |
| Max. Negotiated Rate |
$4,486.44 |
| Rate for Payer: Aetna Commercial |
$4,388.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,193.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,584.58
|
| Rate for Payer: Cash Price |
$1,406.70
|
| Rate for Payer: Cigna Commercial |
$4,486.44
|
| Rate for Payer: Health EOS Commercial |
$4,340.14
|
| Rate for Payer: HFN Commercial |
$4,486.44
|
| Rate for Payer: Multiplan Commercial |
$3,901.25
|
| Rate for Payer: Preferred Network Access Commercial |
$4,486.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,389.51
|
| Rate for Payer: Quartz Commercial |
$2,925.94
|
| Rate for Payer: WEA Trust Commercial |
$2,682.11
|
| Rate for Payer: WPS Commercial |
$3,611.94
|
|
|
Foreign Body Retrieval
|
Facility
|
OP
|
$4,689.00
|
|
|
Service Code
|
CPT 37197
|
| Hospital Charge Code |
3052433
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,389.51 |
| Max. Negotiated Rate |
$13,291.62 |
| Rate for Payer: Aetna Commercial |
$4,388.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,193.84
|
| Rate for Payer: Aetna Managed Medicare |
$3,322.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,584.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,322.90
|
| Rate for Payer: Cash Price |
$1,406.70
|
| Rate for Payer: Cash Price |
$1,406.70
|
| Rate for Payer: Cash Price |
$1,406.70
|
| Rate for Payer: Cigna Commercial |
$4,486.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,322.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,322.90
|
| Rate for Payer: Health EOS Commercial |
$4,340.14
|
| Rate for Payer: HFN Commercial |
$4,486.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,361.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,322.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,322.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,322.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,322.90
|
| Rate for Payer: Multiplan Commercial |
$3,901.25
|
| Rate for Payer: NAPHCARE Commercial |
$4,984.36
|
| Rate for Payer: Preferred Network Access Commercial |
$4,486.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,389.51
|
| Rate for Payer: Quartz Commercial |
$3,169.76
|
| Rate for Payer: Quartz Medicare Advantage |
$3,322.90
|
| Rate for Payer: The Alliance Commercial |
$13,291.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,322.90
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: WEA Trust Commercial |
$2,682.11
|
| Rate for Payer: Wellcare Medicare |
$3,322.90
|
| Rate for Payer: WPS Commercial |
$3,611.94
|
|
|
Foreskin Manipulationincluding Lysis Of Prepubital Adhesions And Stretching
|
Professional
|
Both
|
$289.00
|
|
|
Service Code
|
CPT 54450
|
| Hospital Charge Code |
1190847
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$26.76 |
| Max. Negotiated Rate |
$285.53 |
| Rate for Payer: Aetna Commercial |
$285.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$258.48
|
| Rate for Payer: Aetna Managed Medicare |
$48.45
|
| Rate for Payer: Anthem Medicare Advantage |
$48.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$48.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$48.45
|
| Rate for Payer: Cash Price |
$86.70
|
| Rate for Payer: Cash Price |
$86.70
|
| Rate for Payer: Cash Price |
$86.70
|
| Rate for Payer: Cigna Commercial |
$285.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$26.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.45
|
| Rate for Payer: Health EOS Commercial |
$273.51
|
| Rate for Payer: HFN Commercial |
$285.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$198.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$198.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$48.45
|
| Rate for Payer: Multiplan Commercial |
$240.45
|
| Rate for Payer: NAPHCARE Commercial |
$72.68
|
| Rate for Payer: Preferred Network Access Commercial |
$285.53
|
| Rate for Payer: Quartz Beloit One Network |
$132.25
|
| Rate for Payer: Quartz Commercial |
$171.32
|
| Rate for Payer: Quartz Medicare Advantage |
$48.45
|
| Rate for Payer: The Alliance Commercial |
$205.93
|
| Rate for Payer: United Healthcare Medicaid |
$26.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$48.45
|
| Rate for Payer: WEA Trust Commercial |
$165.31
|
| Rate for Payer: WPS Commercial |
$218.04
|
|
|
Fosphenytoin JW Waste Charge per 50 mg
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
HCPCS Q2009 JW
|
| Hospital Charge Code |
5266711
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.59 |
| Max. Negotiated Rate |
$8.61 |
| Rate for Payer: Aetna Commercial |
$8.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.96
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna Commercial |
$8.61
|
| Rate for Payer: Health EOS Commercial |
$8.33
|
| Rate for Payer: HFN Commercial |
$8.61
|
| Rate for Payer: Multiplan Commercial |
$7.49
|
| Rate for Payer: Preferred Network Access Commercial |
$8.61
|
| Rate for Payer: Quartz Beloit One Network |
$4.59
|
| Rate for Payer: Quartz Commercial |
$5.62
|
| Rate for Payer: WEA Trust Commercial |
$5.15
|
| Rate for Payer: WPS Commercial |
$6.93
|
|
|
Fosphenytoin JW Waste Charge per 50 mg
|
Professional
|
Both
|
$9.00
|
|
|
Service Code
|
HCPCS Q2009 JW
|
| Hospital Charge Code |
5266711
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$8.89 |
| Rate for Payer: Aetna Commercial |
$8.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.05
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna Commercial |
$8.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.62
|
| Rate for Payer: Health EOS Commercial |
$8.52
|
| Rate for Payer: HFN Commercial |
$8.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.31
|
| Rate for Payer: Multiplan Commercial |
$7.49
|
| Rate for Payer: Preferred Network Access Commercial |
$8.89
|
| Rate for Payer: Quartz Beloit One Network |
$4.12
|
| Rate for Payer: Quartz Commercial |
$5.34
|
| Rate for Payer: The Alliance Commercial |
$4.68
|
| Rate for Payer: United Healthcare Medicaid |
$1.47
|
| Rate for Payer: WEA Trust Commercial |
$5.15
|
| Rate for Payer: WPS Commercial |
$6.93
|
|
|
Fosphenytoin JW Waste Charge per 50 mg
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
HCPCS Q2009 JW
|
| Hospital Charge Code |
5266711
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$8.61 |
| Rate for Payer: Aetna Commercial |
$8.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.05
|
| Rate for Payer: Aetna Managed Medicare |
$2.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.96
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna Commercial |
$8.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.24
|
| Rate for Payer: Health EOS Commercial |
$8.33
|
| Rate for Payer: HFN Commercial |
$8.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7.02
|
| Rate for Payer: Multiplan Commercial |
$7.49
|
| Rate for Payer: NAPHCARE Commercial |
$5.62
|
| Rate for Payer: Preferred Network Access Commercial |
$8.61
|
| Rate for Payer: Quartz Beloit One Network |
$4.59
|
| Rate for Payer: Quartz Commercial |
$6.08
|
| Rate for Payer: Quartz Medicare Advantage |
$5.62
|
| Rate for Payer: The Alliance Commercial |
$4.68
|
| Rate for Payer: WEA Trust Commercial |
$5.15
|
| Rate for Payer: WPS Commercial |
$6.93
|
|
|
FRACTURE OF FEMUR
|
Facility
|
IP
|
$8,680.63
|
|
|
Service Code
|
APR-DRG 3403
|
| 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
|
|
|
FRACTURE OF FEMUR
|
Facility
|
IP
|
$5,787.08
|
|
|
Service Code
|
APR-DRG 3402
|
| Min. Negotiated Rate |
$5,140.45 |
| Max. Negotiated Rate |
$5,787.08 |
| Rate for Payer: Anthem Medicaid |
$5,541.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$5,541.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,541.45
|
| Rate for Payer: Dean Health Medicaid |
$5,541.45
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5,140.45
|
| Rate for Payer: Managed Health Services Medicaid |
$5,787.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,541.45
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5,541.45
|
| Rate for Payer: United Healthcare Medicaid |
$5,541.45
|
|
|
FRACTURE OF FEMUR
|
Facility
|
IP
|
$4,559.52
|
|
|
Service Code
|
APR-DRG 3401
|
| Min. Negotiated Rate |
$4,050.05 |
| Max. Negotiated Rate |
$4,559.52 |
| Rate for Payer: Anthem Medicaid |
$4,365.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$4,365.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,365.99
|
| Rate for Payer: Dean Health Medicaid |
$4,365.99
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4,050.05
|
| Rate for Payer: Managed Health Services Medicaid |
$4,559.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,365.99
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4,365.99
|
| Rate for Payer: United Healthcare Medicaid |
$4,365.99
|
|
|
FRACTURE OF FEMUR
|
Facility
|
IP
|
$13,415.51
|
|
|
Service Code
|
APR-DRG 3404
|
| Min. Negotiated Rate |
$11,916.50 |
| Max. Negotiated Rate |
$13,415.51 |
| Rate for Payer: Anthem Medicaid |
$12,846.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$12,846.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12,846.09
|
| Rate for Payer: Dean Health Medicaid |
$12,846.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11,916.50
|
| Rate for Payer: Managed Health Services Medicaid |
$13,415.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,846.09
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12,846.09
|
| Rate for Payer: United Healthcare Medicaid |
$12,846.09
|
|
|
FRACTURE OF PELVIS OR DISLOCATION OF HIP
|
Facility
|
IP
|
$6,225.50
|
|
|
Service Code
|
APR-DRG 3412
|
| Min. Negotiated Rate |
$5,529.88 |
| Max. Negotiated Rate |
$6,225.50 |
| Rate for Payer: Anthem Medicaid |
$5,961.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$5,961.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,961.26
|
| Rate for Payer: Dean Health Medicaid |
$5,961.26
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5,529.88
|
| Rate for Payer: Managed Health Services Medicaid |
$6,225.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,961.26
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5,961.26
|
| Rate for Payer: United Healthcare Medicaid |
$5,961.26
|
|
|
FRACTURE OF PELVIS OR DISLOCATION OF HIP
|
Facility
|
IP
|
$9,206.73
|
|
|
Service Code
|
APR-DRG 3413
|
| Min. Negotiated Rate |
$8,177.99 |
| Max. Negotiated Rate |
$9,206.73 |
| Rate for Payer: Anthem Medicaid |
$8,815.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$8,815.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8,815.95
|
| Rate for Payer: Dean Health Medicaid |
$8,815.95
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8,177.99
|
| Rate for Payer: Managed Health Services Medicaid |
$9,206.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,815.95
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8,815.95
|
| Rate for Payer: United Healthcare Medicaid |
$8,815.95
|
|
|
FRACTURE OF PELVIS OR DISLOCATION OF HIP
|
Facility
|
IP
|
$4,910.25
|
|
|
Service Code
|
APR-DRG 3411
|
| Min. Negotiated Rate |
$4,361.59 |
| Max. Negotiated Rate |
$4,910.25 |
| Rate for Payer: Anthem Medicaid |
$4,701.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$4,701.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,701.84
|
| Rate for Payer: Dean Health Medicaid |
$4,701.84
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4,361.59
|
| Rate for Payer: Managed Health Services Medicaid |
$4,910.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,701.84
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4,701.84
|
| Rate for Payer: United Healthcare Medicaid |
$4,701.84
|
|
|
FRACTURE OF PELVIS OR DISLOCATION OF HIP
|
Facility
|
IP
|
$16,835.16
|
|
|
Service Code
|
APR-DRG 3414
|
| Min. Negotiated Rate |
$14,954.04 |
| Max. Negotiated Rate |
$16,835.16 |
| Rate for Payer: Anthem Medicaid |
$16,120.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$16,120.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16,120.59
|
| Rate for Payer: Dean Health Medicaid |
$16,120.59
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14,954.04
|
| Rate for Payer: Managed Health Services Medicaid |
$16,835.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$16,120.59
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$16,120.59
|
| Rate for Payer: United Healthcare Medicaid |
$16,120.59
|
|
|
FRACTURES AND DISLOCATIONS EXCEPT FEMUR, PELVIS AND BACK
|
Facility
|
IP
|
$5,348.67
|
|
|
Service Code
|
APR-DRG 3421
|
| Min. Negotiated Rate |
$4,751.02 |
| Max. Negotiated Rate |
$5,348.67 |
| Rate for Payer: Anthem Medicaid |
$5,121.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$5,121.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,121.65
|
| Rate for Payer: Dean Health Medicaid |
$5,121.65
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4,751.02
|
| Rate for Payer: Managed Health Services Medicaid |
$5,348.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,121.65
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5,121.65
|
| Rate for Payer: United Healthcare Medicaid |
$5,121.65
|
|
|
FRACTURES AND DISLOCATIONS EXCEPT FEMUR, PELVIS AND BACK
|
Facility
|
IP
|
$17,887.35
|
|
|
Service Code
|
APR-DRG 3424
|
| Min. Negotiated Rate |
$15,888.66 |
| Max. Negotiated Rate |
$17,887.35 |
| Rate for Payer: Anthem Medicaid |
$17,128.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$17,128.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17,128.13
|
| Rate for Payer: Dean Health Medicaid |
$17,128.13
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15,888.66
|
| Rate for Payer: Managed Health Services Medicaid |
$17,887.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$17,128.13
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17,128.13
|
| Rate for Payer: United Healthcare Medicaid |
$17,128.13
|
|
|
FRACTURES AND DISLOCATIONS EXCEPT FEMUR, PELVIS AND BACK
|
Facility
|
IP
|
$6,926.96
|
|
|
Service Code
|
APR-DRG 3422
|
| Min. Negotiated Rate |
$6,152.96 |
| Max. Negotiated Rate |
$6,926.96 |
| Rate for Payer: Anthem Medicaid |
$6,632.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$6,632.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,632.95
|
| Rate for Payer: Dean Health Medicaid |
$6,632.95
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6,152.96
|
| Rate for Payer: Managed Health Services Medicaid |
$6,926.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,632.95
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6,632.95
|
| Rate for Payer: United Healthcare Medicaid |
$6,632.95
|
|
