|
FRACTURES AND DISLOCATIONS EXCEPT FEMUR, PELVIS AND BACK
|
Facility
|
IP
|
$9,820.51
|
|
|
Service Code
|
APR-DRG 3423
|
| Min. Negotiated Rate |
$8,723.19 |
| Max. Negotiated Rate |
$9,820.51 |
| Rate for Payer: Anthem Medicaid |
$9,403.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$9,403.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9,403.68
|
| Rate for Payer: Dean Health Medicaid |
$9,403.68
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8,723.19
|
| Rate for Payer: Managed Health Services Medicaid |
$9,820.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,403.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$9,403.68
|
| Rate for Payer: United Healthcare Medicaid |
$9,403.68
|
|
|
FRACTURES, DISLOCATIONS AND SPRAINS OF THE SKULL, CRANIUM AND FACE
|
Facility
|
OP
|
$100.89
|
|
|
Service Code
|
EAPG 00648
|
| Min. Negotiated Rate |
$97.01 |
| Max. Negotiated Rate |
$100.89 |
| Rate for Payer: Anthem Medicaid |
$97.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$97.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$97.01
|
| Rate for Payer: Dean Health Medicaid |
$97.01
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$97.01
|
| Rate for Payer: Managed Health Services Medicaid |
$100.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$97.01
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$97.01
|
| Rate for Payer: United Healthcare Medicaid |
$97.01
|
|
|
FRACTURES, DISLOCATIONS, OTHER INJURIES - LOWER EXTREMITY INCLUDING FEMUR
|
Facility
|
OP
|
$149.37
|
|
|
Service Code
|
EAPG 00650
|
| Min. Negotiated Rate |
$143.63 |
| Max. Negotiated Rate |
$149.37 |
| Rate for Payer: Anthem Medicaid |
$143.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$143.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$143.63
|
| Rate for Payer: Dean Health Medicaid |
$143.63
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$143.63
|
| Rate for Payer: Managed Health Services Medicaid |
$149.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$143.63
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$143.63
|
| Rate for Payer: United Healthcare Medicaid |
$143.63
|
|
|
FRACTURES, DISLOCATIONS & OTHER INJURIES OF THE NECK, UPPER BACK AND CHEST
|
Facility
|
OP
|
$106.13
|
|
|
Service Code
|
EAPG 00656
|
| Min. Negotiated Rate |
$102.05 |
| Max. Negotiated Rate |
$106.13 |
| Rate for Payer: Anthem Medicaid |
$102.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$102.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$102.05
|
| Rate for Payer: Dean Health Medicaid |
$102.05
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$102.05
|
| Rate for Payer: Managed Health Services Medicaid |
$106.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$102.05
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$102.05
|
| Rate for Payer: United Healthcare Medicaid |
$102.05
|
|
|
FRACTURES, DISLOCATIONS, SPRAINS AND OTHER INJURIES OF THE LOWER BACK
|
Facility
|
OP
|
$103.51
|
|
|
Service Code
|
EAPG 00657
|
| Min. Negotiated Rate |
$99.53 |
| Max. Negotiated Rate |
$103.51 |
| Rate for Payer: Anthem Medicaid |
$99.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$99.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$99.53
|
| Rate for Payer: Dean Health Medicaid |
$99.53
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$99.53
|
| Rate for Payer: Managed Health Services Medicaid |
$103.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$99.53
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$99.53
|
| Rate for Payer: United Healthcare Medicaid |
$99.53
|
|
|
FRACTURES, DISLOCATIONS, SPRAINS AND OTHER INJURIES OF THE PELVIS AND HIP
|
Facility
|
OP
|
$136.27
|
|
|
Service Code
|
EAPG 00651
|
| Min. Negotiated Rate |
$131.03 |
| Max. Negotiated Rate |
$136.27 |
| Rate for Payer: Anthem Medicaid |
$131.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$131.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$131.03
|
| Rate for Payer: Dean Health Medicaid |
$131.03
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$131.03
|
| Rate for Payer: Managed Health Services Medicaid |
$136.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$131.03
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$131.03
|
| Rate for Payer: United Healthcare Medicaid |
$131.03
|
|
|
FRACTURES, DISLOCATIONS, SPRAINS, OTHER INJURIES OF THE SHOULDER AND UPPER ARM
|
Facility
|
OP
|
$121.86
|
|
|
Service Code
|
EAPG 00647
|
| Min. Negotiated Rate |
$117.17 |
| Max. Negotiated Rate |
$121.86 |
| Rate for Payer: Anthem Medicaid |
$117.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$117.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$117.17
|
| Rate for Payer: Dean Health Medicaid |
$117.17
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$117.17
|
| Rate for Payer: Managed Health Services Medicaid |
$121.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$117.17
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$117.17
|
| Rate for Payer: United Healthcare Medicaid |
$117.17
|
|
|
FRACTURES OF FEMUR WITH MCC
|
Facility
|
IP
|
$45,440.72
|
|
|
Service Code
|
MSDRG 533
|
| Min. Negotiated Rate |
$12,512.54 |
| Max. Negotiated Rate |
$45,440.72 |
| Rate for Payer: Aetna Managed Medicare |
$12,512.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$34,205.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26,218.59
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24,909.37
|
| Rate for Payer: Anthem Medicare Advantage |
$12,512.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12,512.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12,512.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12,512.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27,651.69
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12,512.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33,084.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12,512.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12,512.54
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12,512.54
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12,512.54
|
| Rate for Payer: NAPHCARE Commercial |
$18,768.81
|
| Rate for Payer: Quartz Medicare Advantage |
$12,512.54
|
| Rate for Payer: The Alliance Commercial |
$45,440.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,512.54
|
| Rate for Payer: United Healthcare PPO |
$25,756.93
|
| Rate for Payer: Wellcare Medicare |
$12,512.54
|
|
|
FRACTURES OF FEMUR WITHOUT MCC
|
Facility
|
IP
|
$22,729.20
|
|
|
Service Code
|
MSDRG 534
|
| Min. Negotiated Rate |
$6,680.06 |
| Max. Negotiated Rate |
$22,729.20 |
| Rate for Payer: Aetna Managed Medicare |
$6,680.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17,588.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,481.41
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,808.22
|
| Rate for Payer: Anthem Medicare Advantage |
$6,680.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,680.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,680.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,680.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14,218.30
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,680.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16,426.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,680.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,680.06
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,680.06
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,680.06
|
| Rate for Payer: NAPHCARE Commercial |
$10,020.08
|
| Rate for Payer: Quartz Medicare Advantage |
$6,680.06
|
| Rate for Payer: The Alliance Commercial |
$22,729.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,680.06
|
| Rate for Payer: United Healthcare PPO |
$12,788.47
|
| Rate for Payer: Wellcare Medicare |
$6,680.06
|
|
|
FRACTURES OF HIP AND PELVIS WITH MCC
|
Facility
|
IP
|
$36,185.76
|
|
|
Service Code
|
MSDRG 535
|
| Min. Negotiated Rate |
$10,324.60 |
| Max. Negotiated Rate |
$36,185.76 |
| Rate for Payer: Aetna Managed Medicare |
$10,324.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$27,972.21
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21,440.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20,369.85
|
| Rate for Payer: Anthem Medicare Advantage |
$10,324.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,324.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,324.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,324.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22,612.40
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,324.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26,297.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,324.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,324.60
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,324.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,324.60
|
| Rate for Payer: NAPHCARE Commercial |
$15,486.90
|
| Rate for Payer: Quartz Medicare Advantage |
$10,324.60
|
| Rate for Payer: The Alliance Commercial |
$36,185.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,324.60
|
| Rate for Payer: United Healthcare PPO |
$20,472.61
|
| Rate for Payer: Wellcare Medicare |
$10,324.60
|
|
|
FRACTURES OF HIP AND PELVIS WITHOUT MCC
|
Facility
|
IP
|
$22,095.84
|
|
|
Service Code
|
MSDRG 536
|
| Min. Negotiated Rate |
$6,691.54 |
| Max. Negotiated Rate |
$22,095.84 |
| Rate for Payer: Aetna Managed Medicare |
$6,691.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17,621.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,506.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,832.05
|
| Rate for Payer: Anthem Medicare Advantage |
$6,691.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,691.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,691.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,691.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14,244.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,691.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,962.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,691.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,691.54
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,691.54
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,691.54
|
| Rate for Payer: NAPHCARE Commercial |
$10,037.31
|
| Rate for Payer: Quartz Medicare Advantage |
$6,691.54
|
| Rate for Payer: The Alliance Commercial |
$22,095.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,691.54
|
| Rate for Payer: United Healthcare PPO |
$12,426.93
|
| Rate for Payer: Wellcare Medicare |
$6,691.54
|
|
|
FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC
|
Facility
|
IP
|
$42,380.00
|
|
|
Service Code
|
MSDRG 562
|
| Min. Negotiated Rate |
$11,418.18 |
| Max. Negotiated Rate |
$42,380.00 |
| Rate for Payer: Aetna Managed Medicare |
$11,418.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31,088.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23,828.70
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22,638.82
|
| Rate for Payer: Anthem Medicare Advantage |
$11,418.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,418.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,418.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,418.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25,131.16
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,418.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30,839.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,418.18
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,418.18
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,418.18
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,418.18
|
| Rate for Payer: NAPHCARE Commercial |
$17,127.27
|
| Rate for Payer: Quartz Medicare Advantage |
$11,418.18
|
| Rate for Payer: The Alliance Commercial |
$42,380.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,418.18
|
| Rate for Payer: United Healthcare PPO |
$24,009.18
|
| Rate for Payer: Wellcare Medicare |
$11,418.18
|
|
|
FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC
|
Facility
|
IP
|
$25,096.24
|
|
|
Service Code
|
MSDRG 563
|
| Min. Negotiated Rate |
$7,364.69 |
| Max. Negotiated Rate |
$25,096.24 |
| Rate for Payer: Aetna Managed Medicare |
$7,364.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,539.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,976.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14,228.71
|
| Rate for Payer: Anthem Medicare Advantage |
$7,364.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,364.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,364.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,364.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15,795.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,364.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18,162.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,364.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,364.69
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,364.69
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,364.69
|
| Rate for Payer: NAPHCARE Commercial |
$11,047.03
|
| Rate for Payer: Quartz Medicare Advantage |
$7,364.69
|
| Rate for Payer: The Alliance Commercial |
$25,096.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,364.69
|
| Rate for Payer: United Healthcare PPO |
$14,139.94
|
| Rate for Payer: Wellcare Medicare |
$7,364.69
|
|
|
Fragile X DNA Detection
|
Facility
|
IP
|
$1,372.00
|
|
|
Service Code
|
CPT 81243
|
| Hospital Charge Code |
977952
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$699.17 |
| Max. Negotiated Rate |
$1,312.73 |
| Rate for Payer: Aetna Commercial |
$1,284.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,227.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$756.25
|
| Rate for Payer: Cash Price |
$411.60
|
| Rate for Payer: Cigna Commercial |
$1,312.73
|
| Rate for Payer: Health EOS Commercial |
$1,269.92
|
| Rate for Payer: HFN Commercial |
$1,312.73
|
| Rate for Payer: Multiplan Commercial |
$1,141.50
|
| Rate for Payer: Preferred Network Access Commercial |
$1,312.73
|
| Rate for Payer: Quartz Beloit One Network |
$699.17
|
| Rate for Payer: Quartz Commercial |
$856.13
|
| Rate for Payer: WEA Trust Commercial |
$784.78
|
| Rate for Payer: WPS Commercial |
$1,056.85
|
|
|
Fragile X DNA Detection
|
Professional
|
Both
|
$1,372.00
|
|
|
Service Code
|
CPT 81243
|
| Hospital Charge Code |
977952
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.32 |
| Max. Negotiated Rate |
$1,355.54 |
| Rate for Payer: Aetna Commercial |
$1,355.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,227.12
|
| Rate for Payer: Aetna Managed Medicare |
$59.32
|
| Rate for Payer: Anthem Medicare Advantage |
$59.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$59.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$59.32
|
| Rate for Payer: Cash Price |
$411.60
|
| Rate for Payer: Cash Price |
$411.60
|
| Rate for Payer: Cigna Commercial |
$1,355.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$713.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$59.32
|
| Rate for Payer: Health EOS Commercial |
$1,298.46
|
| Rate for Payer: HFN Commercial |
$1,355.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$209.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$209.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$59.32
|
| Rate for Payer: Multiplan Commercial |
$1,141.50
|
| Rate for Payer: NAPHCARE Commercial |
$88.98
|
| Rate for Payer: Preferred Network Access Commercial |
$1,355.54
|
| Rate for Payer: Quartz Beloit One Network |
$627.83
|
| Rate for Payer: Quartz Commercial |
$813.32
|
| Rate for Payer: Quartz Medicare Advantage |
$59.32
|
| Rate for Payer: The Alliance Commercial |
$234.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$59.32
|
| Rate for Payer: WEA Trust Commercial |
$784.78
|
| Rate for Payer: WPS Commercial |
$261.02
|
|
|
Fragile X DNA Detection
|
Facility
|
OP
|
$1,372.00
|
|
|
Service Code
|
CPT 81243
|
| Hospital Charge Code |
977952
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.32 |
| Max. Negotiated Rate |
$1,312.73 |
| Rate for Payer: Aetna Commercial |
$1,284.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,227.12
|
| Rate for Payer: Aetna Managed Medicare |
$59.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$222.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$103.81
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$98.47
|
| Rate for Payer: Anthem Medicare Advantage |
$59.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$756.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$59.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$59.32
|
| Rate for Payer: Cash Price |
$411.60
|
| Rate for Payer: Cash Price |
$411.60
|
| Rate for Payer: Cigna Commercial |
$1,312.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$59.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$798.50
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$59.32
|
| Rate for Payer: Health EOS Commercial |
$1,269.92
|
| Rate for Payer: HFN Commercial |
$1,312.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$220.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$59.32
|
| Rate for Payer: Independent Care Health Plan Medicare |
$59.32
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$59.32
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$59.32
|
| Rate for Payer: Multiplan Commercial |
$1,141.50
|
| Rate for Payer: NAPHCARE Commercial |
$88.98
|
| Rate for Payer: Preferred Network Access Commercial |
$1,312.73
|
| Rate for Payer: Quartz Beloit One Network |
$699.17
|
| Rate for Payer: Quartz Commercial |
$927.47
|
| Rate for Payer: Quartz Medicare Advantage |
$59.32
|
| Rate for Payer: The Alliance Commercial |
$237.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$59.32
|
| Rate for Payer: United Healthcare PPO |
$1,070.16
|
| Rate for Payer: WEA Trust Commercial |
$784.78
|
| Rate for Payer: Wellcare Medicare |
$59.32
|
| Rate for Payer: WPS Commercial |
$1,056.85
|
|
|
FRAGMENTING OF KIDNEY STONE 50590
|
Professional
|
Both
|
$9,848.00
|
|
|
Service Code
|
CPT 50590
|
| Hospital Charge Code |
3014942
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$505.26 |
| Max. Negotiated Rate |
$9,729.82 |
| Rate for Payer: Aetna Commercial |
$9,729.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,808.05
|
| Rate for Payer: Aetna Managed Medicare |
$505.26
|
| Rate for Payer: Anthem Medicare Advantage |
$505.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$505.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$505.26
|
| Rate for Payer: Cash Price |
$2,954.40
|
| Rate for Payer: Cash Price |
$2,954.40
|
| Rate for Payer: Cash Price |
$2,954.40
|
| Rate for Payer: Cigna Commercial |
$9,729.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$923.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$505.26
|
| Rate for Payer: Health EOS Commercial |
$9,320.15
|
| Rate for Payer: HFN Commercial |
$9,729.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,984.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,984.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$505.26
|
| Rate for Payer: Multiplan Commercial |
$8,193.54
|
| Rate for Payer: NAPHCARE Commercial |
$757.89
|
| Rate for Payer: Preferred Network Access Commercial |
$9,729.82
|
| Rate for Payer: Quartz Beloit One Network |
$4,506.44
|
| Rate for Payer: Quartz Commercial |
$5,837.89
|
| Rate for Payer: Quartz Medicare Advantage |
$505.26
|
| Rate for Payer: The Alliance Commercial |
$2,147.37
|
| Rate for Payer: United Healthcare Medicaid |
$923.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$505.26
|
| Rate for Payer: WEA Trust Commercial |
$5,633.06
|
| Rate for Payer: WPS Commercial |
$2,273.68
|
|
|
Fragmenting of Kidney Stone 5059022
|
Professional
|
Both
|
$11,363.00
|
|
|
Service Code
|
CPT 50590
|
| Hospital Charge Code |
5639623
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$505.26 |
| Max. Negotiated Rate |
$11,226.64 |
| Rate for Payer: Aetna Commercial |
$11,226.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,163.07
|
| Rate for Payer: Aetna Managed Medicare |
$505.26
|
| Rate for Payer: Anthem Medicare Advantage |
$505.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$505.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$505.26
|
| Rate for Payer: Cash Price |
$3,408.90
|
| Rate for Payer: Cash Price |
$3,408.90
|
| Rate for Payer: Cash Price |
$3,408.90
|
| Rate for Payer: Cigna Commercial |
$11,226.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$923.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$505.26
|
| Rate for Payer: Health EOS Commercial |
$10,753.94
|
| Rate for Payer: HFN Commercial |
$11,226.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,984.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,984.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$505.26
|
| Rate for Payer: Multiplan Commercial |
$9,454.02
|
| Rate for Payer: NAPHCARE Commercial |
$757.89
|
| Rate for Payer: Preferred Network Access Commercial |
$11,226.64
|
| Rate for Payer: Quartz Beloit One Network |
$5,199.71
|
| Rate for Payer: Quartz Commercial |
$6,735.99
|
| Rate for Payer: Quartz Medicare Advantage |
$505.26
|
| Rate for Payer: The Alliance Commercial |
$2,147.37
|
| Rate for Payer: United Healthcare Medicaid |
$923.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$505.26
|
| Rate for Payer: WEA Trust Commercial |
$6,499.64
|
| Rate for Payer: WPS Commercial |
$2,273.68
|
|
|
Fragmenting of Kidney Stone 5059050
|
Professional
|
Both
|
$15,151.00
|
|
|
Service Code
|
CPT 50590 50
|
| Hospital Charge Code |
5432714
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$923.60 |
| Max. Negotiated Rate |
$14,969.19 |
| Rate for Payer: Aetna Commercial |
$14,969.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,551.05
|
| Rate for Payer: Cash Price |
$4,545.30
|
| Rate for Payer: Cash Price |
$4,545.30
|
| Rate for Payer: Cash Price |
$4,545.30
|
| Rate for Payer: Cigna Commercial |
$14,969.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$923.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,454.22
|
| Rate for Payer: Health EOS Commercial |
$14,338.91
|
| Rate for Payer: HFN Commercial |
$14,969.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,984.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,984.99
|
| Rate for Payer: Multiplan Commercial |
$12,605.63
|
| Rate for Payer: Preferred Network Access Commercial |
$14,969.19
|
| Rate for Payer: Quartz Beloit One Network |
$6,933.10
|
| Rate for Payer: Quartz Commercial |
$8,981.51
|
| Rate for Payer: The Alliance Commercial |
$7,878.52
|
| Rate for Payer: United Healthcare Medicaid |
$923.60
|
| Rate for Payer: WEA Trust Commercial |
$8,666.37
|
| Rate for Payer: WPS Commercial |
$11,670.82
|
|
|
FRENOPLASTY (SURGICAL REVISION OF FRENUM, EG, WITH Z-PLASTY)
|
Facility
|
OP
|
$13,956.63
|
|
|
Service Code
|
CPT 41520
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,835.04 |
| Max. Negotiated Rate |
$13,956.63 |
| Rate for Payer: Aetna Managed Medicare |
$3,489.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$3,489.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,489.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,489.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,489.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,489.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,979.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,489.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,489.16
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,489.16
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,489.16
|
| Rate for Payer: NAPHCARE Commercial |
$5,233.74
|
| Rate for Payer: Quartz Medicare Advantage |
$3,489.16
|
| Rate for Payer: The Alliance Commercial |
$13,956.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,489.16
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$3,489.16
|
|
|
FRENULECTOMY/FRENOTOMY/FRENULOPLASTY
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960079
|
|
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
|
|
|
FRENULECTOMY/FRENOTOMY/FRENULOPLASTY
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960079
|
|
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
|
|
|
Fructosamine
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
CPT 82985
|
| Hospital Charge Code |
633732
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$74.91 |
| Max. Negotiated Rate |
$140.65 |
| Rate for Payer: Aetna Commercial |
$137.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$131.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.03
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna Commercial |
$140.65
|
| Rate for Payer: Health EOS Commercial |
$136.06
|
| Rate for Payer: HFN Commercial |
$140.65
|
| Rate for Payer: Multiplan Commercial |
$122.30
|
| Rate for Payer: Preferred Network Access Commercial |
$140.65
|
| Rate for Payer: Quartz Beloit One Network |
$74.91
|
| Rate for Payer: Quartz Commercial |
$91.73
|
| Rate for Payer: WEA Trust Commercial |
$84.08
|
| Rate for Payer: WPS Commercial |
$113.23
|
|
|
Fructosamine
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
CPT 82985
|
| Hospital Charge Code |
633732
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.43 |
| Max. Negotiated Rate |
$140.65 |
| Rate for Payer: Aetna Commercial |
$137.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$131.48
|
| Rate for Payer: Aetna Managed Medicare |
$17.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$65.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.93
|
| Rate for Payer: Anthem Medicare Advantage |
$17.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.43
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna Commercial |
$140.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$85.55
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.43
|
| Rate for Payer: Health EOS Commercial |
$136.06
|
| Rate for Payer: HFN Commercial |
$140.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.43
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.43
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.43
|
| Rate for Payer: Multiplan Commercial |
$122.30
|
| Rate for Payer: NAPHCARE Commercial |
$26.15
|
| Rate for Payer: Preferred Network Access Commercial |
$140.65
|
| Rate for Payer: Quartz Beloit One Network |
$74.91
|
| Rate for Payer: Quartz Commercial |
$99.37
|
| Rate for Payer: Quartz Medicare Advantage |
$17.43
|
| Rate for Payer: The Alliance Commercial |
$69.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.43
|
| Rate for Payer: United Healthcare PPO |
$114.66
|
| Rate for Payer: WEA Trust Commercial |
$84.08
|
| Rate for Payer: Wellcare Medicare |
$17.43
|
| Rate for Payer: WPS Commercial |
$113.23
|
|
|
Fructosamine
|
Professional
|
Both
|
$147.00
|
|
|
Service Code
|
CPT 82985
|
| Hospital Charge Code |
633732
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.43 |
| Max. Negotiated Rate |
$145.24 |
| Rate for Payer: Aetna Commercial |
$145.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$131.48
|
| Rate for Payer: Aetna Managed Medicare |
$17.43
|
| Rate for Payer: Anthem Medicare Advantage |
$17.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.43
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna Commercial |
$145.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$76.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.43
|
| Rate for Payer: Health EOS Commercial |
$139.12
|
| Rate for Payer: HFN Commercial |
$145.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$61.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$61.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.43
|
| Rate for Payer: Multiplan Commercial |
$122.30
|
| Rate for Payer: NAPHCARE Commercial |
$26.15
|
| Rate for Payer: Preferred Network Access Commercial |
$145.24
|
| Rate for Payer: Quartz Beloit One Network |
$67.27
|
| Rate for Payer: Quartz Commercial |
$87.14
|
| Rate for Payer: Quartz Medicare Advantage |
$17.43
|
| Rate for Payer: The Alliance Commercial |
$68.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.43
|
| Rate for Payer: WEA Trust Commercial |
$84.08
|
| Rate for Payer: WPS Commercial |
$76.69
|
|
