|
AMPUTATION, ABOVE KNEE
|
Facility
IP
|
$1,757.00
|
|
| Hospital Charge Code |
2959785
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$860.93 |
| Max. Negotiated Rate |
$1,616.44 |
| Rate for Payer: Aetna Commercial |
$1,581.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$931.21
|
| Rate for Payer: Cash Price |
$527.10
|
| Rate for Payer: Cigna Commercial |
$1,616.44
|
| Rate for Payer: Health EOS Commercial |
$1,563.73
|
| Rate for Payer: HFN Commercial |
$1,616.44
|
| Rate for Payer: Multiplan Commercial |
$1,405.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,054.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,616.44
|
| Rate for Payer: Quartz Beloit One Network |
$860.93
|
| Rate for Payer: Quartz Commercial |
$1,054.20
|
| Rate for Payer: WEA Trust Commercial |
$966.35
|
| Rate for Payer: WPS Commercial |
$1,301.41
|
|
|
AMPUTATION, BELOW KNEE/ANKLE
|
Facility
OP
|
$1,757.00
|
|
| Hospital Charge Code |
2959787
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$491.96 |
| Max. Negotiated Rate |
$7,028.00 |
| Rate for Payer: Aetna Commercial |
$1,581.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,511.02
|
| Rate for Payer: Aetna Managed Medicare |
$491.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,142.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$878.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$843.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$931.21
|
| Rate for Payer: Cash Price |
$527.10
|
| Rate for Payer: Cigna Commercial |
$1,616.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$983.22
|
| Rate for Payer: Health EOS Commercial |
$1,563.73
|
| Rate for Payer: HFN Commercial |
$1,616.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,317.75
|
| Rate for Payer: Multiplan Commercial |
$1,405.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,054.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,616.44
|
| Rate for Payer: Quartz Beloit One Network |
$860.93
|
| Rate for Payer: Quartz Commercial |
$1,142.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,054.20
|
| Rate for Payer: The Alliance Commercial |
$7,028.00
|
| Rate for Payer: WEA Trust Commercial |
$966.35
|
| Rate for Payer: WPS Commercial |
$1,301.41
|
|
|
AMPUTATION, BELOW KNEE/ANKLE
|
Facility
IP
|
$1,757.00
|
|
| Hospital Charge Code |
2959787
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$860.93 |
| Max. Negotiated Rate |
$1,616.44 |
| Rate for Payer: Aetna Commercial |
$1,581.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$931.21
|
| Rate for Payer: Cash Price |
$527.10
|
| Rate for Payer: Cigna Commercial |
$1,616.44
|
| Rate for Payer: Health EOS Commercial |
$1,563.73
|
| Rate for Payer: HFN Commercial |
$1,616.44
|
| Rate for Payer: Multiplan Commercial |
$1,405.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,054.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,616.44
|
| Rate for Payer: Quartz Beloit One Network |
$860.93
|
| Rate for Payer: Quartz Commercial |
$1,054.20
|
| Rate for Payer: WEA Trust Commercial |
$966.35
|
| Rate for Payer: WPS Commercial |
$1,301.41
|
|
|
AMPUTATION, ELBOW/FOREARM/WRIST/HAND
|
Facility
OP
|
$1,632.00
|
|
| Hospital Charge Code |
2959788
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$456.96 |
| Max. Negotiated Rate |
$6,528.00 |
| Rate for Payer: Aetna Commercial |
$1,468.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,403.52
|
| Rate for Payer: Aetna Managed Medicare |
$456.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,060.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$816.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$783.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$864.96
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cigna Commercial |
$1,501.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$913.27
|
| Rate for Payer: Health EOS Commercial |
$1,452.48
|
| Rate for Payer: HFN Commercial |
$1,501.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,224.00
|
| Rate for Payer: Multiplan Commercial |
$1,305.60
|
| Rate for Payer: NAPHCARE Commercial |
$979.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,501.44
|
| Rate for Payer: Quartz Beloit One Network |
$799.68
|
| Rate for Payer: Quartz Commercial |
$1,060.80
|
| Rate for Payer: Quartz Medicare Advantage |
$979.20
|
| Rate for Payer: The Alliance Commercial |
$6,528.00
|
| Rate for Payer: WEA Trust Commercial |
$897.60
|
| Rate for Payer: WPS Commercial |
$1,208.82
|
|
|
AMPUTATION, ELBOW/FOREARM/WRIST/HAND
|
Facility
IP
|
$1,632.00
|
|
| Hospital Charge Code |
2959788
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$799.68 |
| Max. Negotiated Rate |
$1,501.44 |
| Rate for Payer: Aetna Commercial |
$1,468.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$864.96
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cigna Commercial |
$1,501.44
|
| Rate for Payer: Health EOS Commercial |
$1,452.48
|
| Rate for Payer: HFN Commercial |
$1,501.44
|
| Rate for Payer: Multiplan Commercial |
$1,305.60
|
| Rate for Payer: NAPHCARE Commercial |
$979.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,501.44
|
| Rate for Payer: Quartz Beloit One Network |
$799.68
|
| Rate for Payer: Quartz Commercial |
$979.20
|
| Rate for Payer: WEA Trust Commercial |
$897.60
|
| Rate for Payer: WPS Commercial |
$1,208.82
|
|
|
AMPUTATION, FINGER
|
Facility
IP
|
$1,757.00
|
|
| Hospital Charge Code |
2959789
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$860.93 |
| Max. Negotiated Rate |
$1,616.44 |
| Rate for Payer: Aetna Commercial |
$1,581.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$931.21
|
| Rate for Payer: Cash Price |
$527.10
|
| Rate for Payer: Cigna Commercial |
$1,616.44
|
| Rate for Payer: Health EOS Commercial |
$1,563.73
|
| Rate for Payer: HFN Commercial |
$1,616.44
|
| Rate for Payer: Multiplan Commercial |
$1,405.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,054.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,616.44
|
| Rate for Payer: Quartz Beloit One Network |
$860.93
|
| Rate for Payer: Quartz Commercial |
$1,054.20
|
| Rate for Payer: WEA Trust Commercial |
$966.35
|
| Rate for Payer: WPS Commercial |
$1,301.41
|
|
|
AMPUTATION, FINGER
|
Facility
OP
|
$1,757.00
|
|
| Hospital Charge Code |
2959789
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$491.96 |
| Max. Negotiated Rate |
$7,028.00 |
| Rate for Payer: Aetna Commercial |
$1,581.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,511.02
|
| Rate for Payer: Aetna Managed Medicare |
$491.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,142.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$878.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$843.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$931.21
|
| Rate for Payer: Cash Price |
$527.10
|
| Rate for Payer: Cigna Commercial |
$1,616.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$983.22
|
| Rate for Payer: Health EOS Commercial |
$1,563.73
|
| Rate for Payer: HFN Commercial |
$1,616.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,317.75
|
| Rate for Payer: Multiplan Commercial |
$1,405.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,054.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,616.44
|
| Rate for Payer: Quartz Beloit One Network |
$860.93
|
| Rate for Payer: Quartz Commercial |
$1,142.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,054.20
|
| Rate for Payer: The Alliance Commercial |
$7,028.00
|
| Rate for Payer: WEA Trust Commercial |
$966.35
|
| Rate for Payer: WPS Commercial |
$1,301.41
|
|
|
AMPUTATION, FINGER OR THUMB, PRIMARY OR SECONDARY, ANY JOINT OR PHALANX, SINGLE, INCLUDING NEURECTOMIES; WITH DIRECT CLOSURE
|
Facility
OP
|
$50,159.28
|
|
|
Service Code
|
CPT 26951
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,199.31 |
| Max. Negotiated Rate |
$50,159.28 |
| Rate for Payer: Aetna Managed Medicare |
$3,199.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,199.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,199.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,199.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,199.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,199.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,901.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,199.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,199.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,199.31
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,199.31
|
| Rate for Payer: NAPHCARE Commercial |
$4,798.96
|
| Rate for Payer: Quartz Medicare Advantage |
$3,199.31
|
| Rate for Payer: The Alliance Commercial |
$50,159.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,199.31
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: Wellcare Medicare |
$3,199.31
|
|
|
AMPUTATION, FINGER OR THUMB, PRIMARY OR SECONDARY, ANY JOINT OR PHALANX, SINGLE, INCLUDING NEURECTOMIES; WITH LOCAL ADVANCEMENT FLAPS (V-Y, HOOD)
|
Facility
OP
|
$50,159.28
|
|
|
Service Code
|
CPT 26952
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,199.31 |
| Max. Negotiated Rate |
$50,159.28 |
| Rate for Payer: Aetna Managed Medicare |
$3,199.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,199.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,199.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,199.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,199.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,795.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,199.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,901.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,199.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,199.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,199.31
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,199.31
|
| Rate for Payer: NAPHCARE Commercial |
$4,798.96
|
| Rate for Payer: Quartz Medicare Advantage |
$3,199.31
|
| Rate for Payer: The Alliance Commercial |
$50,159.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,199.31
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: Wellcare Medicare |
$3,199.31
|
|
|
AMPUTATION, FOOT/TOE/SYME
|
Facility
OP
|
$1,757.00
|
|
| Hospital Charge Code |
2959791
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$491.96 |
| Max. Negotiated Rate |
$7,028.00 |
| Rate for Payer: Aetna Commercial |
$1,581.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,511.02
|
| Rate for Payer: Aetna Managed Medicare |
$491.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,142.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$878.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$843.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$931.21
|
| Rate for Payer: Cash Price |
$527.10
|
| Rate for Payer: Cigna Commercial |
$1,616.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$983.22
|
| Rate for Payer: Health EOS Commercial |
$1,563.73
|
| Rate for Payer: HFN Commercial |
$1,616.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,317.75
|
| Rate for Payer: Multiplan Commercial |
$1,405.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,054.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,616.44
|
| Rate for Payer: Quartz Beloit One Network |
$860.93
|
| Rate for Payer: Quartz Commercial |
$1,142.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,054.20
|
| Rate for Payer: The Alliance Commercial |
$7,028.00
|
| Rate for Payer: WEA Trust Commercial |
$966.35
|
| Rate for Payer: WPS Commercial |
$1,301.41
|
|
|
AMPUTATION, FOOT/TOE/SYME
|
Facility
IP
|
$1,757.00
|
|
| Hospital Charge Code |
2959791
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$860.93 |
| Max. Negotiated Rate |
$1,616.44 |
| Rate for Payer: Aetna Commercial |
$1,581.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$931.21
|
| Rate for Payer: Cash Price |
$527.10
|
| Rate for Payer: Cigna Commercial |
$1,616.44
|
| Rate for Payer: Health EOS Commercial |
$1,563.73
|
| Rate for Payer: HFN Commercial |
$1,616.44
|
| Rate for Payer: Multiplan Commercial |
$1,405.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,054.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,616.44
|
| Rate for Payer: Quartz Beloit One Network |
$860.93
|
| Rate for Payer: Quartz Commercial |
$1,054.20
|
| Rate for Payer: WEA Trust Commercial |
$966.35
|
| Rate for Payer: WPS Commercial |
$1,301.41
|
|
|
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC
|
Facility
IP
|
$75,006.00
|
|
|
Service Code
|
MS-DRG 240
|
| Min. Negotiated Rate |
$26,980.47 |
| Max. Negotiated Rate |
$75,006.00 |
| Rate for Payer: Aetna Managed Medicare |
$26,980.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$58,953.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$45,187.61
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$42,931.18
|
| Rate for Payer: Anthem Medicare Advantage |
$26,980.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26,980.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26,980.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$26,980.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47,657.54
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$26,980.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54,779.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$26,980.47
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26,980.47
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$26,980.47
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$26,980.47
|
| Rate for Payer: NAPHCARE Commercial |
$40,470.70
|
| Rate for Payer: Quartz Medicare Advantage |
$26,980.47
|
| Rate for Payer: The Alliance Commercial |
$75,006.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26,980.47
|
| Rate for Payer: United Healthcare PPO |
$42,646.47
|
| Rate for Payer: Wellcare Medicare |
$26,980.47
|
|
|
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC
|
Facility
IP
|
$128,114.00
|
|
|
Service Code
|
MS-DRG 239
|
| Min. Negotiated Rate |
$46,084.10 |
| Max. Negotiated Rate |
$128,114.00 |
| Rate for Payer: Aetna Managed Medicare |
$46,084.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$100,913.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$77,349.61
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$73,487.18
|
| Rate for Payer: Anthem Medicare Advantage |
$46,084.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$46,084.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$46,084.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$46,084.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$81,577.50
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$46,084.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$93,732.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46,084.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$46,084.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$46,084.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$46,084.10
|
| Rate for Payer: NAPHCARE Commercial |
$69,126.15
|
| Rate for Payer: Quartz Medicare Advantage |
$46,084.10
|
| Rate for Payer: The Alliance Commercial |
$128,114.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46,084.10
|
| Rate for Payer: United Healthcare PPO |
$72,972.03
|
| Rate for Payer: Wellcare Medicare |
$46,084.10
|
|
|
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC
|
Facility
IP
|
$37,381.00
|
|
|
Service Code
|
MS-DRG 241
|
| Min. Negotiated Rate |
$13,446.49 |
| Max. Negotiated Rate |
$37,381.00 |
| Rate for Payer: Aetna Managed Medicare |
$13,446.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29,162.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22,352.59
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21,236.42
|
| Rate for Payer: Anthem Medicare Advantage |
$13,446.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,446.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,446.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,446.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23,574.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,446.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27,101.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,446.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,446.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,446.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,446.49
|
| Rate for Payer: NAPHCARE Commercial |
$20,169.74
|
| Rate for Payer: Quartz Medicare Advantage |
$13,446.49
|
| Rate for Payer: The Alliance Commercial |
$37,381.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,446.49
|
| Rate for Payer: United Healthcare PPO |
$21,098.55
|
| Rate for Payer: Wellcare Medicare |
$13,446.49
|
|
|
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC
|
Facility
IP
|
$57,339.00
|
|
|
Service Code
|
MS-DRG 475
|
| Min. Negotiated Rate |
$20,625.65 |
| Max. Negotiated Rate |
$57,339.00 |
| Rate for Payer: Aetna Managed Medicare |
$20,625.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44,897.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$34,413.34
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32,694.92
|
| Rate for Payer: Anthem Medicare Advantage |
$20,625.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20,625.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20,625.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$20,625.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36,294.36
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$20,625.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$41,821.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20,625.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20,625.65
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$20,625.65
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$20,625.65
|
| Rate for Payer: NAPHCARE Commercial |
$30,938.48
|
| Rate for Payer: Quartz Medicare Advantage |
$20,625.65
|
| Rate for Payer: The Alliance Commercial |
$57,339.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20,625.65
|
| Rate for Payer: United Healthcare PPO |
$32,558.69
|
| Rate for Payer: Wellcare Medicare |
$20,625.65
|
|
|
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC
|
Facility
IP
|
$114,714.00
|
|
|
Service Code
|
MS-DRG 474
|
| Min. Negotiated Rate |
$41,264.20 |
| Max. Negotiated Rate |
$114,714.00 |
| Rate for Payer: Wellcare Medicare |
$41,264.20
|
| Rate for Payer: Aetna Managed Medicare |
$41,264.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$90,214.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$69,148.30
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$65,695.40
|
| Rate for Payer: Anthem Medicare Advantage |
$41,264.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$41,264.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$41,264.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$41,264.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$72,927.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$41,264.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83,904.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$41,264.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$41,264.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$41,264.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$41,264.20
|
| Rate for Payer: NAPHCARE Commercial |
$61,896.30
|
| Rate for Payer: Quartz Medicare Advantage |
$41,264.20
|
| Rate for Payer: The Alliance Commercial |
$114,714.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$41,264.20
|
| Rate for Payer: United Healthcare PPO |
$65,320.81
|
|
|
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC
|
Facility
IP
|
$31,609.00
|
|
|
Service Code
|
MS-DRG 476
|
| Min. Negotiated Rate |
$11,370.32 |
| Max. Negotiated Rate |
$31,609.00 |
| Rate for Payer: Aetna Managed Medicare |
$11,370.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$24,756.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,975.58
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18,028.04
|
| Rate for Payer: Anthem Medicare Advantage |
$11,370.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,370.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,370.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,370.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20,012.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,370.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22,949.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,370.32
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,370.32
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,370.32
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,370.32
|
| Rate for Payer: NAPHCARE Commercial |
$17,055.48
|
| Rate for Payer: Quartz Medicare Advantage |
$11,370.32
|
| Rate for Payer: The Alliance Commercial |
$31,609.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,370.32
|
| Rate for Payer: United Healthcare PPO |
$17,866.52
|
| Rate for Payer: Wellcare Medicare |
$11,370.32
|
|
|
AMPUTATION, HIP
|
Facility
IP
|
$4,324.00
|
|
| Hospital Charge Code |
2959793
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,118.76 |
| Max. Negotiated Rate |
$3,978.08 |
| Rate for Payer: Aetna Commercial |
$3,891.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,291.72
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$3,978.08
|
| Rate for Payer: Health EOS Commercial |
$3,848.36
|
| Rate for Payer: HFN Commercial |
$3,978.08
|
| Rate for Payer: Multiplan Commercial |
$3,459.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,594.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,978.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,118.76
|
| Rate for Payer: Quartz Commercial |
$2,594.40
|
| Rate for Payer: WEA Trust Commercial |
$2,378.20
|
| Rate for Payer: WPS Commercial |
$3,202.79
|
|
|
AMPUTATION, HIP
|
Facility
OP
|
$4,324.00
|
|
| Hospital Charge Code |
2959793
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,210.72 |
| Max. Negotiated Rate |
$17,296.00 |
| Rate for Payer: Aetna Commercial |
$3,891.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,718.64
|
| Rate for Payer: Aetna Managed Medicare |
$1,210.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,810.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,162.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,075.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,291.72
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$3,978.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,419.71
|
| Rate for Payer: Health EOS Commercial |
$3,848.36
|
| Rate for Payer: HFN Commercial |
$3,978.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,243.00
|
| Rate for Payer: Multiplan Commercial |
$3,459.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,594.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,978.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,118.76
|
| Rate for Payer: Quartz Commercial |
$2,810.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2,594.40
|
| Rate for Payer: The Alliance Commercial |
$17,296.00
|
| Rate for Payer: WEA Trust Commercial |
$2,378.20
|
| Rate for Payer: WPS Commercial |
$3,202.79
|
|
|
AMPUTATION, METATARSAL, WITH TOE, SINGLE
|
Facility
OP
|
$27,265.32
|
|
|
Service Code
|
CPT 28810
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,199.31 |
| Max. Negotiated Rate |
$27,265.32 |
| Rate for Payer: Aetna Managed Medicare |
$3,199.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,199.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,199.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,199.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,199.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,199.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,901.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,199.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,199.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,199.31
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,199.31
|
| Rate for Payer: NAPHCARE Commercial |
$4,798.96
|
| Rate for Payer: Quartz Medicare Advantage |
$3,199.31
|
| Rate for Payer: The Alliance Commercial |
$27,265.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,199.31
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: Wellcare Medicare |
$3,199.31
|
|
|
AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC
|
Facility
IP
|
$53,080.00
|
|
|
Service Code
|
MS-DRG 617
|
| Min. Negotiated Rate |
$19,093.61 |
| Max. Negotiated Rate |
$53,080.00 |
| Rate for Payer: Aetna Managed Medicare |
$19,093.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$41,540.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31,840.38
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30,250.44
|
| Rate for Payer: Anthem Medicare Advantage |
$19,093.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19,093.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19,093.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19,093.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33,580.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19,093.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$38,697.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19,093.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19,093.61
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19,093.61
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19,093.61
|
| Rate for Payer: NAPHCARE Commercial |
$28,640.42
|
| Rate for Payer: Quartz Medicare Advantage |
$19,093.61
|
| Rate for Payer: The Alliance Commercial |
$53,080.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19,093.61
|
| Rate for Payer: United Healthcare PPO |
$30,126.69
|
| Rate for Payer: Wellcare Medicare |
$19,093.61
|
|
|
AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC
|
Facility
IP
|
$105,540.00
|
|
|
Service Code
|
MS-DRG 616
|
| Min. Negotiated Rate |
$37,963.91 |
| Max. Negotiated Rate |
$105,540.00 |
| Rate for Payer: Aetna Managed Medicare |
$37,963.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$83,080.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$63,680.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$60,500.88
|
| Rate for Payer: Anthem Medicare Advantage |
$37,963.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$37,963.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$37,963.91
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$37,963.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$67,161.52
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$37,963.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$77,175.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$37,963.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$37,963.91
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$37,963.91
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$37,963.91
|
| Rate for Payer: NAPHCARE Commercial |
$56,945.86
|
| Rate for Payer: Quartz Medicare Advantage |
$37,963.91
|
| Rate for Payer: The Alliance Commercial |
$105,540.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37,963.91
|
| Rate for Payer: United Healthcare PPO |
$60,081.84
|
| Rate for Payer: Wellcare Medicare |
$37,963.91
|
|
|
AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC
|
Facility
IP
|
$31,200.00
|
|
|
Service Code
|
MS-DRG 618
|
| Min. Negotiated Rate |
$11,223.04 |
| Max. Negotiated Rate |
$31,200.00 |
| Rate for Payer: Aetna Managed Medicare |
$11,223.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$24,336.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,653.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,722.48
|
| Rate for Payer: Anthem Medicare Advantage |
$11,223.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,223.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,223.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,223.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19,673.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,223.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22,649.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,223.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,223.04
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,223.04
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,223.04
|
| Rate for Payer: NAPHCARE Commercial |
$16,834.56
|
| Rate for Payer: Quartz Medicare Advantage |
$11,223.04
|
| Rate for Payer: The Alliance Commercial |
$31,200.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,223.04
|
| Rate for Payer: United Healthcare PPO |
$17,632.73
|
| Rate for Payer: Wellcare Medicare |
$11,223.04
|
|
|
AMPUTATION OF TOE 28820
|
Professional
|
$1,290.00
|
|
|
Service Code
|
CPT 28820
|
| Hospital Charge Code |
3014285
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$166.87 |
| Max. Negotiated Rate |
$1,225.50 |
| Rate for Payer: Aetna Commercial |
$1,225.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,109.40
|
| Rate for Payer: Aetna Managed Medicare |
$166.87
|
| Rate for Payer: Anthem Medicare Advantage |
$166.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$166.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$166.87
|
| Rate for Payer: Cash Price |
$387.00
|
| Rate for Payer: Cash Price |
$387.00
|
| Rate for Payer: Cigna Commercial |
$1,225.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$645.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$166.87
|
| Rate for Payer: Health EOS Commercial |
$1,173.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$603.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$603.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$166.87
|
| Rate for Payer: Multiplan Commercial |
$1,032.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,225.50
|
| Rate for Payer: Quartz Beloit One Network |
$567.60
|
| Rate for Payer: Quartz Commercial |
$735.30
|
| Rate for Payer: Quartz Medicare Advantage |
$166.87
|
| Rate for Payer: The Alliance Commercial |
$709.20
|
| Rate for Payer: United Healthcare Medicaid |
$180.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$166.87
|
| Rate for Payer: WEA Trust Commercial |
$709.50
|
| Rate for Payer: WPS Commercial |
$750.92
|
|
|
AMPUTATION, PENILE
|
Facility
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2959795
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,101.80 |
| Max. Negotiated Rate |
$15,740.00 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,101.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,557.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,967.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,888.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,202.03
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,951.25
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,557.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,361.00
|
| Rate for Payer: The Alliance Commercial |
$15,740.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
