|
LIVER RESECTION
|
Facility
|
OP
|
$4,460.00
|
|
| Hospital Charge Code |
2960206
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,248.80 |
| Max. Negotiated Rate |
$17,840.00 |
| Rate for Payer: Aetna Commercial |
$4,014.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,835.60
|
| Rate for Payer: Aetna Managed Medicare |
$1,248.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,899.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,230.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,140.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,363.80
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,103.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,495.82
|
| Rate for Payer: Health EOS Commercial |
$3,969.40
|
| Rate for Payer: HFN Commercial |
$4,103.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,345.00
|
| Rate for Payer: Multiplan Commercial |
$3,568.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,676.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,103.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,185.40
|
| Rate for Payer: Quartz Commercial |
$2,899.00
|
| Rate for Payer: Quartz Medicare Advantage |
$2,676.00
|
| Rate for Payer: The Alliance Commercial |
$17,840.00
|
| Rate for Payer: WEA Trust Commercial |
$2,453.00
|
| Rate for Payer: WPS Commercial |
$3,303.52
|
|
|
LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT
|
Facility
|
IP
|
$275,485.00
|
|
|
Service Code
|
MSDRG 005
|
| Min. Negotiated Rate |
$99,095.35 |
| Max. Negotiated Rate |
$275,485.00 |
| Rate for Payer: Aetna Managed Medicare |
$99,095.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$217,143.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$166,438.35
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$158,127.30
|
| Rate for Payer: Anthem Medicare Advantage |
$99,095.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$99,095.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$99,095.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$99,095.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$175,535.79
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$99,095.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$201,825.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$99,095.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$99,095.35
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$99,095.35
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$99,095.35
|
| Rate for Payer: NAPHCARE Commercial |
$148,643.02
|
| Rate for Payer: Quartz Medicare Advantage |
$99,095.35
|
| Rate for Payer: The Alliance Commercial |
$275,485.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$99,095.35
|
| Rate for Payer: Wellcare Medicare |
$99,095.35
|
|
|
LIVER TRANSPLANT WITHOUT MCC
|
Facility
|
IP
|
$128,914.00
|
|
|
Service Code
|
MSDRG 006
|
| Min. Negotiated Rate |
$46,371.96 |
| Max. Negotiated Rate |
$128,914.00 |
| Rate for Payer: Aetna Managed Medicare |
$46,371.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$101,543.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$77,832.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$73,945.52
|
| Rate for Payer: Anthem Medicare Advantage |
$46,371.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$46,371.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$46,371.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$46,371.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$82,086.30
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$46,371.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$94,319.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46,371.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$46,371.96
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$46,371.96
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$46,371.96
|
| Rate for Payer: NAPHCARE Commercial |
$69,557.94
|
| Rate for Payer: Quartz Medicare Advantage |
$46,371.96
|
| Rate for Payer: The Alliance Commercial |
$128,914.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46,371.96
|
| Rate for Payer: Wellcare Medicare |
$46,371.96
|
|
|
LLE Additional Markers
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
2942939
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$86.73 |
| Max. Negotiated Rate |
$162.84 |
| Rate for Payer: Aetna Commercial |
$159.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$152.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$93.81
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna Commercial |
$162.84
|
| Rate for Payer: Health EOS Commercial |
$157.53
|
| Rate for Payer: HFN Commercial |
$162.84
|
| Rate for Payer: Multiplan Commercial |
$141.60
|
| Rate for Payer: NAPHCARE Commercial |
$106.20
|
| Rate for Payer: Preferred Network Access Commercial |
$162.84
|
| Rate for Payer: Quartz Beloit One Network |
$86.73
|
| Rate for Payer: Quartz Commercial |
$106.20
|
| Rate for Payer: WEA Trust Commercial |
$97.35
|
| Rate for Payer: WPS Commercial |
$131.10
|
|
|
LLE Additional Markers
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
2942939
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.56 |
| Max. Negotiated Rate |
$708.00 |
| Rate for Payer: Aetna Commercial |
$159.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$152.22
|
| Rate for Payer: Aetna Managed Medicare |
$49.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$115.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$88.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$84.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$93.81
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna Commercial |
$162.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$99.05
|
| Rate for Payer: Health EOS Commercial |
$157.53
|
| Rate for Payer: HFN Commercial |
$162.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$132.75
|
| Rate for Payer: Multiplan Commercial |
$141.60
|
| Rate for Payer: NAPHCARE Commercial |
$106.20
|
| Rate for Payer: Preferred Network Access Commercial |
$162.84
|
| Rate for Payer: Quartz Beloit One Network |
$86.73
|
| Rate for Payer: Quartz Commercial |
$115.05
|
| Rate for Payer: Quartz Medicare Advantage |
$106.20
|
| Rate for Payer: The Alliance Commercial |
$708.00
|
| Rate for Payer: United Healthcare PPO |
$132.75
|
| Rate for Payer: WEA Trust Commercial |
$97.35
|
| Rate for Payer: WPS Commercial |
$131.10
|
|
|
LLE Additional Markers
|
Professional
|
Both
|
$177.00
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
2942939
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.57 |
| Max. Negotiated Rate |
$168.15 |
| Rate for Payer: Aetna Commercial |
$168.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$152.22
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna Commercial |
$168.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$88.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$106.20
|
| Rate for Payer: Health EOS Commercial |
$161.07
|
| Rate for Payer: HFN Commercial |
$168.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$76.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$76.57
|
| Rate for Payer: Multiplan Commercial |
$141.60
|
| Rate for Payer: Preferred Network Access Commercial |
$168.15
|
| Rate for Payer: Quartz Beloit One Network |
$77.88
|
| Rate for Payer: Quartz Commercial |
$100.89
|
| Rate for Payer: The Alliance Commercial |
$88.50
|
| Rate for Payer: WEA Trust Commercial |
$97.35
|
| Rate for Payer: WPS Commercial |
$131.10
|
|
|
LLE Markers
|
Professional
|
Both
|
$142.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
2942938
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$62.48 |
| Max. Negotiated Rate |
$230.47 |
| Rate for Payer: Aetna Commercial |
$134.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$122.12
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cigna Commercial |
$134.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$71.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$85.20
|
| Rate for Payer: Health EOS Commercial |
$129.22
|
| Rate for Payer: HFN Commercial |
$134.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$230.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$230.47
|
| Rate for Payer: Multiplan Commercial |
$113.60
|
| Rate for Payer: Preferred Network Access Commercial |
$134.90
|
| Rate for Payer: Quartz Beloit One Network |
$62.48
|
| Rate for Payer: Quartz Commercial |
$80.94
|
| Rate for Payer: The Alliance Commercial |
$71.00
|
| Rate for Payer: WEA Trust Commercial |
$78.10
|
| Rate for Payer: WPS Commercial |
$105.18
|
|
|
LLE Markers
|
Facility
|
IP
|
$142.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
2942938
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$69.58 |
| Max. Negotiated Rate |
$130.64 |
| Rate for Payer: Aetna Commercial |
$127.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$122.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$75.26
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cigna Commercial |
$130.64
|
| Rate for Payer: Health EOS Commercial |
$126.38
|
| Rate for Payer: HFN Commercial |
$130.64
|
| Rate for Payer: Multiplan Commercial |
$113.60
|
| Rate for Payer: NAPHCARE Commercial |
$85.20
|
| Rate for Payer: Preferred Network Access Commercial |
$130.64
|
| Rate for Payer: Quartz Beloit One Network |
$69.58
|
| Rate for Payer: Quartz Commercial |
$85.20
|
| Rate for Payer: WEA Trust Commercial |
$78.10
|
| Rate for Payer: WPS Commercial |
$105.18
|
|
|
LLE Markers
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
2942938
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$69.58 |
| Max. Negotiated Rate |
$1,421.12 |
| Rate for Payer: Aetna Commercial |
$127.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$122.12
|
| Rate for Payer: Aetna Managed Medicare |
$355.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,332.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$621.74
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$589.76
|
| Rate for Payer: Anthem Medicare Advantage |
$355.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$75.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$355.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$355.28
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cigna Commercial |
$130.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$355.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$79.46
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$355.28
|
| Rate for Payer: Health EOS Commercial |
$126.38
|
| Rate for Payer: HFN Commercial |
$130.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,321.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$355.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$355.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$355.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$355.28
|
| Rate for Payer: Multiplan Commercial |
$113.60
|
| Rate for Payer: NAPHCARE Commercial |
$532.92
|
| Rate for Payer: Preferred Network Access Commercial |
$130.64
|
| Rate for Payer: Quartz Beloit One Network |
$69.58
|
| Rate for Payer: Quartz Commercial |
$92.30
|
| Rate for Payer: Quartz Medicare Advantage |
$355.28
|
| Rate for Payer: The Alliance Commercial |
$1,421.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$355.28
|
| Rate for Payer: United Healthcare PPO |
$106.50
|
| Rate for Payer: WEA Trust Commercial |
$78.10
|
| Rate for Payer: Wellcare Medicare |
$355.28
|
| Rate for Payer: WPS Commercial |
$105.18
|
|
|
LOANER ARTHREX INSTRUMENT SET 992
|
Facility
|
OP
|
$2,931.00
|
|
| Hospital Charge Code |
5306688
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$820.68 |
| Max. Negotiated Rate |
$11,724.00 |
| Rate for Payer: Aetna Commercial |
$2,637.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,520.66
|
| Rate for Payer: Aetna Managed Medicare |
$820.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,905.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,465.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,406.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,553.43
|
| Rate for Payer: Cash Price |
$879.30
|
| Rate for Payer: Cigna Commercial |
$2,696.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,640.19
|
| Rate for Payer: Health EOS Commercial |
$2,608.59
|
| Rate for Payer: HFN Commercial |
$2,696.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,198.25
|
| Rate for Payer: Multiplan Commercial |
$2,344.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,758.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,696.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,436.19
|
| Rate for Payer: Quartz Commercial |
$1,905.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,758.60
|
| Rate for Payer: The Alliance Commercial |
$11,724.00
|
| Rate for Payer: WEA Trust Commercial |
$1,612.05
|
| Rate for Payer: WPS Commercial |
$2,170.99
|
|
|
LOANER ARTHREX INSTRUMENT SET 992
|
Facility
|
IP
|
$2,931.00
|
|
| Hospital Charge Code |
5306688
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1,436.19 |
| Max. Negotiated Rate |
$2,696.52 |
| Rate for Payer: Aetna Commercial |
$2,637.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,520.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,553.43
|
| Rate for Payer: Cash Price |
$879.30
|
| Rate for Payer: Cigna Commercial |
$2,696.52
|
| Rate for Payer: Health EOS Commercial |
$2,608.59
|
| Rate for Payer: HFN Commercial |
$2,696.52
|
| Rate for Payer: Multiplan Commercial |
$2,344.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,758.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,696.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,436.19
|
| Rate for Payer: Quartz Commercial |
$1,758.60
|
| Rate for Payer: WEA Trust Commercial |
$1,612.05
|
| Rate for Payer: WPS Commercial |
$2,170.99
|
|
|
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC
|
Facility
|
IP
|
$53,160.00
|
|
|
Service Code
|
MSDRG 496
|
| Min. Negotiated Rate |
$19,122.31 |
| Max. Negotiated Rate |
$53,160.00 |
| Rate for Payer: Quartz Medicare Advantage |
$19,122.31
|
| Rate for Payer: The Alliance Commercial |
$53,160.00
|
| Rate for Payer: Aetna Managed Medicare |
$19,122.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$41,750.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32,001.19
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30,403.22
|
| Rate for Payer: Anthem Medicare Advantage |
$19,122.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19,122.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19,122.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19,122.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33,750.36
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19,122.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$38,756.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19,122.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19,122.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19,122.31
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19,122.31
|
| Rate for Payer: NAPHCARE Commercial |
$28,683.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19,122.31
|
| Rate for Payer: United Healthcare PPO |
$30,172.24
|
| Rate for Payer: Wellcare Medicare |
$19,122.31
|
|
|
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH MCC
|
Facility
|
IP
|
$95,530.00
|
|
|
Service Code
|
MSDRG 495
|
| Min. Negotiated Rate |
$34,363.34 |
| Max. Negotiated Rate |
$95,530.00 |
| Rate for Payer: Aetna Managed Medicare |
$34,363.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$75,108.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$57,569.98
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$54,695.24
|
| Rate for Payer: Anthem Medicare Advantage |
$34,363.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$34,363.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$34,363.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$34,363.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$60,716.73
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$34,363.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69,833.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$34,363.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$34,363.34
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$34,363.34
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$34,363.34
|
| Rate for Payer: NAPHCARE Commercial |
$51,545.01
|
| Rate for Payer: Quartz Medicare Advantage |
$34,363.34
|
| Rate for Payer: The Alliance Commercial |
$95,530.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$34,363.34
|
| Rate for Payer: United Healthcare PPO |
$54,366.20
|
| Rate for Payer: Wellcare Medicare |
$34,363.34
|
|
|
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC/MCC
|
Facility
|
IP
|
$38,269.00
|
|
|
Service Code
|
MSDRG 497
|
| Min. Negotiated Rate |
$13,765.91 |
| Max. Negotiated Rate |
$38,269.00 |
| Rate for Payer: Aetna Managed Medicare |
$13,765.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30,001.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22,995.83
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21,847.54
|
| Rate for Payer: Anthem Medicare Advantage |
$13,765.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,765.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,765.91
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,765.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24,252.77
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,765.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27,834.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,765.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,765.91
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,765.91
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,765.91
|
| Rate for Payer: NAPHCARE Commercial |
$20,648.86
|
| Rate for Payer: Quartz Medicare Advantage |
$13,765.91
|
| Rate for Payer: The Alliance Commercial |
$38,269.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,765.91
|
| Rate for Payer: United Healthcare PPO |
$21,669.36
|
| Rate for Payer: Wellcare Medicare |
$13,765.91
|
|
|
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CC/MCC
|
Facility
|
IP
|
$69,736.00
|
|
|
Service Code
|
MSDRG 498
|
| Min. Negotiated Rate |
$25,085.03 |
| Max. Negotiated Rate |
$69,736.00 |
| Rate for Payer: Aetna Managed Medicare |
$25,085.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$54,757.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$41,971.41
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$39,875.58
|
| Rate for Payer: Anthem Medicare Advantage |
$25,085.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25,085.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25,085.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$25,085.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44,265.55
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$25,085.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50,914.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$25,085.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25,085.03
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$25,085.03
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$25,085.03
|
| Rate for Payer: NAPHCARE Commercial |
$37,627.54
|
| Rate for Payer: Quartz Medicare Advantage |
$25,085.03
|
| Rate for Payer: The Alliance Commercial |
$69,736.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25,085.03
|
| Rate for Payer: United Healthcare PPO |
$39,637.59
|
| Rate for Payer: Wellcare Medicare |
$25,085.03
|
|
|
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT CC/MCC
|
Facility
|
IP
|
$34,611.00
|
|
|
Service Code
|
MSDRG 499
|
| Min. Negotiated Rate |
$12,449.99 |
| Max. Negotiated Rate |
$34,611.00 |
| Rate for Payer: Aetna Managed Medicare |
$12,449.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$27,064.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20,744.49
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19,708.62
|
| Rate for Payer: Anthem Medicare Advantage |
$12,449.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12,449.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12,449.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12,449.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21,878.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12,449.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25,151.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12,449.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12,449.99
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12,449.99
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12,449.99
|
| Rate for Payer: NAPHCARE Commercial |
$18,674.98
|
| Rate for Payer: Quartz Medicare Advantage |
$12,449.99
|
| Rate for Payer: The Alliance Commercial |
$34,611.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,449.99
|
| Rate for Payer: United Healthcare PPO |
$19,580.45
|
| Rate for Payer: Wellcare Medicare |
$12,449.99
|
|
|
LOCKING BOLT RECLAIM CONICAL PROXIMAL BODY CEMENTLESS 20MM X 75MM 75MM 1975-20-075
|
Facility
|
IP
|
$29,411.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6151671
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14,411.39 |
| Max. Negotiated Rate |
$27,058.12 |
| Rate for Payer: Aetna Commercial |
$26,469.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25,293.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15,587.83
|
| Rate for Payer: Cash Price |
$8,823.30
|
| Rate for Payer: Cigna Commercial |
$27,058.12
|
| Rate for Payer: Health EOS Commercial |
$26,175.79
|
| Rate for Payer: HFN Commercial |
$27,058.12
|
| Rate for Payer: Multiplan Commercial |
$23,528.80
|
| Rate for Payer: NAPHCARE Commercial |
$17,646.60
|
| Rate for Payer: Preferred Network Access Commercial |
$27,058.12
|
| Rate for Payer: Quartz Beloit One Network |
$14,411.39
|
| Rate for Payer: Quartz Commercial |
$17,646.60
|
| Rate for Payer: WEA Trust Commercial |
$16,176.05
|
| Rate for Payer: WPS Commercial |
$21,784.73
|
|
|
LOCKING BOLT RECLAIM CONICAL PROXIMAL BODY CEMENTLESS 20MM X 75MM 75MM 1975-20-075
|
Facility
|
OP
|
$29,411.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6151671
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,235.08 |
| Max. Negotiated Rate |
$117,644.00 |
| Rate for Payer: Aetna Commercial |
$26,469.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25,293.46
|
| Rate for Payer: Aetna Managed Medicare |
$8,235.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,117.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,705.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14,117.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15,587.83
|
| Rate for Payer: Cash Price |
$8,823.30
|
| Rate for Payer: Cigna Commercial |
$27,058.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16,458.40
|
| Rate for Payer: Health EOS Commercial |
$26,175.79
|
| Rate for Payer: HFN Commercial |
$27,058.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22,058.25
|
| Rate for Payer: Multiplan Commercial |
$23,528.80
|
| Rate for Payer: NAPHCARE Commercial |
$17,646.60
|
| Rate for Payer: Preferred Network Access Commercial |
$27,058.12
|
| Rate for Payer: Quartz Beloit One Network |
$14,411.39
|
| Rate for Payer: Quartz Commercial |
$19,117.15
|
| Rate for Payer: Quartz Medicare Advantage |
$17,646.60
|
| Rate for Payer: The Alliance Commercial |
$117,644.00
|
| Rate for Payer: WEA Trust Commercial |
$16,176.05
|
| Rate for Payer: WPS Commercial |
$21,784.73
|
|
|
LOCKING DEVICE & BIOPSY CAP RX
|
Facility
|
OP
|
$234.00
|
|
| Hospital Charge Code |
2972332
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.52 |
| Max. Negotiated Rate |
$936.00 |
| Rate for Payer: Aetna Commercial |
$210.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$201.24
|
| Rate for Payer: Aetna Managed Medicare |
$65.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$152.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$117.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$112.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$124.02
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$215.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$130.95
|
| Rate for Payer: Health EOS Commercial |
$208.26
|
| Rate for Payer: HFN Commercial |
$215.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$175.50
|
| Rate for Payer: Multiplan Commercial |
$187.20
|
| Rate for Payer: NAPHCARE Commercial |
$140.40
|
| Rate for Payer: Preferred Network Access Commercial |
$215.28
|
| Rate for Payer: Quartz Beloit One Network |
$114.66
|
| Rate for Payer: Quartz Commercial |
$152.10
|
| Rate for Payer: Quartz Medicare Advantage |
$140.40
|
| Rate for Payer: The Alliance Commercial |
$936.00
|
| Rate for Payer: WEA Trust Commercial |
$128.70
|
| Rate for Payer: WPS Commercial |
$173.32
|
|
|
LOCKING DEVICE & BIOPSY CAP RX
|
Facility
|
IP
|
$234.00
|
|
| Hospital Charge Code |
2972332
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$114.66 |
| Max. Negotiated Rate |
$215.28 |
| Rate for Payer: Aetna Commercial |
$210.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$201.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$124.02
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$215.28
|
| Rate for Payer: Health EOS Commercial |
$208.26
|
| Rate for Payer: HFN Commercial |
$215.28
|
| Rate for Payer: Multiplan Commercial |
$187.20
|
| Rate for Payer: NAPHCARE Commercial |
$140.40
|
| Rate for Payer: Preferred Network Access Commercial |
$215.28
|
| Rate for Payer: Quartz Beloit One Network |
$114.66
|
| Rate for Payer: Quartz Commercial |
$140.40
|
| Rate for Payer: WEA Trust Commercial |
$128.70
|
| Rate for Payer: WPS Commercial |
$173.32
|
|
|
LOCKING SCREW GLENOSPHERE EQUINOXE REVERSE SHOULDER 320-15-05
|
Facility
|
OP
|
$1,137.89
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6240161
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$318.61 |
| Max. Negotiated Rate |
$4,551.56 |
| Rate for Payer: Aetna Commercial |
$1,024.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$978.59
|
| Rate for Payer: Aetna Managed Medicare |
$318.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$739.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$568.94
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$546.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$603.08
|
| Rate for Payer: Cash Price |
$341.37
|
| Rate for Payer: Cigna Commercial |
$1,046.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$636.76
|
| Rate for Payer: Health EOS Commercial |
$1,012.72
|
| Rate for Payer: HFN Commercial |
$1,046.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$853.42
|
| Rate for Payer: Multiplan Commercial |
$910.31
|
| Rate for Payer: NAPHCARE Commercial |
$682.73
|
| Rate for Payer: Preferred Network Access Commercial |
$1,046.86
|
| Rate for Payer: Quartz Beloit One Network |
$557.57
|
| Rate for Payer: Quartz Commercial |
$739.63
|
| Rate for Payer: Quartz Medicare Advantage |
$682.73
|
| Rate for Payer: The Alliance Commercial |
$4,551.56
|
| Rate for Payer: WEA Trust Commercial |
$625.84
|
| Rate for Payer: WPS Commercial |
$842.84
|
|
|
LOCKING SCREW GLENOSPHERE EQUINOXE REVERSE SHOULDER 320-15-05
|
Facility
|
IP
|
$1,137.89
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6240161
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$557.57 |
| Max. Negotiated Rate |
$1,046.86 |
| Rate for Payer: Aetna Commercial |
$1,024.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$978.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$603.08
|
| Rate for Payer: Cash Price |
$341.37
|
| Rate for Payer: Cigna Commercial |
$1,046.86
|
| Rate for Payer: Health EOS Commercial |
$1,012.72
|
| Rate for Payer: HFN Commercial |
$1,046.86
|
| Rate for Payer: Multiplan Commercial |
$910.31
|
| Rate for Payer: NAPHCARE Commercial |
$682.73
|
| Rate for Payer: Preferred Network Access Commercial |
$1,046.86
|
| Rate for Payer: Quartz Beloit One Network |
$557.57
|
| Rate for Payer: Quartz Commercial |
$682.73
|
| Rate for Payer: WEA Trust Commercial |
$625.84
|
| Rate for Payer: WPS Commercial |
$842.84
|
|
|
LOOP ELECTRICAL EXCISION PROCEDURE CERVIX CONIZATION (LEEP)/CERVIX, COLD CONIZATION
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2950462
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$531.16 |
| Max. Negotiated Rate |
$997.28 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$650.40
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
LOOP ELECTRICAL EXCISION PROCEDURE CERVIX CONIZATION (LEEP)/CERVIX, COLD CONIZATION
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2950462
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$303.52 |
| Max. Negotiated Rate |
$4,336.00 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Aetna Managed Medicare |
$303.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$704.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$542.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$520.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$606.61
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$813.00
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$704.60
|
| Rate for Payer: Quartz Medicare Advantage |
$650.40
|
| Rate for Payer: The Alliance Commercial |
$4,336.00
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
Loop Electrode Excision
|
Professional
|
Both
|
$1,485.00
|
|
|
Service Code
|
CPT 57522
|
| Hospital Charge Code |
1188889
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$232.61 |
| Max. Negotiated Rate |
$1,410.75 |
| Rate for Payer: Aetna Commercial |
$1,410.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,277.10
|
| Rate for Payer: Cash Price |
$445.50
|
| Rate for Payer: Cash Price |
$445.50
|
| Rate for Payer: Cash Price |
$445.50
|
| Rate for Payer: Cigna Commercial |
$1,410.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$232.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$891.00
|
| Rate for Payer: Health EOS Commercial |
$1,351.35
|
| Rate for Payer: HFN Commercial |
$1,410.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$847.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$847.16
|
| Rate for Payer: Multiplan Commercial |
$1,188.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,410.75
|
| Rate for Payer: Quartz Beloit One Network |
$653.40
|
| Rate for Payer: Quartz Commercial |
$846.45
|
| Rate for Payer: The Alliance Commercial |
$742.50
|
| Rate for Payer: United Healthcare Medicaid |
$232.61
|
| Rate for Payer: WEA Trust Commercial |
$816.75
|
| Rate for Payer: WPS Commercial |
$1,099.94
|
|
