|
Liver Kidney Microsome (LKM-1) Antibody, IgG
|
Facility
|
OP
|
$216.00
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
983305
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.13 |
| Max. Negotiated Rate |
$206.67 |
| Rate for Payer: Aetna Commercial |
$202.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$193.19
|
| Rate for Payer: Aetna Managed Medicare |
$15.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.12
|
| Rate for Payer: Anthem Medicare Advantage |
$15.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$119.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.13
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cigna Commercial |
$206.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$125.71
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.13
|
| Rate for Payer: Health EOS Commercial |
$199.93
|
| Rate for Payer: HFN Commercial |
$206.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.13
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.13
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.13
|
| Rate for Payer: Multiplan Commercial |
$179.71
|
| Rate for Payer: NAPHCARE Commercial |
$22.70
|
| Rate for Payer: Preferred Network Access Commercial |
$206.67
|
| Rate for Payer: Quartz Beloit One Network |
$110.07
|
| Rate for Payer: Quartz Commercial |
$146.02
|
| Rate for Payer: Quartz Medicare Advantage |
$15.13
|
| Rate for Payer: The Alliance Commercial |
$60.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.13
|
| Rate for Payer: United Healthcare PPO |
$168.48
|
| Rate for Payer: WEA Trust Commercial |
$123.55
|
| Rate for Payer: Wellcare Medicare |
$15.13
|
| Rate for Payer: WPS Commercial |
$166.38
|
|
|
LIVER RESECTION
|
Facility
|
IP
|
$4,460.00
|
|
| Hospital Charge Code |
2960206
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,272.82 |
| Max. Negotiated Rate |
$4,267.33 |
| Rate for Payer: Aetna Commercial |
$4,174.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,989.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,458.35
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,267.33
|
| Rate for Payer: Health EOS Commercial |
$4,128.18
|
| Rate for Payer: HFN Commercial |
$4,267.33
|
| Rate for Payer: Multiplan Commercial |
$3,710.72
|
| Rate for Payer: Preferred Network Access Commercial |
$4,267.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,272.82
|
| Rate for Payer: Quartz Commercial |
$2,783.04
|
| Rate for Payer: WEA Trust Commercial |
$2,551.12
|
| Rate for Payer: WPS Commercial |
$3,435.54
|
|
|
LIVER RESECTION
|
Facility
|
OP
|
$4,460.00
|
|
| Hospital Charge Code |
2960206
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,298.75 |
| Max. Negotiated Rate |
$4,267.33 |
| Rate for Payer: Aetna Commercial |
$4,174.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,989.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,298.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,014.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,319.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,226.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,458.35
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,267.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,595.72
|
| Rate for Payer: Health EOS Commercial |
$4,128.18
|
| Rate for Payer: HFN Commercial |
$4,267.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,478.80
|
| Rate for Payer: Multiplan Commercial |
$3,710.72
|
| Rate for Payer: NAPHCARE Commercial |
$2,783.04
|
| Rate for Payer: Preferred Network Access Commercial |
$4,267.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,272.82
|
| Rate for Payer: Quartz Commercial |
$3,014.96
|
| Rate for Payer: Quartz Medicare Advantage |
$2,783.04
|
| Rate for Payer: The Alliance Commercial |
$2,319.20
|
| Rate for Payer: WEA Trust Commercial |
$2,551.12
|
| Rate for Payer: WPS Commercial |
$3,435.54
|
|
|
LIVER TRANSPLANT AND/OR INTESTINAL TRANSPLANT
|
Facility
|
IP
|
$80,142.35
|
|
|
Service Code
|
APR-DRG 0013
|
| Min. Negotiated Rate |
$71,187.44 |
| Max. Negotiated Rate |
$80,142.35 |
| Rate for Payer: Anthem Medicaid |
$76,740.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$76,740.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$76,740.72
|
| Rate for Payer: Dean Health Medicaid |
$76,740.72
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$71,187.44
|
| Rate for Payer: Managed Health Services Medicaid |
$80,142.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$76,740.72
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$76,740.72
|
| Rate for Payer: United Healthcare Medicaid |
$76,740.72
|
|
|
LIVER TRANSPLANT AND/OR INTESTINAL TRANSPLANT
|
Facility
|
IP
|
$54,363.52
|
|
|
Service Code
|
APR-DRG 0011
|
| Min. Negotiated Rate |
$48,289.07 |
| Max. Negotiated Rate |
$54,363.52 |
| Rate for Payer: Anthem Medicaid |
$52,056.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$52,056.07
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$52,056.07
|
| Rate for Payer: Dean Health Medicaid |
$52,056.07
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$48,289.07
|
| Rate for Payer: Managed Health Services Medicaid |
$54,363.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$52,056.07
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$52,056.07
|
| Rate for Payer: United Healthcare Medicaid |
$52,056.07
|
|
|
LIVER TRANSPLANT AND/OR INTESTINAL TRANSPLANT
|
Facility
|
IP
|
$154,322.26
|
|
|
Service Code
|
APR-DRG 0014
|
| Min. Negotiated Rate |
$137,078.66 |
| Max. Negotiated Rate |
$154,322.26 |
| Rate for Payer: Anthem Medicaid |
$147,772.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$147,772.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$147,772.06
|
| Rate for Payer: Dean Health Medicaid |
$147,772.06
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$137,078.66
|
| Rate for Payer: Managed Health Services Medicaid |
$154,322.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$147,772.06
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$147,772.06
|
| Rate for Payer: United Healthcare Medicaid |
$147,772.06
|
|
|
LIVER TRANSPLANT AND/OR INTESTINAL TRANSPLANT
|
Facility
|
IP
|
$61,904.27
|
|
|
Service Code
|
APR-DRG 0012
|
| Min. Negotiated Rate |
$54,987.23 |
| Max. Negotiated Rate |
$61,904.27 |
| Rate for Payer: Anthem Medicaid |
$59,276.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$59,276.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$59,276.75
|
| Rate for Payer: Dean Health Medicaid |
$59,276.75
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$54,987.23
|
| Rate for Payer: Managed Health Services Medicaid |
$61,904.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$59,276.75
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$59,276.75
|
| Rate for Payer: United Healthcare Medicaid |
$59,276.75
|
|
|
LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT
|
Facility
|
IP
|
$286,504.40
|
|
|
Service Code
|
MSDRG 005
|
| Min. Negotiated Rate |
$79,466.61 |
| Max. Negotiated Rate |
$286,504.40 |
| Rate for Payer: Aetna Managed Medicare |
$79,466.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$224,966.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$172,435.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$163,824.77
|
| Rate for Payer: Anthem Medicare Advantage |
$79,466.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$79,466.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$79,466.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$79,466.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$181,860.52
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$79,466.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$79,466.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$79,466.61
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$79,466.61
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$79,466.61
|
| Rate for Payer: NAPHCARE Commercial |
$119,199.91
|
| Rate for Payer: Quartz Medicare Advantage |
$79,466.61
|
| Rate for Payer: The Alliance Commercial |
$286,504.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$79,466.61
|
| Rate for Payer: Wellcare Medicare |
$79,466.61
|
|
|
LIVER TRANSPLANT WITHOUT MCC
|
Facility
|
IP
|
$134,070.56
|
|
|
Service Code
|
MSDRG 006
|
| Min. Negotiated Rate |
$36,017.84 |
| Max. Negotiated Rate |
$134,070.56 |
| Rate for Payer: Aetna Managed Medicare |
$36,017.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$101,175.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$77,550.30
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$73,677.85
|
| Rate for Payer: Anthem Medicare Advantage |
$36,017.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36,017.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36,017.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$36,017.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$81,789.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$36,017.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$36,017.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36,017.84
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$36,017.84
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$36,017.84
|
| Rate for Payer: NAPHCARE Commercial |
$54,026.76
|
| Rate for Payer: Quartz Medicare Advantage |
$36,017.84
|
| Rate for Payer: The Alliance Commercial |
$134,070.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36,017.84
|
| Rate for Payer: Wellcare Medicare |
$36,017.84
|
|
|
LLE Additional Markers
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
2942939
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$90.20 |
| Max. Negotiated Rate |
$169.35 |
| Rate for Payer: Aetna Commercial |
$165.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$158.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$97.56
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna Commercial |
$169.35
|
| Rate for Payer: Health EOS Commercial |
$163.83
|
| Rate for Payer: HFN Commercial |
$169.35
|
| Rate for Payer: Multiplan Commercial |
$147.26
|
| Rate for Payer: Preferred Network Access Commercial |
$169.35
|
| Rate for Payer: Quartz Beloit One Network |
$90.20
|
| Rate for Payer: Quartz Commercial |
$110.45
|
| Rate for Payer: WEA Trust Commercial |
$101.24
|
| Rate for Payer: WPS Commercial |
$136.34
|
|
|
LLE Additional Markers
|
Professional
|
Both
|
$177.00
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
2942939
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.96 |
| Max. Negotiated Rate |
$174.88 |
| Rate for Payer: Aetna Commercial |
$174.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$158.31
|
| Rate for Payer: Aetna Managed Medicare |
$22.96
|
| Rate for Payer: Anthem Medicare Advantage |
$22.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22.96
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna Commercial |
$174.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$92.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22.96
|
| Rate for Payer: Health EOS Commercial |
$167.51
|
| Rate for Payer: HFN Commercial |
$174.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$79.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$79.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22.96
|
| Rate for Payer: Multiplan Commercial |
$147.26
|
| Rate for Payer: NAPHCARE Commercial |
$34.44
|
| Rate for Payer: Preferred Network Access Commercial |
$174.88
|
| Rate for Payer: Quartz Beloit One Network |
$81.00
|
| Rate for Payer: Quartz Commercial |
$104.93
|
| Rate for Payer: Quartz Medicare Advantage |
$22.96
|
| Rate for Payer: The Alliance Commercial |
$90.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.96
|
| Rate for Payer: WEA Trust Commercial |
$101.24
|
| Rate for Payer: WPS Commercial |
$101.04
|
|
|
LLE Additional Markers
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
2942939
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.54 |
| Max. Negotiated Rate |
$169.35 |
| Rate for Payer: Aetna Commercial |
$165.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$158.31
|
| Rate for Payer: Aetna Managed Medicare |
$51.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$119.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$92.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$88.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$97.56
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna Commercial |
$169.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$103.01
|
| Rate for Payer: Health EOS Commercial |
$163.83
|
| Rate for Payer: HFN Commercial |
$169.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$138.06
|
| Rate for Payer: Multiplan Commercial |
$147.26
|
| Rate for Payer: NAPHCARE Commercial |
$110.45
|
| Rate for Payer: Preferred Network Access Commercial |
$169.35
|
| Rate for Payer: Quartz Beloit One Network |
$90.20
|
| Rate for Payer: Quartz Commercial |
$119.65
|
| Rate for Payer: Quartz Medicare Advantage |
$110.45
|
| Rate for Payer: The Alliance Commercial |
$91.85
|
| Rate for Payer: United Healthcare PPO |
$138.06
|
| Rate for Payer: WEA Trust Commercial |
$101.24
|
| Rate for Payer: WPS Commercial |
$136.34
|
|
|
LLE Markers
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
2942938
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$72.36 |
| Max. Negotiated Rate |
$1,508.92 |
| Rate for Payer: Aetna Commercial |
$132.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$127.00
|
| Rate for Payer: Aetna Managed Medicare |
$377.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,385.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$646.61
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$613.36
|
| Rate for Payer: Anthem Medicare Advantage |
$377.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$78.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$377.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$377.23
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cigna Commercial |
$135.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$377.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$82.64
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$377.23
|
| Rate for Payer: Health EOS Commercial |
$131.44
|
| Rate for Payer: HFN Commercial |
$135.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,403.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$377.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$377.23
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$377.23
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$377.23
|
| Rate for Payer: Multiplan Commercial |
$118.14
|
| Rate for Payer: NAPHCARE Commercial |
$565.84
|
| Rate for Payer: Preferred Network Access Commercial |
$135.87
|
| Rate for Payer: Quartz Beloit One Network |
$72.36
|
| Rate for Payer: Quartz Commercial |
$95.99
|
| Rate for Payer: Quartz Medicare Advantage |
$377.23
|
| Rate for Payer: The Alliance Commercial |
$1,508.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$377.23
|
| Rate for Payer: United Healthcare PPO |
$110.76
|
| Rate for Payer: WEA Trust Commercial |
$81.22
|
| Rate for Payer: Wellcare Medicare |
$377.23
|
| Rate for Payer: WPS Commercial |
$109.38
|
|
|
LLE Markers
|
Professional
|
Both
|
$142.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
2942938
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.98 |
| Max. Negotiated Rate |
$353.82 |
| Rate for Payer: Aetna Commercial |
$140.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$127.00
|
| Rate for Payer: Aetna Managed Medicare |
$80.41
|
| Rate for Payer: Anthem Medicare Advantage |
$80.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$80.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$80.41
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cigna Commercial |
$140.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$73.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$80.41
|
| Rate for Payer: Health EOS Commercial |
$134.39
|
| Rate for Payer: HFN Commercial |
$140.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$239.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$239.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$80.41
|
| Rate for Payer: Multiplan Commercial |
$118.14
|
| Rate for Payer: NAPHCARE Commercial |
$120.62
|
| Rate for Payer: Preferred Network Access Commercial |
$140.30
|
| Rate for Payer: Quartz Beloit One Network |
$64.98
|
| Rate for Payer: Quartz Commercial |
$84.18
|
| Rate for Payer: Quartz Medicare Advantage |
$80.41
|
| Rate for Payer: The Alliance Commercial |
$317.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$80.41
|
| Rate for Payer: WEA Trust Commercial |
$81.22
|
| Rate for Payer: WPS Commercial |
$353.82
|
|
|
LLE Markers
|
Facility
|
IP
|
$142.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
2942938
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$72.36 |
| Max. Negotiated Rate |
$135.87 |
| Rate for Payer: Aetna Commercial |
$132.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$127.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$78.27
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cigna Commercial |
$135.87
|
| Rate for Payer: Health EOS Commercial |
$131.44
|
| Rate for Payer: HFN Commercial |
$135.87
|
| Rate for Payer: Multiplan Commercial |
$118.14
|
| Rate for Payer: Preferred Network Access Commercial |
$135.87
|
| Rate for Payer: Quartz Beloit One Network |
$72.36
|
| Rate for Payer: Quartz Commercial |
$88.61
|
| Rate for Payer: WEA Trust Commercial |
$81.22
|
| Rate for Payer: WPS Commercial |
$109.38
|
|
|
LOANER ARTHREX INSTRUMENT SET 992
|
Facility
|
OP
|
$2,931.00
|
|
| Hospital Charge Code |
5306688
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$853.51 |
| Max. Negotiated Rate |
$2,804.38 |
| Rate for Payer: Aetna Commercial |
$2,743.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,621.49
|
| Rate for Payer: Aetna Managed Medicare |
$853.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,981.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,524.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,463.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,615.57
|
| Rate for Payer: Cash Price |
$879.30
|
| Rate for Payer: Cigna Commercial |
$2,804.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,705.84
|
| Rate for Payer: Health EOS Commercial |
$2,712.93
|
| Rate for Payer: HFN Commercial |
$2,804.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,286.18
|
| Rate for Payer: Multiplan Commercial |
$2,438.59
|
| Rate for Payer: NAPHCARE Commercial |
$1,828.94
|
| Rate for Payer: Preferred Network Access Commercial |
$2,804.38
|
| Rate for Payer: Quartz Beloit One Network |
$1,493.64
|
| Rate for Payer: Quartz Commercial |
$1,981.36
|
| Rate for Payer: Quartz Medicare Advantage |
$1,828.94
|
| Rate for Payer: The Alliance Commercial |
$1,524.12
|
| Rate for Payer: WEA Trust Commercial |
$1,676.53
|
| Rate for Payer: WPS Commercial |
$2,257.75
|
|
|
LOANER ARTHREX INSTRUMENT SET 992
|
Facility
|
IP
|
$2,931.00
|
|
| Hospital Charge Code |
5306688
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1,493.64 |
| Max. Negotiated Rate |
$2,804.38 |
| Rate for Payer: Aetna Commercial |
$2,743.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,621.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,615.57
|
| Rate for Payer: Cash Price |
$879.30
|
| Rate for Payer: Cigna Commercial |
$2,804.38
|
| Rate for Payer: Health EOS Commercial |
$2,712.93
|
| Rate for Payer: HFN Commercial |
$2,804.38
|
| Rate for Payer: Multiplan Commercial |
$2,438.59
|
| Rate for Payer: Preferred Network Access Commercial |
$2,804.38
|
| Rate for Payer: Quartz Beloit One Network |
$1,493.64
|
| Rate for Payer: Quartz Commercial |
$1,828.94
|
| Rate for Payer: WEA Trust Commercial |
$1,676.53
|
| Rate for Payer: WPS Commercial |
$2,257.75
|
|
|
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC
|
Facility
|
IP
|
$55,286.40
|
|
|
Service Code
|
MSDRG 496
|
| Min. Negotiated Rate |
$14,321.40 |
| Max. Negotiated Rate |
$55,286.40 |
| Rate for Payer: Aetna Managed Medicare |
$14,321.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39,359.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30,168.86
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28,662.38
|
| Rate for Payer: Anthem Medicare Advantage |
$14,321.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14,321.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14,321.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14,321.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31,817.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14,321.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40,306.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14,321.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14,321.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14,321.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14,321.40
|
| Rate for Payer: NAPHCARE Commercial |
$21,482.10
|
| Rate for Payer: Quartz Medicare Advantage |
$14,321.40
|
| Rate for Payer: The Alliance Commercial |
$55,286.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14,321.40
|
| Rate for Payer: United Healthcare PPO |
$31,379.13
|
| Rate for Payer: Wellcare Medicare |
$14,321.40
|
|
|
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH MCC
|
Facility
|
IP
|
$99,351.20
|
|
|
Service Code
|
MSDRG 495
|
| Min. Negotiated Rate |
$28,273.12 |
| Max. Negotiated Rate |
$99,351.20 |
| Rate for Payer: Aetna Managed Medicare |
$28,273.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$79,109.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$60,637.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$57,609.18
|
| Rate for Payer: Anthem Medicare Advantage |
$28,273.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28,273.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28,273.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$28,273.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63,951.47
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$28,273.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72,626.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$28,273.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28,273.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$28,273.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$28,273.12
|
| Rate for Payer: NAPHCARE Commercial |
$42,409.68
|
| Rate for Payer: Quartz Medicare Advantage |
$28,273.12
|
| Rate for Payer: The Alliance Commercial |
$99,351.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28,273.12
|
| Rate for Payer: United Healthcare PPO |
$56,540.85
|
| Rate for Payer: Wellcare Medicare |
$28,273.12
|
|
|
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC/MCC
|
Facility
|
IP
|
$39,799.76
|
|
|
Service Code
|
MSDRG 497
|
| Min. Negotiated Rate |
$9,760.18 |
| Max. Negotiated Rate |
$39,799.76 |
| Rate for Payer: Aetna Managed Medicare |
$9,760.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25,129.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,261.31
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18,299.50
|
| Rate for Payer: Anthem Medicare Advantage |
$9,760.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,760.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,760.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,760.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20,314.12
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,760.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28,947.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,760.18
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9,760.18
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9,760.18
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,760.18
|
| Rate for Payer: NAPHCARE Commercial |
$14,640.27
|
| Rate for Payer: Quartz Medicare Advantage |
$9,760.18
|
| Rate for Payer: The Alliance Commercial |
$39,799.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,760.18
|
| Rate for Payer: United Healthcare PPO |
$22,536.13
|
| Rate for Payer: Wellcare Medicare |
$9,760.18
|
|
|
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CC/MCC
|
Facility
|
IP
|
$72,525.44
|
|
|
Service Code
|
MSDRG 498
|
| Min. Negotiated Rate |
$23,610.03 |
| Max. Negotiated Rate |
$72,525.44 |
| Rate for Payer: Aetna Managed Medicare |
$23,610.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$65,824.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$50,453.69
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$47,934.30
|
| Rate for Payer: Anthem Medicare Advantage |
$23,610.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23,610.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23,610.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$23,610.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$53,211.46
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$23,610.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$52,951.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$23,610.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23,610.03
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$23,610.03
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$23,610.03
|
| Rate for Payer: NAPHCARE Commercial |
$35,415.04
|
| Rate for Payer: Quartz Medicare Advantage |
$23,610.03
|
| Rate for Payer: The Alliance Commercial |
$72,525.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23,610.03
|
| Rate for Payer: United Healthcare PPO |
$41,223.09
|
| Rate for Payer: Wellcare Medicare |
$23,610.03
|
|
|
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT CC/MCC
|
Facility
|
IP
|
$43,961.32
|
|
|
Service Code
|
MSDRG 499
|
| Min. Negotiated Rate |
$15,936.52 |
| Max. Negotiated Rate |
$43,961.32 |
| Rate for Payer: Aetna Managed Medicare |
$15,936.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$43,961.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33,696.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32,013.40
|
| Rate for Payer: Anthem Medicare Advantage |
$15,936.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15,936.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15,936.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15,936.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35,537.81
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15,936.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26,157.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15,936.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15,936.52
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15,936.52
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15,936.52
|
| Rate for Payer: NAPHCARE Commercial |
$23,904.78
|
| Rate for Payer: Quartz Medicare Advantage |
$15,936.52
|
| Rate for Payer: The Alliance Commercial |
$35,995.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15,936.52
|
| Rate for Payer: United Healthcare PPO |
$20,363.67
|
| Rate for Payer: Wellcare Medicare |
$15,936.52
|
|
|
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 |
$14,987.85 |
| Max. Negotiated Rate |
$28,140.44 |
| Rate for Payer: Aetna Commercial |
$27,528.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26,305.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16,211.34
|
| Rate for Payer: Cash Price |
$8,823.30
|
| Rate for Payer: Cigna Commercial |
$28,140.44
|
| Rate for Payer: Health EOS Commercial |
$27,222.82
|
| Rate for Payer: HFN Commercial |
$28,140.44
|
| Rate for Payer: Multiplan Commercial |
$24,469.95
|
| Rate for Payer: Preferred Network Access Commercial |
$28,140.44
|
| Rate for Payer: Quartz Beloit One Network |
$14,987.85
|
| Rate for Payer: Quartz Commercial |
$18,352.46
|
| Rate for Payer: WEA Trust Commercial |
$16,823.09
|
| Rate for Payer: WPS Commercial |
$22,655.29
|
|
|
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 |
$8,564.48 |
| Max. Negotiated Rate |
$28,140.44 |
| Rate for Payer: Aetna Commercial |
$27,528.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26,305.20
|
| Rate for Payer: Aetna Managed Medicare |
$8,564.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,881.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15,293.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14,681.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16,211.34
|
| Rate for Payer: Cash Price |
$8,823.30
|
| Rate for Payer: Cigna Commercial |
$28,140.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17,117.20
|
| Rate for Payer: Health EOS Commercial |
$27,222.82
|
| Rate for Payer: HFN Commercial |
$28,140.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22,940.58
|
| Rate for Payer: Multiplan Commercial |
$24,469.95
|
| Rate for Payer: NAPHCARE Commercial |
$18,352.46
|
| Rate for Payer: Preferred Network Access Commercial |
$28,140.44
|
| Rate for Payer: Quartz Beloit One Network |
$14,987.85
|
| Rate for Payer: Quartz Commercial |
$19,881.84
|
| Rate for Payer: Quartz Medicare Advantage |
$18,352.46
|
| Rate for Payer: The Alliance Commercial |
$15,293.72
|
| Rate for Payer: WEA Trust Commercial |
$16,823.09
|
| Rate for Payer: WPS Commercial |
$22,655.29
|
|
|
LOCKING DEVICE & BIOPSY CAP RX
|
Facility
|
OP
|
$234.00
|
|
| Hospital Charge Code |
2972332
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.14 |
| Max. Negotiated Rate |
$223.89 |
| Rate for Payer: Aetna Commercial |
$219.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$209.29
|
| Rate for Payer: Aetna Managed Medicare |
$68.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$158.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$121.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$116.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$128.98
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$223.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$136.19
|
| Rate for Payer: Health EOS Commercial |
$216.59
|
| Rate for Payer: HFN Commercial |
$223.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$182.52
|
| Rate for Payer: Multiplan Commercial |
$194.69
|
| Rate for Payer: NAPHCARE Commercial |
$146.02
|
| Rate for Payer: Preferred Network Access Commercial |
$223.89
|
| Rate for Payer: Quartz Beloit One Network |
$119.25
|
| Rate for Payer: Quartz Commercial |
$158.18
|
| Rate for Payer: Quartz Medicare Advantage |
$146.02
|
| Rate for Payer: The Alliance Commercial |
$121.68
|
| Rate for Payer: WEA Trust Commercial |
$133.85
|
| Rate for Payer: WPS Commercial |
$180.25
|
|
