|
REPAIR OF HAMMERTOE 28286
|
Professional
|
Both
|
$1,884.00
|
|
|
Service Code
|
CPT 28286
|
| Hospital Charge Code |
3014230
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$235.04 |
| Max. Negotiated Rate |
$1,861.39 |
| Rate for Payer: Aetna Commercial |
$1,861.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,685.05
|
| Rate for Payer: Aetna Managed Medicare |
$274.52
|
| Rate for Payer: Anthem Medicare Advantage |
$274.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$274.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$274.52
|
| Rate for Payer: Cash Price |
$565.20
|
| Rate for Payer: Cash Price |
$565.20
|
| Rate for Payer: Cash Price |
$565.20
|
| Rate for Payer: Cigna Commercial |
$1,861.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$235.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$274.52
|
| Rate for Payer: Health EOS Commercial |
$1,783.02
|
| Rate for Payer: HFN Commercial |
$1,861.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,043.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,043.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$274.52
|
| Rate for Payer: Multiplan Commercial |
$1,567.49
|
| Rate for Payer: NAPHCARE Commercial |
$411.78
|
| Rate for Payer: Preferred Network Access Commercial |
$1,861.39
|
| Rate for Payer: Quartz Beloit One Network |
$862.12
|
| Rate for Payer: Quartz Commercial |
$1,116.84
|
| Rate for Payer: Quartz Medicare Advantage |
$274.52
|
| Rate for Payer: The Alliance Commercial |
$1,166.70
|
| Rate for Payer: United Healthcare Medicaid |
$235.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$274.52
|
| Rate for Payer: WEA Trust Commercial |
$1,077.65
|
| Rate for Payer: WPS Commercial |
$1,235.33
|
|
|
REPAIR OF METATARSALS 28322
|
Professional
|
Both
|
$1,638.00
|
|
|
Service Code
|
CPT 28322
|
| Hospital Charge Code |
3014244
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$391.73 |
| Max. Negotiated Rate |
$2,344.49 |
| Rate for Payer: Aetna Commercial |
$1,618.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,465.03
|
| Rate for Payer: Aetna Managed Medicare |
$521.00
|
| Rate for Payer: Anthem Medicare Advantage |
$521.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$521.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$521.00
|
| Rate for Payer: Cash Price |
$491.40
|
| Rate for Payer: Cash Price |
$491.40
|
| Rate for Payer: Cash Price |
$491.40
|
| Rate for Payer: Cigna Commercial |
$1,618.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$391.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$521.00
|
| Rate for Payer: Health EOS Commercial |
$1,550.20
|
| Rate for Payer: HFN Commercial |
$1,618.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,002.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,002.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$521.00
|
| Rate for Payer: Multiplan Commercial |
$1,362.82
|
| Rate for Payer: NAPHCARE Commercial |
$781.50
|
| Rate for Payer: Preferred Network Access Commercial |
$1,618.34
|
| Rate for Payer: Quartz Beloit One Network |
$749.55
|
| Rate for Payer: Quartz Commercial |
$971.01
|
| Rate for Payer: Quartz Medicare Advantage |
$521.00
|
| Rate for Payer: The Alliance Commercial |
$2,214.24
|
| Rate for Payer: United Healthcare Medicaid |
$391.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$521.00
|
| Rate for Payer: WEA Trust Commercial |
$936.94
|
| Rate for Payer: WPS Commercial |
$2,344.49
|
|
|
REPAIR OF NAIL BED 11760
|
Professional
|
Both
|
$770.00
|
|
|
Service Code
|
CPT 11760
|
| Hospital Charge Code |
3013573
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$43.54 |
| Max. Negotiated Rate |
$760.76 |
| Rate for Payer: Aetna Commercial |
$760.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$688.69
|
| Rate for Payer: Aetna Managed Medicare |
$101.52
|
| Rate for Payer: Anthem Medicare Advantage |
$101.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$101.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$101.52
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cigna Commercial |
$760.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$43.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$101.52
|
| Rate for Payer: Health EOS Commercial |
$728.73
|
| Rate for Payer: HFN Commercial |
$760.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$395.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$395.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$101.52
|
| Rate for Payer: Multiplan Commercial |
$640.64
|
| Rate for Payer: NAPHCARE Commercial |
$152.29
|
| Rate for Payer: Preferred Network Access Commercial |
$760.76
|
| Rate for Payer: Quartz Beloit One Network |
$352.35
|
| Rate for Payer: Quartz Commercial |
$456.46
|
| Rate for Payer: Quartz Medicare Advantage |
$101.52
|
| Rate for Payer: The Alliance Commercial |
$431.48
|
| Rate for Payer: United Healthcare Medicaid |
$43.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$101.52
|
| Rate for Payer: WEA Trust Commercial |
$440.44
|
| Rate for Payer: WPS Commercial |
$456.86
|
|
|
REPAIR OF NASAL VESTIBULAR STENOSIS (EG, SPREADER GRAFTING, LATERAL NASAL WALL RECONSTRUCTION)
|
Facility
|
OP
|
$24,919.86
|
|
|
Service Code
|
CPT 30465
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,409.60 |
| Max. Negotiated Rate |
$24,919.86 |
| Rate for Payer: Aetna Managed Medicare |
$6,229.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,727.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,350.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,781.68
|
| Rate for Payer: Anthem Medicare Advantage |
$6,229.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,229.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,229.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,229.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,107.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,229.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23,175.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,229.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,229.96
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,229.96
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,229.96
|
| Rate for Payer: NAPHCARE Commercial |
$9,344.95
|
| Rate for Payer: Quartz Medicare Advantage |
$6,229.96
|
| Rate for Payer: The Alliance Commercial |
$24,919.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,229.96
|
| Rate for Payer: United Healthcare PPO |
$4,409.60
|
| Rate for Payer: Wellcare Medicare |
$6,229.96
|
|
|
REPAIR OF NONUNION OR MALUNION, HUMERUS; WITHOUT GRAFT (EG, COMPRESSION TECHNIQUE)
|
Facility
|
OP
|
$54,045.18
|
|
|
Service Code
|
CPT 24430
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,807.99 |
| Max. Negotiated Rate |
$54,045.18 |
| Rate for Payer: Aetna Managed Medicare |
$13,511.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,394.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,394.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,919.20
|
| Rate for Payer: Anthem Medicare Advantage |
$13,511.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,511.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,511.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,511.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,511.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50,262.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,511.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,511.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,511.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,511.30
|
| Rate for Payer: NAPHCARE Commercial |
$20,266.94
|
| Rate for Payer: Quartz Medicare Advantage |
$13,511.30
|
| Rate for Payer: The Alliance Commercial |
$54,045.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,511.30
|
| Rate for Payer: United Healthcare PPO |
$9,979.84
|
| Rate for Payer: Wellcare Medicare |
$13,511.30
|
|
|
REPAIR OF RUPTURED MUSCULOTENDINOUS CUFF (EG, ROTATOR CUFF) OPEN; CHRONIC
|
Facility
|
OP
|
$30,545.47
|
|
|
Service Code
|
CPT 23412
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,636.37 |
| Max. Negotiated Rate |
$30,545.47 |
| Rate for Payer: Aetna Managed Medicare |
$7,636.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,182.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,724.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,889.12
|
| Rate for Payer: Anthem Medicare Advantage |
$7,636.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,636.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,636.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,636.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,105.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,636.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28,407.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,636.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,636.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,636.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,636.37
|
| Rate for Payer: NAPHCARE Commercial |
$11,454.55
|
| Rate for Payer: Quartz Medicare Advantage |
$7,636.37
|
| Rate for Payer: The Alliance Commercial |
$30,545.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,636.37
|
| Rate for Payer: United Healthcare PPO |
$8,790.08
|
| Rate for Payer: Wellcare Medicare |
$7,636.37
|
|
|
Repair of Wound or Lesion 1315150
|
Professional
|
Both
|
$2,126.00
|
|
|
Service Code
|
CPT 13151
|
| Hospital Charge Code |
5382835
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$215.13 |
| Max. Negotiated Rate |
$2,100.49 |
| Rate for Payer: Aetna Commercial |
$2,100.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,901.49
|
| Rate for Payer: Aetna Managed Medicare |
$227.17
|
| Rate for Payer: Anthem Medicare Advantage |
$227.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$227.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$227.17
|
| Rate for Payer: Cash Price |
$637.80
|
| Rate for Payer: Cash Price |
$637.80
|
| Rate for Payer: Cash Price |
$637.80
|
| Rate for Payer: Cigna Commercial |
$2,100.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$215.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$227.17
|
| Rate for Payer: Health EOS Commercial |
$2,012.05
|
| Rate for Payer: HFN Commercial |
$2,100.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$968.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$968.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$227.17
|
| Rate for Payer: Multiplan Commercial |
$1,768.83
|
| Rate for Payer: NAPHCARE Commercial |
$340.75
|
| Rate for Payer: Preferred Network Access Commercial |
$2,100.49
|
| Rate for Payer: Quartz Beloit One Network |
$972.86
|
| Rate for Payer: Quartz Commercial |
$1,260.29
|
| Rate for Payer: Quartz Medicare Advantage |
$227.17
|
| Rate for Payer: The Alliance Commercial |
$965.46
|
| Rate for Payer: United Healthcare Medicaid |
$215.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.17
|
| Rate for Payer: WEA Trust Commercial |
$1,216.07
|
| Rate for Payer: WPS Commercial |
$1,022.25
|
|
|
REPAIR, PRIMARY, DISRUPTED LIGAMENT, ANKLE; COLLATERAL
|
Facility
|
OP
|
$30,545.47
|
|
|
Service Code
|
CPT 27695
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,947.89 |
| Max. Negotiated Rate |
$30,545.47 |
| Rate for Payer: Aetna Managed Medicare |
$7,636.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,182.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,724.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,889.12
|
| Rate for Payer: Anthem Medicare Advantage |
$7,636.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,636.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,636.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,636.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,636.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28,407.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,636.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,636.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,636.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,636.37
|
| Rate for Payer: NAPHCARE Commercial |
$11,454.55
|
| Rate for Payer: Quartz Medicare Advantage |
$7,636.37
|
| Rate for Payer: The Alliance Commercial |
$30,545.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,636.37
|
| Rate for Payer: United Healthcare PPO |
$8,790.08
|
| Rate for Payer: Wellcare Medicare |
$7,636.37
|
|
|
REPAIR, PRIMARY, OPEN OR PERCUTANEOUS, RUPTURED ACHILLES TENDON;
|
Facility
|
OP
|
$30,545.47
|
|
|
Service Code
|
CPT 27650
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,267.12 |
| Max. Negotiated Rate |
$30,545.47 |
| Rate for Payer: Aetna Managed Medicare |
$7,636.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$7,636.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,636.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,636.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,636.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,636.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28,407.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,636.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,636.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,636.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,636.37
|
| Rate for Payer: NAPHCARE Commercial |
$11,454.55
|
| Rate for Payer: Quartz Medicare Advantage |
$7,636.37
|
| Rate for Payer: The Alliance Commercial |
$30,545.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,636.37
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$7,636.37
|
|
|
REPAIR, PRIMARY, TORN LIGAMENT AND/OR CAPSULE, KNEE; CRUCIATE
|
Facility
|
OP
|
$30,545.47
|
|
|
Service Code
|
CPT 27407
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,636.37 |
| Max. Negotiated Rate |
$30,545.47 |
| Rate for Payer: Aetna Managed Medicare |
$7,636.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,182.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,724.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,889.12
|
| Rate for Payer: Anthem Medicare Advantage |
$7,636.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,636.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,636.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,636.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,107.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,636.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28,407.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,636.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,636.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,636.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,636.37
|
| Rate for Payer: NAPHCARE Commercial |
$11,454.55
|
| Rate for Payer: Quartz Medicare Advantage |
$7,636.37
|
| Rate for Payer: The Alliance Commercial |
$30,545.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,636.37
|
| Rate for Payer: United Healthcare PPO |
$8,790.08
|
| Rate for Payer: Wellcare Medicare |
$7,636.37
|
|
|
REPAIR RECURRENT INGUINAL HERNIA, ANY AGE; INCARCERATED OR STRANGULATED
|
Facility
|
OP
|
$27,251.91
|
|
|
Service Code
|
CPT 49521
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,267.12 |
| Max. Negotiated Rate |
$27,251.91 |
| Rate for Payer: Aetna Managed Medicare |
$6,812.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$6,812.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,812.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,812.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,812.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,105.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,812.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25,344.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,812.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,812.98
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,812.98
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,812.98
|
| Rate for Payer: NAPHCARE Commercial |
$10,219.47
|
| Rate for Payer: Quartz Medicare Advantage |
$6,812.98
|
| Rate for Payer: The Alliance Commercial |
$27,251.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,812.98
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$6,812.98
|
|
|
REPAIR RECURRENT INGUINAL HERNIA, ANY AGE; REDUCIBLE
|
Facility
|
OP
|
$15,071.89
|
|
|
Service Code
|
CPT 49520
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,767.97 |
| Max. Negotiated Rate |
$15,071.89 |
| Rate for Payer: Aetna Managed Medicare |
$3,767.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,767.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,767.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,767.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,767.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,105.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,767.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,016.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,767.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,767.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,767.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,767.97
|
| Rate for Payer: NAPHCARE Commercial |
$5,651.96
|
| Rate for Payer: Quartz Medicare Advantage |
$3,767.97
|
| Rate for Payer: The Alliance Commercial |
$15,071.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,767.97
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$3,767.97
|
|
|
REPAIR, SECONDARY, ACHILLES TENDON, WITH OR WITHOUT GRAFT
|
Facility
|
OP
|
$30,545.47
|
|
|
Service Code
|
CPT 27654
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,807.99 |
| Max. Negotiated Rate |
$30,545.47 |
| Rate for Payer: Aetna Managed Medicare |
$7,636.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,182.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,724.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,889.12
|
| Rate for Payer: Anthem Medicare Advantage |
$7,636.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,636.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,636.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,636.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,636.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28,407.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,636.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,636.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,636.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,636.37
|
| Rate for Payer: NAPHCARE Commercial |
$11,454.55
|
| Rate for Payer: Quartz Medicare Advantage |
$7,636.37
|
| Rate for Payer: The Alliance Commercial |
$30,545.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,636.37
|
| Rate for Payer: United Healthcare PPO |
$8,790.08
|
| Rate for Payer: Wellcare Medicare |
$7,636.37
|
|
|
Repair Superficial Wounds (S) 12001
|
Professional
|
Both
|
$490.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
3713510
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$41.06 |
| Max. Negotiated Rate |
$484.12 |
| Rate for Payer: Aetna Commercial |
$484.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$438.26
|
| Rate for Payer: Aetna Managed Medicare |
$41.06
|
| Rate for Payer: Anthem Medicare Advantage |
$41.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$41.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$41.06
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cigna Commercial |
$484.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$53.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.06
|
| Rate for Payer: Health EOS Commercial |
$463.74
|
| Rate for Payer: HFN Commercial |
$484.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$150.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$150.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$41.06
|
| Rate for Payer: Multiplan Commercial |
$407.68
|
| Rate for Payer: NAPHCARE Commercial |
$61.59
|
| Rate for Payer: Preferred Network Access Commercial |
$484.12
|
| Rate for Payer: Quartz Beloit One Network |
$224.22
|
| Rate for Payer: Quartz Commercial |
$290.47
|
| Rate for Payer: Quartz Medicare Advantage |
$41.06
|
| Rate for Payer: The Alliance Commercial |
$174.50
|
| Rate for Payer: United Healthcare Medicaid |
$53.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$41.06
|
| Rate for Payer: WEA Trust Commercial |
$280.28
|
| Rate for Payer: WPS Commercial |
$184.77
|
|
|
Repair Superficial Wounds (S) 3779912001
|
Professional
|
Both
|
$462.00
|
|
|
Service Code
|
CPT 37799
|
| Hospital Charge Code |
5453139
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$211.41 |
| Max. Negotiated Rate |
$456.46 |
| Rate for Payer: Aetna Commercial |
$456.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$413.21
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cigna Commercial |
$456.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$240.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$288.29
|
| Rate for Payer: Health EOS Commercial |
$437.24
|
| Rate for Payer: HFN Commercial |
$456.46
|
| Rate for Payer: Multiplan Commercial |
$384.38
|
| Rate for Payer: Preferred Network Access Commercial |
$456.46
|
| Rate for Payer: Quartz Beloit One Network |
$211.41
|
| Rate for Payer: Quartz Commercial |
$273.87
|
| Rate for Payer: The Alliance Commercial |
$240.24
|
| Rate for Payer: WEA Trust Commercial |
$264.26
|
| Rate for Payer: WPS Commercial |
$355.88
|
|
|
REPAIR SYSTEM AC KNOTLESS AR-2371
|
Facility
|
IP
|
$13,004.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5307086
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,626.84 |
| Max. Negotiated Rate |
$12,442.23 |
| Rate for Payer: Aetna Commercial |
$12,171.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,630.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,167.80
|
| Rate for Payer: Cash Price |
$3,901.20
|
| Rate for Payer: Cigna Commercial |
$12,442.23
|
| Rate for Payer: Health EOS Commercial |
$12,036.50
|
| Rate for Payer: HFN Commercial |
$12,442.23
|
| Rate for Payer: Multiplan Commercial |
$10,819.33
|
| Rate for Payer: Preferred Network Access Commercial |
$12,442.23
|
| Rate for Payer: Quartz Beloit One Network |
$6,626.84
|
| Rate for Payer: Quartz Commercial |
$8,114.50
|
| Rate for Payer: WEA Trust Commercial |
$7,438.29
|
| Rate for Payer: WPS Commercial |
$10,016.98
|
|
|
REPAIR SYSTEM AC KNOTLESS AR-2371
|
Facility
|
OP
|
$13,004.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5307086
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,786.76 |
| Max. Negotiated Rate |
$12,442.23 |
| Rate for Payer: Aetna Commercial |
$12,171.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,630.78
|
| Rate for Payer: Aetna Managed Medicare |
$3,786.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,790.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,762.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,491.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,167.80
|
| Rate for Payer: Cash Price |
$3,901.20
|
| Rate for Payer: Cigna Commercial |
$12,442.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,568.33
|
| Rate for Payer: Health EOS Commercial |
$12,036.50
|
| Rate for Payer: HFN Commercial |
$12,442.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,143.12
|
| Rate for Payer: Multiplan Commercial |
$10,819.33
|
| Rate for Payer: NAPHCARE Commercial |
$8,114.50
|
| Rate for Payer: Preferred Network Access Commercial |
$12,442.23
|
| Rate for Payer: Quartz Beloit One Network |
$6,626.84
|
| Rate for Payer: Quartz Commercial |
$8,790.70
|
| Rate for Payer: Quartz Medicare Advantage |
$8,114.50
|
| Rate for Payer: The Alliance Commercial |
$6,762.08
|
| Rate for Payer: WEA Trust Commercial |
$7,438.29
|
| Rate for Payer: WPS Commercial |
$10,016.98
|
|
|
REPAIR, TENDON, FLEXOR, FOOT; PRIMARY OR SECONDARY, WITHOUT FREE GRAFT, EACH TENDON
|
Facility
|
OP
|
$13,773.68
|
|
|
Service Code
|
CPT 28200
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,443.42 |
| Max. Negotiated Rate |
$13,773.68 |
| Rate for Payer: Aetna Managed Medicare |
$3,443.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,443.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,443.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,443.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,443.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,443.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,809.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,443.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,443.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,443.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,443.42
|
| Rate for Payer: NAPHCARE Commercial |
$5,165.13
|
| Rate for Payer: Quartz Medicare Advantage |
$3,443.42
|
| Rate for Payer: The Alliance Commercial |
$13,773.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,443.42
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$3,443.42
|
|
|
REPAIR, TENDON OR MUSCLE, FLEXOR, FOREARM AND/OR WRIST; PRIMARY, SINGLE, EACH TENDON OR MUSCLE
|
Facility
|
OP
|
$13,773.68
|
|
|
Service Code
|
CPT 25260
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,443.42 |
| Max. Negotiated Rate |
$13,773.68 |
| Rate for Payer: Aetna Managed Medicare |
$3,443.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,443.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,443.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,443.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,443.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,107.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,443.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,809.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,443.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,443.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,443.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,443.42
|
| Rate for Payer: NAPHCARE Commercial |
$5,165.13
|
| Rate for Payer: Quartz Medicare Advantage |
$3,443.42
|
| Rate for Payer: The Alliance Commercial |
$13,773.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,443.42
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$3,443.42
|
|
|
REPAIR TOE DISLOCATION 28645
|
Professional
|
Both
|
$2,227.00
|
|
|
Service Code
|
CPT 28645
|
| Hospital Charge Code |
3014272
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$391.73 |
| Max. Negotiated Rate |
$2,200.28 |
| Rate for Payer: Aetna Commercial |
$2,200.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,991.83
|
| Rate for Payer: Aetna Managed Medicare |
$449.82
|
| Rate for Payer: Anthem Medicare Advantage |
$449.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$449.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$449.82
|
| Rate for Payer: Cash Price |
$668.10
|
| Rate for Payer: Cash Price |
$668.10
|
| Rate for Payer: Cash Price |
$668.10
|
| Rate for Payer: Cigna Commercial |
$2,200.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$391.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$449.82
|
| Rate for Payer: Health EOS Commercial |
$2,107.63
|
| Rate for Payer: HFN Commercial |
$2,200.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,700.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,700.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$449.82
|
| Rate for Payer: Multiplan Commercial |
$1,852.86
|
| Rate for Payer: NAPHCARE Commercial |
$674.73
|
| Rate for Payer: Preferred Network Access Commercial |
$2,200.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,019.08
|
| Rate for Payer: Quartz Commercial |
$1,320.17
|
| Rate for Payer: Quartz Medicare Advantage |
$449.82
|
| Rate for Payer: The Alliance Commercial |
$1,911.74
|
| Rate for Payer: United Healthcare Medicaid |
$391.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$449.82
|
| Rate for Payer: WEA Trust Commercial |
$1,273.84
|
| Rate for Payer: WPS Commercial |
$2,024.19
|
|
|
REPAIR TOE DISLOCATION 28675
|
Professional
|
Both
|
$1,096.00
|
|
|
Service Code
|
CPT 28675
|
| Hospital Charge Code |
3014275
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$235.04 |
| Max. Negotiated Rate |
$1,731.93 |
| Rate for Payer: Aetna Commercial |
$1,082.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$980.26
|
| Rate for Payer: Aetna Managed Medicare |
$384.87
|
| Rate for Payer: Anthem Medicare Advantage |
$384.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$384.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$384.87
|
| Rate for Payer: Cash Price |
$328.80
|
| Rate for Payer: Cash Price |
$328.80
|
| Rate for Payer: Cash Price |
$328.80
|
| Rate for Payer: Cigna Commercial |
$1,082.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$235.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$384.87
|
| Rate for Payer: Health EOS Commercial |
$1,037.25
|
| Rate for Payer: HFN Commercial |
$1,082.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,414.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,414.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$384.87
|
| Rate for Payer: Multiplan Commercial |
$911.87
|
| Rate for Payer: NAPHCARE Commercial |
$577.31
|
| Rate for Payer: Preferred Network Access Commercial |
$1,082.85
|
| Rate for Payer: Quartz Beloit One Network |
$501.53
|
| Rate for Payer: Quartz Commercial |
$649.71
|
| Rate for Payer: Quartz Medicare Advantage |
$384.87
|
| Rate for Payer: The Alliance Commercial |
$1,635.71
|
| Rate for Payer: United Healthcare Medicaid |
$235.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$384.87
|
| Rate for Payer: WEA Trust Commercial |
$626.91
|
| Rate for Payer: WPS Commercial |
$1,731.93
|
|
|
REPAIR TONGUE LACERATION 41250
|
Professional
|
Both
|
$503.00
|
|
|
Service Code
|
CPT 41250
|
| Hospital Charge Code |
3014617
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$62.68 |
| Max. Negotiated Rate |
$717.12 |
| Rate for Payer: Aetna Commercial |
$496.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$449.88
|
| Rate for Payer: Aetna Managed Medicare |
$159.36
|
| Rate for Payer: Anthem Medicare Advantage |
$159.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$159.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$159.36
|
| Rate for Payer: Cash Price |
$150.90
|
| Rate for Payer: Cash Price |
$150.90
|
| Rate for Payer: Cash Price |
$150.90
|
| Rate for Payer: Cigna Commercial |
$496.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$62.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$159.36
|
| Rate for Payer: Health EOS Commercial |
$476.04
|
| Rate for Payer: HFN Commercial |
$496.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$531.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$531.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$159.36
|
| Rate for Payer: Multiplan Commercial |
$418.50
|
| Rate for Payer: NAPHCARE Commercial |
$239.04
|
| Rate for Payer: Preferred Network Access Commercial |
$496.96
|
| Rate for Payer: Quartz Beloit One Network |
$230.17
|
| Rate for Payer: Quartz Commercial |
$298.18
|
| Rate for Payer: Quartz Medicare Advantage |
$159.36
|
| Rate for Payer: The Alliance Commercial |
$677.28
|
| Rate for Payer: United Healthcare Medicaid |
$62.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$159.36
|
| Rate for Payer: WEA Trust Commercial |
$287.72
|
| Rate for Payer: WPS Commercial |
$717.12
|
|
|
REPAIR TONGUE LACERATION 41252
|
Professional
|
Both
|
$957.00
|
|
|
Service Code
|
CPT 41252
|
| Hospital Charge Code |
3014618
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$170.90 |
| Max. Negotiated Rate |
$945.52 |
| Rate for Payer: Aetna Commercial |
$945.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$855.94
|
| Rate for Payer: Aetna Managed Medicare |
$187.68
|
| Rate for Payer: Anthem Medicare Advantage |
$187.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$187.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$187.68
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Cigna Commercial |
$945.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$170.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$187.68
|
| Rate for Payer: Health EOS Commercial |
$905.70
|
| Rate for Payer: HFN Commercial |
$945.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$721.21
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$721.21
|
| Rate for Payer: Independent Care Health Plan Medicare |
$187.68
|
| Rate for Payer: Multiplan Commercial |
$796.22
|
| Rate for Payer: NAPHCARE Commercial |
$281.52
|
| Rate for Payer: Preferred Network Access Commercial |
$945.52
|
| Rate for Payer: Quartz Beloit One Network |
$437.92
|
| Rate for Payer: Quartz Commercial |
$567.31
|
| Rate for Payer: Quartz Medicare Advantage |
$187.68
|
| Rate for Payer: The Alliance Commercial |
$797.63
|
| Rate for Payer: United Healthcare Medicaid |
$170.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$187.68
|
| Rate for Payer: WEA Trust Commercial |
$547.40
|
| Rate for Payer: WPS Commercial |
$844.55
|
|
|
REPAIR UPPER JAW FISTULA 30580
|
Professional
|
Both
|
$2,978.00
|
|
|
Service Code
|
CPT 30580
|
| Hospital Charge Code |
3014361
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$408.68 |
| Max. Negotiated Rate |
$2,942.26 |
| Rate for Payer: Aetna Commercial |
$2,942.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,663.52
|
| Rate for Payer: Aetna Managed Medicare |
$408.68
|
| Rate for Payer: Anthem Medicare Advantage |
$408.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$408.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$408.68
|
| Rate for Payer: Cash Price |
$893.40
|
| Rate for Payer: Cash Price |
$893.40
|
| Rate for Payer: Cash Price |
$893.40
|
| Rate for Payer: Cigna Commercial |
$2,942.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$532.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$408.68
|
| Rate for Payer: Health EOS Commercial |
$2,818.38
|
| Rate for Payer: HFN Commercial |
$2,942.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,631.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,631.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$408.68
|
| Rate for Payer: Multiplan Commercial |
$2,477.70
|
| Rate for Payer: NAPHCARE Commercial |
$613.02
|
| Rate for Payer: Preferred Network Access Commercial |
$2,942.26
|
| Rate for Payer: Quartz Beloit One Network |
$1,362.73
|
| Rate for Payer: Quartz Commercial |
$1,765.36
|
| Rate for Payer: Quartz Medicare Advantage |
$408.68
|
| Rate for Payer: The Alliance Commercial |
$1,736.88
|
| Rate for Payer: United Healthcare Medicaid |
$532.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$408.68
|
| Rate for Payer: WEA Trust Commercial |
$1,703.42
|
| Rate for Payer: WPS Commercial |
$1,839.05
|
|
|
REPLACE GASTROSTOMY/CECOSTOMY TUBE PERCUTANEOUS 49450
|
Professional
|
Both
|
$3,177.00
|
|
|
Service Code
|
CPT 49450
|
| Hospital Charge Code |
6187349
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$54.80 |
| Max. Negotiated Rate |
$3,138.88 |
| Rate for Payer: Aetna Commercial |
$3,138.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,841.51
|
| Rate for Payer: Aetna Managed Medicare |
$54.80
|
| Rate for Payer: Anthem Medicare Advantage |
$54.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$54.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$54.80
|
| Rate for Payer: Cash Price |
$953.10
|
| Rate for Payer: Cash Price |
$953.10
|
| Rate for Payer: Cash Price |
$953.10
|
| Rate for Payer: Cigna Commercial |
$3,138.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$601.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.80
|
| Rate for Payer: Health EOS Commercial |
$3,006.71
|
| Rate for Payer: HFN Commercial |
$3,138.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$229.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$229.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$54.80
|
| Rate for Payer: Multiplan Commercial |
$2,643.26
|
| Rate for Payer: NAPHCARE Commercial |
$82.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,138.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,453.80
|
| Rate for Payer: Quartz Commercial |
$1,883.33
|
| Rate for Payer: Quartz Medicare Advantage |
$54.80
|
| Rate for Payer: The Alliance Commercial |
$232.89
|
| Rate for Payer: United Healthcare Medicaid |
$601.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54.80
|
| Rate for Payer: WEA Trust Commercial |
$1,817.24
|
| Rate for Payer: WPS Commercial |
$246.59
|
|
