|
TREAT HUMERUS FRACTURE 24535
|
Professional
|
Both
|
$1,670.00
|
|
|
Service Code
|
CPT 24535
|
| Hospital Charge Code |
3013835
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$523.35 |
| Max. Negotiated Rate |
$1,905.28 |
| Rate for Payer: Aetna Commercial |
$1,586.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,436.20
|
| Rate for Payer: Cash Price |
$501.00
|
| Rate for Payer: Cash Price |
$501.00
|
| Rate for Payer: Cash Price |
$501.00
|
| Rate for Payer: Cigna Commercial |
$1,586.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$523.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,002.00
|
| Rate for Payer: Health EOS Commercial |
$1,519.70
|
| Rate for Payer: HFN Commercial |
$1,586.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,905.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,905.28
|
| Rate for Payer: Multiplan Commercial |
$1,336.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,586.50
|
| Rate for Payer: Quartz Beloit One Network |
$734.80
|
| Rate for Payer: Quartz Commercial |
$951.90
|
| Rate for Payer: The Alliance Commercial |
$835.00
|
| Rate for Payer: United Healthcare Medicaid |
$523.35
|
| Rate for Payer: WEA Trust Commercial |
$918.50
|
| Rate for Payer: WPS Commercial |
$1,236.97
|
|
|
Treat Kneecap Dislocation 27560
|
Professional
|
Both
|
$884.00
|
|
|
Service Code
|
CPT 27560
|
| Hospital Charge Code |
4076168
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$262.79 |
| Max. Negotiated Rate |
$1,152.26 |
| Rate for Payer: Aetna Commercial |
$839.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$760.24
|
| Rate for Payer: Cash Price |
$265.20
|
| Rate for Payer: Cash Price |
$265.20
|
| Rate for Payer: Cash Price |
$265.20
|
| Rate for Payer: Cigna Commercial |
$839.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$262.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$530.40
|
| Rate for Payer: Health EOS Commercial |
$804.44
|
| Rate for Payer: HFN Commercial |
$839.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,152.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,152.26
|
| Rate for Payer: Multiplan Commercial |
$707.20
|
| Rate for Payer: Preferred Network Access Commercial |
$839.80
|
| Rate for Payer: Quartz Beloit One Network |
$388.96
|
| Rate for Payer: Quartz Commercial |
$503.88
|
| Rate for Payer: The Alliance Commercial |
$442.00
|
| Rate for Payer: United Healthcare Medicaid |
$262.79
|
| Rate for Payer: WEA Trust Commercial |
$486.20
|
| Rate for Payer: WPS Commercial |
$654.78
|
|
|
TREAT KNEE DISLOCATION 27550
|
Professional
|
Both
|
$959.00
|
|
|
Service Code
|
CPT 27550
|
| Hospital Charge Code |
3014101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$226.00 |
| Max. Negotiated Rate |
$1,621.15 |
| Rate for Payer: Aetna Commercial |
$911.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$824.74
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cigna Commercial |
$911.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$226.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$575.40
|
| Rate for Payer: Health EOS Commercial |
$872.69
|
| Rate for Payer: HFN Commercial |
$911.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,621.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,621.15
|
| Rate for Payer: Multiplan Commercial |
$767.20
|
| Rate for Payer: Preferred Network Access Commercial |
$911.05
|
| Rate for Payer: Quartz Beloit One Network |
$421.96
|
| Rate for Payer: Quartz Commercial |
$546.63
|
| Rate for Payer: The Alliance Commercial |
$479.50
|
| Rate for Payer: United Healthcare Medicaid |
$226.00
|
| Rate for Payer: WEA Trust Commercial |
$527.45
|
| Rate for Payer: WPS Commercial |
$710.33
|
|
|
TREAT KNEE FRACTURE 27532
|
Professional
|
Both
|
$1,684.00
|
|
|
Service Code
|
CPT 27532
|
| Hospital Charge Code |
3014096
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$376.66 |
| Max. Negotiated Rate |
$1,917.14 |
| Rate for Payer: Aetna Commercial |
$1,599.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,448.24
|
| Rate for Payer: Cash Price |
$505.20
|
| Rate for Payer: Cash Price |
$505.20
|
| Rate for Payer: Cash Price |
$505.20
|
| Rate for Payer: Cigna Commercial |
$1,599.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$376.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,010.40
|
| Rate for Payer: Health EOS Commercial |
$1,532.44
|
| Rate for Payer: HFN Commercial |
$1,599.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,917.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,917.14
|
| Rate for Payer: Multiplan Commercial |
$1,347.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,599.80
|
| Rate for Payer: Quartz Beloit One Network |
$740.96
|
| Rate for Payer: Quartz Commercial |
$959.88
|
| Rate for Payer: The Alliance Commercial |
$842.00
|
| Rate for Payer: United Healthcare Medicaid |
$376.66
|
| Rate for Payer: WEA Trust Commercial |
$926.20
|
| Rate for Payer: WPS Commercial |
$1,247.34
|
|
|
TREAT KNUCKLE DISLOCATION 26705
|
Professional
|
Both
|
$964.00
|
|
|
Service Code
|
CPT 26705
|
| Hospital Charge Code |
3013979
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$120.52 |
| Max. Negotiated Rate |
$1,293.46 |
| Rate for Payer: Aetna Commercial |
$915.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$829.04
|
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cigna Commercial |
$915.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$120.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$578.40
|
| Rate for Payer: Health EOS Commercial |
$877.24
|
| Rate for Payer: HFN Commercial |
$915.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,293.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,293.46
|
| Rate for Payer: Multiplan Commercial |
$771.20
|
| Rate for Payer: Preferred Network Access Commercial |
$915.80
|
| Rate for Payer: Quartz Beloit One Network |
$424.16
|
| Rate for Payer: Quartz Commercial |
$549.48
|
| Rate for Payer: The Alliance Commercial |
$482.00
|
| Rate for Payer: United Healthcare Medicaid |
$120.52
|
| Rate for Payer: WEA Trust Commercial |
$530.20
|
| Rate for Payer: WPS Commercial |
$714.03
|
|
|
TREAT LOWER LEG FRACTURE 27825
|
Professional
|
Both
|
$2,793.00
|
|
|
Service Code
|
CPT 27825
|
| Hospital Charge Code |
3014160
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$426.59 |
| Max. Negotiated Rate |
$2,653.35 |
| Rate for Payer: Aetna Commercial |
$2,653.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,401.98
|
| Rate for Payer: Cash Price |
$837.90
|
| Rate for Payer: Cash Price |
$837.90
|
| Rate for Payer: Cash Price |
$837.90
|
| Rate for Payer: Cigna Commercial |
$2,653.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$426.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,675.80
|
| Rate for Payer: Health EOS Commercial |
$2,541.63
|
| Rate for Payer: HFN Commercial |
$2,653.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,635.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,635.31
|
| Rate for Payer: Multiplan Commercial |
$2,234.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,653.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,228.92
|
| Rate for Payer: Quartz Commercial |
$1,592.01
|
| Rate for Payer: The Alliance Commercial |
$1,396.50
|
| Rate for Payer: United Healthcare Medicaid |
$426.59
|
| Rate for Payer: WEA Trust Commercial |
$1,536.15
|
| Rate for Payer: WPS Commercial |
$2,068.78
|
|
|
TREAT LUNG LINING CHEMICALLY 32560
|
Professional
|
Both
|
$2,192.00
|
|
|
Service Code
|
CPT 32560
|
| Hospital Charge Code |
3014416
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$227.35 |
| Max. Negotiated Rate |
$2,082.40 |
| Rate for Payer: Aetna Commercial |
$2,082.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,885.12
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Cigna Commercial |
$2,082.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$227.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,315.20
|
| Rate for Payer: Health EOS Commercial |
$1,994.72
|
| Rate for Payer: HFN Commercial |
$2,082.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$253.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$253.77
|
| Rate for Payer: Multiplan Commercial |
$1,753.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,082.40
|
| Rate for Payer: Quartz Beloit One Network |
$964.48
|
| Rate for Payer: Quartz Commercial |
$1,249.44
|
| Rate for Payer: The Alliance Commercial |
$1,096.00
|
| Rate for Payer: United Healthcare Medicaid |
$227.35
|
| Rate for Payer: WEA Trust Commercial |
$1,205.60
|
| Rate for Payer: WPS Commercial |
$1,623.61
|
|
|
TREATMENT ANKLE FRACTURE - OPEN, EXT 2781422
|
Professional
|
Both
|
$5,307.00
|
|
|
Service Code
|
CPT 27814
|
| Hospital Charge Code |
6180168
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$661.80 |
| Max. Negotiated Rate |
$5,041.65 |
| Rate for Payer: Aetna Commercial |
$5,041.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,564.02
|
| Rate for Payer: Cash Price |
$1,592.10
|
| Rate for Payer: Cash Price |
$1,592.10
|
| Rate for Payer: Cash Price |
$1,592.10
|
| Rate for Payer: Cigna Commercial |
$5,041.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$661.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,184.20
|
| Rate for Payer: Health EOS Commercial |
$4,829.37
|
| Rate for Payer: HFN Commercial |
$5,041.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,541.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,541.74
|
| Rate for Payer: Multiplan Commercial |
$4,245.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,041.65
|
| Rate for Payer: Quartz Beloit One Network |
$2,335.08
|
| Rate for Payer: Quartz Commercial |
$3,024.99
|
| Rate for Payer: The Alliance Commercial |
$2,653.50
|
| Rate for Payer: United Healthcare Medicaid |
$661.80
|
| Rate for Payer: WEA Trust Commercial |
$2,918.85
|
| Rate for Payer: WPS Commercial |
$3,930.89
|
|
|
Treatment Device Complex
|
Facility
|
OP
|
$2,181.00
|
|
|
Service Code
|
CPT 77334
|
| Hospital Charge Code |
3040390
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$365.21 |
| Max. Negotiated Rate |
$2,006.52 |
| Rate for Payer: Aetna Commercial |
$1,962.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,875.66
|
| Rate for Payer: Aetna Managed Medicare |
$365.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,369.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,095.63
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,040.85
|
| Rate for Payer: Anthem Medicare Advantage |
$365.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,155.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$365.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$365.21
|
| Rate for Payer: Cash Price |
$654.30
|
| Rate for Payer: Cash Price |
$654.30
|
| Rate for Payer: Cigna Commercial |
$2,006.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$365.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,220.49
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$365.21
|
| Rate for Payer: Health EOS Commercial |
$1,941.09
|
| Rate for Payer: HFN Commercial |
$2,006.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,358.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$365.21
|
| Rate for Payer: Independent Care Health Plan Medicare |
$365.21
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$365.21
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$365.21
|
| Rate for Payer: Multiplan Commercial |
$1,744.80
|
| Rate for Payer: NAPHCARE Commercial |
$547.82
|
| Rate for Payer: Preferred Network Access Commercial |
$2,006.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,068.69
|
| Rate for Payer: Quartz Commercial |
$1,417.65
|
| Rate for Payer: Quartz Medicare Advantage |
$365.21
|
| Rate for Payer: The Alliance Commercial |
$1,460.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$365.21
|
| Rate for Payer: United Healthcare PPO |
$1,635.75
|
| Rate for Payer: WEA Trust Commercial |
$1,199.55
|
| Rate for Payer: Wellcare Medicare |
$365.21
|
| Rate for Payer: WPS Commercial |
$1,615.47
|
|
|
Treatment Device Complex
|
Facility
|
IP
|
$2,181.00
|
|
|
Service Code
|
CPT 77334
|
| Hospital Charge Code |
3040390
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,068.69 |
| Max. Negotiated Rate |
$2,006.52 |
| Rate for Payer: Aetna Commercial |
$1,962.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,875.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,155.93
|
| Rate for Payer: Cash Price |
$654.30
|
| Rate for Payer: Cigna Commercial |
$2,006.52
|
| Rate for Payer: Health EOS Commercial |
$1,941.09
|
| Rate for Payer: HFN Commercial |
$2,006.52
|
| Rate for Payer: Multiplan Commercial |
$1,744.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,308.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,006.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,068.69
|
| Rate for Payer: Quartz Commercial |
$1,308.60
|
| Rate for Payer: WEA Trust Commercial |
$1,199.55
|
| Rate for Payer: WPS Commercial |
$1,615.47
|
|
|
Treatment Device Intermediate
|
Facility
|
OP
|
$658.00
|
|
|
Service Code
|
CPT 77333
|
| Hospital Charge Code |
3040387
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$134.11 |
| Max. Negotiated Rate |
$605.36 |
| Rate for Payer: Aetna Commercial |
$592.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$565.88
|
| Rate for Payer: Aetna Managed Medicare |
$134.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$502.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$402.33
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$382.21
|
| Rate for Payer: Anthem Medicare Advantage |
$134.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$348.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$134.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$134.11
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cigna Commercial |
$605.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$134.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$368.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$134.11
|
| Rate for Payer: Health EOS Commercial |
$585.62
|
| Rate for Payer: HFN Commercial |
$605.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$498.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$134.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$134.11
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$134.11
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$134.11
|
| Rate for Payer: Multiplan Commercial |
$526.40
|
| Rate for Payer: NAPHCARE Commercial |
$201.16
|
| Rate for Payer: Preferred Network Access Commercial |
$605.36
|
| Rate for Payer: Quartz Beloit One Network |
$322.42
|
| Rate for Payer: Quartz Commercial |
$427.70
|
| Rate for Payer: Quartz Medicare Advantage |
$134.11
|
| Rate for Payer: The Alliance Commercial |
$536.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$134.11
|
| Rate for Payer: United Healthcare PPO |
$493.50
|
| Rate for Payer: WEA Trust Commercial |
$361.90
|
| Rate for Payer: Wellcare Medicare |
$134.11
|
| Rate for Payer: WPS Commercial |
$487.38
|
|
|
Treatment Device Intermediate
|
Facility
|
IP
|
$658.00
|
|
|
Service Code
|
CPT 77333
|
| Hospital Charge Code |
3040387
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$322.42 |
| Max. Negotiated Rate |
$605.36 |
| Rate for Payer: Aetna Commercial |
$592.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$565.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$348.74
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cigna Commercial |
$605.36
|
| Rate for Payer: Health EOS Commercial |
$585.62
|
| Rate for Payer: HFN Commercial |
$605.36
|
| Rate for Payer: Multiplan Commercial |
$526.40
|
| Rate for Payer: NAPHCARE Commercial |
$394.80
|
| Rate for Payer: Preferred Network Access Commercial |
$605.36
|
| Rate for Payer: Quartz Beloit One Network |
$322.42
|
| Rate for Payer: Quartz Commercial |
$394.80
|
| Rate for Payer: WEA Trust Commercial |
$361.90
|
| Rate for Payer: WPS Commercial |
$487.38
|
|
|
Treatment Device Simple
|
Facility
|
OP
|
$757.00
|
|
|
Service Code
|
CPT 77332
|
| Hospital Charge Code |
3040386
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$134.11 |
| Max. Negotiated Rate |
$696.44 |
| Rate for Payer: Aetna Commercial |
$681.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$651.02
|
| Rate for Payer: Aetna Managed Medicare |
$134.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$502.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$402.33
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$382.21
|
| Rate for Payer: Anthem Medicare Advantage |
$134.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$401.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$134.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$134.11
|
| Rate for Payer: Cash Price |
$227.10
|
| Rate for Payer: Cash Price |
$227.10
|
| Rate for Payer: Cigna Commercial |
$696.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$134.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$423.62
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$134.11
|
| Rate for Payer: Health EOS Commercial |
$673.73
|
| Rate for Payer: HFN Commercial |
$696.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$498.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$134.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$134.11
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$134.11
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$134.11
|
| Rate for Payer: Multiplan Commercial |
$605.60
|
| Rate for Payer: NAPHCARE Commercial |
$201.16
|
| Rate for Payer: Preferred Network Access Commercial |
$696.44
|
| Rate for Payer: Quartz Beloit One Network |
$370.93
|
| Rate for Payer: Quartz Commercial |
$492.05
|
| Rate for Payer: Quartz Medicare Advantage |
$134.11
|
| Rate for Payer: The Alliance Commercial |
$536.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$134.11
|
| Rate for Payer: United Healthcare PPO |
$567.75
|
| Rate for Payer: WEA Trust Commercial |
$416.35
|
| Rate for Payer: Wellcare Medicare |
$134.11
|
| Rate for Payer: WPS Commercial |
$560.71
|
|
|
Treatment Device Simple
|
Facility
|
IP
|
$757.00
|
|
|
Service Code
|
CPT 77332
|
| Hospital Charge Code |
3040386
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$370.93 |
| Max. Negotiated Rate |
$696.44 |
| Rate for Payer: Aetna Commercial |
$681.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$651.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$401.21
|
| Rate for Payer: Cash Price |
$227.10
|
| Rate for Payer: Cigna Commercial |
$696.44
|
| Rate for Payer: Health EOS Commercial |
$673.73
|
| Rate for Payer: HFN Commercial |
$696.44
|
| Rate for Payer: Multiplan Commercial |
$605.60
|
| Rate for Payer: NAPHCARE Commercial |
$454.20
|
| Rate for Payer: Preferred Network Access Commercial |
$696.44
|
| Rate for Payer: Quartz Beloit One Network |
$370.93
|
| Rate for Payer: Quartz Commercial |
$454.20
|
| Rate for Payer: WEA Trust Commercial |
$416.35
|
| Rate for Payer: WPS Commercial |
$560.71
|
|
|
TREATMENT OF ANKLE FRACTURE 27788
|
Professional
|
Both
|
$1,031.00
|
|
|
Service Code
|
CPT 27788
|
| Hospital Charge Code |
3014151
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$226.00 |
| Max. Negotiated Rate |
$1,289.76 |
| Rate for Payer: Aetna Commercial |
$979.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$886.66
|
| Rate for Payer: Cash Price |
$309.30
|
| Rate for Payer: Cash Price |
$309.30
|
| Rate for Payer: Cash Price |
$309.30
|
| Rate for Payer: Cigna Commercial |
$979.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$226.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$618.60
|
| Rate for Payer: Health EOS Commercial |
$938.21
|
| Rate for Payer: HFN Commercial |
$979.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,289.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,289.76
|
| Rate for Payer: Multiplan Commercial |
$824.80
|
| Rate for Payer: Preferred Network Access Commercial |
$979.45
|
| Rate for Payer: Quartz Beloit One Network |
$453.64
|
| Rate for Payer: Quartz Commercial |
$587.67
|
| Rate for Payer: The Alliance Commercial |
$515.50
|
| Rate for Payer: United Healthcare Medicaid |
$226.00
|
| Rate for Payer: WEA Trust Commercial |
$567.05
|
| Rate for Payer: WPS Commercial |
$763.66
|
|
|
TREATMENT OF ANKLE FRACTURE 27810
|
Professional
|
Both
|
$1,554.00
|
|
|
Service Code
|
CPT 27810
|
| Hospital Charge Code |
3014154
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$386.66 |
| Max. Negotiated Rate |
$1,476.30 |
| Rate for Payer: Aetna Commercial |
$1,476.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,336.44
|
| Rate for Payer: Cash Price |
$466.20
|
| Rate for Payer: Cash Price |
$466.20
|
| Rate for Payer: Cash Price |
$466.20
|
| Rate for Payer: Cigna Commercial |
$1,476.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$386.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$932.40
|
| Rate for Payer: Health EOS Commercial |
$1,414.14
|
| Rate for Payer: HFN Commercial |
$1,476.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,418.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,418.00
|
| Rate for Payer: Multiplan Commercial |
$1,243.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,476.30
|
| Rate for Payer: Quartz Beloit One Network |
$683.76
|
| Rate for Payer: Quartz Commercial |
$885.78
|
| Rate for Payer: The Alliance Commercial |
$777.00
|
| Rate for Payer: United Healthcare Medicaid |
$386.66
|
| Rate for Payer: WEA Trust Commercial |
$854.70
|
| Rate for Payer: WPS Commercial |
$1,151.05
|
|
|
Treatment of Ankle Fracture 27816
|
Professional
|
Both
|
$1,029.00
|
|
|
Service Code
|
CPT 27816
|
| Hospital Charge Code |
4213317
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$376.66 |
| Max. Negotiated Rate |
$986.39 |
| Rate for Payer: Aetna Commercial |
$977.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$884.94
|
| Rate for Payer: Cash Price |
$308.70
|
| Rate for Payer: Cash Price |
$308.70
|
| Rate for Payer: Cash Price |
$308.70
|
| Rate for Payer: Cigna Commercial |
$977.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$376.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$617.40
|
| Rate for Payer: Health EOS Commercial |
$936.39
|
| Rate for Payer: HFN Commercial |
$977.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$986.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$986.39
|
| Rate for Payer: Multiplan Commercial |
$823.20
|
| Rate for Payer: Preferred Network Access Commercial |
$977.55
|
| Rate for Payer: Quartz Beloit One Network |
$452.76
|
| Rate for Payer: Quartz Commercial |
$586.53
|
| Rate for Payer: The Alliance Commercial |
$514.50
|
| Rate for Payer: United Healthcare Medicaid |
$376.66
|
| Rate for Payer: WEA Trust Commercial |
$565.95
|
| Rate for Payer: WPS Commercial |
$762.18
|
|
|
TREATMENT OF ANKLE FRACTURE 27818
|
Professional
|
Both
|
$2,716.00
|
|
|
Service Code
|
CPT 27818
|
| Hospital Charge Code |
3014156
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$452.00 |
| Max. Negotiated Rate |
$2,580.20 |
| Rate for Payer: Aetna Commercial |
$2,580.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,335.76
|
| Rate for Payer: Cash Price |
$814.80
|
| Rate for Payer: Cash Price |
$814.80
|
| Rate for Payer: Cash Price |
$814.80
|
| Rate for Payer: Cigna Commercial |
$2,580.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$452.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,629.60
|
| Rate for Payer: Health EOS Commercial |
$2,471.56
|
| Rate for Payer: HFN Commercial |
$2,580.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,454.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,454.54
|
| Rate for Payer: Multiplan Commercial |
$2,172.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,580.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,195.04
|
| Rate for Payer: Quartz Commercial |
$1,548.12
|
| Rate for Payer: The Alliance Commercial |
$1,358.00
|
| Rate for Payer: United Healthcare Medicaid |
$452.00
|
| Rate for Payer: WEA Trust Commercial |
$1,493.80
|
| Rate for Payer: WPS Commercial |
$2,011.74
|
|
|
TREATMENT OF ANKLE FRACTURE 28435
|
Professional
|
Both
|
$959.00
|
|
|
Service Code
|
CPT 28435
|
| Hospital Charge Code |
3014248
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$301.31 |
| Max. Negotiated Rate |
$987.80 |
| Rate for Payer: Aetna Commercial |
$911.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$824.74
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cigna Commercial |
$911.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$301.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$575.40
|
| Rate for Payer: Health EOS Commercial |
$872.69
|
| Rate for Payer: HFN Commercial |
$911.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$987.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$987.80
|
| Rate for Payer: Multiplan Commercial |
$767.20
|
| Rate for Payer: Preferred Network Access Commercial |
$911.05
|
| Rate for Payer: Quartz Beloit One Network |
$421.96
|
| Rate for Payer: Quartz Commercial |
$546.63
|
| Rate for Payer: The Alliance Commercial |
$479.50
|
| Rate for Payer: United Healthcare Medicaid |
$301.31
|
| Rate for Payer: WEA Trust Commercial |
$527.45
|
| Rate for Payer: WPS Commercial |
$710.33
|
|
|
Treatment of Bladder Lesion 51720PP
|
Professional
|
Both
|
$896.00
|
|
|
Service Code
|
CPT 51720
|
| Hospital Charge Code |
3748919
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$33.63 |
| Max. Negotiated Rate |
$851.20 |
| Rate for Payer: Aetna Commercial |
$851.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$770.56
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cigna Commercial |
$851.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$33.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$537.60
|
| Rate for Payer: Health EOS Commercial |
$815.36
|
| Rate for Payer: HFN Commercial |
$851.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$145.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$145.61
|
| Rate for Payer: Multiplan Commercial |
$716.80
|
| Rate for Payer: Preferred Network Access Commercial |
$851.20
|
| Rate for Payer: Quartz Beloit One Network |
$394.24
|
| Rate for Payer: Quartz Commercial |
$510.72
|
| Rate for Payer: The Alliance Commercial |
$448.00
|
| Rate for Payer: United Healthcare Medicaid |
$33.63
|
| Rate for Payer: WEA Trust Commercial |
$492.80
|
| Rate for Payer: WPS Commercial |
$663.67
|
|
|
Treatment of Extensive Or Progressive Retinopathy, 1 Or More Sessions
|
Professional
|
Both
|
$3,076.00
|
|
|
Service Code
|
CPT 67228
|
| Hospital Charge Code |
1188904
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$602.65 |
| Max. Negotiated Rate |
$2,922.20 |
| Rate for Payer: Aetna Commercial |
$2,922.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,645.36
|
| Rate for Payer: Cash Price |
$922.80
|
| Rate for Payer: Cash Price |
$922.80
|
| Rate for Payer: Cash Price |
$922.80
|
| Rate for Payer: Cigna Commercial |
$2,922.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$602.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,845.60
|
| Rate for Payer: Health EOS Commercial |
$2,799.16
|
| Rate for Payer: HFN Commercial |
$2,922.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,021.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,021.51
|
| Rate for Payer: Multiplan Commercial |
$2,460.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,922.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,353.44
|
| Rate for Payer: Quartz Commercial |
$1,753.32
|
| Rate for Payer: The Alliance Commercial |
$1,538.00
|
| Rate for Payer: United Healthcare Medicaid |
$602.65
|
| Rate for Payer: WEA Trust Commercial |
$1,691.80
|
| Rate for Payer: WPS Commercial |
$2,278.39
|
|
|
Treatment of Extensive Or Progressive Retinopathy, 1 or More Sessions 6722850
|
Professional
|
Both
|
$6,154.00
|
|
|
Service Code
|
CPT 67228 50
|
| Hospital Charge Code |
5555346
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$602.65 |
| Max. Negotiated Rate |
$5,846.30 |
| Rate for Payer: Aetna Commercial |
$5,846.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,292.44
|
| Rate for Payer: Cash Price |
$1,846.20
|
| Rate for Payer: Cash Price |
$1,846.20
|
| Rate for Payer: Cash Price |
$1,846.20
|
| Rate for Payer: Cigna Commercial |
$5,846.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$602.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,692.40
|
| Rate for Payer: Health EOS Commercial |
$5,600.14
|
| Rate for Payer: HFN Commercial |
$5,846.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,021.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,021.51
|
| Rate for Payer: Multiplan Commercial |
$4,923.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,846.30
|
| Rate for Payer: Quartz Beloit One Network |
$2,707.76
|
| Rate for Payer: Quartz Commercial |
$3,507.78
|
| Rate for Payer: The Alliance Commercial |
$3,077.00
|
| Rate for Payer: United Healthcare Medicaid |
$602.65
|
| Rate for Payer: WEA Trust Commercial |
$3,384.70
|
| Rate for Payer: WPS Commercial |
$4,558.27
|
|
|
TREATMENT OF INCOMPLETE ABORTION, ANY TRIMESTER, COMPLETED SURGICALLY
|
Facility
|
OP
|
$12,360.48
|
|
|
Service Code
|
CPT 59812
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,726.00 |
| Max. Negotiated Rate |
$12,360.48 |
| Rate for Payer: Aetna Managed Medicare |
$3,090.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,090.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,090.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,090.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,090.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,090.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,495.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,090.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,090.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,090.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,090.12
|
| Rate for Payer: NAPHCARE Commercial |
$4,635.18
|
| Rate for Payer: Quartz Medicare Advantage |
$3,090.12
|
| Rate for Payer: The Alliance Commercial |
$12,360.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,090.12
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$3,090.12
|
|
|
TREATMENT OF INTERTROCHANTERIC, PERITROCHANTERIC, OR SUBTROCHANTERIC FEMORAL FRACTURE; WITH INTRAMEDULLARY IMPLANT, WITH OR WITHOUT INTERLOCKING SCREWS AND/OR CERCLAGE
|
Facility
|
OP
|
$11,874.87
|
|
|
Service Code
|
CPT 27245
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,103.00 |
| Max. Negotiated Rate |
$11,874.87 |
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
|
|
TREATMENT OF MISCARRIAGE 59812
|
Professional
|
Both
|
$1,556.00
|
|
|
Service Code
|
CPT 59812
|
| Hospital Charge Code |
3015169
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$272.00 |
| Max. Negotiated Rate |
$1,478.20 |
| Rate for Payer: Aetna Commercial |
$1,478.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,338.16
|
| Rate for Payer: Cash Price |
$466.80
|
| Rate for Payer: Cash Price |
$466.80
|
| Rate for Payer: Cash Price |
$466.80
|
| Rate for Payer: Cigna Commercial |
$1,478.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$272.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$933.60
|
| Rate for Payer: Health EOS Commercial |
$1,415.96
|
| Rate for Payer: HFN Commercial |
$1,478.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$983.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$983.49
|
| Rate for Payer: Multiplan Commercial |
$1,244.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,478.20
|
| Rate for Payer: Quartz Beloit One Network |
$684.64
|
| Rate for Payer: Quartz Commercial |
$886.92
|
| Rate for Payer: The Alliance Commercial |
$778.00
|
| Rate for Payer: United Healthcare Medicaid |
$272.00
|
| Rate for Payer: WEA Trust Commercial |
$855.80
|
| Rate for Payer: WPS Commercial |
$1,152.53
|
|
