|
TREATMENT OF MISCARRIAGE 59821
|
Professional
|
Both
|
$1,692.00
|
|
|
Service Code
|
CPT 59821
|
| Hospital Charge Code |
3015171
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$327.42 |
| Max. Negotiated Rate |
$1,607.40 |
| Rate for Payer: Aetna Commercial |
$1,607.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,455.12
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cigna Commercial |
$1,607.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$327.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,015.20
|
| Rate for Payer: Health EOS Commercial |
$1,539.72
|
| Rate for Payer: HFN Commercial |
$1,607.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,204.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,204.68
|
| Rate for Payer: Multiplan Commercial |
$1,353.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,607.40
|
| Rate for Payer: Quartz Beloit One Network |
$744.48
|
| Rate for Payer: Quartz Commercial |
$964.44
|
| Rate for Payer: The Alliance Commercial |
$846.00
|
| Rate for Payer: United Healthcare Medicaid |
$327.42
|
| Rate for Payer: WEA Trust Commercial |
$930.60
|
| Rate for Payer: WPS Commercial |
$1,253.26
|
|
|
TREATMENT OF MISSED ABORTION, COMPLETED SURGICALLY; FIRST TRIMESTER
|
Facility
|
OP
|
$12,360.48
|
|
|
Service Code
|
CPT 59820
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,726.00 |
| Max. Negotiated Rate |
$12,360.48 |
| Rate for Payer: The Alliance Commercial |
$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 |
$8,339.76
|
| 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: 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 MISSED ABORTION, COMPLETED SURGICALLY; SECOND TRIMESTER
|
Facility
|
OP
|
$12,360.48
|
|
|
Service Code
|
CPT 59821
|
|
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 MOUTH LESION 40820
|
Professional
|
Both
|
$318.00
|
|
|
Service Code
|
CPT 40820
|
| Hospital Charge Code |
3014610
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.11 |
| Max. Negotiated Rate |
$580.90 |
| Rate for Payer: Aetna Commercial |
$302.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$273.48
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cigna Commercial |
$302.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$30.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$190.80
|
| Rate for Payer: Health EOS Commercial |
$289.38
|
| Rate for Payer: HFN Commercial |
$302.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$580.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$580.90
|
| Rate for Payer: Multiplan Commercial |
$254.40
|
| Rate for Payer: Preferred Network Access Commercial |
$302.10
|
| Rate for Payer: Quartz Beloit One Network |
$139.92
|
| Rate for Payer: Quartz Commercial |
$181.26
|
| Rate for Payer: The Alliance Commercial |
$159.00
|
| Rate for Payer: United Healthcare Medicaid |
$30.11
|
| Rate for Payer: WEA Trust Commercial |
$174.90
|
| Rate for Payer: WPS Commercial |
$235.54
|
|
|
TREATMENT OF NOSE FRACTURE 21320
|
Professional
|
Both
|
$1,037.00
|
|
|
Service Code
|
CPT 21320
|
| Hospital Charge Code |
3013728
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$244.20 |
| Max. Negotiated Rate |
$985.15 |
| Rate for Payer: Aetna Commercial |
$985.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$891.82
|
| Rate for Payer: Cash Price |
$311.10
|
| Rate for Payer: Cash Price |
$311.10
|
| Rate for Payer: Cash Price |
$311.10
|
| Rate for Payer: Cigna Commercial |
$985.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$244.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$622.20
|
| Rate for Payer: Health EOS Commercial |
$943.67
|
| Rate for Payer: HFN Commercial |
$985.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$446.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$446.40
|
| Rate for Payer: Multiplan Commercial |
$829.60
|
| Rate for Payer: Preferred Network Access Commercial |
$985.15
|
| Rate for Payer: Quartz Beloit One Network |
$456.28
|
| Rate for Payer: Quartz Commercial |
$591.09
|
| Rate for Payer: The Alliance Commercial |
$518.50
|
| Rate for Payer: United Healthcare Medicaid |
$244.20
|
| Rate for Payer: WEA Trust Commercial |
$570.35
|
| Rate for Payer: WPS Commercial |
$768.11
|
|
|
TREATMENT OF PENIS LESION 54200
|
Professional
|
Both
|
$474.00
|
|
|
Service Code
|
CPT 54200
|
| Hospital Charge Code |
3015027
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.11 |
| Max. Negotiated Rate |
$450.30 |
| Rate for Payer: Aetna Commercial |
$450.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$407.64
|
| Rate for Payer: Cash Price |
$142.20
|
| Rate for Payer: Cash Price |
$142.20
|
| Rate for Payer: Cash Price |
$142.20
|
| Rate for Payer: Cigna Commercial |
$450.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$30.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$284.40
|
| Rate for Payer: Health EOS Commercial |
$431.34
|
| Rate for Payer: HFN Commercial |
$450.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$286.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$286.49
|
| Rate for Payer: Multiplan Commercial |
$379.20
|
| Rate for Payer: Preferred Network Access Commercial |
$450.30
|
| Rate for Payer: Quartz Beloit One Network |
$208.56
|
| Rate for Payer: Quartz Commercial |
$270.18
|
| Rate for Payer: The Alliance Commercial |
$237.00
|
| Rate for Payer: United Healthcare Medicaid |
$30.11
|
| Rate for Payer: WEA Trust Commercial |
$260.70
|
| Rate for Payer: WPS Commercial |
$351.09
|
|
|
TREATMENT OF PENIS LESION 54220
|
Professional
|
Both
|
$795.00
|
|
|
Service Code
|
CPT 54220
|
| Hospital Charge Code |
3015028
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$335.19 |
| Max. Negotiated Rate |
$755.25 |
| Rate for Payer: Aetna Commercial |
$755.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$683.70
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Cigna Commercial |
$755.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$335.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$477.00
|
| Rate for Payer: Health EOS Commercial |
$723.45
|
| Rate for Payer: HFN Commercial |
$755.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$439.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$439.98
|
| Rate for Payer: Multiplan Commercial |
$636.00
|
| Rate for Payer: Preferred Network Access Commercial |
$755.25
|
| Rate for Payer: Quartz Beloit One Network |
$349.80
|
| Rate for Payer: Quartz Commercial |
$453.15
|
| Rate for Payer: The Alliance Commercial |
$397.50
|
| Rate for Payer: United Healthcare Medicaid |
$335.19
|
| Rate for Payer: WEA Trust Commercial |
$437.25
|
| Rate for Payer: WPS Commercial |
$588.86
|
|
|
TREATMENT OF RIB FRACTURE 21800
|
Professional
|
Both
|
$277.00
|
|
| Hospital Charge Code |
3013743
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$121.88 |
| Max. Negotiated Rate |
$263.15 |
| Rate for Payer: Aetna Commercial |
$263.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$238.22
|
| Rate for Payer: Cash Price |
$83.10
|
| Rate for Payer: Cigna Commercial |
$263.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$138.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$166.20
|
| Rate for Payer: Health EOS Commercial |
$252.07
|
| Rate for Payer: HFN Commercial |
$263.15
|
| Rate for Payer: Multiplan Commercial |
$221.60
|
| Rate for Payer: Preferred Network Access Commercial |
$263.15
|
| Rate for Payer: Quartz Beloit One Network |
$121.88
|
| Rate for Payer: Quartz Commercial |
$157.89
|
| Rate for Payer: The Alliance Commercial |
$138.50
|
| Rate for Payer: WEA Trust Commercial |
$152.35
|
| Rate for Payer: WPS Commercial |
$205.17
|
|
|
TREATMENT OF THIGH FRACTURE 27500
|
Professional
|
Both
|
$2,166.00
|
|
|
Service Code
|
CPT 27500
|
| Hospital Charge Code |
3014081
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$602.65 |
| Max. Negotiated Rate |
$2,057.70 |
| Rate for Payer: Aetna Commercial |
$2,057.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,862.76
|
| Rate for Payer: Cash Price |
$649.80
|
| Rate for Payer: Cash Price |
$649.80
|
| Rate for Payer: Cash Price |
$649.80
|
| Rate for Payer: Cigna Commercial |
$2,057.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$602.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,299.60
|
| Rate for Payer: Health EOS Commercial |
$1,971.06
|
| Rate for Payer: HFN Commercial |
$2,057.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,598.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,598.95
|
| Rate for Payer: Multiplan Commercial |
$1,732.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,057.70
|
| Rate for Payer: Quartz Beloit One Network |
$953.04
|
| Rate for Payer: Quartz Commercial |
$1,234.62
|
| Rate for Payer: The Alliance Commercial |
$1,083.00
|
| Rate for Payer: United Healthcare Medicaid |
$602.65
|
| Rate for Payer: WEA Trust Commercial |
$1,191.30
|
| Rate for Payer: WPS Commercial |
$1,604.36
|
|
|
TREATMENT OF THIGH FRACTURE 27501
|
Professional
|
Both
|
$2,622.00
|
|
|
Service Code
|
CPT 27501
|
| Hospital Charge Code |
3014082
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$443.01 |
| Max. Negotiated Rate |
$2,490.90 |
| Rate for Payer: Aetna Commercial |
$2,490.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,254.92
|
| Rate for Payer: Cash Price |
$786.60
|
| Rate for Payer: Cash Price |
$786.60
|
| Rate for Payer: Cash Price |
$786.60
|
| Rate for Payer: Cigna Commercial |
$2,490.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$443.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,573.20
|
| Rate for Payer: Health EOS Commercial |
$2,386.02
|
| Rate for Payer: HFN Commercial |
$2,490.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,654.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,654.93
|
| Rate for Payer: Multiplan Commercial |
$2,097.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,490.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,153.68
|
| Rate for Payer: Quartz Commercial |
$1,494.54
|
| Rate for Payer: The Alliance Commercial |
$1,311.00
|
| Rate for Payer: United Healthcare Medicaid |
$443.01
|
| Rate for Payer: WEA Trust Commercial |
$1,442.10
|
| Rate for Payer: WPS Commercial |
$1,942.12
|
|
|
TREATMENT OF THIGH FRACTURE 27508
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
CPT 27508
|
| Hospital Charge Code |
3014086
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$602.39 |
| Max. Negotiated Rate |
$1,710.00 |
| Rate for Payer: Aetna Commercial |
$1,710.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,548.00
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cigna Commercial |
$1,710.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$602.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,080.00
|
| Rate for Payer: Health EOS Commercial |
$1,638.00
|
| Rate for Payer: HFN Commercial |
$1,710.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,660.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,660.58
|
| Rate for Payer: Multiplan Commercial |
$1,440.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,710.00
|
| Rate for Payer: Quartz Beloit One Network |
$792.00
|
| Rate for Payer: Quartz Commercial |
$1,026.00
|
| Rate for Payer: The Alliance Commercial |
$900.00
|
| Rate for Payer: United Healthcare Medicaid |
$602.39
|
| Rate for Payer: WEA Trust Commercial |
$990.00
|
| Rate for Payer: WPS Commercial |
$1,333.26
|
|
|
TREATMENT OF TIBIA FRACTURE 27752
|
Professional
|
Both
|
$1,973.00
|
|
|
Service Code
|
CPT 27752
|
| Hospital Charge Code |
3014140
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$492.26 |
| Max. Negotiated Rate |
$1,874.35 |
| Rate for Payer: Aetna Commercial |
$1,874.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,696.78
|
| Rate for Payer: Cash Price |
$591.90
|
| Rate for Payer: Cash Price |
$591.90
|
| Rate for Payer: Cash Price |
$591.90
|
| Rate for Payer: Cigna Commercial |
$1,874.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$492.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,183.80
|
| Rate for Payer: Health EOS Commercial |
$1,795.43
|
| Rate for Payer: HFN Commercial |
$1,874.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,637.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,637.04
|
| Rate for Payer: Multiplan Commercial |
$1,578.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,874.35
|
| Rate for Payer: Quartz Beloit One Network |
$868.12
|
| Rate for Payer: Quartz Commercial |
$1,124.61
|
| Rate for Payer: The Alliance Commercial |
$986.50
|
| Rate for Payer: United Healthcare Medicaid |
$492.26
|
| Rate for Payer: WEA Trust Commercial |
$1,085.15
|
| Rate for Payer: WPS Commercial |
$1,461.40
|
|
|
TREATMENT OF TOE FRACTURE 28515
|
Professional
|
Both
|
$341.00
|
|
|
Service Code
|
CPT 28515
|
| Hospital Charge Code |
3014261
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$75.33 |
| Max. Negotiated Rate |
$478.77 |
| Rate for Payer: Aetna Commercial |
$323.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$293.26
|
| Rate for Payer: Cash Price |
$102.30
|
| Rate for Payer: Cash Price |
$102.30
|
| Rate for Payer: Cash Price |
$102.30
|
| Rate for Payer: Cigna Commercial |
$323.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$75.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$204.60
|
| Rate for Payer: Health EOS Commercial |
$310.31
|
| Rate for Payer: HFN Commercial |
$323.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$478.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$478.77
|
| Rate for Payer: Multiplan Commercial |
$272.80
|
| Rate for Payer: Preferred Network Access Commercial |
$323.95
|
| Rate for Payer: Quartz Beloit One Network |
$150.04
|
| Rate for Payer: Quartz Commercial |
$194.37
|
| Rate for Payer: The Alliance Commercial |
$170.50
|
| Rate for Payer: United Healthcare Medicaid |
$75.33
|
| Rate for Payer: WEA Trust Commercial |
$187.55
|
| Rate for Payer: WPS Commercial |
$252.58
|
|
|
TREATMENT OF URETHRA LESION 53260
|
Professional
|
Both
|
$675.00
|
|
|
Service Code
|
CPT 53260
|
| Hospital Charge Code |
3015011
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$75.33 |
| Max. Negotiated Rate |
$641.25 |
| Rate for Payer: Aetna Commercial |
$641.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$580.50
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cigna Commercial |
$641.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$75.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$405.00
|
| Rate for Payer: Health EOS Commercial |
$614.25
|
| Rate for Payer: HFN Commercial |
$641.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$603.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$603.98
|
| Rate for Payer: Multiplan Commercial |
$540.00
|
| Rate for Payer: Preferred Network Access Commercial |
$641.25
|
| Rate for Payer: Quartz Beloit One Network |
$297.00
|
| Rate for Payer: Quartz Commercial |
$384.75
|
| Rate for Payer: The Alliance Commercial |
$337.50
|
| Rate for Payer: United Healthcare Medicaid |
$75.33
|
| Rate for Payer: WEA Trust Commercial |
$371.25
|
| Rate for Payer: WPS Commercial |
$499.97
|
|
|
TREATMENT OF URETHRA LESION 53265
|
Professional
|
Both
|
$1,290.00
|
|
|
Service Code
|
CPT 53265
|
| Hospital Charge Code |
3015012
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$105.45 |
| Max. Negotiated Rate |
$1,225.50 |
| Rate for Payer: Aetna Commercial |
$1,225.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,109.40
|
| Rate for Payer: Cash Price |
$387.00
|
| Rate for Payer: Cash Price |
$387.00
|
| Rate for Payer: Cash Price |
$387.00
|
| Rate for Payer: Cigna Commercial |
$1,225.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$105.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$774.00
|
| Rate for Payer: Health EOS Commercial |
$1,173.90
|
| Rate for Payer: HFN Commercial |
$1,225.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$627.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$627.74
|
| Rate for Payer: Multiplan Commercial |
$1,032.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,225.50
|
| Rate for Payer: Quartz Beloit One Network |
$567.60
|
| Rate for Payer: Quartz Commercial |
$735.30
|
| Rate for Payer: The Alliance Commercial |
$645.00
|
| Rate for Payer: United Healthcare Medicaid |
$105.45
|
| Rate for Payer: WEA Trust Commercial |
$709.50
|
| Rate for Payer: WPS Commercial |
$955.50
|
|
|
TREAT METACARPAL FRACTURE 26605
|
Professional
|
Both
|
$672.00
|
|
|
Service Code
|
CPT 26605
|
| Hospital Charge Code |
3013970
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$230.56 |
| Max. Negotiated Rate |
$997.72 |
| Rate for Payer: Aetna Commercial |
$638.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$577.92
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cigna Commercial |
$638.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$230.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$403.20
|
| Rate for Payer: Health EOS Commercial |
$611.52
|
| Rate for Payer: HFN Commercial |
$638.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$997.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$997.72
|
| Rate for Payer: Multiplan Commercial |
$537.60
|
| Rate for Payer: Preferred Network Access Commercial |
$638.40
|
| Rate for Payer: Quartz Beloit One Network |
$295.68
|
| Rate for Payer: Quartz Commercial |
$383.04
|
| Rate for Payer: The Alliance Commercial |
$336.00
|
| Rate for Payer: United Healthcare Medicaid |
$230.56
|
| Rate for Payer: WEA Trust Commercial |
$369.60
|
| Rate for Payer: WPS Commercial |
$497.75
|
|
|
Treat Radius Fracture 2465050
|
Professional
|
Both
|
$1,295.00
|
|
|
Service Code
|
CPT 24650 50
|
| Hospital Charge Code |
5454900
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$190.57 |
| Max. Negotiated Rate |
$1,230.25 |
| Rate for Payer: Aetna Commercial |
$1,230.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,113.70
|
| Rate for Payer: Cash Price |
$388.50
|
| Rate for Payer: Cash Price |
$388.50
|
| Rate for Payer: Cash Price |
$388.50
|
| Rate for Payer: Cigna Commercial |
$1,230.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$190.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$777.00
|
| Rate for Payer: Health EOS Commercial |
$1,178.45
|
| Rate for Payer: HFN Commercial |
$1,230.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$826.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$826.20
|
| Rate for Payer: Multiplan Commercial |
$1,036.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,230.25
|
| Rate for Payer: Quartz Beloit One Network |
$569.80
|
| Rate for Payer: Quartz Commercial |
$738.15
|
| Rate for Payer: The Alliance Commercial |
$647.50
|
| Rate for Payer: United Healthcare Medicaid |
$190.57
|
| Rate for Payer: WEA Trust Commercial |
$712.25
|
| Rate for Payer: WPS Commercial |
$959.21
|
|
|
TREAT SESAMOID BONE FRACTURE 28530
|
Professional
|
Both
|
$770.00
|
|
|
Service Code
|
CPT 28530
|
| Hospital Charge Code |
3014263
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$59.85 |
| Max. Negotiated Rate |
$731.50 |
| Rate for Payer: Aetna Commercial |
$731.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$662.20
|
| 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 |
$731.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$59.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$462.00
|
| Rate for Payer: Health EOS Commercial |
$700.70
|
| Rate for Payer: HFN Commercial |
$731.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$336.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$336.83
|
| Rate for Payer: Multiplan Commercial |
$616.00
|
| Rate for Payer: Preferred Network Access Commercial |
$731.50
|
| Rate for Payer: Quartz Beloit One Network |
$338.80
|
| Rate for Payer: Quartz Commercial |
$438.90
|
| Rate for Payer: The Alliance Commercial |
$385.00
|
| Rate for Payer: United Healthcare Medicaid |
$59.85
|
| Rate for Payer: WEA Trust Commercial |
$423.50
|
| Rate for Payer: WPS Commercial |
$570.34
|
|
|
TREAT SHOULDER BLADE FX 23570
|
Professional
|
Both
|
$644.00
|
|
|
Service Code
|
CPT 23570
|
| Hospital Charge Code |
3013787
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$99.64 |
| Max. Negotiated Rate |
$814.12 |
| Rate for Payer: Aetna Commercial |
$611.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$553.84
|
| Rate for Payer: Cash Price |
$193.20
|
| Rate for Payer: Cash Price |
$193.20
|
| Rate for Payer: Cash Price |
$193.20
|
| Rate for Payer: Cigna Commercial |
$611.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$99.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$386.40
|
| Rate for Payer: Health EOS Commercial |
$586.04
|
| Rate for Payer: HFN Commercial |
$611.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$814.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$814.12
|
| Rate for Payer: Multiplan Commercial |
$515.20
|
| Rate for Payer: Preferred Network Access Commercial |
$611.80
|
| Rate for Payer: Quartz Beloit One Network |
$283.36
|
| Rate for Payer: Quartz Commercial |
$367.08
|
| Rate for Payer: The Alliance Commercial |
$322.00
|
| Rate for Payer: United Healthcare Medicaid |
$99.64
|
| Rate for Payer: WEA Trust Commercial |
$354.20
|
| Rate for Payer: WPS Commercial |
$477.01
|
|
|
TREAT SHOULDER DISLOCATION 23650
|
Professional
|
Both
|
$967.00
|
|
|
Service Code
|
CPT 23650
|
| Hospital Charge Code |
3013796
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$188.66 |
| Max. Negotiated Rate |
$978.97 |
| Rate for Payer: Aetna Commercial |
$918.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$831.62
|
| Rate for Payer: Cash Price |
$290.10
|
| Rate for Payer: Cash Price |
$290.10
|
| Rate for Payer: Cash Price |
$290.10
|
| Rate for Payer: Cigna Commercial |
$918.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$188.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$580.20
|
| Rate for Payer: Health EOS Commercial |
$879.97
|
| Rate for Payer: HFN Commercial |
$918.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$978.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$978.97
|
| Rate for Payer: Multiplan Commercial |
$773.60
|
| Rate for Payer: Preferred Network Access Commercial |
$918.65
|
| Rate for Payer: Quartz Beloit One Network |
$425.48
|
| Rate for Payer: Quartz Commercial |
$551.19
|
| Rate for Payer: The Alliance Commercial |
$483.50
|
| Rate for Payer: United Healthcare Medicaid |
$188.66
|
| Rate for Payer: WEA Trust Commercial |
$531.85
|
| Rate for Payer: WPS Commercial |
$716.26
|
|
|
TREAT SPINE FRACTURE 22310
|
Professional
|
Both
|
$1,714.00
|
|
|
Service Code
|
CPT 22310
|
| Hospital Charge Code |
3013751
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$452.00 |
| Max. Negotiated Rate |
$1,628.30 |
| Rate for Payer: Aetna Commercial |
$1,628.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,474.04
|
| Rate for Payer: Cash Price |
$514.20
|
| Rate for Payer: Cash Price |
$514.20
|
| Rate for Payer: Cash Price |
$514.20
|
| Rate for Payer: Cigna Commercial |
$1,628.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$452.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,028.40
|
| Rate for Payer: Health EOS Commercial |
$1,559.74
|
| Rate for Payer: HFN Commercial |
$1,628.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$977.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$977.53
|
| Rate for Payer: Multiplan Commercial |
$1,371.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,628.30
|
| Rate for Payer: Quartz Beloit One Network |
$754.16
|
| Rate for Payer: Quartz Commercial |
$976.98
|
| Rate for Payer: The Alliance Commercial |
$857.00
|
| Rate for Payer: United Healthcare Medicaid |
$452.00
|
| Rate for Payer: WEA Trust Commercial |
$942.70
|
| Rate for Payer: WPS Commercial |
$1,269.56
|
|
|
TREAT SPINE FRACTURE 22315
|
Professional
|
Both
|
$2,834.00
|
|
|
Service Code
|
CPT 22315
|
| Hospital Charge Code |
3013752
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$452.00 |
| Max. Negotiated Rate |
$2,692.30 |
| Rate for Payer: Aetna Commercial |
$2,692.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,437.24
|
| Rate for Payer: Cash Price |
$850.20
|
| Rate for Payer: Cash Price |
$850.20
|
| Rate for Payer: Cash Price |
$850.20
|
| Rate for Payer: Cigna Commercial |
$2,692.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$452.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,700.40
|
| Rate for Payer: Health EOS Commercial |
$2,578.94
|
| Rate for Payer: HFN Commercial |
$2,692.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,534.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,534.75
|
| Rate for Payer: Multiplan Commercial |
$2,267.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,692.30
|
| Rate for Payer: Quartz Beloit One Network |
$1,246.96
|
| Rate for Payer: Quartz Commercial |
$1,615.38
|
| Rate for Payer: The Alliance Commercial |
$1,417.00
|
| Rate for Payer: United Healthcare Medicaid |
$452.00
|
| Rate for Payer: WEA Trust Commercial |
$1,558.70
|
| Rate for Payer: WPS Commercial |
$2,099.14
|
|
|
TREAT STERNUM FRACTURE 21820
|
Professional
|
Both
|
$648.00
|
|
|
Service Code
|
CPT 21820
|
| Hospital Charge Code |
3013744
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$136.73 |
| Max. Negotiated Rate |
$615.60 |
| Rate for Payer: Aetna Commercial |
$615.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$557.28
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cigna Commercial |
$615.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$136.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$388.80
|
| Rate for Payer: Health EOS Commercial |
$589.68
|
| Rate for Payer: HFN Commercial |
$615.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$489.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$489.12
|
| Rate for Payer: Multiplan Commercial |
$518.40
|
| Rate for Payer: Preferred Network Access Commercial |
$615.60
|
| Rate for Payer: Quartz Beloit One Network |
$285.12
|
| Rate for Payer: Quartz Commercial |
$369.36
|
| Rate for Payer: The Alliance Commercial |
$324.00
|
| Rate for Payer: United Healthcare Medicaid |
$136.73
|
| Rate for Payer: WEA Trust Commercial |
$356.40
|
| Rate for Payer: WPS Commercial |
$479.97
|
|
|
TREAT TAIL BONE FRACTURE 27200
|
Professional
|
Both
|
$518.00
|
|
|
Service Code
|
CPT 27200
|
| Hospital Charge Code |
3014027
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$150.66 |
| Max. Negotiated Rate |
$627.88 |
| Rate for Payer: Aetna Commercial |
$492.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$445.48
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$492.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$150.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$310.80
|
| Rate for Payer: Health EOS Commercial |
$471.38
|
| Rate for Payer: HFN Commercial |
$492.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$627.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$627.88
|
| Rate for Payer: Multiplan Commercial |
$414.40
|
| Rate for Payer: Preferred Network Access Commercial |
$492.10
|
| Rate for Payer: Quartz Beloit One Network |
$227.92
|
| Rate for Payer: Quartz Commercial |
$295.26
|
| Rate for Payer: The Alliance Commercial |
$259.00
|
| Rate for Payer: United Healthcare Medicaid |
$150.66
|
| Rate for Payer: WEA Trust Commercial |
$284.90
|
| Rate for Payer: WPS Commercial |
$383.68
|
|
|
TREAT THIGH FRACTURE 27230
|
Professional
|
Both
|
$1,961.00
|
|
|
Service Code
|
CPT 27230
|
| Hospital Charge Code |
3014029
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$527.35 |
| Max. Negotiated Rate |
$1,862.95 |
| Rate for Payer: Aetna Commercial |
$1,862.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,686.46
|
| Rate for Payer: Cash Price |
$588.30
|
| Rate for Payer: Cash Price |
$588.30
|
| Rate for Payer: Cash Price |
$588.30
|
| Rate for Payer: Cigna Commercial |
$1,862.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$527.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,176.60
|
| Rate for Payer: Health EOS Commercial |
$1,784.51
|
| Rate for Payer: HFN Commercial |
$1,862.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,589.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,589.49
|
| Rate for Payer: Multiplan Commercial |
$1,568.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,862.95
|
| Rate for Payer: Quartz Beloit One Network |
$862.84
|
| Rate for Payer: Quartz Commercial |
$1,117.77
|
| Rate for Payer: The Alliance Commercial |
$980.50
|
| Rate for Payer: United Healthcare Medicaid |
$527.35
|
| Rate for Payer: WEA Trust Commercial |
$1,078.55
|
| Rate for Payer: WPS Commercial |
$1,452.51
|
|
