|
TREAT EYELID LESION 67850
|
Professional
|
Both
|
$626.00
|
|
|
Service Code
|
CPT 67850
|
| Hospital Charge Code |
3015245
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$54.64 |
| Max. Negotiated Rate |
$618.49 |
| Rate for Payer: Aetna Commercial |
$618.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$559.89
|
| Rate for Payer: Aetna Managed Medicare |
$111.24
|
| Rate for Payer: Anthem Medicare Advantage |
$111.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$111.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$111.24
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$618.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$54.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$111.24
|
| Rate for Payer: Health EOS Commercial |
$592.45
|
| Rate for Payer: HFN Commercial |
$618.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$457.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$457.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$111.24
|
| Rate for Payer: Multiplan Commercial |
$520.83
|
| Rate for Payer: NAPHCARE Commercial |
$166.86
|
| Rate for Payer: Preferred Network Access Commercial |
$618.49
|
| Rate for Payer: Quartz Beloit One Network |
$286.46
|
| Rate for Payer: Quartz Commercial |
$371.09
|
| Rate for Payer: Quartz Medicare Advantage |
$111.24
|
| Rate for Payer: The Alliance Commercial |
$472.76
|
| Rate for Payer: United Healthcare Medicaid |
$54.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$111.24
|
| Rate for Payer: WEA Trust Commercial |
$358.07
|
| Rate for Payer: WPS Commercial |
$500.57
|
|
|
TREAT FINGER DISLOCATION 26770
|
Professional
|
Both
|
$691.00
|
|
|
Service Code
|
CPT 26770
|
| Hospital Charge Code |
3013991
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$76.32 |
| Max. Negotiated Rate |
$1,329.26 |
| Rate for Payer: Aetna Commercial |
$682.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$618.03
|
| Rate for Payer: Aetna Managed Medicare |
$295.39
|
| Rate for Payer: Anthem Medicare Advantage |
$295.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$295.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$295.39
|
| Rate for Payer: Cash Price |
$207.30
|
| Rate for Payer: Cash Price |
$207.30
|
| Rate for Payer: Cash Price |
$207.30
|
| Rate for Payer: Cigna Commercial |
$682.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$76.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$295.39
|
| Rate for Payer: Health EOS Commercial |
$653.96
|
| Rate for Payer: HFN Commercial |
$682.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$900.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$900.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$295.39
|
| Rate for Payer: Multiplan Commercial |
$574.91
|
| Rate for Payer: NAPHCARE Commercial |
$443.09
|
| Rate for Payer: Preferred Network Access Commercial |
$682.71
|
| Rate for Payer: Quartz Beloit One Network |
$316.20
|
| Rate for Payer: Quartz Commercial |
$409.62
|
| Rate for Payer: Quartz Medicare Advantage |
$295.39
|
| Rate for Payer: The Alliance Commercial |
$1,255.41
|
| Rate for Payer: United Healthcare Medicaid |
$76.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$295.39
|
| Rate for Payer: WEA Trust Commercial |
$395.25
|
| Rate for Payer: WPS Commercial |
$1,329.26
|
|
|
TREAT FINGER DISLOCATION 26775
|
Professional
|
Both
|
$866.00
|
|
|
Service Code
|
CPT 26775
|
| Hospital Charge Code |
3013992
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$97.96 |
| Max. Negotiated Rate |
$1,550.06 |
| Rate for Payer: Aetna Commercial |
$855.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$774.55
|
| Rate for Payer: Aetna Managed Medicare |
$344.46
|
| Rate for Payer: Anthem Medicare Advantage |
$344.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$344.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$344.46
|
| Rate for Payer: Cash Price |
$259.80
|
| Rate for Payer: Cash Price |
$259.80
|
| Rate for Payer: Cash Price |
$259.80
|
| Rate for Payer: Cigna Commercial |
$855.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$97.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$344.46
|
| Rate for Payer: Health EOS Commercial |
$819.58
|
| Rate for Payer: HFN Commercial |
$855.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,228.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,228.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$344.46
|
| Rate for Payer: Multiplan Commercial |
$720.51
|
| Rate for Payer: NAPHCARE Commercial |
$516.69
|
| Rate for Payer: Preferred Network Access Commercial |
$855.61
|
| Rate for Payer: Quartz Beloit One Network |
$396.28
|
| Rate for Payer: Quartz Commercial |
$513.36
|
| Rate for Payer: Quartz Medicare Advantage |
$344.46
|
| Rate for Payer: The Alliance Commercial |
$1,463.95
|
| Rate for Payer: United Healthcare Medicaid |
$97.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$344.46
|
| Rate for Payer: WEA Trust Commercial |
$495.35
|
| Rate for Payer: WPS Commercial |
$1,550.06
|
|
|
Treat Finger Fracture, Each 26742
|
Professional
|
Both
|
$1,925.00
|
|
|
Service Code
|
CPT 26742
|
| Hospital Charge Code |
3935372
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$171.76 |
| Max. Negotiated Rate |
$1,901.90 |
| Rate for Payer: Aetna Commercial |
$1,901.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,721.72
|
| Rate for Payer: Aetna Managed Medicare |
$327.05
|
| Rate for Payer: Anthem Medicare Advantage |
$327.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$327.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$327.05
|
| Rate for Payer: Cash Price |
$577.50
|
| Rate for Payer: Cash Price |
$577.50
|
| Rate for Payer: Cash Price |
$577.50
|
| Rate for Payer: Cigna Commercial |
$1,901.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$171.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$327.05
|
| Rate for Payer: Health EOS Commercial |
$1,821.82
|
| Rate for Payer: HFN Commercial |
$1,901.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,176.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,176.32
|
| Rate for Payer: Independent Care Health Plan Medicare |
$327.05
|
| Rate for Payer: Multiplan Commercial |
$1,601.60
|
| Rate for Payer: NAPHCARE Commercial |
$490.57
|
| Rate for Payer: Preferred Network Access Commercial |
$1,901.90
|
| Rate for Payer: Quartz Beloit One Network |
$880.88
|
| Rate for Payer: Quartz Commercial |
$1,141.14
|
| Rate for Payer: Quartz Medicare Advantage |
$327.05
|
| Rate for Payer: The Alliance Commercial |
$1,389.96
|
| Rate for Payer: United Healthcare Medicaid |
$171.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$327.05
|
| Rate for Payer: WEA Trust Commercial |
$1,101.10
|
| Rate for Payer: WPS Commercial |
$1,471.72
|
|
|
TREAT FINGER FRACTURE, EACH 26750
|
Professional
|
Both
|
$363.00
|
|
|
Service Code
|
CPT 26750
|
| Hospital Charge Code |
3013987
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$60.26 |
| Max. Negotiated Rate |
$908.39 |
| Rate for Payer: Aetna Commercial |
$358.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$324.67
|
| Rate for Payer: Aetna Managed Medicare |
$201.86
|
| Rate for Payer: Anthem Medicare Advantage |
$201.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$201.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$201.86
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cigna Commercial |
$358.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$60.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$201.86
|
| Rate for Payer: Health EOS Commercial |
$343.54
|
| Rate for Payer: HFN Commercial |
$358.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$657.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$657.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$201.86
|
| Rate for Payer: Multiplan Commercial |
$302.02
|
| Rate for Payer: NAPHCARE Commercial |
$302.80
|
| Rate for Payer: Preferred Network Access Commercial |
$358.64
|
| Rate for Payer: Quartz Beloit One Network |
$166.11
|
| Rate for Payer: Quartz Commercial |
$215.19
|
| Rate for Payer: Quartz Medicare Advantage |
$201.86
|
| Rate for Payer: The Alliance Commercial |
$857.92
|
| Rate for Payer: United Healthcare Medicaid |
$60.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$201.86
|
| Rate for Payer: WEA Trust Commercial |
$207.64
|
| Rate for Payer: WPS Commercial |
$908.39
|
|
|
TREAT FINGER FRACTURE, EACH 26755
|
Professional
|
Both
|
$480.00
|
|
|
Service Code
|
CPT 26755
|
| Hospital Charge Code |
3013988
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$64.77 |
| Max. Negotiated Rate |
$1,293.36 |
| Rate for Payer: Aetna Commercial |
$474.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$429.31
|
| Rate for Payer: Aetna Managed Medicare |
$287.41
|
| Rate for Payer: Anthem Medicare Advantage |
$287.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$287.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$287.41
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$474.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$64.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$287.41
|
| Rate for Payer: Health EOS Commercial |
$454.27
|
| Rate for Payer: HFN Commercial |
$474.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$958.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$958.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$287.41
|
| Rate for Payer: Multiplan Commercial |
$399.36
|
| Rate for Payer: NAPHCARE Commercial |
$431.12
|
| Rate for Payer: Preferred Network Access Commercial |
$474.24
|
| Rate for Payer: Quartz Beloit One Network |
$219.65
|
| Rate for Payer: Quartz Commercial |
$284.54
|
| Rate for Payer: Quartz Medicare Advantage |
$287.41
|
| Rate for Payer: The Alliance Commercial |
$1,221.51
|
| Rate for Payer: United Healthcare Medicaid |
$64.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$287.41
|
| Rate for Payer: WEA Trust Commercial |
$274.56
|
| Rate for Payer: WPS Commercial |
$1,293.36
|
|
|
TREAT FOOT DISLOCATION 28545
|
Professional
|
Both
|
$564.00
|
|
|
Service Code
|
CPT 28545
|
| Hospital Charge Code |
3014264
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$156.69 |
| Max. Negotiated Rate |
$1,205.76 |
| Rate for Payer: Aetna Commercial |
$557.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$504.44
|
| Rate for Payer: Aetna Managed Medicare |
$267.95
|
| Rate for Payer: Anthem Medicare Advantage |
$267.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$267.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$267.95
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Cigna Commercial |
$557.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$156.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$267.95
|
| Rate for Payer: Health EOS Commercial |
$533.77
|
| Rate for Payer: HFN Commercial |
$557.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$936.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$936.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$267.95
|
| Rate for Payer: Multiplan Commercial |
$469.25
|
| Rate for Payer: NAPHCARE Commercial |
$401.92
|
| Rate for Payer: Preferred Network Access Commercial |
$557.23
|
| Rate for Payer: Quartz Beloit One Network |
$258.09
|
| Rate for Payer: Quartz Commercial |
$334.34
|
| Rate for Payer: Quartz Medicare Advantage |
$267.95
|
| Rate for Payer: The Alliance Commercial |
$1,138.77
|
| Rate for Payer: United Healthcare Medicaid |
$156.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$267.95
|
| Rate for Payer: WEA Trust Commercial |
$322.61
|
| Rate for Payer: WPS Commercial |
$1,205.76
|
|
|
TREAT FOOT DISLOCATION 28600
|
Professional
|
Both
|
$564.00
|
|
|
Service Code
|
CPT 28600
|
| Hospital Charge Code |
3014268
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$109.67 |
| Max. Negotiated Rate |
$703.97 |
| Rate for Payer: Aetna Commercial |
$557.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$504.44
|
| Rate for Payer: Aetna Managed Medicare |
$156.44
|
| Rate for Payer: Anthem Medicare Advantage |
$156.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$156.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$156.44
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Cigna Commercial |
$557.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$109.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$156.44
|
| Rate for Payer: Health EOS Commercial |
$533.77
|
| Rate for Payer: HFN Commercial |
$557.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$649.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$649.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$156.44
|
| Rate for Payer: Multiplan Commercial |
$469.25
|
| Rate for Payer: NAPHCARE Commercial |
$234.66
|
| Rate for Payer: Preferred Network Access Commercial |
$557.23
|
| Rate for Payer: Quartz Beloit One Network |
$258.09
|
| Rate for Payer: Quartz Commercial |
$334.34
|
| Rate for Payer: Quartz Medicare Advantage |
$156.44
|
| Rate for Payer: The Alliance Commercial |
$664.86
|
| Rate for Payer: United Healthcare Medicaid |
$109.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$156.44
|
| Rate for Payer: WEA Trust Commercial |
$322.61
|
| Rate for Payer: WPS Commercial |
$703.97
|
|
|
TREAT FRACTURE OF RADIUS 25505
|
Professional
|
Both
|
$1,886.00
|
|
|
Service Code
|
CPT 25505
|
| Hospital Charge Code |
3013891
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$313.36 |
| Max. Negotiated Rate |
$2,112.79 |
| Rate for Payer: Aetna Commercial |
$1,863.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,686.84
|
| Rate for Payer: Aetna Managed Medicare |
$469.51
|
| Rate for Payer: Anthem Medicare Advantage |
$469.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$469.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$469.51
|
| Rate for Payer: Cash Price |
$565.80
|
| Rate for Payer: Cash Price |
$565.80
|
| Rate for Payer: Cash Price |
$565.80
|
| Rate for Payer: Cigna Commercial |
$1,863.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$313.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$469.51
|
| Rate for Payer: Health EOS Commercial |
$1,784.91
|
| Rate for Payer: HFN Commercial |
$1,863.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,596.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,596.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$469.51
|
| Rate for Payer: Multiplan Commercial |
$1,569.15
|
| Rate for Payer: NAPHCARE Commercial |
$704.26
|
| Rate for Payer: Preferred Network Access Commercial |
$1,863.37
|
| Rate for Payer: Quartz Beloit One Network |
$863.03
|
| Rate for Payer: Quartz Commercial |
$1,118.02
|
| Rate for Payer: Quartz Medicare Advantage |
$469.51
|
| Rate for Payer: The Alliance Commercial |
$1,995.41
|
| Rate for Payer: United Healthcare Medicaid |
$313.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$469.51
|
| Rate for Payer: WEA Trust Commercial |
$1,078.79
|
| Rate for Payer: WPS Commercial |
$2,112.79
|
|
|
TREAT FRACTURE OF RADIUS 25520
|
Professional
|
Both
|
$2,207.00
|
|
|
Service Code
|
CPT 25520
|
| Hospital Charge Code |
3013893
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$494.85 |
| Max. Negotiated Rate |
$2,291.00 |
| Rate for Payer: Aetna Commercial |
$2,180.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,973.94
|
| Rate for Payer: Aetna Managed Medicare |
$509.11
|
| Rate for Payer: Anthem Medicare Advantage |
$509.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$509.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$509.11
|
| Rate for Payer: Cash Price |
$662.10
|
| Rate for Payer: Cash Price |
$662.10
|
| Rate for Payer: Cash Price |
$662.10
|
| Rate for Payer: Cigna Commercial |
$2,180.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$494.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$509.11
|
| Rate for Payer: Health EOS Commercial |
$2,088.70
|
| Rate for Payer: HFN Commercial |
$2,180.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,888.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,888.32
|
| Rate for Payer: Independent Care Health Plan Medicare |
$509.11
|
| Rate for Payer: Multiplan Commercial |
$1,836.22
|
| Rate for Payer: NAPHCARE Commercial |
$763.67
|
| Rate for Payer: Preferred Network Access Commercial |
$2,180.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,009.92
|
| Rate for Payer: Quartz Commercial |
$1,308.31
|
| Rate for Payer: Quartz Medicare Advantage |
$509.11
|
| Rate for Payer: The Alliance Commercial |
$2,163.72
|
| Rate for Payer: United Healthcare Medicaid |
$494.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$509.11
|
| Rate for Payer: WEA Trust Commercial |
$1,262.40
|
| Rate for Payer: WPS Commercial |
$2,291.00
|
|
|
TREAT FRACTURE OF ULNA 25535
|
Professional
|
Both
|
$1,169.00
|
|
|
Service Code
|
CPT 25535
|
| Hospital Charge Code |
3013897
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$313.36 |
| Max. Negotiated Rate |
$1,956.71 |
| Rate for Payer: Aetna Commercial |
$1,154.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,045.55
|
| Rate for Payer: Aetna Managed Medicare |
$434.82
|
| Rate for Payer: Anthem Medicare Advantage |
$434.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$434.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$434.82
|
| Rate for Payer: Cash Price |
$350.70
|
| Rate for Payer: Cash Price |
$350.70
|
| Rate for Payer: Cash Price |
$350.70
|
| Rate for Payer: Cigna Commercial |
$1,154.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$313.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$434.82
|
| Rate for Payer: Health EOS Commercial |
$1,106.34
|
| Rate for Payer: HFN Commercial |
$1,154.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,594.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,594.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$434.82
|
| Rate for Payer: Multiplan Commercial |
$972.61
|
| Rate for Payer: NAPHCARE Commercial |
$652.24
|
| Rate for Payer: Preferred Network Access Commercial |
$1,154.97
|
| Rate for Payer: Quartz Beloit One Network |
$534.93
|
| Rate for Payer: Quartz Commercial |
$692.98
|
| Rate for Payer: Quartz Medicare Advantage |
$434.82
|
| Rate for Payer: The Alliance Commercial |
$1,848.00
|
| Rate for Payer: United Healthcare Medicaid |
$313.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$434.82
|
| Rate for Payer: WEA Trust Commercial |
$668.67
|
| Rate for Payer: WPS Commercial |
$1,956.71
|
|
|
TREAT FRACTURE RADIUS AND ULNA 25565
|
Professional
|
Both
|
$1,947.00
|
|
|
Service Code
|
CPT 25565
|
| Hospital Charge Code |
3013900
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$404.70 |
| Max. Negotiated Rate |
$2,189.54 |
| Rate for Payer: Aetna Commercial |
$1,923.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,741.40
|
| Rate for Payer: Aetna Managed Medicare |
$486.56
|
| Rate for Payer: Anthem Medicare Advantage |
$486.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$486.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$486.56
|
| Rate for Payer: Cash Price |
$584.10
|
| Rate for Payer: Cash Price |
$584.10
|
| Rate for Payer: Cash Price |
$584.10
|
| Rate for Payer: Cigna Commercial |
$1,923.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$404.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$486.56
|
| Rate for Payer: Health EOS Commercial |
$1,842.64
|
| Rate for Payer: HFN Commercial |
$1,923.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,611.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,611.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$486.56
|
| Rate for Payer: Multiplan Commercial |
$1,619.90
|
| Rate for Payer: NAPHCARE Commercial |
$729.85
|
| Rate for Payer: Preferred Network Access Commercial |
$1,923.64
|
| Rate for Payer: Quartz Beloit One Network |
$890.95
|
| Rate for Payer: Quartz Commercial |
$1,154.18
|
| Rate for Payer: Quartz Medicare Advantage |
$486.56
|
| Rate for Payer: The Alliance Commercial |
$2,067.90
|
| Rate for Payer: United Healthcare Medicaid |
$404.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$486.56
|
| Rate for Payer: WEA Trust Commercial |
$1,113.68
|
| Rate for Payer: WPS Commercial |
$2,189.54
|
|
|
TREAT FRACTURE RADIUS/ULNA 25605
|
Professional
|
Both
|
$913.00
|
|
|
Service Code
|
CPT 25605
|
| Hospital Charge Code |
3013904
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$395.92 |
| Max. Negotiated Rate |
$2,364.20 |
| Rate for Payer: Aetna Commercial |
$902.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$816.59
|
| Rate for Payer: Aetna Managed Medicare |
$525.38
|
| Rate for Payer: Anthem Medicare Advantage |
$525.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$525.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$525.38
|
| Rate for Payer: Cash Price |
$273.90
|
| Rate for Payer: Cash Price |
$273.90
|
| Rate for Payer: Cash Price |
$273.90
|
| Rate for Payer: Cigna Commercial |
$902.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$395.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$525.38
|
| Rate for Payer: Health EOS Commercial |
$864.06
|
| Rate for Payer: HFN Commercial |
$902.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,774.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,774.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$525.38
|
| Rate for Payer: Multiplan Commercial |
$759.62
|
| Rate for Payer: NAPHCARE Commercial |
$788.07
|
| Rate for Payer: Preferred Network Access Commercial |
$902.04
|
| Rate for Payer: Quartz Beloit One Network |
$417.79
|
| Rate for Payer: Quartz Commercial |
$541.23
|
| Rate for Payer: Quartz Medicare Advantage |
$525.38
|
| Rate for Payer: The Alliance Commercial |
$2,232.85
|
| Rate for Payer: United Healthcare Medicaid |
$395.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$525.38
|
| Rate for Payer: WEA Trust Commercial |
$522.24
|
| Rate for Payer: WPS Commercial |
$2,364.20
|
|
|
TREAT HAND DISLOCATION 26675
|
Professional
|
Both
|
$1,262.00
|
|
|
Service Code
|
CPT 26675
|
| Hospital Charge Code |
3013976
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$125.34 |
| Max. Negotiated Rate |
$1,806.67 |
| Rate for Payer: Aetna Commercial |
$1,246.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,128.73
|
| Rate for Payer: Aetna Managed Medicare |
$401.48
|
| Rate for Payer: Anthem Medicare Advantage |
$401.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$401.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$401.48
|
| Rate for Payer: Cash Price |
$378.60
|
| Rate for Payer: Cash Price |
$378.60
|
| Rate for Payer: Cash Price |
$378.60
|
| Rate for Payer: Cigna Commercial |
$1,246.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$125.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$401.48
|
| Rate for Payer: Health EOS Commercial |
$1,194.36
|
| Rate for Payer: HFN Commercial |
$1,246.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,467.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,467.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$401.48
|
| Rate for Payer: Multiplan Commercial |
$1,049.98
|
| Rate for Payer: NAPHCARE Commercial |
$602.22
|
| Rate for Payer: Preferred Network Access Commercial |
$1,246.86
|
| Rate for Payer: Quartz Beloit One Network |
$577.49
|
| Rate for Payer: Quartz Commercial |
$748.11
|
| Rate for Payer: Quartz Medicare Advantage |
$401.48
|
| Rate for Payer: The Alliance Commercial |
$1,706.30
|
| Rate for Payer: United Healthcare Medicaid |
$125.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$401.48
|
| Rate for Payer: WEA Trust Commercial |
$721.86
|
| Rate for Payer: WPS Commercial |
$1,806.67
|
|
|
TREAT HIP SOCKET FRACTURE 27220
|
Professional
|
Both
|
$1,334.00
|
|
|
Service Code
|
CPT 27220
|
| Hospital Charge Code |
3014028
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$371.10 |
| Max. Negotiated Rate |
$1,669.96 |
| Rate for Payer: Aetna Commercial |
$1,317.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,193.13
|
| Rate for Payer: Aetna Managed Medicare |
$371.10
|
| Rate for Payer: Anthem Medicare Advantage |
$371.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$371.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$371.10
|
| Rate for Payer: Cash Price |
$400.20
|
| Rate for Payer: Cash Price |
$400.20
|
| Rate for Payer: Cash Price |
$400.20
|
| Rate for Payer: Cigna Commercial |
$1,317.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$391.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$371.10
|
| Rate for Payer: Health EOS Commercial |
$1,262.50
|
| Rate for Payer: HFN Commercial |
$1,317.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,423.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,423.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$371.10
|
| Rate for Payer: Multiplan Commercial |
$1,109.89
|
| Rate for Payer: NAPHCARE Commercial |
$556.65
|
| Rate for Payer: Preferred Network Access Commercial |
$1,317.99
|
| Rate for Payer: Quartz Beloit One Network |
$610.44
|
| Rate for Payer: Quartz Commercial |
$790.80
|
| Rate for Payer: Quartz Medicare Advantage |
$371.10
|
| Rate for Payer: The Alliance Commercial |
$1,577.19
|
| Rate for Payer: United Healthcare Medicaid |
$391.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$371.10
|
| Rate for Payer: WEA Trust Commercial |
$763.05
|
| Rate for Payer: WPS Commercial |
$1,669.96
|
|
|
TREAT HUMERUS FRACTURE 23605
|
Professional
|
Both
|
$1,512.00
|
|
|
Service Code
|
CPT 23605
|
| Hospital Charge Code |
3013790
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$422.07 |
| Max. Negotiated Rate |
$1,899.33 |
| Rate for Payer: Aetna Commercial |
$1,493.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,352.33
|
| Rate for Payer: Aetna Managed Medicare |
$422.07
|
| Rate for Payer: Anthem Medicare Advantage |
$422.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$422.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$422.07
|
| Rate for Payer: Cash Price |
$453.60
|
| Rate for Payer: Cash Price |
$453.60
|
| Rate for Payer: Cash Price |
$453.60
|
| Rate for Payer: Cigna Commercial |
$1,493.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$470.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$422.07
|
| Rate for Payer: Health EOS Commercial |
$1,430.96
|
| Rate for Payer: HFN Commercial |
$1,493.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,486.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,486.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$422.07
|
| Rate for Payer: Multiplan Commercial |
$1,257.98
|
| Rate for Payer: NAPHCARE Commercial |
$633.11
|
| Rate for Payer: Preferred Network Access Commercial |
$1,493.86
|
| Rate for Payer: Quartz Beloit One Network |
$691.89
|
| Rate for Payer: Quartz Commercial |
$896.31
|
| Rate for Payer: Quartz Medicare Advantage |
$422.07
|
| Rate for Payer: The Alliance Commercial |
$1,793.81
|
| Rate for Payer: United Healthcare Medicaid |
$470.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$422.07
|
| Rate for Payer: WEA Trust Commercial |
$864.86
|
| Rate for Payer: WPS Commercial |
$1,899.33
|
|
|
TREAT HUMERUS FRACTURE 24505
|
Professional
|
Both
|
$1,562.00
|
|
|
Service Code
|
CPT 24505
|
| Hospital Charge Code |
3013831
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$391.73 |
| Max. Negotiated Rate |
$2,037.11 |
| Rate for Payer: Aetna Commercial |
$1,543.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,397.05
|
| Rate for Payer: Aetna Managed Medicare |
$452.69
|
| Rate for Payer: Anthem Medicare Advantage |
$452.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$452.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$452.69
|
| Rate for Payer: Cash Price |
$468.60
|
| Rate for Payer: Cash Price |
$468.60
|
| Rate for Payer: Cash Price |
$468.60
|
| Rate for Payer: Cigna Commercial |
$1,543.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$391.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$452.69
|
| Rate for Payer: Health EOS Commercial |
$1,478.28
|
| Rate for Payer: HFN Commercial |
$1,543.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,570.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,570.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$452.69
|
| Rate for Payer: Multiplan Commercial |
$1,299.58
|
| Rate for Payer: NAPHCARE Commercial |
$679.04
|
| Rate for Payer: Preferred Network Access Commercial |
$1,543.26
|
| Rate for Payer: Quartz Beloit One Network |
$714.77
|
| Rate for Payer: Quartz Commercial |
$925.95
|
| Rate for Payer: Quartz Medicare Advantage |
$452.69
|
| Rate for Payer: The Alliance Commercial |
$1,923.94
|
| Rate for Payer: United Healthcare Medicaid |
$391.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$452.69
|
| Rate for Payer: WEA Trust Commercial |
$893.46
|
| Rate for Payer: WPS Commercial |
$2,037.11
|
|
|
TREAT HUMERUS FRACTURE 24535
|
Professional
|
Both
|
$1,670.00
|
|
|
Service Code
|
CPT 24535
|
| Hospital Charge Code |
3013835
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$539.65 |
| Max. Negotiated Rate |
$2,428.41 |
| Rate for Payer: Aetna Commercial |
$1,649.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,493.65
|
| Rate for Payer: Aetna Managed Medicare |
$539.65
|
| Rate for Payer: Anthem Medicare Advantage |
$539.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$539.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$539.65
|
| 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 |
$1,649.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$544.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$539.65
|
| Rate for Payer: Health EOS Commercial |
$1,580.49
|
| Rate for Payer: HFN Commercial |
$1,649.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,981.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,981.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$539.65
|
| Rate for Payer: Multiplan Commercial |
$1,389.44
|
| Rate for Payer: NAPHCARE Commercial |
$809.47
|
| Rate for Payer: Preferred Network Access Commercial |
$1,649.96
|
| Rate for Payer: Quartz Beloit One Network |
$764.19
|
| Rate for Payer: Quartz Commercial |
$989.98
|
| Rate for Payer: Quartz Medicare Advantage |
$539.65
|
| Rate for Payer: The Alliance Commercial |
$2,293.49
|
| Rate for Payer: United Healthcare Medicaid |
$544.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$539.65
|
| Rate for Payer: WEA Trust Commercial |
$955.24
|
| Rate for Payer: WPS Commercial |
$2,428.41
|
|
|
Treat Kneecap Dislocation 27560
|
Professional
|
Both
|
$884.00
|
|
|
Service Code
|
CPT 27560
|
| Hospital Charge Code |
4076168
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$273.30 |
| Max. Negotiated Rate |
$1,718.12 |
| Rate for Payer: Aetna Commercial |
$873.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$790.65
|
| Rate for Payer: Aetna Managed Medicare |
$381.80
|
| Rate for Payer: Anthem Medicare Advantage |
$381.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$381.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$381.80
|
| 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 |
$873.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$273.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$381.80
|
| Rate for Payer: Health EOS Commercial |
$836.62
|
| Rate for Payer: HFN Commercial |
$873.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,198.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,198.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$381.80
|
| Rate for Payer: Multiplan Commercial |
$735.49
|
| Rate for Payer: NAPHCARE Commercial |
$572.71
|
| Rate for Payer: Preferred Network Access Commercial |
$873.39
|
| Rate for Payer: Quartz Beloit One Network |
$404.52
|
| Rate for Payer: Quartz Commercial |
$524.04
|
| Rate for Payer: Quartz Medicare Advantage |
$381.80
|
| Rate for Payer: The Alliance Commercial |
$1,622.67
|
| Rate for Payer: United Healthcare Medicaid |
$273.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$381.80
|
| Rate for Payer: WEA Trust Commercial |
$505.65
|
| Rate for Payer: WPS Commercial |
$1,718.12
|
|
|
TREAT KNEE DISLOCATION 27550
|
Professional
|
Both
|
$959.00
|
|
|
Service Code
|
CPT 27550
|
| Hospital Charge Code |
3014101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$235.04 |
| Max. Negotiated Rate |
$2,248.23 |
| Rate for Payer: Aetna Commercial |
$947.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$857.73
|
| Rate for Payer: Aetna Managed Medicare |
$499.61
|
| Rate for Payer: Anthem Medicare Advantage |
$499.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$499.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$499.61
|
| 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 |
$947.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$235.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$499.61
|
| Rate for Payer: Health EOS Commercial |
$907.60
|
| Rate for Payer: HFN Commercial |
$947.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,686.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,686.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$499.61
|
| Rate for Payer: Multiplan Commercial |
$797.89
|
| Rate for Payer: NAPHCARE Commercial |
$749.41
|
| Rate for Payer: Preferred Network Access Commercial |
$947.49
|
| Rate for Payer: Quartz Beloit One Network |
$438.84
|
| Rate for Payer: Quartz Commercial |
$568.50
|
| Rate for Payer: Quartz Medicare Advantage |
$499.61
|
| Rate for Payer: The Alliance Commercial |
$2,123.32
|
| Rate for Payer: United Healthcare Medicaid |
$235.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$499.61
|
| Rate for Payer: WEA Trust Commercial |
$548.55
|
| Rate for Payer: WPS Commercial |
$2,248.23
|
|
|
TREAT KNEE FRACTURE 27532
|
Professional
|
Both
|
$1,684.00
|
|
|
Service Code
|
CPT 27532
|
| Hospital Charge Code |
3014096
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$391.73 |
| Max. Negotiated Rate |
$2,383.71 |
| Rate for Payer: Aetna Commercial |
$1,663.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,506.17
|
| Rate for Payer: Aetna Managed Medicare |
$529.71
|
| Rate for Payer: Anthem Medicare Advantage |
$529.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$529.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$529.71
|
| 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 |
$1,663.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$391.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$529.71
|
| Rate for Payer: Health EOS Commercial |
$1,593.74
|
| Rate for Payer: HFN Commercial |
$1,663.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,993.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,993.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$529.71
|
| Rate for Payer: Multiplan Commercial |
$1,401.09
|
| Rate for Payer: NAPHCARE Commercial |
$794.57
|
| Rate for Payer: Preferred Network Access Commercial |
$1,663.79
|
| Rate for Payer: Quartz Beloit One Network |
$770.60
|
| Rate for Payer: Quartz Commercial |
$998.28
|
| Rate for Payer: Quartz Medicare Advantage |
$529.71
|
| Rate for Payer: The Alliance Commercial |
$2,251.28
|
| Rate for Payer: United Healthcare Medicaid |
$391.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$529.71
|
| Rate for Payer: WEA Trust Commercial |
$963.25
|
| Rate for Payer: WPS Commercial |
$2,383.71
|
|
|
TREAT KNUCKLE DISLOCATION 26705
|
Professional
|
Both
|
$964.00
|
|
|
Service Code
|
CPT 26705
|
| Hospital Charge Code |
3013979
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$125.34 |
| Max. Negotiated Rate |
$1,713.11 |
| Rate for Payer: Aetna Commercial |
$952.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$862.20
|
| Rate for Payer: Aetna Managed Medicare |
$380.69
|
| Rate for Payer: Anthem Medicare Advantage |
$380.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$380.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$380.69
|
| 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 |
$952.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$125.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$380.69
|
| Rate for Payer: Health EOS Commercial |
$912.33
|
| Rate for Payer: HFN Commercial |
$952.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,345.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,345.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$380.69
|
| Rate for Payer: Multiplan Commercial |
$802.05
|
| Rate for Payer: NAPHCARE Commercial |
$571.04
|
| Rate for Payer: Preferred Network Access Commercial |
$952.43
|
| Rate for Payer: Quartz Beloit One Network |
$441.13
|
| Rate for Payer: Quartz Commercial |
$571.46
|
| Rate for Payer: Quartz Medicare Advantage |
$380.69
|
| Rate for Payer: The Alliance Commercial |
$1,617.94
|
| Rate for Payer: United Healthcare Medicaid |
$125.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.69
|
| Rate for Payer: WEA Trust Commercial |
$551.41
|
| Rate for Payer: WPS Commercial |
$1,713.11
|
|
|
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 |
$443.65 |
| Max. Negotiated Rate |
$2,759.48 |
| Rate for Payer: Aetna Commercial |
$2,759.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,498.06
|
| Rate for Payer: Aetna Managed Medicare |
$456.24
|
| Rate for Payer: Anthem Medicare Advantage |
$456.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$456.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$456.24
|
| 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 |
$2,759.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$443.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$456.24
|
| Rate for Payer: Health EOS Commercial |
$2,643.30
|
| Rate for Payer: HFN Commercial |
$2,759.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,700.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,700.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$456.24
|
| Rate for Payer: Multiplan Commercial |
$2,323.78
|
| Rate for Payer: NAPHCARE Commercial |
$684.36
|
| Rate for Payer: Preferred Network Access Commercial |
$2,759.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,278.08
|
| Rate for Payer: Quartz Commercial |
$1,655.69
|
| Rate for Payer: Quartz Medicare Advantage |
$456.24
|
| Rate for Payer: The Alliance Commercial |
$1,939.01
|
| Rate for Payer: United Healthcare Medicaid |
$443.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$456.24
|
| Rate for Payer: WEA Trust Commercial |
$1,597.60
|
| Rate for Payer: WPS Commercial |
$2,053.07
|
|
|
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 |
$65.22 |
| Max. Negotiated Rate |
$2,165.70 |
| Rate for Payer: Aetna Commercial |
$2,165.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,960.52
|
| Rate for Payer: Aetna Managed Medicare |
$65.22
|
| Rate for Payer: Anthem Medicare Advantage |
$65.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$65.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$65.22
|
| 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 |
$2,165.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$236.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$65.22
|
| Rate for Payer: Health EOS Commercial |
$2,074.51
|
| Rate for Payer: HFN Commercial |
$2,165.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$263.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$263.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$65.22
|
| Rate for Payer: Multiplan Commercial |
$1,823.74
|
| Rate for Payer: NAPHCARE Commercial |
$97.83
|
| Rate for Payer: Preferred Network Access Commercial |
$2,165.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,003.06
|
| Rate for Payer: Quartz Commercial |
$1,299.42
|
| Rate for Payer: Quartz Medicare Advantage |
$65.22
|
| Rate for Payer: The Alliance Commercial |
$277.18
|
| Rate for Payer: United Healthcare Medicaid |
$236.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$65.22
|
| Rate for Payer: WEA Trust Commercial |
$1,253.82
|
| Rate for Payer: WPS Commercial |
$293.48
|
|
|
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 |
$680.86 |
| Max. Negotiated Rate |
$5,243.32 |
| Rate for Payer: Aetna Commercial |
$5,243.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,746.58
|
| Rate for Payer: Aetna Managed Medicare |
$680.86
|
| Rate for Payer: Anthem Medicare Advantage |
$680.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$680.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$680.86
|
| 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 |
$5,243.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$688.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$680.86
|
| Rate for Payer: Health EOS Commercial |
$5,022.54
|
| Rate for Payer: HFN Commercial |
$5,243.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,643.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,643.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$680.86
|
| Rate for Payer: Multiplan Commercial |
$4,415.42
|
| Rate for Payer: NAPHCARE Commercial |
$1,021.29
|
| Rate for Payer: Preferred Network Access Commercial |
$5,243.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,428.48
|
| Rate for Payer: Quartz Commercial |
$3,145.99
|
| Rate for Payer: Quartz Medicare Advantage |
$680.86
|
| Rate for Payer: The Alliance Commercial |
$2,893.64
|
| Rate for Payer: United Healthcare Medicaid |
$688.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$680.86
|
| Rate for Payer: WEA Trust Commercial |
$3,035.60
|
| Rate for Payer: WPS Commercial |
$3,063.86
|
|
