|
TRAY UROLOGIST DISP 123400
|
Facility
|
OP
|
$3,002.00
|
|
| Hospital Charge Code |
2962998
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$840.56 |
| Max. Negotiated Rate |
$12,008.00 |
| Rate for Payer: Aetna Commercial |
$2,701.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,581.72
|
| Rate for Payer: Aetna Managed Medicare |
$840.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,951.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,501.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,440.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,591.06
|
| Rate for Payer: Cash Price |
$900.60
|
| Rate for Payer: Cigna Commercial |
$2,761.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,679.92
|
| Rate for Payer: Health EOS Commercial |
$2,671.78
|
| Rate for Payer: HFN Commercial |
$2,761.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,251.50
|
| Rate for Payer: Multiplan Commercial |
$2,401.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,801.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,761.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,470.98
|
| Rate for Payer: Quartz Commercial |
$1,951.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,801.20
|
| Rate for Payer: The Alliance Commercial |
$12,008.00
|
| Rate for Payer: WEA Trust Commercial |
$1,651.10
|
| Rate for Payer: WPS Commercial |
$2,223.58
|
|
|
Trazodone Level
|
Facility
|
OP
|
$158.00
|
|
|
Service Code
|
CPT 80338
|
| Hospital Charge Code |
3256241
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.24 |
| Max. Negotiated Rate |
$632.00 |
| Rate for Payer: Aetna Commercial |
$142.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.88
|
| Rate for Payer: Aetna Managed Medicare |
$44.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$102.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$79.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$75.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.74
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cigna Commercial |
$145.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$88.42
|
| Rate for Payer: Health EOS Commercial |
$140.62
|
| Rate for Payer: HFN Commercial |
$145.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$118.50
|
| Rate for Payer: Multiplan Commercial |
$126.40
|
| Rate for Payer: NAPHCARE Commercial |
$94.80
|
| Rate for Payer: Preferred Network Access Commercial |
$145.36
|
| Rate for Payer: Quartz Beloit One Network |
$77.42
|
| Rate for Payer: Quartz Commercial |
$102.70
|
| Rate for Payer: Quartz Medicare Advantage |
$94.80
|
| Rate for Payer: The Alliance Commercial |
$632.00
|
| Rate for Payer: United Healthcare PPO |
$118.50
|
| Rate for Payer: WEA Trust Commercial |
$86.90
|
| Rate for Payer: WPS Commercial |
$117.03
|
|
|
Trazodone Level
|
Professional
|
Both
|
$158.00
|
|
|
Service Code
|
CPT 80338
|
| Hospital Charge Code |
3256241
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.01 |
| Max. Negotiated Rate |
$150.10 |
| Rate for Payer: Aetna Commercial |
$150.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.88
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cigna Commercial |
$150.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$79.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$94.80
|
| Rate for Payer: Health EOS Commercial |
$143.78
|
| Rate for Payer: HFN Commercial |
$150.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$45.01
|
| Rate for Payer: Multiplan Commercial |
$126.40
|
| Rate for Payer: Preferred Network Access Commercial |
$150.10
|
| Rate for Payer: Quartz Beloit One Network |
$69.52
|
| Rate for Payer: Quartz Commercial |
$90.06
|
| Rate for Payer: The Alliance Commercial |
$79.00
|
| Rate for Payer: WEA Trust Commercial |
$86.90
|
| Rate for Payer: WPS Commercial |
$117.03
|
|
|
Trazodone Level
|
Facility
|
IP
|
$158.00
|
|
|
Service Code
|
CPT 80338
|
| Hospital Charge Code |
3256241
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$77.42 |
| Max. Negotiated Rate |
$145.36 |
| Rate for Payer: Aetna Commercial |
$142.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.74
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cigna Commercial |
$145.36
|
| Rate for Payer: Health EOS Commercial |
$140.62
|
| Rate for Payer: HFN Commercial |
$145.36
|
| Rate for Payer: Multiplan Commercial |
$126.40
|
| Rate for Payer: NAPHCARE Commercial |
$94.80
|
| Rate for Payer: Preferred Network Access Commercial |
$145.36
|
| Rate for Payer: Quartz Beloit One Network |
$77.42
|
| Rate for Payer: Quartz Commercial |
$94.80
|
| Rate for Payer: WEA Trust Commercial |
$86.90
|
| Rate for Payer: WPS Commercial |
$117.03
|
|
|
TR Band
|
Facility
|
IP
|
$888.00
|
|
| Hospital Charge Code |
5184606
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$435.12 |
| Max. Negotiated Rate |
$816.96 |
| Rate for Payer: Aetna Commercial |
$799.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$763.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$470.64
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cigna Commercial |
$816.96
|
| Rate for Payer: Health EOS Commercial |
$790.32
|
| Rate for Payer: HFN Commercial |
$816.96
|
| Rate for Payer: Multiplan Commercial |
$710.40
|
| Rate for Payer: NAPHCARE Commercial |
$532.80
|
| Rate for Payer: Preferred Network Access Commercial |
$816.96
|
| Rate for Payer: Quartz Beloit One Network |
$435.12
|
| Rate for Payer: Quartz Commercial |
$532.80
|
| Rate for Payer: WEA Trust Commercial |
$488.40
|
| Rate for Payer: WPS Commercial |
$657.74
|
|
|
TR Band
|
Facility
|
OP
|
$888.00
|
|
| Hospital Charge Code |
5184606
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$248.64 |
| Max. Negotiated Rate |
$3,552.00 |
| Rate for Payer: Aetna Commercial |
$799.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$763.68
|
| Rate for Payer: Aetna Managed Medicare |
$248.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$577.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$444.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$426.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$470.64
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cigna Commercial |
$816.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$496.92
|
| Rate for Payer: Health EOS Commercial |
$790.32
|
| Rate for Payer: HFN Commercial |
$816.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$666.00
|
| Rate for Payer: Multiplan Commercial |
$710.40
|
| Rate for Payer: NAPHCARE Commercial |
$532.80
|
| Rate for Payer: Preferred Network Access Commercial |
$816.96
|
| Rate for Payer: Quartz Beloit One Network |
$435.12
|
| Rate for Payer: Quartz Commercial |
$577.20
|
| Rate for Payer: Quartz Medicare Advantage |
$532.80
|
| Rate for Payer: The Alliance Commercial |
$3,552.00
|
| Rate for Payer: WEA Trust Commercial |
$488.40
|
| Rate for Payer: WPS Commercial |
$657.74
|
|
|
Treanda 1 mg Charge
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
HCPCS J9034
|
| Hospital Charge Code |
2958920
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.76 |
| Max. Negotiated Rate |
$61.64 |
| Rate for Payer: Aetna Commercial |
$60.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$57.62
|
| Rate for Payer: Aetna Managed Medicare |
$14.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$43.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.16
|
| Rate for Payer: Anthem Medicare Advantage |
$14.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$35.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.76
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$61.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.30
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.76
|
| Rate for Payer: Health EOS Commercial |
$59.63
|
| Rate for Payer: HFN Commercial |
$61.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.76
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.76
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.76
|
| Rate for Payer: Multiplan Commercial |
$53.60
|
| Rate for Payer: NAPHCARE Commercial |
$22.13
|
| Rate for Payer: Preferred Network Access Commercial |
$61.64
|
| Rate for Payer: Quartz Beloit One Network |
$32.83
|
| Rate for Payer: Quartz Commercial |
$43.55
|
| Rate for Payer: Quartz Medicare Advantage |
$14.76
|
| Rate for Payer: The Alliance Commercial |
$59.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.76
|
| Rate for Payer: WEA Trust Commercial |
$36.85
|
| Rate for Payer: Wellcare Medicare |
$14.76
|
| Rate for Payer: WPS Commercial |
$34.58
|
|
|
Treanda 1 mg Charge
|
Professional
|
Both
|
$67.00
|
|
|
Service Code
|
HCPCS J9034
|
| Hospital Charge Code |
2958920
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.83 |
| Max. Negotiated Rate |
$63.65 |
| Rate for Payer: Aetna Commercial |
$63.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$57.62
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$63.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.83
|
| Rate for Payer: Health EOS Commercial |
$60.97
|
| Rate for Payer: HFN Commercial |
$63.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$28.59
|
| Rate for Payer: Multiplan Commercial |
$53.60
|
| Rate for Payer: Preferred Network Access Commercial |
$63.65
|
| Rate for Payer: Quartz Beloit One Network |
$29.48
|
| Rate for Payer: Quartz Commercial |
$38.19
|
| Rate for Payer: The Alliance Commercial |
$33.50
|
| Rate for Payer: United Healthcare Medicaid |
$13.83
|
| Rate for Payer: WEA Trust Commercial |
$36.85
|
| Rate for Payer: WPS Commercial |
$34.58
|
|
|
Treanda 1 mg Charge
|
Facility
|
IP
|
$67.00
|
|
|
Service Code
|
HCPCS J9034
|
| Hospital Charge Code |
2958920
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.83 |
| Max. Negotiated Rate |
$61.64 |
| Rate for Payer: Aetna Commercial |
$60.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$57.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$35.51
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$61.64
|
| Rate for Payer: Health EOS Commercial |
$59.63
|
| Rate for Payer: HFN Commercial |
$61.64
|
| Rate for Payer: Multiplan Commercial |
$53.60
|
| Rate for Payer: NAPHCARE Commercial |
$40.20
|
| Rate for Payer: Preferred Network Access Commercial |
$61.64
|
| Rate for Payer: Quartz Beloit One Network |
$32.83
|
| Rate for Payer: Quartz Commercial |
$40.20
|
| Rate for Payer: WEA Trust Commercial |
$36.85
|
| Rate for Payer: WPS Commercial |
$49.63
|
|
|
TREAT BIG TOE FRACTURE 28496
|
Professional
|
Both
|
$920.00
|
|
|
Service Code
|
CPT 28496
|
| Hospital Charge Code |
3014258
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$207.99 |
| Max. Negotiated Rate |
$874.00 |
| Rate for Payer: Aetna Commercial |
$874.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$791.20
|
| Rate for Payer: Cash Price |
$276.00
|
| Rate for Payer: Cash Price |
$276.00
|
| Rate for Payer: Cigna Commercial |
$874.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$207.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$552.00
|
| Rate for Payer: Health EOS Commercial |
$837.20
|
| Rate for Payer: HFN Commercial |
$874.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$820.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$820.58
|
| Rate for Payer: Multiplan Commercial |
$736.00
|
| Rate for Payer: Preferred Network Access Commercial |
$874.00
|
| Rate for Payer: Quartz Beloit One Network |
$404.80
|
| Rate for Payer: Quartz Commercial |
$524.40
|
| Rate for Payer: The Alliance Commercial |
$460.00
|
| Rate for Payer: United Healthcare Medicaid |
$207.99
|
| Rate for Payer: WEA Trust Commercial |
$506.00
|
| Rate for Payer: WPS Commercial |
$681.44
|
|
|
TREAT BIG TOE FRACTURE 28505
|
Professional
|
Both
|
$1,410.00
|
|
|
Service Code
|
CPT 28505
|
| Hospital Charge Code |
3014259
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$226.00 |
| Max. Negotiated Rate |
$1,668.95 |
| Rate for Payer: Aetna Commercial |
$1,339.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,212.60
|
| Rate for Payer: Cash Price |
$423.00
|
| Rate for Payer: Cash Price |
$423.00
|
| Rate for Payer: Cigna Commercial |
$1,339.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$226.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$846.00
|
| Rate for Payer: Health EOS Commercial |
$1,283.10
|
| Rate for Payer: HFN Commercial |
$1,339.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,668.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,668.95
|
| Rate for Payer: Multiplan Commercial |
$1,128.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,339.50
|
| Rate for Payer: Quartz Beloit One Network |
$620.40
|
| Rate for Payer: Quartz Commercial |
$803.70
|
| Rate for Payer: The Alliance Commercial |
$705.00
|
| Rate for Payer: United Healthcare Medicaid |
$226.00
|
| Rate for Payer: WEA Trust Commercial |
$775.50
|
| Rate for Payer: WPS Commercial |
$1,044.39
|
|
|
TREAT CHEEK BONE FRACTURE 21356
|
Professional
|
Both
|
$2,726.00
|
|
|
Service Code
|
CPT 21356
|
| Hospital Charge Code |
3013732
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$404.73 |
| Max. Negotiated Rate |
$2,589.70 |
| Rate for Payer: Aetna Commercial |
$2,589.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,344.36
|
| Rate for Payer: Cash Price |
$817.80
|
| Rate for Payer: Cash Price |
$817.80
|
| Rate for Payer: Cigna Commercial |
$2,589.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$404.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,635.60
|
| Rate for Payer: Health EOS Commercial |
$2,480.66
|
| Rate for Payer: HFN Commercial |
$2,589.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,262.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,262.08
|
| Rate for Payer: Multiplan Commercial |
$2,180.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,589.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,199.44
|
| Rate for Payer: Quartz Commercial |
$1,553.82
|
| Rate for Payer: The Alliance Commercial |
$1,363.00
|
| Rate for Payer: United Healthcare Medicaid |
$404.73
|
| Rate for Payer: WEA Trust Commercial |
$1,499.30
|
| Rate for Payer: WPS Commercial |
$2,019.15
|
|
|
TREAT CLAVICLE FRACTURE 23505
|
Professional
|
Both
|
$1,499.00
|
|
|
Service Code
|
CPT 23505
|
| Hospital Charge Code |
3013782
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$226.00 |
| Max. Negotiated Rate |
$1,424.05 |
| Rate for Payer: Aetna Commercial |
$1,424.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,289.14
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cigna Commercial |
$1,424.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$226.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$899.40
|
| Rate for Payer: Health EOS Commercial |
$1,364.09
|
| Rate for Payer: HFN Commercial |
$1,424.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,116.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,116.01
|
| Rate for Payer: Multiplan Commercial |
$1,199.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,424.05
|
| Rate for Payer: Quartz Beloit One Network |
$659.56
|
| Rate for Payer: Quartz Commercial |
$854.43
|
| Rate for Payer: The Alliance Commercial |
$749.50
|
| Rate for Payer: United Healthcare Medicaid |
$226.00
|
| Rate for Payer: WEA Trust Commercial |
$824.45
|
| Rate for Payer: WPS Commercial |
$1,110.31
|
|
|
TREAT ELBOW DISLOCATION 24600
|
Professional
|
Both
|
$1,011.00
|
|
|
Service Code
|
CPT 24600
|
| Hospital Charge Code |
3013844
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$75.33 |
| Max. Negotiated Rate |
$1,124.23 |
| Rate for Payer: Aetna Commercial |
$960.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$869.46
|
| Rate for Payer: Cash Price |
$303.30
|
| Rate for Payer: Cash Price |
$303.30
|
| Rate for Payer: Cigna Commercial |
$960.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$75.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$606.60
|
| Rate for Payer: Health EOS Commercial |
$920.01
|
| Rate for Payer: HFN Commercial |
$960.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,124.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,124.23
|
| Rate for Payer: Multiplan Commercial |
$808.80
|
| Rate for Payer: Preferred Network Access Commercial |
$960.45
|
| Rate for Payer: Quartz Beloit One Network |
$444.84
|
| Rate for Payer: Quartz Commercial |
$576.27
|
| Rate for Payer: The Alliance Commercial |
$505.50
|
| Rate for Payer: United Healthcare Medicaid |
$75.33
|
| Rate for Payer: WEA Trust Commercial |
$556.05
|
| Rate for Payer: WPS Commercial |
$748.85
|
|
|
TREAT ELBOW DISLOCATION 24640
|
Professional
|
Both
|
$383.00
|
|
|
Service Code
|
CPT 24640
|
| Hospital Charge Code |
3013847
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$61.04 |
| Max. Negotiated Rate |
$363.85 |
| Rate for Payer: Aetna Commercial |
$363.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$329.38
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Cigna Commercial |
$363.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$61.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$229.80
|
| Rate for Payer: Health EOS Commercial |
$348.53
|
| Rate for Payer: HFN Commercial |
$363.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$272.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$272.13
|
| Rate for Payer: Multiplan Commercial |
$306.40
|
| Rate for Payer: Preferred Network Access Commercial |
$363.85
|
| Rate for Payer: Quartz Beloit One Network |
$168.52
|
| Rate for Payer: Quartz Commercial |
$218.31
|
| Rate for Payer: The Alliance Commercial |
$191.50
|
| Rate for Payer: United Healthcare Medicaid |
$61.04
|
| Rate for Payer: WEA Trust Commercial |
$210.65
|
| Rate for Payer: WPS Commercial |
$283.69
|
|
|
TREAT EYELID LESION 67850
|
Professional
|
Both
|
$626.00
|
|
|
Service Code
|
CPT 67850
|
| Hospital Charge Code |
3015245
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$52.54 |
| Max. Negotiated Rate |
$594.70 |
| Rate for Payer: Aetna Commercial |
$594.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$538.36
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$594.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$52.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$375.60
|
| Rate for Payer: Health EOS Commercial |
$569.66
|
| Rate for Payer: HFN Commercial |
$594.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$439.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$439.87
|
| Rate for Payer: Multiplan Commercial |
$500.80
|
| Rate for Payer: Preferred Network Access Commercial |
$594.70
|
| Rate for Payer: Quartz Beloit One Network |
$275.44
|
| Rate for Payer: Quartz Commercial |
$356.82
|
| Rate for Payer: The Alliance Commercial |
$313.00
|
| Rate for Payer: United Healthcare Medicaid |
$52.54
|
| Rate for Payer: WEA Trust Commercial |
$344.30
|
| Rate for Payer: WPS Commercial |
$463.68
|
|
|
TREAT FINGER DISLOCATION 26770
|
Professional
|
Both
|
$691.00
|
|
|
Service Code
|
CPT 26770
|
| Hospital Charge Code |
3013991
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$73.38 |
| Max. Negotiated Rate |
$866.23 |
| Rate for Payer: Aetna Commercial |
$656.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$594.26
|
| Rate for Payer: Cash Price |
$207.30
|
| Rate for Payer: Cash Price |
$207.30
|
| Rate for Payer: Cigna Commercial |
$656.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$73.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$414.60
|
| Rate for Payer: Health EOS Commercial |
$628.81
|
| Rate for Payer: HFN Commercial |
$656.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$866.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$866.23
|
| Rate for Payer: Multiplan Commercial |
$552.80
|
| Rate for Payer: Preferred Network Access Commercial |
$656.45
|
| Rate for Payer: Quartz Beloit One Network |
$304.04
|
| Rate for Payer: Quartz Commercial |
$393.87
|
| Rate for Payer: The Alliance Commercial |
$345.50
|
| Rate for Payer: United Healthcare Medicaid |
$73.38
|
| Rate for Payer: WEA Trust Commercial |
$380.05
|
| Rate for Payer: WPS Commercial |
$511.82
|
|
|
TREAT FINGER DISLOCATION 26775
|
Professional
|
Both
|
$866.00
|
|
|
Service Code
|
CPT 26775
|
| Hospital Charge Code |
3013992
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$94.19 |
| Max. Negotiated Rate |
$1,181.56 |
| Rate for Payer: Aetna Commercial |
$822.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$744.76
|
| Rate for Payer: Cash Price |
$259.80
|
| Rate for Payer: Cash Price |
$259.80
|
| Rate for Payer: Cigna Commercial |
$822.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$94.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$519.60
|
| Rate for Payer: Health EOS Commercial |
$788.06
|
| Rate for Payer: HFN Commercial |
$822.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,181.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,181.56
|
| Rate for Payer: Multiplan Commercial |
$692.80
|
| Rate for Payer: Preferred Network Access Commercial |
$822.70
|
| Rate for Payer: Quartz Beloit One Network |
$381.04
|
| Rate for Payer: Quartz Commercial |
$493.62
|
| Rate for Payer: The Alliance Commercial |
$433.00
|
| Rate for Payer: United Healthcare Medicaid |
$94.19
|
| Rate for Payer: WEA Trust Commercial |
$476.30
|
| Rate for Payer: WPS Commercial |
$641.45
|
|
|
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 |
$165.15 |
| Max. Negotiated Rate |
$1,828.75 |
| Rate for Payer: Aetna Commercial |
$1,828.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,655.50
|
| Rate for Payer: Cash Price |
$577.50
|
| Rate for Payer: Cash Price |
$577.50
|
| Rate for Payer: Cigna Commercial |
$1,828.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$165.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,155.00
|
| Rate for Payer: Health EOS Commercial |
$1,751.75
|
| Rate for Payer: HFN Commercial |
$1,828.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,131.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,131.08
|
| Rate for Payer: Multiplan Commercial |
$1,540.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,828.75
|
| Rate for Payer: Quartz Beloit One Network |
$847.00
|
| Rate for Payer: Quartz Commercial |
$1,097.25
|
| Rate for Payer: The Alliance Commercial |
$962.50
|
| Rate for Payer: United Healthcare Medicaid |
$165.15
|
| Rate for Payer: WEA Trust Commercial |
$1,058.75
|
| Rate for Payer: WPS Commercial |
$1,425.85
|
|
|
TREAT FINGER FRACTURE, EACH 26750
|
Professional
|
Both
|
$363.00
|
|
|
Service Code
|
CPT 26750
|
| Hospital Charge Code |
3013987
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$57.94 |
| Max. Negotiated Rate |
$632.08 |
| Rate for Payer: Aetna Commercial |
$344.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$312.18
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cigna Commercial |
$344.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$57.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$217.80
|
| Rate for Payer: Health EOS Commercial |
$330.33
|
| Rate for Payer: HFN Commercial |
$344.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$632.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$632.08
|
| Rate for Payer: Multiplan Commercial |
$290.40
|
| Rate for Payer: Preferred Network Access Commercial |
$344.85
|
| Rate for Payer: Quartz Beloit One Network |
$159.72
|
| Rate for Payer: Quartz Commercial |
$206.91
|
| Rate for Payer: The Alliance Commercial |
$181.50
|
| Rate for Payer: United Healthcare Medicaid |
$57.94
|
| Rate for Payer: WEA Trust Commercial |
$199.65
|
| Rate for Payer: WPS Commercial |
$268.87
|
|
|
TREAT FINGER FRACTURE, EACH 26755
|
Professional
|
Both
|
$480.00
|
|
|
Service Code
|
CPT 26755
|
| Hospital Charge Code |
3013988
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$62.28 |
| Max. Negotiated Rate |
$922.07 |
| Rate for Payer: Aetna Commercial |
$456.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$412.80
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$456.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$62.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$288.00
|
| Rate for Payer: Health EOS Commercial |
$436.80
|
| Rate for Payer: HFN Commercial |
$456.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$922.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$922.07
|
| Rate for Payer: Multiplan Commercial |
$384.00
|
| Rate for Payer: Preferred Network Access Commercial |
$456.00
|
| Rate for Payer: Quartz Beloit One Network |
$211.20
|
| Rate for Payer: Quartz Commercial |
$273.60
|
| Rate for Payer: The Alliance Commercial |
$240.00
|
| Rate for Payer: United Healthcare Medicaid |
$62.28
|
| Rate for Payer: WEA Trust Commercial |
$264.00
|
| Rate for Payer: WPS Commercial |
$355.54
|
|
|
TREAT FOOT DISLOCATION 28545
|
Professional
|
Both
|
$564.00
|
|
|
Service Code
|
CPT 28545
|
| Hospital Charge Code |
3014264
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$150.66 |
| Max. Negotiated Rate |
$900.79 |
| Rate for Payer: Aetna Commercial |
$535.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$485.04
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Cigna Commercial |
$535.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$150.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$338.40
|
| Rate for Payer: Health EOS Commercial |
$513.24
|
| Rate for Payer: HFN Commercial |
$535.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$900.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$900.79
|
| Rate for Payer: Multiplan Commercial |
$451.20
|
| Rate for Payer: Preferred Network Access Commercial |
$535.80
|
| Rate for Payer: Quartz Beloit One Network |
$248.16
|
| Rate for Payer: Quartz Commercial |
$321.48
|
| Rate for Payer: The Alliance Commercial |
$282.00
|
| Rate for Payer: United Healthcare Medicaid |
$150.66
|
| Rate for Payer: WEA Trust Commercial |
$310.20
|
| Rate for Payer: WPS Commercial |
$417.75
|
|
|
TREAT FOOT DISLOCATION 28600
|
Professional
|
Both
|
$564.00
|
|
|
Service Code
|
CPT 28600
|
| Hospital Charge Code |
3014268
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$105.45 |
| Max. Negotiated Rate |
$624.95 |
| Rate for Payer: Aetna Commercial |
$535.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$485.04
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Cigna Commercial |
$535.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$105.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$338.40
|
| Rate for Payer: Health EOS Commercial |
$513.24
|
| Rate for Payer: HFN Commercial |
$535.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$624.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$624.95
|
| Rate for Payer: Multiplan Commercial |
$451.20
|
| Rate for Payer: Preferred Network Access Commercial |
$535.80
|
| Rate for Payer: Quartz Beloit One Network |
$248.16
|
| Rate for Payer: Quartz Commercial |
$321.48
|
| Rate for Payer: The Alliance Commercial |
$282.00
|
| Rate for Payer: United Healthcare Medicaid |
$105.45
|
| Rate for Payer: WEA Trust Commercial |
$310.20
|
| Rate for Payer: WPS Commercial |
$417.75
|
|
|
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 |
$301.31 |
| Max. Negotiated Rate |
$1,791.70 |
| Rate for Payer: Aetna Commercial |
$1,791.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,621.96
|
| Rate for Payer: Cash Price |
$565.80
|
| Rate for Payer: Cash Price |
$565.80
|
| Rate for Payer: Cigna Commercial |
$1,791.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$301.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,131.60
|
| Rate for Payer: Health EOS Commercial |
$1,716.26
|
| Rate for Payer: HFN Commercial |
$1,791.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,534.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,534.99
|
| Rate for Payer: Multiplan Commercial |
$1,508.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,791.70
|
| Rate for Payer: Quartz Beloit One Network |
$829.84
|
| Rate for Payer: Quartz Commercial |
$1,075.02
|
| Rate for Payer: The Alliance Commercial |
$943.00
|
| Rate for Payer: United Healthcare Medicaid |
$301.31
|
| Rate for Payer: WEA Trust Commercial |
$1,037.30
|
| Rate for Payer: WPS Commercial |
$1,396.96
|
|
|
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 |
$475.82 |
| Max. Negotiated Rate |
$2,096.65 |
| Rate for Payer: Aetna Commercial |
$2,096.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,898.02
|
| Rate for Payer: Cash Price |
$662.10
|
| Rate for Payer: Cash Price |
$662.10
|
| Rate for Payer: Cigna Commercial |
$2,096.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$475.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,324.20
|
| Rate for Payer: Health EOS Commercial |
$2,008.37
|
| Rate for Payer: HFN Commercial |
$2,096.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,815.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,815.69
|
| Rate for Payer: Multiplan Commercial |
$1,765.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,096.65
|
| Rate for Payer: Quartz Beloit One Network |
$971.08
|
| Rate for Payer: Quartz Commercial |
$1,257.99
|
| Rate for Payer: The Alliance Commercial |
$1,103.50
|
| Rate for Payer: United Healthcare Medicaid |
$475.82
|
| Rate for Payer: WEA Trust Commercial |
$1,213.85
|
| Rate for Payer: WPS Commercial |
$1,634.72
|
|
