|
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 |
$301.31 |
| Max. Negotiated Rate |
$1,533.15 |
| Rate for Payer: Aetna Commercial |
$1,110.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,005.34
|
| Rate for Payer: Cash Price |
$350.70
|
| Rate for Payer: Cash Price |
$350.70
|
| Rate for Payer: Cigna Commercial |
$1,110.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$301.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$701.40
|
| Rate for Payer: Health EOS Commercial |
$1,063.79
|
| Rate for Payer: HFN Commercial |
$1,110.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,533.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,533.15
|
| Rate for Payer: Multiplan Commercial |
$935.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,110.55
|
| Rate for Payer: Quartz Beloit One Network |
$514.36
|
| Rate for Payer: Quartz Commercial |
$666.33
|
| Rate for Payer: The Alliance Commercial |
$584.50
|
| Rate for Payer: United Healthcare Medicaid |
$301.31
|
| Rate for Payer: WEA Trust Commercial |
$642.95
|
| Rate for Payer: WPS Commercial |
$865.88
|
|
|
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 |
$389.13 |
| Max. Negotiated Rate |
$1,849.65 |
| Rate for Payer: Aetna Commercial |
$1,849.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,674.42
|
| Rate for Payer: Cash Price |
$584.10
|
| Rate for Payer: Cash Price |
$584.10
|
| Rate for Payer: Cigna Commercial |
$1,849.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$389.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,168.20
|
| Rate for Payer: Health EOS Commercial |
$1,771.77
|
| Rate for Payer: HFN Commercial |
$1,849.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,549.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,549.18
|
| Rate for Payer: Multiplan Commercial |
$1,557.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,849.65
|
| Rate for Payer: Quartz Beloit One Network |
$856.68
|
| Rate for Payer: Quartz Commercial |
$1,109.79
|
| Rate for Payer: The Alliance Commercial |
$973.50
|
| Rate for Payer: United Healthcare Medicaid |
$389.13
|
| Rate for Payer: WEA Trust Commercial |
$1,070.85
|
| Rate for Payer: WPS Commercial |
$1,442.14
|
|
|
TREAT FRACTURE RADIUS/ULNA 25605
|
Professional
|
Both
|
$913.00
|
|
|
Service Code
|
CPT 25605
|
| Hospital Charge Code |
3013904
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$380.69 |
| Max. Negotiated Rate |
$1,706.15 |
| Rate for Payer: Aetna Commercial |
$867.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$785.18
|
| Rate for Payer: Cash Price |
$273.90
|
| Rate for Payer: Cash Price |
$273.90
|
| Rate for Payer: Cigna Commercial |
$867.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$380.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$547.80
|
| Rate for Payer: Health EOS Commercial |
$830.83
|
| Rate for Payer: HFN Commercial |
$867.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,706.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,706.15
|
| Rate for Payer: Multiplan Commercial |
$730.40
|
| Rate for Payer: Preferred Network Access Commercial |
$867.35
|
| Rate for Payer: Quartz Beloit One Network |
$401.72
|
| Rate for Payer: Quartz Commercial |
$520.41
|
| Rate for Payer: The Alliance Commercial |
$456.50
|
| Rate for Payer: United Healthcare Medicaid |
$380.69
|
| Rate for Payer: WEA Trust Commercial |
$502.15
|
| Rate for Payer: WPS Commercial |
$676.26
|
|
|
TREAT HAND DISLOCATION 26675
|
Professional
|
Both
|
$1,262.00
|
|
|
Service Code
|
CPT 26675
|
| Hospital Charge Code |
3013976
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$120.52 |
| Max. Negotiated Rate |
$1,411.15 |
| Rate for Payer: Aetna Commercial |
$1,198.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,085.32
|
| Rate for Payer: Cash Price |
$378.60
|
| Rate for Payer: Cash Price |
$378.60
|
| Rate for Payer: Cigna Commercial |
$1,198.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$120.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$757.20
|
| Rate for Payer: Health EOS Commercial |
$1,148.42
|
| Rate for Payer: HFN Commercial |
$1,198.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,411.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,411.15
|
| Rate for Payer: Multiplan Commercial |
$1,009.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,198.90
|
| Rate for Payer: Quartz Beloit One Network |
$555.28
|
| Rate for Payer: Quartz Commercial |
$719.34
|
| Rate for Payer: The Alliance Commercial |
$631.00
|
| Rate for Payer: United Healthcare Medicaid |
$120.52
|
| Rate for Payer: WEA Trust Commercial |
$694.10
|
| Rate for Payer: WPS Commercial |
$934.76
|
|
|
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 |
$376.66 |
| Max. Negotiated Rate |
$1,368.48 |
| Rate for Payer: Aetna Commercial |
$1,267.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,147.24
|
| Rate for Payer: Cash Price |
$400.20
|
| Rate for Payer: Cash Price |
$400.20
|
| Rate for Payer: Cigna Commercial |
$1,267.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$376.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$800.40
|
| Rate for Payer: Health EOS Commercial |
$1,213.94
|
| Rate for Payer: HFN Commercial |
$1,267.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,368.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,368.48
|
| Rate for Payer: Multiplan Commercial |
$1,067.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,267.30
|
| Rate for Payer: Quartz Beloit One Network |
$586.96
|
| Rate for Payer: Quartz Commercial |
$760.38
|
| Rate for Payer: The Alliance Commercial |
$667.00
|
| Rate for Payer: United Healthcare Medicaid |
$376.66
|
| Rate for Payer: WEA Trust Commercial |
$733.70
|
| Rate for Payer: WPS Commercial |
$988.09
|
|
|
TREAT HUMERUS FRACTURE 23605
|
Professional
|
Both
|
$1,512.00
|
|
|
Service Code
|
CPT 23605
|
| Hospital Charge Code |
3013790
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$452.00 |
| Max. Negotiated Rate |
$1,436.40 |
| Rate for Payer: Aetna Commercial |
$1,436.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,300.32
|
| Rate for Payer: Cash Price |
$453.60
|
| Rate for Payer: Cash Price |
$453.60
|
| Rate for Payer: Cigna Commercial |
$1,436.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$452.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$907.20
|
| Rate for Payer: Health EOS Commercial |
$1,375.92
|
| Rate for Payer: HFN Commercial |
$1,436.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,429.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,429.72
|
| Rate for Payer: Multiplan Commercial |
$1,209.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,436.40
|
| Rate for Payer: Quartz Beloit One Network |
$665.28
|
| Rate for Payer: Quartz Commercial |
$861.84
|
| Rate for Payer: The Alliance Commercial |
$756.00
|
| Rate for Payer: United Healthcare Medicaid |
$452.00
|
| Rate for Payer: WEA Trust Commercial |
$831.60
|
| Rate for Payer: WPS Commercial |
$1,119.94
|
|
|
TREAT HUMERUS FRACTURE 24505
|
Professional
|
Both
|
$1,562.00
|
|
|
Service Code
|
CPT 24505
|
| Hospital Charge Code |
3013831
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$376.66 |
| Max. Negotiated Rate |
$1,510.49 |
| Rate for Payer: Aetna Commercial |
$1,483.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,343.32
|
| Rate for Payer: Cash Price |
$468.60
|
| Rate for Payer: Cash Price |
$468.60
|
| Rate for Payer: Cigna Commercial |
$1,483.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$376.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$937.20
|
| Rate for Payer: Health EOS Commercial |
$1,421.42
|
| Rate for Payer: HFN Commercial |
$1,483.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,510.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,510.49
|
| Rate for Payer: Multiplan Commercial |
$1,249.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,483.90
|
| Rate for Payer: Quartz Beloit One Network |
$687.28
|
| Rate for Payer: Quartz Commercial |
$890.34
|
| Rate for Payer: The Alliance Commercial |
$781.00
|
| Rate for Payer: United Healthcare Medicaid |
$376.66
|
| Rate for Payer: WEA Trust Commercial |
$859.10
|
| Rate for Payer: WPS Commercial |
$1,156.97
|
|
|
TREAT HUMERUS FRACTURE 24535
|
Professional
|
Both
|
$1,670.00
|
|
|
Service Code
|
CPT 24535
|
| Hospital Charge Code |
3013835
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$523.35 |
| Max. Negotiated Rate |
$1,905.28 |
| Rate for Payer: Aetna Commercial |
$1,586.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,436.20
|
| Rate for Payer: Cash Price |
$501.00
|
| Rate for Payer: Cash Price |
$501.00
|
| Rate for Payer: Cigna Commercial |
$1,586.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$523.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,002.00
|
| Rate for Payer: Health EOS Commercial |
$1,519.70
|
| Rate for Payer: HFN Commercial |
$1,586.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,905.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,905.28
|
| Rate for Payer: Multiplan Commercial |
$1,336.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,586.50
|
| Rate for Payer: Quartz Beloit One Network |
$734.80
|
| Rate for Payer: Quartz Commercial |
$951.90
|
| Rate for Payer: The Alliance Commercial |
$835.00
|
| Rate for Payer: United Healthcare Medicaid |
$523.35
|
| Rate for Payer: WEA Trust Commercial |
$918.50
|
| Rate for Payer: WPS Commercial |
$1,236.97
|
|
|
Treat Kneecap Dislocation 27560
|
Professional
|
Both
|
$884.00
|
|
|
Service Code
|
CPT 27560
|
| Hospital Charge Code |
4076168
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$262.79 |
| Max. Negotiated Rate |
$1,152.26 |
| Rate for Payer: Aetna Commercial |
$839.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$760.24
|
| Rate for Payer: Cash Price |
$265.20
|
| Rate for Payer: Cash Price |
$265.20
|
| Rate for Payer: Cigna Commercial |
$839.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$262.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$530.40
|
| Rate for Payer: Health EOS Commercial |
$804.44
|
| Rate for Payer: HFN Commercial |
$839.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,152.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,152.26
|
| Rate for Payer: Multiplan Commercial |
$707.20
|
| Rate for Payer: Preferred Network Access Commercial |
$839.80
|
| Rate for Payer: Quartz Beloit One Network |
$388.96
|
| Rate for Payer: Quartz Commercial |
$503.88
|
| Rate for Payer: The Alliance Commercial |
$442.00
|
| Rate for Payer: United Healthcare Medicaid |
$262.79
|
| Rate for Payer: WEA Trust Commercial |
$486.20
|
| Rate for Payer: WPS Commercial |
$654.78
|
|
|
TREAT KNEE DISLOCATION 27550
|
Professional
|
Both
|
$959.00
|
|
|
Service Code
|
CPT 27550
|
| Hospital Charge Code |
3014101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$226.00 |
| Max. Negotiated Rate |
$1,621.15 |
| Rate for Payer: Aetna Commercial |
$911.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$824.74
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cigna Commercial |
$911.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$226.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$575.40
|
| Rate for Payer: Health EOS Commercial |
$872.69
|
| Rate for Payer: HFN Commercial |
$911.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,621.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,621.15
|
| Rate for Payer: Multiplan Commercial |
$767.20
|
| Rate for Payer: Preferred Network Access Commercial |
$911.05
|
| Rate for Payer: Quartz Beloit One Network |
$421.96
|
| Rate for Payer: Quartz Commercial |
$546.63
|
| Rate for Payer: The Alliance Commercial |
$479.50
|
| Rate for Payer: United Healthcare Medicaid |
$226.00
|
| Rate for Payer: WEA Trust Commercial |
$527.45
|
| Rate for Payer: WPS Commercial |
$710.33
|
|
|
TREAT KNEE FRACTURE 27532
|
Professional
|
Both
|
$1,684.00
|
|
|
Service Code
|
CPT 27532
|
| Hospital Charge Code |
3014096
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$376.66 |
| Max. Negotiated Rate |
$1,917.14 |
| Rate for Payer: Aetna Commercial |
$1,599.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,448.24
|
| Rate for Payer: Cash Price |
$505.20
|
| Rate for Payer: Cash Price |
$505.20
|
| Rate for Payer: Cigna Commercial |
$1,599.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$376.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,010.40
|
| Rate for Payer: Health EOS Commercial |
$1,532.44
|
| Rate for Payer: HFN Commercial |
$1,599.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,917.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,917.14
|
| Rate for Payer: Multiplan Commercial |
$1,347.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,599.80
|
| Rate for Payer: Quartz Beloit One Network |
$740.96
|
| Rate for Payer: Quartz Commercial |
$959.88
|
| Rate for Payer: The Alliance Commercial |
$842.00
|
| Rate for Payer: United Healthcare Medicaid |
$376.66
|
| Rate for Payer: WEA Trust Commercial |
$926.20
|
| Rate for Payer: WPS Commercial |
$1,247.34
|
|
|
TREAT KNUCKLE DISLOCATION 26705
|
Professional
|
Both
|
$964.00
|
|
|
Service Code
|
CPT 26705
|
| Hospital Charge Code |
3013979
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$120.52 |
| Max. Negotiated Rate |
$1,293.46 |
| Rate for Payer: Aetna Commercial |
$915.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$829.04
|
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cigna Commercial |
$915.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$120.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$578.40
|
| Rate for Payer: Health EOS Commercial |
$877.24
|
| Rate for Payer: HFN Commercial |
$915.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,293.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,293.46
|
| Rate for Payer: Multiplan Commercial |
$771.20
|
| Rate for Payer: Preferred Network Access Commercial |
$915.80
|
| Rate for Payer: Quartz Beloit One Network |
$424.16
|
| Rate for Payer: Quartz Commercial |
$549.48
|
| Rate for Payer: The Alliance Commercial |
$482.00
|
| Rate for Payer: United Healthcare Medicaid |
$120.52
|
| Rate for Payer: WEA Trust Commercial |
$530.20
|
| Rate for Payer: WPS Commercial |
$714.03
|
|
|
TREAT LOWER LEG FRACTURE 27825
|
Professional
|
Both
|
$2,793.00
|
|
|
Service Code
|
CPT 27825
|
| Hospital Charge Code |
3014160
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$426.59 |
| Max. Negotiated Rate |
$2,653.35 |
| Rate for Payer: Aetna Commercial |
$2,653.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,401.98
|
| Rate for Payer: Cash Price |
$837.90
|
| Rate for Payer: Cash Price |
$837.90
|
| Rate for Payer: Cigna Commercial |
$2,653.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$426.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,675.80
|
| Rate for Payer: Health EOS Commercial |
$2,541.63
|
| Rate for Payer: HFN Commercial |
$2,653.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,635.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,635.31
|
| Rate for Payer: Multiplan Commercial |
$2,234.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,653.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,228.92
|
| Rate for Payer: Quartz Commercial |
$1,592.01
|
| Rate for Payer: The Alliance Commercial |
$1,396.50
|
| Rate for Payer: United Healthcare Medicaid |
$426.59
|
| Rate for Payer: WEA Trust Commercial |
$1,536.15
|
| Rate for Payer: WPS Commercial |
$2,068.78
|
|
|
TREAT LUNG LINING CHEMICALLY 32560
|
Professional
|
Both
|
$2,192.00
|
|
|
Service Code
|
CPT 32560
|
| Hospital Charge Code |
3014416
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$227.35 |
| Max. Negotiated Rate |
$2,082.40 |
| Rate for Payer: Aetna Commercial |
$2,082.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,885.12
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Cigna Commercial |
$2,082.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$227.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,315.20
|
| Rate for Payer: Health EOS Commercial |
$1,994.72
|
| Rate for Payer: HFN Commercial |
$2,082.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$253.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$253.77
|
| Rate for Payer: Multiplan Commercial |
$1,753.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,082.40
|
| Rate for Payer: Quartz Beloit One Network |
$964.48
|
| Rate for Payer: Quartz Commercial |
$1,249.44
|
| Rate for Payer: The Alliance Commercial |
$1,096.00
|
| Rate for Payer: United Healthcare Medicaid |
$227.35
|
| Rate for Payer: WEA Trust Commercial |
$1,205.60
|
| Rate for Payer: WPS Commercial |
$1,623.61
|
|
|
TREATMENT ANKLE FRACTURE - OPEN, EXT 2781422
|
Professional
|
Both
|
$5,307.00
|
|
|
Service Code
|
CPT 27814
|
| Hospital Charge Code |
6180168
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$661.80 |
| Max. Negotiated Rate |
$5,041.65 |
| Rate for Payer: Aetna Commercial |
$5,041.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,564.02
|
| Rate for Payer: Cash Price |
$1,592.10
|
| Rate for Payer: Cash Price |
$1,592.10
|
| Rate for Payer: Cigna Commercial |
$5,041.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$661.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,184.20
|
| Rate for Payer: Health EOS Commercial |
$4,829.37
|
| Rate for Payer: HFN Commercial |
$5,041.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,541.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,541.74
|
| Rate for Payer: Multiplan Commercial |
$4,245.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,041.65
|
| Rate for Payer: Quartz Beloit One Network |
$2,335.08
|
| Rate for Payer: Quartz Commercial |
$3,024.99
|
| Rate for Payer: The Alliance Commercial |
$2,653.50
|
| Rate for Payer: United Healthcare Medicaid |
$661.80
|
| Rate for Payer: WEA Trust Commercial |
$2,918.85
|
| Rate for Payer: WPS Commercial |
$3,930.89
|
|
|
Treatment Device Complex
|
Facility
|
OP
|
$2,181.00
|
|
|
Service Code
|
CPT 77334
|
| Hospital Charge Code |
3040390
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$365.21 |
| Max. Negotiated Rate |
$2,006.52 |
| Rate for Payer: Aetna Commercial |
$1,962.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,875.66
|
| Rate for Payer: Aetna Managed Medicare |
$365.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,369.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,095.63
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,040.85
|
| Rate for Payer: Anthem Medicare Advantage |
$365.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,155.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$365.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$365.21
|
| Rate for Payer: Cash Price |
$654.30
|
| Rate for Payer: Cash Price |
$654.30
|
| Rate for Payer: Cigna Commercial |
$2,006.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$365.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,220.49
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$365.21
|
| Rate for Payer: Health EOS Commercial |
$1,941.09
|
| Rate for Payer: HFN Commercial |
$2,006.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,358.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$365.21
|
| Rate for Payer: Independent Care Health Plan Medicare |
$365.21
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$365.21
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$365.21
|
| Rate for Payer: Multiplan Commercial |
$1,744.80
|
| Rate for Payer: NAPHCARE Commercial |
$547.82
|
| Rate for Payer: Preferred Network Access Commercial |
$2,006.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,068.69
|
| Rate for Payer: Quartz Commercial |
$1,417.65
|
| Rate for Payer: Quartz Medicare Advantage |
$365.21
|
| Rate for Payer: The Alliance Commercial |
$1,460.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$365.21
|
| Rate for Payer: United Healthcare PPO |
$1,635.75
|
| Rate for Payer: WEA Trust Commercial |
$1,199.55
|
| Rate for Payer: Wellcare Medicare |
$365.21
|
| Rate for Payer: WPS Commercial |
$1,615.47
|
|
|
Treatment Device Complex
|
Facility
|
IP
|
$2,181.00
|
|
|
Service Code
|
CPT 77334
|
| Hospital Charge Code |
3040390
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,068.69 |
| Max. Negotiated Rate |
$2,006.52 |
| Rate for Payer: Aetna Commercial |
$1,962.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,875.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,155.93
|
| Rate for Payer: Cash Price |
$654.30
|
| Rate for Payer: Cigna Commercial |
$2,006.52
|
| Rate for Payer: Health EOS Commercial |
$1,941.09
|
| Rate for Payer: HFN Commercial |
$2,006.52
|
| Rate for Payer: Multiplan Commercial |
$1,744.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,308.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,006.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,068.69
|
| Rate for Payer: Quartz Commercial |
$1,308.60
|
| Rate for Payer: WEA Trust Commercial |
$1,199.55
|
| Rate for Payer: WPS Commercial |
$1,615.47
|
|
|
Treatment Device Intermediate
|
Facility
|
IP
|
$658.00
|
|
|
Service Code
|
CPT 77333
|
| Hospital Charge Code |
3040387
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$322.42 |
| Max. Negotiated Rate |
$605.36 |
| Rate for Payer: Aetna Commercial |
$592.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$565.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$348.74
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cigna Commercial |
$605.36
|
| Rate for Payer: Health EOS Commercial |
$585.62
|
| Rate for Payer: HFN Commercial |
$605.36
|
| Rate for Payer: Multiplan Commercial |
$526.40
|
| Rate for Payer: NAPHCARE Commercial |
$394.80
|
| Rate for Payer: Preferred Network Access Commercial |
$605.36
|
| Rate for Payer: Quartz Beloit One Network |
$322.42
|
| Rate for Payer: Quartz Commercial |
$394.80
|
| Rate for Payer: WEA Trust Commercial |
$361.90
|
| Rate for Payer: WPS Commercial |
$487.38
|
|
|
Treatment Device Intermediate
|
Facility
|
OP
|
$658.00
|
|
|
Service Code
|
CPT 77333
|
| Hospital Charge Code |
3040387
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$134.11 |
| Max. Negotiated Rate |
$605.36 |
| Rate for Payer: Aetna Commercial |
$592.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$565.88
|
| Rate for Payer: Aetna Managed Medicare |
$134.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$502.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$402.33
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$382.21
|
| Rate for Payer: Anthem Medicare Advantage |
$134.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$348.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$134.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$134.11
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cigna Commercial |
$605.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$134.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$368.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$134.11
|
| Rate for Payer: Health EOS Commercial |
$585.62
|
| Rate for Payer: HFN Commercial |
$605.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$498.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$134.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$134.11
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$134.11
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$134.11
|
| Rate for Payer: Multiplan Commercial |
$526.40
|
| Rate for Payer: NAPHCARE Commercial |
$201.16
|
| Rate for Payer: Preferred Network Access Commercial |
$605.36
|
| Rate for Payer: Quartz Beloit One Network |
$322.42
|
| Rate for Payer: Quartz Commercial |
$427.70
|
| Rate for Payer: Quartz Medicare Advantage |
$134.11
|
| Rate for Payer: The Alliance Commercial |
$536.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$134.11
|
| Rate for Payer: United Healthcare PPO |
$493.50
|
| Rate for Payer: WEA Trust Commercial |
$361.90
|
| Rate for Payer: Wellcare Medicare |
$134.11
|
| Rate for Payer: WPS Commercial |
$487.38
|
|
|
Treatment Device Simple
|
Facility
|
OP
|
$757.00
|
|
|
Service Code
|
CPT 77332
|
| Hospital Charge Code |
3040386
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$134.11 |
| Max. Negotiated Rate |
$696.44 |
| Rate for Payer: Aetna Commercial |
$681.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$651.02
|
| Rate for Payer: Aetna Managed Medicare |
$134.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$502.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$402.33
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$382.21
|
| Rate for Payer: Anthem Medicare Advantage |
$134.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$401.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$134.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$134.11
|
| Rate for Payer: Cash Price |
$227.10
|
| Rate for Payer: Cash Price |
$227.10
|
| Rate for Payer: Cigna Commercial |
$696.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$134.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$423.62
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$134.11
|
| Rate for Payer: Health EOS Commercial |
$673.73
|
| Rate for Payer: HFN Commercial |
$696.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$498.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$134.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$134.11
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$134.11
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$134.11
|
| Rate for Payer: Multiplan Commercial |
$605.60
|
| Rate for Payer: NAPHCARE Commercial |
$201.16
|
| Rate for Payer: Preferred Network Access Commercial |
$696.44
|
| Rate for Payer: Quartz Beloit One Network |
$370.93
|
| Rate for Payer: Quartz Commercial |
$492.05
|
| Rate for Payer: Quartz Medicare Advantage |
$134.11
|
| Rate for Payer: The Alliance Commercial |
$536.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$134.11
|
| Rate for Payer: United Healthcare PPO |
$567.75
|
| Rate for Payer: WEA Trust Commercial |
$416.35
|
| Rate for Payer: Wellcare Medicare |
$134.11
|
| Rate for Payer: WPS Commercial |
$560.71
|
|
|
Treatment Device Simple
|
Facility
|
IP
|
$757.00
|
|
|
Service Code
|
CPT 77332
|
| Hospital Charge Code |
3040386
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$370.93 |
| Max. Negotiated Rate |
$696.44 |
| Rate for Payer: Aetna Commercial |
$681.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$651.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$401.21
|
| Rate for Payer: Cash Price |
$227.10
|
| Rate for Payer: Cigna Commercial |
$696.44
|
| Rate for Payer: Health EOS Commercial |
$673.73
|
| Rate for Payer: HFN Commercial |
$696.44
|
| Rate for Payer: Multiplan Commercial |
$605.60
|
| Rate for Payer: NAPHCARE Commercial |
$454.20
|
| Rate for Payer: Preferred Network Access Commercial |
$696.44
|
| Rate for Payer: Quartz Beloit One Network |
$370.93
|
| Rate for Payer: Quartz Commercial |
$454.20
|
| Rate for Payer: WEA Trust Commercial |
$416.35
|
| Rate for Payer: WPS Commercial |
$560.71
|
|
|
TREATMENT OF ANKLE FRACTURE 27788
|
Professional
|
Both
|
$1,031.00
|
|
|
Service Code
|
CPT 27788
|
| Hospital Charge Code |
3014151
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$226.00 |
| Max. Negotiated Rate |
$1,289.76 |
| Rate for Payer: Aetna Commercial |
$979.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$886.66
|
| Rate for Payer: Cash Price |
$309.30
|
| Rate for Payer: Cash Price |
$309.30
|
| Rate for Payer: Cigna Commercial |
$979.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$226.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$618.60
|
| Rate for Payer: Health EOS Commercial |
$938.21
|
| Rate for Payer: HFN Commercial |
$979.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,289.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,289.76
|
| Rate for Payer: Multiplan Commercial |
$824.80
|
| Rate for Payer: Preferred Network Access Commercial |
$979.45
|
| Rate for Payer: Quartz Beloit One Network |
$453.64
|
| Rate for Payer: Quartz Commercial |
$587.67
|
| Rate for Payer: The Alliance Commercial |
$515.50
|
| Rate for Payer: United Healthcare Medicaid |
$226.00
|
| Rate for Payer: WEA Trust Commercial |
$567.05
|
| Rate for Payer: WPS Commercial |
$763.66
|
|
|
TREATMENT OF ANKLE FRACTURE 27810
|
Professional
|
Both
|
$1,554.00
|
|
|
Service Code
|
CPT 27810
|
| Hospital Charge Code |
3014154
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$386.66 |
| Max. Negotiated Rate |
$1,476.30 |
| Rate for Payer: Aetna Commercial |
$1,476.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,336.44
|
| Rate for Payer: Cash Price |
$466.20
|
| Rate for Payer: Cash Price |
$466.20
|
| Rate for Payer: Cigna Commercial |
$1,476.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$386.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$932.40
|
| Rate for Payer: Health EOS Commercial |
$1,414.14
|
| Rate for Payer: HFN Commercial |
$1,476.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,418.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,418.00
|
| Rate for Payer: Multiplan Commercial |
$1,243.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,476.30
|
| Rate for Payer: Quartz Beloit One Network |
$683.76
|
| Rate for Payer: Quartz Commercial |
$885.78
|
| Rate for Payer: The Alliance Commercial |
$777.00
|
| Rate for Payer: United Healthcare Medicaid |
$386.66
|
| Rate for Payer: WEA Trust Commercial |
$854.70
|
| Rate for Payer: WPS Commercial |
$1,151.05
|
|
|
Treatment of Ankle Fracture 27816
|
Professional
|
Both
|
$1,029.00
|
|
|
Service Code
|
CPT 27816
|
| Hospital Charge Code |
4213317
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$376.66 |
| Max. Negotiated Rate |
$986.39 |
| Rate for Payer: Aetna Commercial |
$977.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$884.94
|
| Rate for Payer: Cash Price |
$308.70
|
| Rate for Payer: Cash Price |
$308.70
|
| Rate for Payer: Cigna Commercial |
$977.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$376.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$617.40
|
| Rate for Payer: Health EOS Commercial |
$936.39
|
| Rate for Payer: HFN Commercial |
$977.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$986.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$986.39
|
| Rate for Payer: Multiplan Commercial |
$823.20
|
| Rate for Payer: Preferred Network Access Commercial |
$977.55
|
| Rate for Payer: Quartz Beloit One Network |
$452.76
|
| Rate for Payer: Quartz Commercial |
$586.53
|
| Rate for Payer: The Alliance Commercial |
$514.50
|
| Rate for Payer: United Healthcare Medicaid |
$376.66
|
| Rate for Payer: WEA Trust Commercial |
$565.95
|
| Rate for Payer: WPS Commercial |
$762.18
|
|
|
TREATMENT OF ANKLE FRACTURE 27818
|
Professional
|
Both
|
$2,716.00
|
|
|
Service Code
|
CPT 27818
|
| Hospital Charge Code |
3014156
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$452.00 |
| Max. Negotiated Rate |
$2,580.20 |
| Rate for Payer: Aetna Commercial |
$2,580.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,335.76
|
| Rate for Payer: Cash Price |
$814.80
|
| Rate for Payer: Cash Price |
$814.80
|
| Rate for Payer: Cigna Commercial |
$2,580.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$452.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,629.60
|
| Rate for Payer: Health EOS Commercial |
$2,471.56
|
| Rate for Payer: HFN Commercial |
$2,580.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,454.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,454.54
|
| Rate for Payer: Multiplan Commercial |
$2,172.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,580.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,195.04
|
| Rate for Payer: Quartz Commercial |
$1,548.12
|
| Rate for Payer: The Alliance Commercial |
$1,358.00
|
| Rate for Payer: United Healthcare Medicaid |
$452.00
|
| Rate for Payer: WEA Trust Commercial |
$1,493.80
|
| Rate for Payer: WPS Commercial |
$2,011.74
|
|
