|
TREATMENT OF ANKLE FRACTURE 28435
|
Professional
|
Both
|
$959.00
|
|
|
Service Code
|
CPT 28435
|
| Hospital Charge Code |
3014248
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$301.31 |
| Max. Negotiated Rate |
$987.80 |
| Rate for Payer: Aetna Commercial |
$911.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$824.74
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cigna Commercial |
$911.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$301.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$575.40
|
| Rate for Payer: Health EOS Commercial |
$872.69
|
| Rate for Payer: HFN Commercial |
$911.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$987.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$987.80
|
| Rate for Payer: Multiplan Commercial |
$767.20
|
| Rate for Payer: Preferred Network Access Commercial |
$911.05
|
| Rate for Payer: Quartz Beloit One Network |
$421.96
|
| Rate for Payer: Quartz Commercial |
$546.63
|
| Rate for Payer: The Alliance Commercial |
$479.50
|
| Rate for Payer: United Healthcare Medicaid |
$301.31
|
| Rate for Payer: WEA Trust Commercial |
$527.45
|
| Rate for Payer: WPS Commercial |
$710.33
|
|
|
Treatment of Bladder Lesion 51720PP
|
Professional
|
Both
|
$896.00
|
|
|
Service Code
|
CPT 51720
|
| Hospital Charge Code |
3748919
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$33.63 |
| Max. Negotiated Rate |
$851.20 |
| Rate for Payer: Aetna Commercial |
$851.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$770.56
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cigna Commercial |
$851.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$33.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$537.60
|
| Rate for Payer: Health EOS Commercial |
$815.36
|
| Rate for Payer: HFN Commercial |
$851.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$145.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$145.61
|
| Rate for Payer: Multiplan Commercial |
$716.80
|
| Rate for Payer: Preferred Network Access Commercial |
$851.20
|
| Rate for Payer: Quartz Beloit One Network |
$394.24
|
| Rate for Payer: Quartz Commercial |
$510.72
|
| Rate for Payer: The Alliance Commercial |
$448.00
|
| Rate for Payer: United Healthcare Medicaid |
$33.63
|
| Rate for Payer: WEA Trust Commercial |
$492.80
|
| Rate for Payer: WPS Commercial |
$663.67
|
|
|
Treatment of Extensive Or Progressive Retinopathy, 1 Or More Sessions
|
Professional
|
Both
|
$3,076.00
|
|
|
Service Code
|
CPT 67228
|
| Hospital Charge Code |
1188904
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$602.65 |
| Max. Negotiated Rate |
$2,922.20 |
| Rate for Payer: Aetna Commercial |
$2,922.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,645.36
|
| Rate for Payer: Cash Price |
$922.80
|
| Rate for Payer: Cash Price |
$922.80
|
| Rate for Payer: Cigna Commercial |
$2,922.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$602.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,845.60
|
| Rate for Payer: Health EOS Commercial |
$2,799.16
|
| Rate for Payer: HFN Commercial |
$2,922.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,021.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,021.51
|
| Rate for Payer: Multiplan Commercial |
$2,460.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,922.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,353.44
|
| Rate for Payer: Quartz Commercial |
$1,753.32
|
| Rate for Payer: The Alliance Commercial |
$1,538.00
|
| Rate for Payer: United Healthcare Medicaid |
$602.65
|
| Rate for Payer: WEA Trust Commercial |
$1,691.80
|
| Rate for Payer: WPS Commercial |
$2,278.39
|
|
|
Treatment of Extensive Or Progressive Retinopathy, 1 or More Sessions 6722850
|
Professional
|
Both
|
$6,154.00
|
|
|
Service Code
|
CPT 67228 50
|
| Hospital Charge Code |
5555346
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,707.76 |
| Max. Negotiated Rate |
$5,846.30 |
| Rate for Payer: Aetna Commercial |
$5,846.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,292.44
|
| Rate for Payer: Cash Price |
$1,846.20
|
| Rate for Payer: Cash Price |
$1,846.20
|
| Rate for Payer: Cigna Commercial |
$5,846.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,077.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,692.40
|
| Rate for Payer: Health EOS Commercial |
$5,600.14
|
| Rate for Payer: HFN Commercial |
$5,846.30
|
| Rate for Payer: Multiplan Commercial |
$4,923.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,846.30
|
| Rate for Payer: Quartz Beloit One Network |
$2,707.76
|
| Rate for Payer: Quartz Commercial |
$3,507.78
|
| Rate for Payer: The Alliance Commercial |
$3,077.00
|
| Rate for Payer: WEA Trust Commercial |
$3,384.70
|
| Rate for Payer: WPS Commercial |
$4,558.27
|
|
|
TREATMENT OF INCOMPLETE ABORTION, ANY TRIMESTER, COMPLETED SURGICALLY
|
Facility
|
OP
|
$12,360.48
|
|
|
Service Code
|
CPT 59812
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,726.00 |
| Max. Negotiated Rate |
$12,360.48 |
| Rate for Payer: Aetna Managed Medicare |
$3,090.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,090.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,090.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,090.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,090.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,090.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,495.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,090.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,090.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,090.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,090.12
|
| Rate for Payer: NAPHCARE Commercial |
$4,635.18
|
| Rate for Payer: Quartz Medicare Advantage |
$3,090.12
|
| Rate for Payer: The Alliance Commercial |
$12,360.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,090.12
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$3,090.12
|
|
|
TREATMENT OF INTERTROCHANTERIC, PERITROCHANTERIC, OR SUBTROCHANTERIC FEMORAL FRACTURE; WITH INTRAMEDULLARY IMPLANT, WITH OR WITHOUT INTERLOCKING SCREWS AND/OR CERCLAGE
|
Facility
|
OP
|
$11,874.87
|
|
|
Service Code
|
CPT 27245
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,103.00 |
| Max. Negotiated Rate |
$11,874.87 |
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
|
|
TREATMENT OF MISCARRIAGE 59812
|
Professional
|
Both
|
$1,556.00
|
|
|
Service Code
|
CPT 59812
|
| Hospital Charge Code |
3015169
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$272.00 |
| Max. Negotiated Rate |
$1,478.20 |
| Rate for Payer: Aetna Commercial |
$1,478.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,338.16
|
| Rate for Payer: Cash Price |
$466.80
|
| Rate for Payer: Cash Price |
$466.80
|
| Rate for Payer: Cigna Commercial |
$1,478.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$272.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$933.60
|
| Rate for Payer: Health EOS Commercial |
$1,415.96
|
| Rate for Payer: HFN Commercial |
$1,478.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$983.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$983.49
|
| Rate for Payer: Multiplan Commercial |
$1,244.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,478.20
|
| Rate for Payer: Quartz Beloit One Network |
$684.64
|
| Rate for Payer: Quartz Commercial |
$886.92
|
| Rate for Payer: The Alliance Commercial |
$778.00
|
| Rate for Payer: United Healthcare Medicaid |
$272.00
|
| Rate for Payer: WEA Trust Commercial |
$855.80
|
| Rate for Payer: WPS Commercial |
$1,152.53
|
|
|
TREATMENT OF MISCARRIAGE 59821
|
Professional
|
Both
|
$1,692.00
|
|
|
Service Code
|
CPT 59821
|
| Hospital Charge Code |
3015171
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$327.42 |
| Max. Negotiated Rate |
$1,607.40 |
| Rate for Payer: Aetna Commercial |
$1,607.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,455.12
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cigna Commercial |
$1,607.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$327.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,015.20
|
| Rate for Payer: Health EOS Commercial |
$1,539.72
|
| Rate for Payer: HFN Commercial |
$1,607.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,204.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,204.68
|
| Rate for Payer: Multiplan Commercial |
$1,353.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,607.40
|
| Rate for Payer: Quartz Beloit One Network |
$744.48
|
| Rate for Payer: Quartz Commercial |
$964.44
|
| Rate for Payer: The Alliance Commercial |
$846.00
|
| Rate for Payer: United Healthcare Medicaid |
$327.42
|
| Rate for Payer: WEA Trust Commercial |
$930.60
|
| Rate for Payer: WPS Commercial |
$1,253.26
|
|
|
TREATMENT OF MISSED ABORTION, COMPLETED SURGICALLY; FIRST TRIMESTER
|
Facility
|
OP
|
$12,360.48
|
|
|
Service Code
|
CPT 59820
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,726.00 |
| Max. Negotiated Rate |
$12,360.48 |
| Rate for Payer: Aetna Managed Medicare |
$3,090.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,090.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,090.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,090.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,090.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,339.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,090.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,495.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,090.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,090.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,090.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,090.12
|
| Rate for Payer: NAPHCARE Commercial |
$4,635.18
|
| Rate for Payer: Quartz Medicare Advantage |
$3,090.12
|
| Rate for Payer: The Alliance Commercial |
$12,360.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,090.12
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$3,090.12
|
|
|
TREATMENT OF MISSED ABORTION, COMPLETED SURGICALLY; SECOND TRIMESTER
|
Facility
|
OP
|
$12,360.48
|
|
|
Service Code
|
CPT 59821
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,726.00 |
| Max. Negotiated Rate |
$12,360.48 |
| Rate for Payer: Aetna Managed Medicare |
$3,090.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,090.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,090.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,090.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,090.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,090.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,495.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,090.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,090.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,090.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,090.12
|
| Rate for Payer: NAPHCARE Commercial |
$4,635.18
|
| Rate for Payer: Quartz Medicare Advantage |
$3,090.12
|
| Rate for Payer: The Alliance Commercial |
$12,360.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,090.12
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$3,090.12
|
|
|
TREATMENT OF MOUTH LESION 40820
|
Professional
|
Both
|
$318.00
|
|
|
Service Code
|
CPT 40820
|
| Hospital Charge Code |
3014610
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.11 |
| Max. Negotiated Rate |
$580.90 |
| Rate for Payer: Aetna Commercial |
$302.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$273.48
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cigna Commercial |
$302.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$30.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$190.80
|
| Rate for Payer: Health EOS Commercial |
$289.38
|
| Rate for Payer: HFN Commercial |
$302.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$580.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$580.90
|
| Rate for Payer: Multiplan Commercial |
$254.40
|
| Rate for Payer: Preferred Network Access Commercial |
$302.10
|
| Rate for Payer: Quartz Beloit One Network |
$139.92
|
| Rate for Payer: Quartz Commercial |
$181.26
|
| Rate for Payer: The Alliance Commercial |
$159.00
|
| Rate for Payer: United Healthcare Medicaid |
$30.11
|
| Rate for Payer: WEA Trust Commercial |
$174.90
|
| Rate for Payer: WPS Commercial |
$235.54
|
|
|
TREATMENT OF NOSE FRACTURE 21320
|
Professional
|
Both
|
$1,037.00
|
|
|
Service Code
|
CPT 21320
|
| Hospital Charge Code |
3013728
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$244.20 |
| Max. Negotiated Rate |
$985.15 |
| Rate for Payer: Aetna Commercial |
$985.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$891.82
|
| Rate for Payer: Cash Price |
$311.10
|
| Rate for Payer: Cash Price |
$311.10
|
| Rate for Payer: Cigna Commercial |
$985.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$244.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$622.20
|
| Rate for Payer: Health EOS Commercial |
$943.67
|
| Rate for Payer: HFN Commercial |
$985.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$446.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$446.40
|
| Rate for Payer: Multiplan Commercial |
$829.60
|
| Rate for Payer: Preferred Network Access Commercial |
$985.15
|
| Rate for Payer: Quartz Beloit One Network |
$456.28
|
| Rate for Payer: Quartz Commercial |
$591.09
|
| Rate for Payer: The Alliance Commercial |
$518.50
|
| Rate for Payer: United Healthcare Medicaid |
$244.20
|
| Rate for Payer: WEA Trust Commercial |
$570.35
|
| Rate for Payer: WPS Commercial |
$768.11
|
|
|
TREATMENT OF PENIS LESION 54200
|
Professional
|
Both
|
$474.00
|
|
|
Service Code
|
CPT 54200
|
| Hospital Charge Code |
3015027
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.11 |
| Max. Negotiated Rate |
$450.30 |
| Rate for Payer: Aetna Commercial |
$450.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$407.64
|
| Rate for Payer: Cash Price |
$142.20
|
| Rate for Payer: Cash Price |
$142.20
|
| Rate for Payer: Cigna Commercial |
$450.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$30.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$284.40
|
| Rate for Payer: Health EOS Commercial |
$431.34
|
| Rate for Payer: HFN Commercial |
$450.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$286.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$286.49
|
| Rate for Payer: Multiplan Commercial |
$379.20
|
| Rate for Payer: Preferred Network Access Commercial |
$450.30
|
| Rate for Payer: Quartz Beloit One Network |
$208.56
|
| Rate for Payer: Quartz Commercial |
$270.18
|
| Rate for Payer: The Alliance Commercial |
$237.00
|
| Rate for Payer: United Healthcare Medicaid |
$30.11
|
| Rate for Payer: WEA Trust Commercial |
$260.70
|
| Rate for Payer: WPS Commercial |
$351.09
|
|
|
TREATMENT OF PENIS LESION 54220
|
Professional
|
Both
|
$795.00
|
|
|
Service Code
|
CPT 54220
|
| Hospital Charge Code |
3015028
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$335.19 |
| Max. Negotiated Rate |
$755.25 |
| Rate for Payer: Aetna Commercial |
$755.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$683.70
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Cigna Commercial |
$755.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$335.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$477.00
|
| Rate for Payer: Health EOS Commercial |
$723.45
|
| Rate for Payer: HFN Commercial |
$755.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$439.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$439.98
|
| Rate for Payer: Multiplan Commercial |
$636.00
|
| Rate for Payer: Preferred Network Access Commercial |
$755.25
|
| Rate for Payer: Quartz Beloit One Network |
$349.80
|
| Rate for Payer: Quartz Commercial |
$453.15
|
| Rate for Payer: The Alliance Commercial |
$397.50
|
| Rate for Payer: United Healthcare Medicaid |
$335.19
|
| Rate for Payer: WEA Trust Commercial |
$437.25
|
| Rate for Payer: WPS Commercial |
$588.86
|
|
|
TREATMENT OF RIB FRACTURE 21800
|
Professional
|
Both
|
$277.00
|
|
| Hospital Charge Code |
3013743
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$121.88 |
| Max. Negotiated Rate |
$263.15 |
| Rate for Payer: Aetna Commercial |
$263.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$238.22
|
| Rate for Payer: Cash Price |
$83.10
|
| Rate for Payer: Cigna Commercial |
$263.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$138.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$166.20
|
| Rate for Payer: Health EOS Commercial |
$252.07
|
| Rate for Payer: HFN Commercial |
$263.15
|
| Rate for Payer: Multiplan Commercial |
$221.60
|
| Rate for Payer: Preferred Network Access Commercial |
$263.15
|
| Rate for Payer: Quartz Beloit One Network |
$121.88
|
| Rate for Payer: Quartz Commercial |
$157.89
|
| Rate for Payer: The Alliance Commercial |
$138.50
|
| Rate for Payer: WEA Trust Commercial |
$152.35
|
| Rate for Payer: WPS Commercial |
$205.17
|
|
|
TREATMENT OF THIGH FRACTURE 27500
|
Professional
|
Both
|
$2,166.00
|
|
|
Service Code
|
CPT 27500
|
| Hospital Charge Code |
3014081
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$602.65 |
| Max. Negotiated Rate |
$2,057.70 |
| Rate for Payer: Aetna Commercial |
$2,057.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,862.76
|
| Rate for Payer: Cash Price |
$649.80
|
| Rate for Payer: Cash Price |
$649.80
|
| Rate for Payer: Cigna Commercial |
$2,057.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$602.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,299.60
|
| Rate for Payer: Health EOS Commercial |
$1,971.06
|
| Rate for Payer: HFN Commercial |
$2,057.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,598.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,598.95
|
| Rate for Payer: Multiplan Commercial |
$1,732.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,057.70
|
| Rate for Payer: Quartz Beloit One Network |
$953.04
|
| Rate for Payer: Quartz Commercial |
$1,234.62
|
| Rate for Payer: The Alliance Commercial |
$1,083.00
|
| Rate for Payer: United Healthcare Medicaid |
$602.65
|
| Rate for Payer: WEA Trust Commercial |
$1,191.30
|
| Rate for Payer: WPS Commercial |
$1,604.36
|
|
|
TREATMENT OF THIGH FRACTURE 27501
|
Professional
|
Both
|
$2,622.00
|
|
|
Service Code
|
CPT 27501
|
| Hospital Charge Code |
3014082
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$443.01 |
| Max. Negotiated Rate |
$2,490.90 |
| Rate for Payer: Aetna Commercial |
$2,490.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,254.92
|
| Rate for Payer: Cash Price |
$786.60
|
| Rate for Payer: Cash Price |
$786.60
|
| Rate for Payer: Cigna Commercial |
$2,490.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$443.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,573.20
|
| Rate for Payer: Health EOS Commercial |
$2,386.02
|
| Rate for Payer: HFN Commercial |
$2,490.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,654.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,654.93
|
| Rate for Payer: Multiplan Commercial |
$2,097.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,490.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,153.68
|
| Rate for Payer: Quartz Commercial |
$1,494.54
|
| Rate for Payer: The Alliance Commercial |
$1,311.00
|
| Rate for Payer: United Healthcare Medicaid |
$443.01
|
| Rate for Payer: WEA Trust Commercial |
$1,442.10
|
| Rate for Payer: WPS Commercial |
$1,942.12
|
|
|
TREATMENT OF THIGH FRACTURE 27508
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
CPT 27508
|
| Hospital Charge Code |
3014086
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$602.39 |
| Max. Negotiated Rate |
$1,710.00 |
| Rate for Payer: Aetna Commercial |
$1,710.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,548.00
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cigna Commercial |
$1,710.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$602.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,080.00
|
| Rate for Payer: Health EOS Commercial |
$1,638.00
|
| Rate for Payer: HFN Commercial |
$1,710.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,660.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,660.58
|
| Rate for Payer: Multiplan Commercial |
$1,440.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,710.00
|
| Rate for Payer: Quartz Beloit One Network |
$792.00
|
| Rate for Payer: Quartz Commercial |
$1,026.00
|
| Rate for Payer: The Alliance Commercial |
$900.00
|
| Rate for Payer: United Healthcare Medicaid |
$602.39
|
| Rate for Payer: WEA Trust Commercial |
$990.00
|
| Rate for Payer: WPS Commercial |
$1,333.26
|
|
|
TREATMENT OF TIBIA FRACTURE 27752
|
Professional
|
Both
|
$1,973.00
|
|
|
Service Code
|
CPT 27752
|
| Hospital Charge Code |
3014140
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$492.26 |
| Max. Negotiated Rate |
$1,874.35 |
| Rate for Payer: Aetna Commercial |
$1,874.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,696.78
|
| Rate for Payer: Cash Price |
$591.90
|
| Rate for Payer: Cash Price |
$591.90
|
| Rate for Payer: Cigna Commercial |
$1,874.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$492.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,183.80
|
| Rate for Payer: Health EOS Commercial |
$1,795.43
|
| Rate for Payer: HFN Commercial |
$1,874.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,637.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,637.04
|
| Rate for Payer: Multiplan Commercial |
$1,578.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,874.35
|
| Rate for Payer: Quartz Beloit One Network |
$868.12
|
| Rate for Payer: Quartz Commercial |
$1,124.61
|
| Rate for Payer: The Alliance Commercial |
$986.50
|
| Rate for Payer: United Healthcare Medicaid |
$492.26
|
| Rate for Payer: WEA Trust Commercial |
$1,085.15
|
| Rate for Payer: WPS Commercial |
$1,461.40
|
|
|
TREATMENT OF TOE FRACTURE 28515
|
Professional
|
Both
|
$341.00
|
|
|
Service Code
|
CPT 28515
|
| Hospital Charge Code |
3014261
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$75.33 |
| Max. Negotiated Rate |
$478.77 |
| Rate for Payer: Aetna Commercial |
$323.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$293.26
|
| Rate for Payer: Cash Price |
$102.30
|
| Rate for Payer: Cash Price |
$102.30
|
| Rate for Payer: Cigna Commercial |
$323.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$75.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$204.60
|
| Rate for Payer: Health EOS Commercial |
$310.31
|
| Rate for Payer: HFN Commercial |
$323.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$478.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$478.77
|
| Rate for Payer: Multiplan Commercial |
$272.80
|
| Rate for Payer: Preferred Network Access Commercial |
$323.95
|
| Rate for Payer: Quartz Beloit One Network |
$150.04
|
| Rate for Payer: Quartz Commercial |
$194.37
|
| Rate for Payer: The Alliance Commercial |
$170.50
|
| Rate for Payer: United Healthcare Medicaid |
$75.33
|
| Rate for Payer: WEA Trust Commercial |
$187.55
|
| Rate for Payer: WPS Commercial |
$252.58
|
|
|
TREATMENT OF URETHRA LESION 53260
|
Professional
|
Both
|
$675.00
|
|
|
Service Code
|
CPT 53260
|
| Hospital Charge Code |
3015011
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$75.33 |
| Max. Negotiated Rate |
$641.25 |
| Rate for Payer: Aetna Commercial |
$641.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$580.50
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cigna Commercial |
$641.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$75.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$405.00
|
| Rate for Payer: Health EOS Commercial |
$614.25
|
| Rate for Payer: HFN Commercial |
$641.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$603.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$603.98
|
| Rate for Payer: Multiplan Commercial |
$540.00
|
| Rate for Payer: Preferred Network Access Commercial |
$641.25
|
| Rate for Payer: Quartz Beloit One Network |
$297.00
|
| Rate for Payer: Quartz Commercial |
$384.75
|
| Rate for Payer: The Alliance Commercial |
$337.50
|
| Rate for Payer: United Healthcare Medicaid |
$75.33
|
| Rate for Payer: WEA Trust Commercial |
$371.25
|
| Rate for Payer: WPS Commercial |
$499.97
|
|
|
TREATMENT OF URETHRA LESION 53265
|
Professional
|
Both
|
$1,290.00
|
|
|
Service Code
|
CPT 53265
|
| Hospital Charge Code |
3015012
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$105.45 |
| Max. Negotiated Rate |
$1,225.50 |
| Rate for Payer: Aetna Commercial |
$1,225.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,109.40
|
| Rate for Payer: Cash Price |
$387.00
|
| Rate for Payer: Cash Price |
$387.00
|
| Rate for Payer: Cigna Commercial |
$1,225.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$105.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$774.00
|
| Rate for Payer: Health EOS Commercial |
$1,173.90
|
| Rate for Payer: HFN Commercial |
$1,225.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$627.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$627.74
|
| Rate for Payer: Multiplan Commercial |
$1,032.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,225.50
|
| Rate for Payer: Quartz Beloit One Network |
$567.60
|
| Rate for Payer: Quartz Commercial |
$735.30
|
| Rate for Payer: The Alliance Commercial |
$645.00
|
| Rate for Payer: United Healthcare Medicaid |
$105.45
|
| Rate for Payer: WEA Trust Commercial |
$709.50
|
| Rate for Payer: WPS Commercial |
$955.50
|
|
|
TREAT METACARPAL FRACTURE 26605
|
Professional
|
Both
|
$672.00
|
|
|
Service Code
|
CPT 26605
|
| Hospital Charge Code |
3013970
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$230.56 |
| Max. Negotiated Rate |
$997.72 |
| Rate for Payer: Aetna Commercial |
$638.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$577.92
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cigna Commercial |
$638.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$230.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$403.20
|
| Rate for Payer: Health EOS Commercial |
$611.52
|
| Rate for Payer: HFN Commercial |
$638.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$997.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$997.72
|
| Rate for Payer: Multiplan Commercial |
$537.60
|
| Rate for Payer: Preferred Network Access Commercial |
$638.40
|
| Rate for Payer: Quartz Beloit One Network |
$295.68
|
| Rate for Payer: Quartz Commercial |
$383.04
|
| Rate for Payer: The Alliance Commercial |
$336.00
|
| Rate for Payer: United Healthcare Medicaid |
$230.56
|
| Rate for Payer: WEA Trust Commercial |
$369.60
|
| Rate for Payer: WPS Commercial |
$497.75
|
|
|
Treat Radius Fracture 2465050
|
Professional
|
Both
|
$1,295.00
|
|
|
Service Code
|
CPT 24650 50
|
| Hospital Charge Code |
5454900
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$569.80 |
| Max. Negotiated Rate |
$1,230.25 |
| Rate for Payer: Aetna Commercial |
$1,230.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,113.70
|
| Rate for Payer: Cash Price |
$388.50
|
| Rate for Payer: Cash Price |
$388.50
|
| Rate for Payer: Cigna Commercial |
$1,230.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$647.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$777.00
|
| Rate for Payer: Health EOS Commercial |
$1,178.45
|
| Rate for Payer: HFN Commercial |
$1,230.25
|
| Rate for Payer: Multiplan Commercial |
$1,036.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,230.25
|
| Rate for Payer: Quartz Beloit One Network |
$569.80
|
| Rate for Payer: Quartz Commercial |
$738.15
|
| Rate for Payer: The Alliance Commercial |
$647.50
|
| Rate for Payer: WEA Trust Commercial |
$712.25
|
| Rate for Payer: WPS Commercial |
$959.21
|
|
|
TREAT SESAMOID BONE FRACTURE 28530
|
Professional
|
Both
|
$770.00
|
|
|
Service Code
|
CPT 28530
|
| Hospital Charge Code |
3014263
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$59.85 |
| Max. Negotiated Rate |
$731.50 |
| Rate for Payer: Aetna Commercial |
$731.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$662.20
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cigna Commercial |
$731.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$59.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$462.00
|
| Rate for Payer: Health EOS Commercial |
$700.70
|
| Rate for Payer: HFN Commercial |
$731.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$336.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$336.83
|
| Rate for Payer: Multiplan Commercial |
$616.00
|
| Rate for Payer: Preferred Network Access Commercial |
$731.50
|
| Rate for Payer: Quartz Beloit One Network |
$338.80
|
| Rate for Payer: Quartz Commercial |
$438.90
|
| Rate for Payer: The Alliance Commercial |
$385.00
|
| Rate for Payer: United Healthcare Medicaid |
$59.85
|
| Rate for Payer: WEA Trust Commercial |
$423.50
|
| Rate for Payer: WPS Commercial |
$570.34
|
|
