|
TREAT LUNG LINING CHEMICALLY 32560
|
Professional
|
Both
|
$2,192.00
|
|
|
Service Code
|
CPT 32560
|
| Hospital Charge Code |
3014416
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$65.22 |
| Max. Negotiated Rate |
$2,165.70 |
| Rate for Payer: Aetna Commercial |
$2,165.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,960.52
|
| Rate for Payer: Aetna Managed Medicare |
$65.22
|
| Rate for Payer: Anthem Medicare Advantage |
$65.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$65.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$65.22
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Cigna Commercial |
$2,165.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$236.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$65.22
|
| Rate for Payer: Health EOS Commercial |
$2,074.51
|
| Rate for Payer: HFN Commercial |
$2,165.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$263.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$263.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$65.22
|
| Rate for Payer: Multiplan Commercial |
$1,823.74
|
| Rate for Payer: NAPHCARE Commercial |
$97.83
|
| Rate for Payer: Preferred Network Access Commercial |
$2,165.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,003.06
|
| Rate for Payer: Quartz Commercial |
$1,299.42
|
| Rate for Payer: Quartz Medicare Advantage |
$65.22
|
| Rate for Payer: The Alliance Commercial |
$277.18
|
| Rate for Payer: United Healthcare Medicaid |
$236.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$65.22
|
| Rate for Payer: WEA Trust Commercial |
$1,253.82
|
| Rate for Payer: WPS Commercial |
$293.48
|
|
|
TREATMENT ANKLE FRACTURE - OPEN, EXT 2781422
|
Professional
|
Both
|
$5,307.00
|
|
|
Service Code
|
CPT 27814
|
| Hospital Charge Code |
6180168
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$680.86 |
| Max. Negotiated Rate |
$5,243.32 |
| Rate for Payer: Aetna Commercial |
$5,243.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,746.58
|
| Rate for Payer: Aetna Managed Medicare |
$680.86
|
| Rate for Payer: Anthem Medicare Advantage |
$680.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$680.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$680.86
|
| Rate for Payer: Cash Price |
$1,592.10
|
| Rate for Payer: Cash Price |
$1,592.10
|
| Rate for Payer: Cash Price |
$1,592.10
|
| Rate for Payer: Cigna Commercial |
$5,243.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$688.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$680.86
|
| Rate for Payer: Health EOS Commercial |
$5,022.54
|
| Rate for Payer: HFN Commercial |
$5,243.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,643.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,643.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$680.86
|
| Rate for Payer: Multiplan Commercial |
$4,415.42
|
| Rate for Payer: NAPHCARE Commercial |
$1,021.29
|
| Rate for Payer: Preferred Network Access Commercial |
$5,243.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,428.48
|
| Rate for Payer: Quartz Commercial |
$3,145.99
|
| Rate for Payer: Quartz Medicare Advantage |
$680.86
|
| Rate for Payer: The Alliance Commercial |
$2,893.64
|
| Rate for Payer: United Healthcare Medicaid |
$688.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$680.86
|
| Rate for Payer: WEA Trust Commercial |
$3,035.60
|
| Rate for Payer: WPS Commercial |
$3,063.86
|
|
|
Treatment Device Complex
|
Facility
|
OP
|
$2,181.00
|
|
|
Service Code
|
CPT 77334
|
| Hospital Charge Code |
3040390
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$394.05 |
| Max. Negotiated Rate |
$2,086.78 |
| Rate for Payer: Aetna Commercial |
$2,041.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,950.69
|
| Rate for Payer: Aetna Managed Medicare |
$394.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,424.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,139.46
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,082.48
|
| Rate for Payer: Anthem Medicare Advantage |
$394.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,202.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$394.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$394.05
|
| Rate for Payer: Cash Price |
$654.30
|
| Rate for Payer: Cash Price |
$654.30
|
| Rate for Payer: Cigna Commercial |
$2,086.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$394.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,269.34
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$394.05
|
| Rate for Payer: Health EOS Commercial |
$2,018.73
|
| Rate for Payer: HFN Commercial |
$2,086.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,465.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$394.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$394.05
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$394.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$394.05
|
| Rate for Payer: Multiplan Commercial |
$1,814.59
|
| Rate for Payer: NAPHCARE Commercial |
$591.07
|
| Rate for Payer: Preferred Network Access Commercial |
$2,086.78
|
| Rate for Payer: Quartz Beloit One Network |
$1,111.44
|
| Rate for Payer: Quartz Commercial |
$1,474.36
|
| Rate for Payer: Quartz Medicare Advantage |
$394.05
|
| Rate for Payer: The Alliance Commercial |
$1,576.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$394.05
|
| Rate for Payer: United Healthcare PPO |
$1,701.18
|
| Rate for Payer: WEA Trust Commercial |
$1,247.53
|
| Rate for Payer: Wellcare Medicare |
$394.05
|
| Rate for Payer: WPS Commercial |
$1,680.02
|
|
|
Treatment Device Complex
|
Facility
|
IP
|
$2,181.00
|
|
|
Service Code
|
CPT 77334
|
| Hospital Charge Code |
3040390
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,111.44 |
| Max. Negotiated Rate |
$2,086.78 |
| Rate for Payer: Aetna Commercial |
$2,041.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,950.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,202.17
|
| Rate for Payer: Cash Price |
$654.30
|
| Rate for Payer: Cigna Commercial |
$2,086.78
|
| Rate for Payer: Health EOS Commercial |
$2,018.73
|
| Rate for Payer: HFN Commercial |
$2,086.78
|
| Rate for Payer: Multiplan Commercial |
$1,814.59
|
| Rate for Payer: Preferred Network Access Commercial |
$2,086.78
|
| Rate for Payer: Quartz Beloit One Network |
$1,111.44
|
| Rate for Payer: Quartz Commercial |
$1,360.94
|
| Rate for Payer: WEA Trust Commercial |
$1,247.53
|
| Rate for Payer: WPS Commercial |
$1,680.02
|
|
|
Treatment Device Intermediate
|
Facility
|
OP
|
$658.00
|
|
|
Service Code
|
CPT 77333
|
| Hospital Charge Code |
3040387
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$141.45 |
| Max. Negotiated Rate |
$629.57 |
| Rate for Payer: Aetna Commercial |
$615.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$588.52
|
| Rate for Payer: Aetna Managed Medicare |
$141.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$523.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$418.42
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$397.50
|
| Rate for Payer: Anthem Medicare Advantage |
$141.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$362.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$141.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$141.45
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cigna Commercial |
$629.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$141.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$382.96
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$141.45
|
| Rate for Payer: Health EOS Commercial |
$609.04
|
| Rate for Payer: HFN Commercial |
$629.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$526.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$141.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$141.45
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$141.45
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$141.45
|
| Rate for Payer: Multiplan Commercial |
$547.46
|
| Rate for Payer: NAPHCARE Commercial |
$212.18
|
| Rate for Payer: Preferred Network Access Commercial |
$629.57
|
| Rate for Payer: Quartz Beloit One Network |
$335.32
|
| Rate for Payer: Quartz Commercial |
$444.81
|
| Rate for Payer: Quartz Medicare Advantage |
$141.45
|
| Rate for Payer: The Alliance Commercial |
$565.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$141.45
|
| Rate for Payer: United Healthcare PPO |
$513.24
|
| Rate for Payer: WEA Trust Commercial |
$376.38
|
| Rate for Payer: Wellcare Medicare |
$141.45
|
| Rate for Payer: WPS Commercial |
$506.86
|
|
|
Treatment Device Intermediate
|
Facility
|
IP
|
$658.00
|
|
|
Service Code
|
CPT 77333
|
| Hospital Charge Code |
3040387
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$335.32 |
| Max. Negotiated Rate |
$629.57 |
| Rate for Payer: Aetna Commercial |
$615.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$588.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$362.69
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cigna Commercial |
$629.57
|
| Rate for Payer: Health EOS Commercial |
$609.04
|
| Rate for Payer: HFN Commercial |
$629.57
|
| Rate for Payer: Multiplan Commercial |
$547.46
|
| Rate for Payer: Preferred Network Access Commercial |
$629.57
|
| Rate for Payer: Quartz Beloit One Network |
$335.32
|
| Rate for Payer: Quartz Commercial |
$410.59
|
| Rate for Payer: WEA Trust Commercial |
$376.38
|
| Rate for Payer: WPS Commercial |
$506.86
|
|
|
Treatment Device Simple
|
Facility
|
OP
|
$757.00
|
|
|
Service Code
|
CPT 77332
|
| Hospital Charge Code |
3040386
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$141.45 |
| Max. Negotiated Rate |
$724.30 |
| Rate for Payer: Aetna Commercial |
$708.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$677.06
|
| Rate for Payer: Aetna Managed Medicare |
$141.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$523.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$418.42
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$397.50
|
| Rate for Payer: Anthem Medicare Advantage |
$141.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$417.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$141.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$141.45
|
| Rate for Payer: Cash Price |
$227.10
|
| Rate for Payer: Cash Price |
$227.10
|
| Rate for Payer: Cigna Commercial |
$724.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$141.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$440.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$141.45
|
| Rate for Payer: Health EOS Commercial |
$700.68
|
| Rate for Payer: HFN Commercial |
$724.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$526.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$141.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$141.45
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$141.45
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$141.45
|
| Rate for Payer: Multiplan Commercial |
$629.82
|
| Rate for Payer: NAPHCARE Commercial |
$212.18
|
| Rate for Payer: Preferred Network Access Commercial |
$724.30
|
| Rate for Payer: Quartz Beloit One Network |
$385.77
|
| Rate for Payer: Quartz Commercial |
$511.73
|
| Rate for Payer: Quartz Medicare Advantage |
$141.45
|
| Rate for Payer: The Alliance Commercial |
$565.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$141.45
|
| Rate for Payer: United Healthcare PPO |
$590.46
|
| Rate for Payer: WEA Trust Commercial |
$433.00
|
| Rate for Payer: Wellcare Medicare |
$141.45
|
| Rate for Payer: WPS Commercial |
$583.12
|
|
|
Treatment Device Simple
|
Facility
|
IP
|
$757.00
|
|
|
Service Code
|
CPT 77332
|
| Hospital Charge Code |
3040386
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$385.77 |
| Max. Negotiated Rate |
$724.30 |
| Rate for Payer: Aetna Commercial |
$708.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$677.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$417.26
|
| Rate for Payer: Cash Price |
$227.10
|
| Rate for Payer: Cigna Commercial |
$724.30
|
| Rate for Payer: Health EOS Commercial |
$700.68
|
| Rate for Payer: HFN Commercial |
$724.30
|
| Rate for Payer: Multiplan Commercial |
$629.82
|
| Rate for Payer: Preferred Network Access Commercial |
$724.30
|
| Rate for Payer: Quartz Beloit One Network |
$385.77
|
| Rate for Payer: Quartz Commercial |
$472.37
|
| Rate for Payer: WEA Trust Commercial |
$433.00
|
| Rate for Payer: WPS Commercial |
$583.12
|
|
|
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 |
$235.04 |
| Max. Negotiated Rate |
$1,785.98 |
| Rate for Payer: Aetna Commercial |
$1,018.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$922.13
|
| Rate for Payer: Aetna Managed Medicare |
$396.88
|
| Rate for Payer: Anthem Medicare Advantage |
$396.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$396.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$396.88
|
| Rate for Payer: Cash Price |
$309.30
|
| Rate for Payer: Cash Price |
$309.30
|
| Rate for Payer: Cash Price |
$309.30
|
| Rate for Payer: Cigna Commercial |
$1,018.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$235.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$396.88
|
| Rate for Payer: Health EOS Commercial |
$975.74
|
| Rate for Payer: HFN Commercial |
$1,018.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,341.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,341.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$396.88
|
| Rate for Payer: Multiplan Commercial |
$857.79
|
| Rate for Payer: NAPHCARE Commercial |
$595.33
|
| Rate for Payer: Preferred Network Access Commercial |
$1,018.63
|
| Rate for Payer: Quartz Beloit One Network |
$471.79
|
| Rate for Payer: Quartz Commercial |
$611.18
|
| Rate for Payer: Quartz Medicare Advantage |
$396.88
|
| Rate for Payer: The Alliance Commercial |
$1,686.76
|
| Rate for Payer: United Healthcare Medicaid |
$235.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$396.88
|
| Rate for Payer: WEA Trust Commercial |
$589.73
|
| Rate for Payer: WPS Commercial |
$1,785.98
|
|
|
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 |
$402.13 |
| Max. Negotiated Rate |
$1,996.72 |
| Rate for Payer: Aetna Commercial |
$1,535.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,389.90
|
| Rate for Payer: Aetna Managed Medicare |
$443.72
|
| Rate for Payer: Anthem Medicare Advantage |
$443.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$443.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$443.72
|
| Rate for Payer: Cash Price |
$466.20
|
| Rate for Payer: Cash Price |
$466.20
|
| Rate for Payer: Cash Price |
$466.20
|
| Rate for Payer: Cigna Commercial |
$1,535.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$402.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$443.72
|
| Rate for Payer: Health EOS Commercial |
$1,470.71
|
| Rate for Payer: HFN Commercial |
$1,535.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,474.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,474.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$443.72
|
| Rate for Payer: Multiplan Commercial |
$1,292.93
|
| Rate for Payer: NAPHCARE Commercial |
$665.57
|
| Rate for Payer: Preferred Network Access Commercial |
$1,535.35
|
| Rate for Payer: Quartz Beloit One Network |
$711.11
|
| Rate for Payer: Quartz Commercial |
$921.21
|
| Rate for Payer: Quartz Medicare Advantage |
$443.72
|
| Rate for Payer: The Alliance Commercial |
$1,885.79
|
| Rate for Payer: United Healthcare Medicaid |
$402.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$443.72
|
| Rate for Payer: WEA Trust Commercial |
$888.89
|
| Rate for Payer: WPS Commercial |
$1,996.72
|
|
|
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 |
$302.85 |
| Max. Negotiated Rate |
$1,362.82 |
| Rate for Payer: Aetna Commercial |
$1,016.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$920.34
|
| Rate for Payer: Aetna Managed Medicare |
$302.85
|
| Rate for Payer: Anthem Medicare Advantage |
$302.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$302.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$302.85
|
| Rate for Payer: Cash Price |
$308.70
|
| Rate for Payer: Cash Price |
$308.70
|
| Rate for Payer: Cash Price |
$308.70
|
| Rate for Payer: Cigna Commercial |
$1,016.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$391.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$302.85
|
| Rate for Payer: Health EOS Commercial |
$973.85
|
| Rate for Payer: HFN Commercial |
$1,016.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,025.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,025.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$302.85
|
| Rate for Payer: Multiplan Commercial |
$856.13
|
| Rate for Payer: NAPHCARE Commercial |
$454.27
|
| Rate for Payer: Preferred Network Access Commercial |
$1,016.65
|
| Rate for Payer: Quartz Beloit One Network |
$470.87
|
| Rate for Payer: Quartz Commercial |
$609.99
|
| Rate for Payer: Quartz Medicare Advantage |
$302.85
|
| Rate for Payer: The Alliance Commercial |
$1,287.10
|
| Rate for Payer: United Healthcare Medicaid |
$391.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$302.85
|
| Rate for Payer: WEA Trust Commercial |
$588.59
|
| Rate for Payer: WPS Commercial |
$1,362.82
|
|
|
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 |
$454.42 |
| Max. Negotiated Rate |
$2,683.41 |
| Rate for Payer: Aetna Commercial |
$2,683.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,429.19
|
| Rate for Payer: Aetna Managed Medicare |
$454.42
|
| Rate for Payer: Anthem Medicare Advantage |
$454.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$454.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$454.42
|
| Rate for Payer: Cash Price |
$814.80
|
| Rate for Payer: Cash Price |
$814.80
|
| Rate for Payer: Cash Price |
$814.80
|
| Rate for Payer: Cigna Commercial |
$2,683.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$470.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$454.42
|
| Rate for Payer: Health EOS Commercial |
$2,570.42
|
| Rate for Payer: HFN Commercial |
$2,683.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,512.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,512.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$454.42
|
| Rate for Payer: Multiplan Commercial |
$2,259.71
|
| Rate for Payer: NAPHCARE Commercial |
$681.63
|
| Rate for Payer: Preferred Network Access Commercial |
$2,683.41
|
| Rate for Payer: Quartz Beloit One Network |
$1,242.84
|
| Rate for Payer: Quartz Commercial |
$1,610.04
|
| Rate for Payer: Quartz Medicare Advantage |
$454.42
|
| Rate for Payer: The Alliance Commercial |
$1,931.27
|
| Rate for Payer: United Healthcare Medicaid |
$470.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$454.42
|
| Rate for Payer: WEA Trust Commercial |
$1,553.55
|
| Rate for Payer: WPS Commercial |
$2,044.88
|
|
|
TREATMENT OF ANKLE FRACTURE 28435
|
Professional
|
Both
|
$959.00
|
|
|
Service Code
|
CPT 28435
|
| Hospital Charge Code |
3014248
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$313.36 |
| Max. Negotiated Rate |
$1,423.52 |
| Rate for Payer: Aetna Commercial |
$947.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$857.73
|
| Rate for Payer: Aetna Managed Medicare |
$316.34
|
| Rate for Payer: Anthem Medicare Advantage |
$316.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$316.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$316.34
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cigna Commercial |
$947.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$313.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$316.34
|
| Rate for Payer: Health EOS Commercial |
$907.60
|
| Rate for Payer: HFN Commercial |
$947.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,027.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,027.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$316.34
|
| Rate for Payer: Multiplan Commercial |
$797.89
|
| Rate for Payer: NAPHCARE Commercial |
$474.51
|
| Rate for Payer: Preferred Network Access Commercial |
$947.49
|
| Rate for Payer: Quartz Beloit One Network |
$438.84
|
| Rate for Payer: Quartz Commercial |
$568.50
|
| Rate for Payer: Quartz Medicare Advantage |
$316.34
|
| Rate for Payer: The Alliance Commercial |
$1,344.43
|
| Rate for Payer: United Healthcare Medicaid |
$313.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$316.34
|
| Rate for Payer: WEA Trust Commercial |
$548.55
|
| Rate for Payer: WPS Commercial |
$1,423.52
|
|
|
Treatment of Bladder Lesion 51720PP
|
Professional
|
Both
|
$896.00
|
|
|
Service Code
|
CPT 51720
|
| Hospital Charge Code |
3748919
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$34.98 |
| Max. Negotiated Rate |
$885.25 |
| Rate for Payer: Aetna Commercial |
$885.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$801.38
|
| Rate for Payer: Aetna Managed Medicare |
$36.69
|
| Rate for Payer: Anthem Medicare Advantage |
$36.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.69
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cigna Commercial |
$885.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$34.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.69
|
| Rate for Payer: Health EOS Commercial |
$847.97
|
| Rate for Payer: HFN Commercial |
$885.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$151.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$151.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.69
|
| Rate for Payer: Multiplan Commercial |
$745.47
|
| Rate for Payer: NAPHCARE Commercial |
$55.04
|
| Rate for Payer: Preferred Network Access Commercial |
$885.25
|
| Rate for Payer: Quartz Beloit One Network |
$410.01
|
| Rate for Payer: Quartz Commercial |
$531.15
|
| Rate for Payer: Quartz Medicare Advantage |
$36.69
|
| Rate for Payer: The Alliance Commercial |
$155.94
|
| Rate for Payer: United Healthcare Medicaid |
$34.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.69
|
| Rate for Payer: WEA Trust Commercial |
$512.51
|
| Rate for Payer: WPS Commercial |
$165.11
|
|
|
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 |
$251.25 |
| Max. Negotiated Rate |
$3,039.09 |
| Rate for Payer: Aetna Commercial |
$3,039.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,751.17
|
| Rate for Payer: Aetna Managed Medicare |
$251.25
|
| Rate for Payer: Anthem Medicare Advantage |
$251.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$251.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$251.25
|
| Rate for Payer: Cash Price |
$922.80
|
| Rate for Payer: Cash Price |
$922.80
|
| Rate for Payer: Cash Price |
$922.80
|
| Rate for Payer: Cigna Commercial |
$3,039.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$626.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$251.25
|
| Rate for Payer: Health EOS Commercial |
$2,911.13
|
| Rate for Payer: HFN Commercial |
$3,039.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,062.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,062.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$251.25
|
| Rate for Payer: Multiplan Commercial |
$2,559.23
|
| Rate for Payer: NAPHCARE Commercial |
$376.88
|
| Rate for Payer: Preferred Network Access Commercial |
$3,039.09
|
| Rate for Payer: Quartz Beloit One Network |
$1,407.58
|
| Rate for Payer: Quartz Commercial |
$1,823.45
|
| Rate for Payer: Quartz Medicare Advantage |
$251.25
|
| Rate for Payer: The Alliance Commercial |
$1,067.83
|
| Rate for Payer: United Healthcare Medicaid |
$626.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$251.25
|
| Rate for Payer: WEA Trust Commercial |
$1,759.47
|
| Rate for Payer: WPS Commercial |
$1,130.64
|
|
|
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 |
$626.76 |
| Max. Negotiated Rate |
$6,080.15 |
| Rate for Payer: Aetna Commercial |
$6,080.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,504.14
|
| Rate for Payer: Cash Price |
$1,846.20
|
| Rate for Payer: Cash Price |
$1,846.20
|
| Rate for Payer: Cash Price |
$1,846.20
|
| Rate for Payer: Cigna Commercial |
$6,080.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$626.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,840.10
|
| Rate for Payer: Health EOS Commercial |
$5,824.15
|
| Rate for Payer: HFN Commercial |
$6,080.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,062.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,062.37
|
| Rate for Payer: Multiplan Commercial |
$5,120.13
|
| Rate for Payer: Preferred Network Access Commercial |
$6,080.15
|
| Rate for Payer: Quartz Beloit One Network |
$2,816.07
|
| Rate for Payer: Quartz Commercial |
$3,648.09
|
| Rate for Payer: The Alliance Commercial |
$3,200.08
|
| Rate for Payer: United Healthcare Medicaid |
$626.76
|
| Rate for Payer: WEA Trust Commercial |
$3,520.09
|
| Rate for Payer: WPS Commercial |
$4,740.43
|
|
|
TREATMENT OF HUMERAL SHAFT FRACTURE, WITH INSERTION OF INTRAMEDULLARY IMPLANT, WITH OR WITHOUT CERCLAGE AND/OR LOCKING SCREWS
|
Facility
|
OP
|
$54,045.18
|
|
|
Service Code
|
CPT 24516
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,107.14 |
| Max. Negotiated Rate |
$54,045.18 |
| Rate for Payer: Aetna Managed Medicare |
$13,511.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,394.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,394.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,919.20
|
| Rate for Payer: Anthem Medicare Advantage |
$13,511.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,511.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,511.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,511.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,107.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,511.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50,262.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,511.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,511.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,511.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,511.30
|
| Rate for Payer: NAPHCARE Commercial |
$20,266.94
|
| Rate for Payer: Quartz Medicare Advantage |
$13,511.30
|
| Rate for Payer: The Alliance Commercial |
$54,045.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,511.30
|
| Rate for Payer: United Healthcare PPO |
$9,979.84
|
| Rate for Payer: Wellcare Medicare |
$13,511.30
|
|
|
Treatment of incomplete abortion, any trimester, completed surgically
|
Facility
|
OP
|
$13,626.87
|
|
|
Service Code
|
CPT 59812
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,835.04 |
| Max. Negotiated Rate |
$13,626.87 |
| Rate for Payer: Quartz Medicare Advantage |
$3,406.72
|
| Rate for Payer: Aetna Managed Medicare |
$3,406.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$3,406.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,406.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,406.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,406.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,406.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,672.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,406.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,406.72
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,406.72
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,406.72
|
| Rate for Payer: NAPHCARE Commercial |
$5,110.08
|
| Rate for Payer: The Alliance Commercial |
$13,626.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,406.72
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$3,406.72
|
|
|
Treatment of intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture; with intramedullary implant, with or without interlocking screws and/or cerclage
|
Facility
|
OP
|
$30,545.47
|
|
|
Service Code
|
CPT 27245
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,267.12 |
| Max. Negotiated Rate |
$30,545.47 |
| Rate for Payer: Aetna Managed Medicare |
$7,636.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$7,636.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,636.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,636.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,636.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,636.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28,407.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,636.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,636.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,636.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,636.37
|
| Rate for Payer: NAPHCARE Commercial |
$11,454.55
|
| Rate for Payer: Quartz Medicare Advantage |
$7,636.37
|
| Rate for Payer: The Alliance Commercial |
$30,545.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,636.37
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$7,636.37
|
|
|
TREATMENT OF MISCARRIAGE 59812
|
Professional
|
Both
|
$1,556.00
|
|
|
Service Code
|
CPT 59812
|
| Hospital Charge Code |
3015169
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$253.92 |
| Max. Negotiated Rate |
$1,537.33 |
| Rate for Payer: Aetna Commercial |
$1,537.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,391.69
|
| Rate for Payer: Aetna Managed Medicare |
$253.92
|
| Rate for Payer: Anthem Medicare Advantage |
$253.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$253.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$253.92
|
| Rate for Payer: Cash Price |
$466.80
|
| Rate for Payer: Cash Price |
$466.80
|
| Rate for Payer: Cash Price |
$466.80
|
| Rate for Payer: Cigna Commercial |
$1,537.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$282.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$253.92
|
| Rate for Payer: Health EOS Commercial |
$1,472.60
|
| Rate for Payer: HFN Commercial |
$1,537.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,022.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,022.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$253.92
|
| Rate for Payer: Multiplan Commercial |
$1,294.59
|
| Rate for Payer: NAPHCARE Commercial |
$380.87
|
| Rate for Payer: Preferred Network Access Commercial |
$1,537.33
|
| Rate for Payer: Quartz Beloit One Network |
$712.03
|
| Rate for Payer: Quartz Commercial |
$922.40
|
| Rate for Payer: Quartz Medicare Advantage |
$253.92
|
| Rate for Payer: The Alliance Commercial |
$1,079.14
|
| Rate for Payer: United Healthcare Medicaid |
$282.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$253.92
|
| Rate for Payer: WEA Trust Commercial |
$890.03
|
| Rate for Payer: WPS Commercial |
$1,142.62
|
|
|
TREATMENT OF MISCARRIAGE 59821
|
Professional
|
Both
|
$1,692.00
|
|
|
Service Code
|
CPT 59821
|
| Hospital Charge Code |
3015171
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$314.10 |
| Max. Negotiated Rate |
$1,671.70 |
| Rate for Payer: Aetna Commercial |
$1,671.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,513.32
|
| Rate for Payer: Aetna Managed Medicare |
$314.10
|
| Rate for Payer: Anthem Medicare Advantage |
$314.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$314.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$314.10
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cigna Commercial |
$1,671.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$340.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$314.10
|
| Rate for Payer: Health EOS Commercial |
$1,601.31
|
| Rate for Payer: HFN Commercial |
$1,671.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,252.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,252.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$314.10
|
| Rate for Payer: Multiplan Commercial |
$1,407.74
|
| Rate for Payer: NAPHCARE Commercial |
$471.15
|
| Rate for Payer: Preferred Network Access Commercial |
$1,671.70
|
| Rate for Payer: Quartz Beloit One Network |
$774.26
|
| Rate for Payer: Quartz Commercial |
$1,003.02
|
| Rate for Payer: Quartz Medicare Advantage |
$314.10
|
| Rate for Payer: The Alliance Commercial |
$1,334.93
|
| Rate for Payer: United Healthcare Medicaid |
$340.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$314.10
|
| Rate for Payer: WEA Trust Commercial |
$967.82
|
| Rate for Payer: WPS Commercial |
$1,413.45
|
|
|
TREATMENT OF MISSED ABORTION, COMPLETED SURGICALLY; FIRST TRIMESTER
|
Facility
|
OP
|
$13,626.87
|
|
|
Service Code
|
CPT 59820
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,835.04 |
| Max. Negotiated Rate |
$13,626.87 |
| Rate for Payer: Aetna Managed Medicare |
$3,406.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$3,406.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,406.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,406.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,406.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,673.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,406.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,672.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,406.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,406.72
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,406.72
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,406.72
|
| Rate for Payer: NAPHCARE Commercial |
$5,110.08
|
| Rate for Payer: Quartz Medicare Advantage |
$3,406.72
|
| Rate for Payer: The Alliance Commercial |
$13,626.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,406.72
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$3,406.72
|
|
|
TREATMENT OF MISSED ABORTION, COMPLETED SURGICALLY; SECOND TRIMESTER
|
Facility
|
OP
|
$13,626.87
|
|
|
Service Code
|
CPT 59821
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,835.04 |
| Max. Negotiated Rate |
$13,626.87 |
| Rate for Payer: Aetna Managed Medicare |
$3,406.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$3,406.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,406.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,406.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,406.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,406.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,672.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,406.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,406.72
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,406.72
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,406.72
|
| Rate for Payer: NAPHCARE Commercial |
$5,110.08
|
| Rate for Payer: Quartz Medicare Advantage |
$3,406.72
|
| Rate for Payer: The Alliance Commercial |
$13,626.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,406.72
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$3,406.72
|
|
|
TREATMENT OF MOUTH LESION 40820
|
Professional
|
Both
|
$318.00
|
|
|
Service Code
|
CPT 40820
|
| Hospital Charge Code |
3014610
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.31 |
| Max. Negotiated Rate |
$680.71 |
| Rate for Payer: Aetna Commercial |
$314.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$284.42
|
| Rate for Payer: Aetna Managed Medicare |
$151.27
|
| Rate for Payer: Anthem Medicare Advantage |
$151.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$151.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$151.27
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cigna Commercial |
$314.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$31.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$151.27
|
| Rate for Payer: Health EOS Commercial |
$300.96
|
| Rate for Payer: HFN Commercial |
$314.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$604.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$604.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$151.27
|
| Rate for Payer: Multiplan Commercial |
$264.58
|
| Rate for Payer: NAPHCARE Commercial |
$226.90
|
| Rate for Payer: Preferred Network Access Commercial |
$314.18
|
| Rate for Payer: Quartz Beloit One Network |
$145.52
|
| Rate for Payer: Quartz Commercial |
$188.51
|
| Rate for Payer: Quartz Medicare Advantage |
$151.27
|
| Rate for Payer: The Alliance Commercial |
$642.89
|
| Rate for Payer: United Healthcare Medicaid |
$31.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$151.27
|
| Rate for Payer: WEA Trust Commercial |
$181.90
|
| Rate for Payer: WPS Commercial |
$680.71
|
|
|
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 |
$78.60 |
| Max. Negotiated Rate |
$1,024.56 |
| Rate for Payer: Aetna Commercial |
$1,024.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$927.49
|
| Rate for Payer: Aetna Managed Medicare |
$78.60
|
| Rate for Payer: Anthem Medicare Advantage |
$78.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$78.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$78.60
|
| Rate for Payer: Cash Price |
$311.10
|
| Rate for Payer: Cash Price |
$311.10
|
| Rate for Payer: Cash Price |
$311.10
|
| Rate for Payer: Cigna Commercial |
$1,024.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$253.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$78.60
|
| Rate for Payer: Health EOS Commercial |
$981.42
|
| Rate for Payer: HFN Commercial |
$1,024.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$464.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$464.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$78.60
|
| Rate for Payer: Multiplan Commercial |
$862.78
|
| Rate for Payer: NAPHCARE Commercial |
$117.90
|
| Rate for Payer: Preferred Network Access Commercial |
$1,024.56
|
| Rate for Payer: Quartz Beloit One Network |
$474.53
|
| Rate for Payer: Quartz Commercial |
$614.73
|
| Rate for Payer: Quartz Medicare Advantage |
$78.60
|
| Rate for Payer: The Alliance Commercial |
$334.06
|
| Rate for Payer: United Healthcare Medicaid |
$253.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$78.60
|
| Rate for Payer: WEA Trust Commercial |
$593.16
|
| Rate for Payer: WPS Commercial |
$353.71
|
|
