|
Cast Sup Short Arm Ped Fbrgl Q4012
|
Professional
|
$46.00
|
|
|
Service Code
|
HCPCS Q4012
|
| Hospital Charge Code |
3133617
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.07 |
| Max. Negotiated Rate |
$43.70 |
| Rate for Payer: Aetna Commercial |
$43.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$39.56
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cigna Commercial |
$43.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$23.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.60
|
| Rate for Payer: Health EOS Commercial |
$41.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$36.08
|
| Rate for Payer: Multiplan Commercial |
$36.80
|
| Rate for Payer: Preferred Network Access Commercial |
$43.70
|
| Rate for Payer: Quartz Beloit One Network |
$20.24
|
| Rate for Payer: Quartz Commercial |
$26.22
|
| Rate for Payer: The Alliance Commercial |
$23.00
|
| Rate for Payer: United Healthcare Medicaid |
$7.07
|
| Rate for Payer: WEA Trust Commercial |
$25.30
|
| Rate for Payer: WPS Commercial |
$34.07
|
|
|
Cast Sup Short Arm Ped Fbrgl Q4012
|
Facility
OP
|
$46.00
|
|
|
Service Code
|
HCPCS Q4012
|
| Hospital Charge Code |
3133617
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$3,051.52 |
| Rate for Payer: Aetna Commercial |
$41.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$39.56
|
| Rate for Payer: Aetna Managed Medicare |
$12.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$24.38
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cigna Commercial |
$42.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25.74
|
| Rate for Payer: Health EOS Commercial |
$40.94
|
| Rate for Payer: HFN Commercial |
$42.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34.50
|
| Rate for Payer: Multiplan Commercial |
$36.80
|
| Rate for Payer: NAPHCARE Commercial |
$27.60
|
| Rate for Payer: Preferred Network Access Commercial |
$42.32
|
| Rate for Payer: Quartz Beloit One Network |
$22.54
|
| Rate for Payer: Quartz Commercial |
$29.90
|
| Rate for Payer: Quartz Medicare Advantage |
$27.60
|
| Rate for Payer: The Alliance Commercial |
$3,051.52
|
| Rate for Payer: WEA Trust Commercial |
$25.30
|
| Rate for Payer: WPS Commercial |
$34.07
|
|
|
Cast Sup Short Arm Splint Fbrgl Q4022
|
Professional
|
$73.00
|
|
|
Service Code
|
HCPCS Q4022
|
| Hospital Charge Code |
3133647
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$69.35 |
| Rate for Payer: Aetna Commercial |
$69.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$62.78
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cigna Commercial |
$69.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$36.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.80
|
| Rate for Payer: Health EOS Commercial |
$66.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$44.94
|
| Rate for Payer: Multiplan Commercial |
$58.40
|
| Rate for Payer: Preferred Network Access Commercial |
$69.35
|
| Rate for Payer: Quartz Beloit One Network |
$32.12
|
| Rate for Payer: Quartz Commercial |
$41.61
|
| Rate for Payer: The Alliance Commercial |
$36.50
|
| Rate for Payer: United Healthcare Medicaid |
$8.82
|
| Rate for Payer: WEA Trust Commercial |
$40.15
|
| Rate for Payer: WPS Commercial |
$54.07
|
|
|
Cast Sup Short Arm Splint Fbrgl Q4022
|
Facility
OP
|
$73.00
|
|
|
Service Code
|
HCPCS Q4022
|
| Hospital Charge Code |
3133647
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.44 |
| Max. Negotiated Rate |
$33,002.00 |
| Rate for Payer: Aetna Commercial |
$65.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$62.78
|
| Rate for Payer: Aetna Managed Medicare |
$20.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$47.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.69
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cigna Commercial |
$67.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.85
|
| Rate for Payer: Health EOS Commercial |
$64.97
|
| Rate for Payer: HFN Commercial |
$67.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.75
|
| Rate for Payer: Multiplan Commercial |
$58.40
|
| Rate for Payer: NAPHCARE Commercial |
$43.80
|
| Rate for Payer: Preferred Network Access Commercial |
$67.16
|
| Rate for Payer: Quartz Beloit One Network |
$35.77
|
| Rate for Payer: Quartz Commercial |
$47.45
|
| Rate for Payer: Quartz Medicare Advantage |
$43.80
|
| Rate for Payer: The Alliance Commercial |
$33,002.00
|
| Rate for Payer: WEA Trust Commercial |
$40.15
|
| Rate for Payer: WPS Commercial |
$54.07
|
|
|
Cast Sup Short Arm Splint Fbrgl Q4022
|
Facility
IP
|
$73.00
|
|
|
Service Code
|
HCPCS Q4022
|
| Hospital Charge Code |
3133647
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$35.77 |
| Max. Negotiated Rate |
$67.16 |
| Rate for Payer: Aetna Commercial |
$65.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.69
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cigna Commercial |
$67.16
|
| Rate for Payer: Health EOS Commercial |
$64.97
|
| Rate for Payer: HFN Commercial |
$67.16
|
| Rate for Payer: Multiplan Commercial |
$58.40
|
| Rate for Payer: NAPHCARE Commercial |
$43.80
|
| Rate for Payer: Preferred Network Access Commercial |
$67.16
|
| Rate for Payer: Quartz Beloit One Network |
$35.77
|
| Rate for Payer: Quartz Commercial |
$43.80
|
| Rate for Payer: WEA Trust Commercial |
$40.15
|
| Rate for Payer: WPS Commercial |
$54.07
|
|
|
Cast Sup Short Arm Splint Ped Fbrgl Q4024
|
Professional
|
$18.00
|
|
|
Service Code
|
HCPCS Q4024
|
| Hospital Charge Code |
3404963
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$22.56 |
| Rate for Payer: Aetna Commercial |
$17.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15.48
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$17.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.80
|
| Rate for Payer: Health EOS Commercial |
$16.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22.56
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Preferred Network Access Commercial |
$17.10
|
| Rate for Payer: Quartz Beloit One Network |
$7.92
|
| Rate for Payer: Quartz Commercial |
$10.26
|
| Rate for Payer: The Alliance Commercial |
$9.00
|
| Rate for Payer: United Healthcare Medicaid |
$4.41
|
| Rate for Payer: WEA Trust Commercial |
$9.90
|
| Rate for Payer: WPS Commercial |
$13.33
|
|
|
Cast Sup Short Arm Splint Ped Fbrgl Q4024
|
Facility
OP
|
$18.00
|
|
|
Service Code
|
HCPCS Q4024
|
| Hospital Charge Code |
3404963
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.04 |
| Max. Negotiated Rate |
$2,042.72 |
| Rate for Payer: Aetna Commercial |
$16.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15.48
|
| Rate for Payer: Aetna Managed Medicare |
$5.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9.54
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$16.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.07
|
| Rate for Payer: Health EOS Commercial |
$16.02
|
| Rate for Payer: HFN Commercial |
$16.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13.50
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: NAPHCARE Commercial |
$10.80
|
| Rate for Payer: Preferred Network Access Commercial |
$16.56
|
| Rate for Payer: Quartz Beloit One Network |
$8.82
|
| Rate for Payer: Quartz Commercial |
$11.70
|
| Rate for Payer: Quartz Medicare Advantage |
$10.80
|
| Rate for Payer: The Alliance Commercial |
$2,042.72
|
| Rate for Payer: WEA Trust Commercial |
$9.90
|
| Rate for Payer: WPS Commercial |
$13.33
|
|
|
Cast Sup Short Arm Splint Ped Fbrgl Q4024
|
Facility
IP
|
$18.00
|
|
|
Service Code
|
HCPCS Q4024
|
| Hospital Charge Code |
3404963
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$16.56 |
| Rate for Payer: Aetna Commercial |
$16.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9.54
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$16.56
|
| Rate for Payer: Health EOS Commercial |
$16.02
|
| Rate for Payer: HFN Commercial |
$16.56
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: NAPHCARE Commercial |
$10.80
|
| Rate for Payer: Preferred Network Access Commercial |
$16.56
|
| Rate for Payer: Quartz Beloit One Network |
$8.82
|
| Rate for Payer: Quartz Commercial |
$10.80
|
| Rate for Payer: WEA Trust Commercial |
$9.90
|
| Rate for Payer: WPS Commercial |
$13.33
|
|
|
Cast Sup Short Leg Fbrgl Q4038
|
Facility
IP
|
$182.00
|
|
|
Service Code
|
HCPCS Q4038
|
| Hospital Charge Code |
3133642
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$89.18 |
| Max. Negotiated Rate |
$167.44 |
| Rate for Payer: Aetna Commercial |
$163.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$96.46
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cigna Commercial |
$167.44
|
| Rate for Payer: Health EOS Commercial |
$161.98
|
| Rate for Payer: HFN Commercial |
$167.44
|
| Rate for Payer: Multiplan Commercial |
$145.60
|
| Rate for Payer: NAPHCARE Commercial |
$109.20
|
| Rate for Payer: Preferred Network Access Commercial |
$167.44
|
| Rate for Payer: Quartz Beloit One Network |
$89.18
|
| Rate for Payer: Quartz Commercial |
$109.20
|
| Rate for Payer: WEA Trust Commercial |
$100.10
|
| Rate for Payer: WPS Commercial |
$134.81
|
|
|
Cast Sup Short Leg Fbrgl Q4038
|
Professional
|
$182.00
|
|
|
Service Code
|
HCPCS Q4038
|
| Hospital Charge Code |
3133642
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$29.89 |
| Max. Negotiated Rate |
$172.90 |
| Rate for Payer: Aetna Commercial |
$172.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$156.52
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cigna Commercial |
$172.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$91.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$109.20
|
| Rate for Payer: Health EOS Commercial |
$165.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$152.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$152.32
|
| Rate for Payer: Multiplan Commercial |
$145.60
|
| Rate for Payer: Preferred Network Access Commercial |
$172.90
|
| Rate for Payer: Quartz Beloit One Network |
$80.08
|
| Rate for Payer: Quartz Commercial |
$103.74
|
| Rate for Payer: The Alliance Commercial |
$91.00
|
| Rate for Payer: United Healthcare Medicaid |
$29.89
|
| Rate for Payer: WEA Trust Commercial |
$100.10
|
| Rate for Payer: WPS Commercial |
$134.81
|
|
|
Cast Sup Short Leg Fbrgl Q4038
|
Facility
OP
|
$182.00
|
|
|
Service Code
|
HCPCS Q4038
|
| Hospital Charge Code |
3133642
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.96 |
| Max. Negotiated Rate |
$700.24 |
| Rate for Payer: Aetna Commercial |
$163.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$156.52
|
| Rate for Payer: Aetna Managed Medicare |
$50.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$118.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$91.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$87.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$96.46
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cigna Commercial |
$167.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$101.85
|
| Rate for Payer: Health EOS Commercial |
$161.98
|
| Rate for Payer: HFN Commercial |
$167.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$136.50
|
| Rate for Payer: Multiplan Commercial |
$145.60
|
| Rate for Payer: NAPHCARE Commercial |
$109.20
|
| Rate for Payer: Preferred Network Access Commercial |
$167.44
|
| Rate for Payer: Quartz Beloit One Network |
$89.18
|
| Rate for Payer: Quartz Commercial |
$118.30
|
| Rate for Payer: Quartz Medicare Advantage |
$109.20
|
| Rate for Payer: The Alliance Commercial |
$700.24
|
| Rate for Payer: WEA Trust Commercial |
$100.10
|
| Rate for Payer: WPS Commercial |
$134.81
|
|
|
Cast Sup Short Leg Ped Fbrgl Q4040
|
Professional
|
$52.00
|
|
|
Service Code
|
HCPCS Q4040
|
| Hospital Charge Code |
3133637
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$14.95 |
| Max. Negotiated Rate |
$76.18 |
| Rate for Payer: Aetna Commercial |
$49.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$44.72
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$49.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$26.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.20
|
| Rate for Payer: Health EOS Commercial |
$47.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$76.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$76.18
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: Preferred Network Access Commercial |
$49.40
|
| Rate for Payer: Quartz Beloit One Network |
$22.88
|
| Rate for Payer: Quartz Commercial |
$29.64
|
| Rate for Payer: The Alliance Commercial |
$26.00
|
| Rate for Payer: United Healthcare Medicaid |
$14.95
|
| Rate for Payer: WEA Trust Commercial |
$28.60
|
| Rate for Payer: WPS Commercial |
$38.52
|
|
|
Cast Sup Short Leg Ped Fbrgl Q4040
|
Facility
OP
|
$52.00
|
|
|
Service Code
|
HCPCS Q4040
|
| Hospital Charge Code |
3133637
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$14.56 |
| Max. Negotiated Rate |
$152.84 |
| Rate for Payer: Aetna Commercial |
$46.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$44.72
|
| Rate for Payer: Aetna Managed Medicare |
$14.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.56
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$47.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.10
|
| Rate for Payer: Health EOS Commercial |
$46.28
|
| Rate for Payer: HFN Commercial |
$47.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39.00
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: NAPHCARE Commercial |
$31.20
|
| Rate for Payer: Preferred Network Access Commercial |
$47.84
|
| Rate for Payer: Quartz Beloit One Network |
$25.48
|
| Rate for Payer: Quartz Commercial |
$33.80
|
| Rate for Payer: Quartz Medicare Advantage |
$31.20
|
| Rate for Payer: The Alliance Commercial |
$152.84
|
| Rate for Payer: WEA Trust Commercial |
$28.60
|
| Rate for Payer: WPS Commercial |
$38.52
|
|
|
Cast Sup Short Leg Ped Fbrgl Q4040
|
Facility
IP
|
$52.00
|
|
|
Service Code
|
HCPCS Q4040
|
| Hospital Charge Code |
3133637
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$25.48 |
| Max. Negotiated Rate |
$47.84 |
| Rate for Payer: Aetna Commercial |
$46.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.56
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$47.84
|
| Rate for Payer: Health EOS Commercial |
$46.28
|
| Rate for Payer: HFN Commercial |
$47.84
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: NAPHCARE Commercial |
$31.20
|
| Rate for Payer: Preferred Network Access Commercial |
$47.84
|
| Rate for Payer: Quartz Beloit One Network |
$25.48
|
| Rate for Payer: Quartz Commercial |
$31.20
|
| Rate for Payer: WEA Trust Commercial |
$28.60
|
| Rate for Payer: WPS Commercial |
$38.52
|
|
|
Cast Sup Short Leg Splint Fbrgl Q4046
|
Facility
IP
|
$67.00
|
|
|
Service Code
|
HCPCS Q4046
|
| Hospital Charge Code |
3133622
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$32.83 |
| Max. Negotiated Rate |
$61.64 |
| Rate for Payer: Aetna Commercial |
$60.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$35.51
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$61.64
|
| Rate for Payer: Health EOS Commercial |
$59.63
|
| Rate for Payer: HFN Commercial |
$61.64
|
| Rate for Payer: Multiplan Commercial |
$53.60
|
| Rate for Payer: NAPHCARE Commercial |
$40.20
|
| Rate for Payer: Preferred Network Access Commercial |
$61.64
|
| Rate for Payer: Quartz Beloit One Network |
$32.83
|
| Rate for Payer: Quartz Commercial |
$40.20
|
| Rate for Payer: WEA Trust Commercial |
$36.85
|
| Rate for Payer: WPS Commercial |
$49.63
|
|
|
Cast Sup Short Leg Splint Fbrgl Q4046
|
Professional
|
$67.00
|
|
|
Service Code
|
HCPCS Q4046
|
| Hospital Charge Code |
3133622
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$13.55 |
| Max. Negotiated Rate |
$69.01 |
| Rate for Payer: Aetna Commercial |
$63.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$57.62
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$63.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$33.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.20
|
| Rate for Payer: Health EOS Commercial |
$60.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$69.01
|
| Rate for Payer: Multiplan Commercial |
$53.60
|
| Rate for Payer: Preferred Network Access Commercial |
$63.65
|
| Rate for Payer: Quartz Beloit One Network |
$29.48
|
| Rate for Payer: Quartz Commercial |
$38.19
|
| Rate for Payer: The Alliance Commercial |
$33.50
|
| Rate for Payer: United Healthcare Medicaid |
$13.55
|
| Rate for Payer: WEA Trust Commercial |
$36.85
|
| Rate for Payer: WPS Commercial |
$49.63
|
|
|
Cast Sup Short Leg Splint Fbrgl Q4046
|
Facility
OP
|
$67.00
|
|
|
Service Code
|
HCPCS Q4046
|
| Hospital Charge Code |
3133622
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$18.76 |
| Max. Negotiated Rate |
$1,571.88 |
| Rate for Payer: Aetna Commercial |
$60.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$57.62
|
| Rate for Payer: Aetna Managed Medicare |
$18.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$43.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$35.51
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$61.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37.49
|
| Rate for Payer: Health EOS Commercial |
$59.63
|
| Rate for Payer: HFN Commercial |
$61.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.25
|
| Rate for Payer: Multiplan Commercial |
$53.60
|
| Rate for Payer: NAPHCARE Commercial |
$40.20
|
| Rate for Payer: Preferred Network Access Commercial |
$61.64
|
| Rate for Payer: Quartz Beloit One Network |
$32.83
|
| Rate for Payer: Quartz Commercial |
$43.55
|
| Rate for Payer: Quartz Medicare Advantage |
$40.20
|
| Rate for Payer: The Alliance Commercial |
$1,571.88
|
| Rate for Payer: WEA Trust Commercial |
$36.85
|
| Rate for Payer: WPS Commercial |
$49.63
|
|
|
Cast Sup Short Leg Splint Ped Fbrgl Q4048
|
Professional
|
$24.00
|
|
|
Service Code
|
HCPCS Q4048
|
| Hospital Charge Code |
3142823
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6.78 |
| Max. Negotiated Rate |
$34.56 |
| Rate for Payer: Aetna Commercial |
$22.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20.64
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$22.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.40
|
| Rate for Payer: Health EOS Commercial |
$21.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$34.56
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: Preferred Network Access Commercial |
$22.80
|
| Rate for Payer: Quartz Beloit One Network |
$10.56
|
| Rate for Payer: Quartz Commercial |
$13.68
|
| Rate for Payer: The Alliance Commercial |
$12.00
|
| Rate for Payer: United Healthcare Medicaid |
$6.78
|
| Rate for Payer: WEA Trust Commercial |
$13.20
|
| Rate for Payer: WPS Commercial |
$17.78
|
|
|
Cast Sup Short Leg Splint Ped Fbrgl Q4048
|
Facility
IP
|
$24.00
|
|
|
Service Code
|
HCPCS Q4048
|
| Hospital Charge Code |
3142823
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11.76 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$21.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.72
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$22.08
|
| Rate for Payer: Health EOS Commercial |
$21.36
|
| Rate for Payer: HFN Commercial |
$22.08
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: NAPHCARE Commercial |
$14.40
|
| Rate for Payer: Preferred Network Access Commercial |
$22.08
|
| Rate for Payer: Quartz Beloit One Network |
$11.76
|
| Rate for Payer: Quartz Commercial |
$14.40
|
| Rate for Payer: WEA Trust Commercial |
$13.20
|
| Rate for Payer: WPS Commercial |
$17.78
|
|
|
Cast Sup Short Leg Splint Ped Fbrgl Q4048
|
Facility
OP
|
$24.00
|
|
|
Service Code
|
HCPCS Q4048
|
| Hospital Charge Code |
3142823
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6.72 |
| Max. Negotiated Rate |
$113.48 |
| Rate for Payer: Aetna Commercial |
$21.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20.64
|
| Rate for Payer: Aetna Managed Medicare |
$6.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.72
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$22.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.43
|
| Rate for Payer: Health EOS Commercial |
$21.36
|
| Rate for Payer: HFN Commercial |
$22.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.00
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: NAPHCARE Commercial |
$14.40
|
| Rate for Payer: Preferred Network Access Commercial |
$22.08
|
| Rate for Payer: Quartz Beloit One Network |
$11.76
|
| Rate for Payer: Quartz Commercial |
$15.60
|
| Rate for Payer: Quartz Medicare Advantage |
$14.40
|
| Rate for Payer: The Alliance Commercial |
$113.48
|
| Rate for Payer: WEA Trust Commercial |
$13.20
|
| Rate for Payer: WPS Commercial |
$17.78
|
|
|
CAST SYNTH 4X15
|
Facility
OP
|
$159.00
|
|
|
Service Code
|
HCPCS A4590
|
| Hospital Charge Code |
2963351
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$44.52 |
| Max. Negotiated Rate |
$636.00 |
| Rate for Payer: Aetna Commercial |
$143.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$136.74
|
| Rate for Payer: Aetna Managed Medicare |
$44.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$103.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$79.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$76.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$84.27
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cigna Commercial |
$146.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$88.98
|
| Rate for Payer: Health EOS Commercial |
$141.51
|
| Rate for Payer: HFN Commercial |
$146.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$119.25
|
| Rate for Payer: Multiplan Commercial |
$127.20
|
| Rate for Payer: NAPHCARE Commercial |
$95.40
|
| Rate for Payer: Preferred Network Access Commercial |
$146.28
|
| Rate for Payer: Quartz Beloit One Network |
$77.91
|
| Rate for Payer: Quartz Commercial |
$103.35
|
| Rate for Payer: Quartz Medicare Advantage |
$95.40
|
| Rate for Payer: The Alliance Commercial |
$636.00
|
| Rate for Payer: WEA Trust Commercial |
$87.45
|
| Rate for Payer: WPS Commercial |
$117.77
|
|
|
CAST SYNTH 4X15
|
Facility
IP
|
$159.00
|
|
|
Service Code
|
HCPCS A4590
|
| Hospital Charge Code |
2963351
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$77.91 |
| Max. Negotiated Rate |
$146.28 |
| Rate for Payer: Aetna Commercial |
$143.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$84.27
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cigna Commercial |
$146.28
|
| Rate for Payer: Health EOS Commercial |
$141.51
|
| Rate for Payer: HFN Commercial |
$146.28
|
| Rate for Payer: Multiplan Commercial |
$127.20
|
| Rate for Payer: NAPHCARE Commercial |
$95.40
|
| Rate for Payer: Preferred Network Access Commercial |
$146.28
|
| Rate for Payer: Quartz Beloit One Network |
$77.91
|
| Rate for Payer: Quartz Commercial |
$95.40
|
| Rate for Payer: WEA Trust Commercial |
$87.45
|
| Rate for Payer: WPS Commercial |
$117.77
|
|
|
CATARACT EXTRACTION W/ INTRAOCULAR LENS IMPLANT
|
Facility
IP
|
$5,660.00
|
|
| Hospital Charge Code |
2960521
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,773.40 |
| Max. Negotiated Rate |
$5,207.20 |
| Rate for Payer: Aetna Commercial |
$5,094.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,999.80
|
| Rate for Payer: Cash Price |
$1,698.00
|
| Rate for Payer: Cigna Commercial |
$5,207.20
|
| Rate for Payer: Health EOS Commercial |
$5,037.40
|
| Rate for Payer: HFN Commercial |
$5,207.20
|
| Rate for Payer: Multiplan Commercial |
$4,528.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,396.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,207.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,773.40
|
| Rate for Payer: Quartz Commercial |
$3,396.00
|
| Rate for Payer: WEA Trust Commercial |
$3,113.00
|
| Rate for Payer: WPS Commercial |
$4,192.36
|
|
|
CATARACT EXTRACTION W/ INTRAOCULAR LENS IMPLANT
|
Facility
OP
|
$5,660.00
|
|
| Hospital Charge Code |
2960521
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,584.80 |
| Max. Negotiated Rate |
$22,640.00 |
| Rate for Payer: Aetna Commercial |
$5,094.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,867.60
|
| Rate for Payer: Aetna Managed Medicare |
$1,584.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,679.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,830.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,716.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,999.80
|
| Rate for Payer: Cash Price |
$1,698.00
|
| Rate for Payer: Cigna Commercial |
$5,207.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,167.34
|
| Rate for Payer: Health EOS Commercial |
$5,037.40
|
| Rate for Payer: HFN Commercial |
$5,207.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,245.00
|
| Rate for Payer: Multiplan Commercial |
$4,528.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,396.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,207.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,773.40
|
| Rate for Payer: Quartz Commercial |
$3,679.00
|
| Rate for Payer: Quartz Medicare Advantage |
$3,396.00
|
| Rate for Payer: The Alliance Commercial |
$22,640.00
|
| Rate for Payer: WEA Trust Commercial |
$3,113.00
|
| Rate for Payer: WPS Commercial |
$4,192.36
|
|
|
CATARACT EXTRACTION W/ IO LENS IMPLANT & ISTENT INSERT +1
|
Facility
IP
|
$8,095.00
|
|
| Hospital Charge Code |
5383076
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,966.55 |
| Max. Negotiated Rate |
$7,447.40 |
| Rate for Payer: Aetna Commercial |
$7,285.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,290.35
|
| Rate for Payer: Cash Price |
$2,428.50
|
| Rate for Payer: Cigna Commercial |
$7,447.40
|
| Rate for Payer: Health EOS Commercial |
$7,204.55
|
| Rate for Payer: HFN Commercial |
$7,447.40
|
| Rate for Payer: Multiplan Commercial |
$6,476.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,857.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,447.40
|
| Rate for Payer: Quartz Beloit One Network |
$3,966.55
|
| Rate for Payer: Quartz Commercial |
$4,857.00
|
| Rate for Payer: WEA Trust Commercial |
$4,452.25
|
| Rate for Payer: WPS Commercial |
$5,995.97
|
|
