|
CAST/SPLINT LONG ARM
|
Facility
|
IP
|
$1,445.00
|
|
| Hospital Charge Code |
3075856
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$736.37 |
| Max. Negotiated Rate |
$1,382.58 |
| Rate for Payer: Aetna Commercial |
$1,352.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,292.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$796.48
|
| Rate for Payer: Cash Price |
$433.50
|
| Rate for Payer: Cigna Commercial |
$1,382.58
|
| Rate for Payer: Health EOS Commercial |
$1,337.49
|
| Rate for Payer: HFN Commercial |
$1,382.58
|
| Rate for Payer: Multiplan Commercial |
$1,202.24
|
| Rate for Payer: Preferred Network Access Commercial |
$1,382.58
|
| Rate for Payer: Quartz Beloit One Network |
$736.37
|
| Rate for Payer: Quartz Commercial |
$901.68
|
| Rate for Payer: WEA Trust Commercial |
$826.54
|
| Rate for Payer: WPS Commercial |
$1,113.08
|
|
|
CAST/SPLINT SHORT ARM
|
Facility
|
IP
|
$1,208.00
|
|
| Hospital Charge Code |
3075857
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$615.60 |
| Max. Negotiated Rate |
$1,155.81 |
| Rate for Payer: Aetna Commercial |
$1,130.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,080.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$665.85
|
| Rate for Payer: Cash Price |
$362.40
|
| Rate for Payer: Cigna Commercial |
$1,155.81
|
| Rate for Payer: Health EOS Commercial |
$1,118.12
|
| Rate for Payer: HFN Commercial |
$1,155.81
|
| Rate for Payer: Multiplan Commercial |
$1,005.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,155.81
|
| Rate for Payer: Quartz Beloit One Network |
$615.60
|
| Rate for Payer: Quartz Commercial |
$753.79
|
| Rate for Payer: WEA Trust Commercial |
$690.98
|
| Rate for Payer: WPS Commercial |
$930.52
|
|
|
CAST/SPLINT SHORT ARM
|
Facility
|
OP
|
$1,208.00
|
|
| Hospital Charge Code |
3075857
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$351.77 |
| Max. Negotiated Rate |
$1,155.81 |
| Rate for Payer: Aetna Commercial |
$1,130.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,080.44
|
| Rate for Payer: Aetna Managed Medicare |
$351.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$816.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$628.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$603.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$665.85
|
| Rate for Payer: Cash Price |
$362.40
|
| Rate for Payer: Cigna Commercial |
$1,155.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$703.06
|
| Rate for Payer: Health EOS Commercial |
$1,118.12
|
| Rate for Payer: HFN Commercial |
$1,155.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$942.24
|
| Rate for Payer: Multiplan Commercial |
$1,005.06
|
| Rate for Payer: NAPHCARE Commercial |
$753.79
|
| Rate for Payer: Preferred Network Access Commercial |
$1,155.81
|
| Rate for Payer: Quartz Beloit One Network |
$615.60
|
| Rate for Payer: Quartz Commercial |
$816.61
|
| Rate for Payer: Quartz Medicare Advantage |
$753.79
|
| Rate for Payer: The Alliance Commercial |
$628.16
|
| Rate for Payer: WEA Trust Commercial |
$690.98
|
| Rate for Payer: WPS Commercial |
$930.52
|
|
|
Cast Sup Long Arm Adult Fbrgl Q4006
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
HCPCS Q4006
|
| Hospital Charge Code |
3133632
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$23.88 |
| Max. Negotiated Rate |
$154.75 |
| Rate for Payer: Aetna Commercial |
$76.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.34
|
| Rate for Payer: Aetna Managed Medicare |
$23.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$55.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$40.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.20
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$78.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.72
|
| Rate for Payer: Health EOS Commercial |
$75.90
|
| Rate for Payer: HFN Commercial |
$78.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.96
|
| Rate for Payer: Multiplan Commercial |
$68.22
|
| Rate for Payer: NAPHCARE Commercial |
$51.17
|
| Rate for Payer: Preferred Network Access Commercial |
$78.46
|
| Rate for Payer: Quartz Beloit One Network |
$41.79
|
| Rate for Payer: Quartz Commercial |
$55.43
|
| Rate for Payer: Quartz Medicare Advantage |
$51.17
|
| Rate for Payer: The Alliance Commercial |
$154.75
|
| Rate for Payer: WEA Trust Commercial |
$46.90
|
| Rate for Payer: WPS Commercial |
$63.16
|
|
|
Cast Sup Long Arm Adult Fbrgl Q4006
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
HCPCS Q4006
|
| Hospital Charge Code |
3133632
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$41.79 |
| Max. Negotiated Rate |
$78.46 |
| Rate for Payer: Aetna Commercial |
$76.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.20
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$78.46
|
| Rate for Payer: Health EOS Commercial |
$75.90
|
| Rate for Payer: HFN Commercial |
$78.46
|
| Rate for Payer: Multiplan Commercial |
$68.22
|
| Rate for Payer: Preferred Network Access Commercial |
$78.46
|
| Rate for Payer: Quartz Beloit One Network |
$41.79
|
| Rate for Payer: Quartz Commercial |
$51.17
|
| Rate for Payer: WEA Trust Commercial |
$46.90
|
| Rate for Payer: WPS Commercial |
$63.16
|
|
|
Cast Sup Long Arm Adult Fbrgl Q4006
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
HCPCS Q4006
|
| Hospital Charge Code |
3133632
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$22.05 |
| Max. Negotiated Rate |
$112.34 |
| Rate for Payer: Aetna Commercial |
$81.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.34
|
| Rate for Payer: Aetna Managed Medicare |
$38.69
|
| Rate for Payer: Anthem Medicare Advantage |
$38.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$38.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$38.69
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$81.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$22.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38.69
|
| Rate for Payer: Health EOS Commercial |
$77.60
|
| Rate for Payer: HFN Commercial |
$81.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$112.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$112.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$38.69
|
| Rate for Payer: Multiplan Commercial |
$68.22
|
| Rate for Payer: NAPHCARE Commercial |
$58.03
|
| Rate for Payer: Preferred Network Access Commercial |
$81.02
|
| Rate for Payer: Quartz Beloit One Network |
$37.52
|
| Rate for Payer: Quartz Commercial |
$48.61
|
| Rate for Payer: Quartz Medicare Advantage |
$38.69
|
| Rate for Payer: The Alliance Commercial |
$106.39
|
| Rate for Payer: United Healthcare Medicaid |
$22.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.69
|
| Rate for Payer: WEA Trust Commercial |
$46.90
|
| Rate for Payer: WPS Commercial |
$67.70
|
|
|
Cast Sup Long Arm Ped Fbrgl Q4008
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
HCPCS Q4008
|
| Hospital Charge Code |
3219507
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11.01 |
| Max. Negotiated Rate |
$56.17 |
| Rate for Payer: Aetna Commercial |
$36.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$33.09
|
| Rate for Payer: Aetna Managed Medicare |
$19.33
|
| Rate for Payer: Anthem Medicare Advantage |
$19.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.33
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cigna Commercial |
$36.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.33
|
| Rate for Payer: Health EOS Commercial |
$35.02
|
| Rate for Payer: HFN Commercial |
$36.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$56.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.33
|
| Rate for Payer: Multiplan Commercial |
$30.78
|
| Rate for Payer: NAPHCARE Commercial |
$29.00
|
| Rate for Payer: Preferred Network Access Commercial |
$36.56
|
| Rate for Payer: Quartz Beloit One Network |
$16.93
|
| Rate for Payer: Quartz Commercial |
$21.93
|
| Rate for Payer: Quartz Medicare Advantage |
$19.33
|
| Rate for Payer: The Alliance Commercial |
$53.17
|
| Rate for Payer: United Healthcare Medicaid |
$11.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.33
|
| Rate for Payer: WEA Trust Commercial |
$21.16
|
| Rate for Payer: WPS Commercial |
$33.83
|
|
|
Cast Sup Long Arm Ped Fbrgl Q4008
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
HCPCS Q4008
|
| Hospital Charge Code |
3219507
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.77 |
| Max. Negotiated Rate |
$77.33 |
| Rate for Payer: Aetna Commercial |
$34.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$33.09
|
| Rate for Payer: Aetna Managed Medicare |
$10.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$20.39
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cigna Commercial |
$35.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21.53
|
| Rate for Payer: Health EOS Commercial |
$34.25
|
| Rate for Payer: HFN Commercial |
$35.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28.86
|
| Rate for Payer: Multiplan Commercial |
$30.78
|
| Rate for Payer: NAPHCARE Commercial |
$23.09
|
| Rate for Payer: Preferred Network Access Commercial |
$35.40
|
| Rate for Payer: Quartz Beloit One Network |
$18.86
|
| Rate for Payer: Quartz Commercial |
$25.01
|
| Rate for Payer: Quartz Medicare Advantage |
$23.09
|
| Rate for Payer: The Alliance Commercial |
$77.33
|
| Rate for Payer: WEA Trust Commercial |
$21.16
|
| Rate for Payer: WPS Commercial |
$28.50
|
|
|
Cast Sup Long Arm Ped Fbrgl Q4008
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
HCPCS Q4008
|
| Hospital Charge Code |
3219507
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$18.86 |
| Max. Negotiated Rate |
$35.40 |
| Rate for Payer: Aetna Commercial |
$34.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$33.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$20.39
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cigna Commercial |
$35.40
|
| Rate for Payer: Health EOS Commercial |
$34.25
|
| Rate for Payer: HFN Commercial |
$35.40
|
| Rate for Payer: Multiplan Commercial |
$30.78
|
| Rate for Payer: Preferred Network Access Commercial |
$35.40
|
| Rate for Payer: Quartz Beloit One Network |
$18.86
|
| Rate for Payer: Quartz Commercial |
$23.09
|
| Rate for Payer: WEA Trust Commercial |
$21.16
|
| Rate for Payer: WPS Commercial |
$28.50
|
|
|
Cast Sup Long Arm Splint Fbrg Q4018
|
Professional
|
Both
|
$73.00
|
|
|
Service Code
|
HCPCS Q4018
|
| Hospital Charge Code |
3133627
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.95 |
| Max. Negotiated Rate |
$72.12 |
| Rate for Payer: Aetna Commercial |
$72.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$65.29
|
| Rate for Payer: Aetna Managed Medicare |
$19.22
|
| Rate for Payer: Anthem Medicare Advantage |
$19.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.22
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cigna Commercial |
$72.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.22
|
| Rate for Payer: Health EOS Commercial |
$69.09
|
| Rate for Payer: HFN Commercial |
$72.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$55.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.22
|
| Rate for Payer: Multiplan Commercial |
$60.74
|
| Rate for Payer: NAPHCARE Commercial |
$28.83
|
| Rate for Payer: Preferred Network Access Commercial |
$72.12
|
| Rate for Payer: Quartz Beloit One Network |
$33.40
|
| Rate for Payer: Quartz Commercial |
$43.27
|
| Rate for Payer: Quartz Medicare Advantage |
$19.22
|
| Rate for Payer: The Alliance Commercial |
$52.85
|
| Rate for Payer: United Healthcare Medicaid |
$10.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.22
|
| Rate for Payer: WEA Trust Commercial |
$41.76
|
| Rate for Payer: WPS Commercial |
$33.63
|
|
|
Cast Sup Long Arm Splint Fbrg Q4018
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
HCPCS Q4018
|
| Hospital Charge Code |
3133627
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$21.26 |
| Max. Negotiated Rate |
$76.88 |
| Rate for Payer: Aetna Commercial |
$68.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$65.29
|
| Rate for Payer: Aetna Managed Medicare |
$21.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$49.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$37.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$36.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.24
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cigna Commercial |
$69.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$42.49
|
| Rate for Payer: Health EOS Commercial |
$67.57
|
| Rate for Payer: HFN Commercial |
$69.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.94
|
| Rate for Payer: Multiplan Commercial |
$60.74
|
| Rate for Payer: NAPHCARE Commercial |
$45.55
|
| Rate for Payer: Preferred Network Access Commercial |
$69.85
|
| Rate for Payer: Quartz Beloit One Network |
$37.20
|
| Rate for Payer: Quartz Commercial |
$49.35
|
| Rate for Payer: Quartz Medicare Advantage |
$45.55
|
| Rate for Payer: The Alliance Commercial |
$76.88
|
| Rate for Payer: WEA Trust Commercial |
$41.76
|
| Rate for Payer: WPS Commercial |
$56.23
|
|
|
Cast Sup Long Arm Splint Fbrg Q4018
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
HCPCS Q4018
|
| Hospital Charge Code |
3133627
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$69.85 |
| Rate for Payer: Aetna Commercial |
$68.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$65.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.24
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cigna Commercial |
$69.85
|
| Rate for Payer: Health EOS Commercial |
$67.57
|
| Rate for Payer: HFN Commercial |
$69.85
|
| Rate for Payer: Multiplan Commercial |
$60.74
|
| Rate for Payer: Preferred Network Access Commercial |
$69.85
|
| Rate for Payer: Quartz Beloit One Network |
$37.20
|
| Rate for Payer: Quartz Commercial |
$45.55
|
| Rate for Payer: WEA Trust Commercial |
$41.76
|
| Rate for Payer: WPS Commercial |
$56.23
|
|
|
Cast Sup Long Arm Splint Ped Fbrgl Q4020
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS Q4020
|
| Hospital Charge Code |
3353514
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5.48 |
| Max. Negotiated Rate |
$34.58 |
| Rate for Payer: Aetna Commercial |
$34.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$31.30
|
| Rate for Payer: Aetna Managed Medicare |
$9.65
|
| Rate for Payer: Anthem Medicare Advantage |
$9.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.65
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cigna Commercial |
$34.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.65
|
| Rate for Payer: Health EOS Commercial |
$33.12
|
| Rate for Payer: HFN Commercial |
$34.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$28.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.65
|
| Rate for Payer: Multiplan Commercial |
$29.12
|
| Rate for Payer: NAPHCARE Commercial |
$14.48
|
| Rate for Payer: Preferred Network Access Commercial |
$34.58
|
| Rate for Payer: Quartz Beloit One Network |
$16.02
|
| Rate for Payer: Quartz Commercial |
$20.75
|
| Rate for Payer: Quartz Medicare Advantage |
$9.65
|
| Rate for Payer: The Alliance Commercial |
$26.54
|
| Rate for Payer: United Healthcare Medicaid |
$5.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.65
|
| Rate for Payer: WEA Trust Commercial |
$20.02
|
| Rate for Payer: WPS Commercial |
$16.89
|
|
|
Cast Sup Long Arm Splint Ped Fbrgl Q4020
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
HCPCS Q4020
|
| Hospital Charge Code |
3353514
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.19 |
| Max. Negotiated Rate |
$38.60 |
| Rate for Payer: Aetna Commercial |
$32.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$31.30
|
| Rate for Payer: Aetna Managed Medicare |
$10.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19.29
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cigna Commercial |
$33.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.37
|
| Rate for Payer: Health EOS Commercial |
$32.40
|
| Rate for Payer: HFN Commercial |
$33.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27.30
|
| Rate for Payer: Multiplan Commercial |
$29.12
|
| Rate for Payer: NAPHCARE Commercial |
$21.84
|
| Rate for Payer: Preferred Network Access Commercial |
$33.49
|
| Rate for Payer: Quartz Beloit One Network |
$17.84
|
| Rate for Payer: Quartz Commercial |
$23.66
|
| Rate for Payer: Quartz Medicare Advantage |
$21.84
|
| Rate for Payer: The Alliance Commercial |
$38.60
|
| Rate for Payer: WEA Trust Commercial |
$20.02
|
| Rate for Payer: WPS Commercial |
$26.96
|
|
|
Cast Sup Long Arm Splint Ped Fbrgl Q4020
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
HCPCS Q4020
|
| Hospital Charge Code |
3353514
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$17.84 |
| Max. Negotiated Rate |
$33.49 |
| Rate for Payer: Aetna Commercial |
$32.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$31.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19.29
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cigna Commercial |
$33.49
|
| Rate for Payer: Health EOS Commercial |
$32.40
|
| Rate for Payer: HFN Commercial |
$33.49
|
| Rate for Payer: Multiplan Commercial |
$29.12
|
| Rate for Payer: Preferred Network Access Commercial |
$33.49
|
| Rate for Payer: Quartz Beloit One Network |
$17.84
|
| Rate for Payer: Quartz Commercial |
$21.84
|
| Rate for Payer: WEA Trust Commercial |
$20.02
|
| Rate for Payer: WPS Commercial |
$26.96
|
|
|
Cast Sup Long Leg Cylinder Fbrgl Q4034
|
Facility
|
OP
|
$182.00
|
|
|
Service Code
|
HCPCS Q4034
|
| Hospital Charge Code |
3243528
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$355.22 |
| Rate for Payer: Aetna Commercial |
$170.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$162.78
|
| Rate for Payer: Aetna Managed Medicare |
$53.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$123.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$94.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$90.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$100.32
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cigna Commercial |
$174.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$105.92
|
| Rate for Payer: Health EOS Commercial |
$168.46
|
| Rate for Payer: HFN Commercial |
$174.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$141.96
|
| Rate for Payer: Multiplan Commercial |
$151.42
|
| Rate for Payer: NAPHCARE Commercial |
$113.57
|
| Rate for Payer: Preferred Network Access Commercial |
$174.14
|
| Rate for Payer: Quartz Beloit One Network |
$92.75
|
| Rate for Payer: Quartz Commercial |
$123.03
|
| Rate for Payer: Quartz Medicare Advantage |
$113.57
|
| Rate for Payer: The Alliance Commercial |
$355.22
|
| Rate for Payer: WEA Trust Commercial |
$104.10
|
| Rate for Payer: WPS Commercial |
$140.19
|
|
|
Cast Sup Long Leg Cylinder Fbrgl Q4034
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
HCPCS Q4034
|
| Hospital Charge Code |
3243528
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$92.75 |
| Max. Negotiated Rate |
$174.14 |
| Rate for Payer: Aetna Commercial |
$170.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$162.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$100.32
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cigna Commercial |
$174.14
|
| Rate for Payer: Health EOS Commercial |
$168.46
|
| Rate for Payer: HFN Commercial |
$174.14
|
| Rate for Payer: Multiplan Commercial |
$151.42
|
| Rate for Payer: Preferred Network Access Commercial |
$174.14
|
| Rate for Payer: Quartz Beloit One Network |
$92.75
|
| Rate for Payer: Quartz Commercial |
$113.57
|
| Rate for Payer: WEA Trust Commercial |
$104.10
|
| Rate for Payer: WPS Commercial |
$140.19
|
|
|
Cast Sup Long Leg Cylinder Fbrgl Q4034
|
Professional
|
Both
|
$182.00
|
|
|
Service Code
|
HCPCS Q4034
|
| Hospital Charge Code |
3243528
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$50.60 |
| Max. Negotiated Rate |
$257.87 |
| Rate for Payer: Aetna Commercial |
$179.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$162.78
|
| Rate for Payer: Aetna Managed Medicare |
$88.81
|
| Rate for Payer: Anthem Medicare Advantage |
$88.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$88.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$88.81
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cigna Commercial |
$179.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$50.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$88.81
|
| Rate for Payer: Health EOS Commercial |
$172.24
|
| Rate for Payer: HFN Commercial |
$179.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$257.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$257.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$88.81
|
| Rate for Payer: Multiplan Commercial |
$151.42
|
| Rate for Payer: NAPHCARE Commercial |
$133.21
|
| Rate for Payer: Preferred Network Access Commercial |
$179.82
|
| Rate for Payer: Quartz Beloit One Network |
$83.28
|
| Rate for Payer: Quartz Commercial |
$107.89
|
| Rate for Payer: Quartz Medicare Advantage |
$88.81
|
| Rate for Payer: The Alliance Commercial |
$244.22
|
| Rate for Payer: United Healthcare Medicaid |
$50.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$88.81
|
| Rate for Payer: WEA Trust Commercial |
$104.10
|
| Rate for Payer: WPS Commercial |
$155.41
|
|
|
Cast Sup Long Leg Cylinder Ped Fblrgl Q4036
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
HCPCS Q4036
|
| Hospital Charge Code |
4548714
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$25.04 |
| Max. Negotiated Rate |
$177.76 |
| Rate for Payer: Aetna Commercial |
$80.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.92
|
| Rate for Payer: Aetna Managed Medicare |
$25.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$58.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$44.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$42.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.40
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$82.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50.05
|
| Rate for Payer: Health EOS Commercial |
$79.60
|
| Rate for Payer: HFN Commercial |
$82.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$67.08
|
| Rate for Payer: Multiplan Commercial |
$71.55
|
| Rate for Payer: NAPHCARE Commercial |
$53.66
|
| Rate for Payer: Preferred Network Access Commercial |
$82.28
|
| Rate for Payer: Quartz Beloit One Network |
$43.83
|
| Rate for Payer: Quartz Commercial |
$58.14
|
| Rate for Payer: Quartz Medicare Advantage |
$53.66
|
| Rate for Payer: The Alliance Commercial |
$177.76
|
| Rate for Payer: WEA Trust Commercial |
$49.19
|
| Rate for Payer: WPS Commercial |
$66.25
|
|
|
Cast Sup Long Leg Cylinder Ped Fblrgl Q4036
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
HCPCS Q4036
|
| Hospital Charge Code |
4548714
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$43.83 |
| Max. Negotiated Rate |
$82.28 |
| Rate for Payer: Aetna Commercial |
$80.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.40
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$82.28
|
| Rate for Payer: Health EOS Commercial |
$79.60
|
| Rate for Payer: HFN Commercial |
$82.28
|
| Rate for Payer: Multiplan Commercial |
$71.55
|
| Rate for Payer: Preferred Network Access Commercial |
$82.28
|
| Rate for Payer: Quartz Beloit One Network |
$43.83
|
| Rate for Payer: Quartz Commercial |
$53.66
|
| Rate for Payer: WEA Trust Commercial |
$49.19
|
| Rate for Payer: WPS Commercial |
$66.25
|
|
|
Cast Sup Long Leg Cylinder Ped Fblrgl Q4036
|
Professional
|
Both
|
$86.00
|
|
|
Service Code
|
HCPCS Q4036
|
| Hospital Charge Code |
4548714
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$25.30 |
| Max. Negotiated Rate |
$129.00 |
| Rate for Payer: Aetna Commercial |
$84.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.92
|
| Rate for Payer: Aetna Managed Medicare |
$44.44
|
| Rate for Payer: Anthem Medicare Advantage |
$44.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$44.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$44.44
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$84.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$25.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.44
|
| Rate for Payer: Health EOS Commercial |
$81.39
|
| Rate for Payer: HFN Commercial |
$84.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$129.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$129.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$44.44
|
| Rate for Payer: Multiplan Commercial |
$71.55
|
| Rate for Payer: NAPHCARE Commercial |
$66.66
|
| Rate for Payer: Preferred Network Access Commercial |
$84.97
|
| Rate for Payer: Quartz Beloit One Network |
$39.35
|
| Rate for Payer: Quartz Commercial |
$50.98
|
| Rate for Payer: Quartz Medicare Advantage |
$44.44
|
| Rate for Payer: The Alliance Commercial |
$122.21
|
| Rate for Payer: United Healthcare Medicaid |
$25.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$44.44
|
| Rate for Payer: WEA Trust Commercial |
$49.19
|
| Rate for Payer: WPS Commercial |
$77.77
|
|
|
Cast Sup Long Leg Fbrgl Q4030
|
Professional
|
Both
|
$208.00
|
|
|
Service Code
|
HCPCS Q4030
|
| Hospital Charge Code |
3318176
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$57.40 |
| Max. Negotiated Rate |
$292.64 |
| Rate for Payer: Aetna Commercial |
$205.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$186.04
|
| Rate for Payer: Aetna Managed Medicare |
$100.80
|
| Rate for Payer: Anthem Medicare Advantage |
$100.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$100.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$100.80
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cigna Commercial |
$205.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$57.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$100.80
|
| Rate for Payer: Health EOS Commercial |
$196.85
|
| Rate for Payer: HFN Commercial |
$205.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$292.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$292.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$100.80
|
| Rate for Payer: Multiplan Commercial |
$173.06
|
| Rate for Payer: NAPHCARE Commercial |
$151.20
|
| Rate for Payer: Preferred Network Access Commercial |
$205.50
|
| Rate for Payer: Quartz Beloit One Network |
$95.18
|
| Rate for Payer: Quartz Commercial |
$123.30
|
| Rate for Payer: Quartz Medicare Advantage |
$100.80
|
| Rate for Payer: The Alliance Commercial |
$277.19
|
| Rate for Payer: United Healthcare Medicaid |
$57.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.80
|
| Rate for Payer: WEA Trust Commercial |
$118.98
|
| Rate for Payer: WPS Commercial |
$176.39
|
|
|
Cast Sup Long Leg Fbrgl Q4030
|
Facility
|
OP
|
$208.00
|
|
|
Service Code
|
HCPCS Q4030
|
| Hospital Charge Code |
3318176
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$60.57 |
| Max. Negotiated Rate |
$403.19 |
| Rate for Payer: Aetna Commercial |
$194.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$186.04
|
| Rate for Payer: Aetna Managed Medicare |
$60.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$140.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$108.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$103.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$114.65
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cigna Commercial |
$199.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$121.06
|
| Rate for Payer: Health EOS Commercial |
$192.52
|
| Rate for Payer: HFN Commercial |
$199.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$162.24
|
| Rate for Payer: Multiplan Commercial |
$173.06
|
| Rate for Payer: NAPHCARE Commercial |
$129.79
|
| Rate for Payer: Preferred Network Access Commercial |
$199.01
|
| Rate for Payer: Quartz Beloit One Network |
$106.00
|
| Rate for Payer: Quartz Commercial |
$140.61
|
| Rate for Payer: Quartz Medicare Advantage |
$129.79
|
| Rate for Payer: The Alliance Commercial |
$403.19
|
| Rate for Payer: WEA Trust Commercial |
$118.98
|
| Rate for Payer: WPS Commercial |
$160.22
|
|
|
Cast Sup Long Leg Fbrgl Q4030
|
Facility
|
IP
|
$208.00
|
|
|
Service Code
|
HCPCS Q4030
|
| Hospital Charge Code |
3318176
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$106.00 |
| Max. Negotiated Rate |
$199.01 |
| Rate for Payer: Aetna Commercial |
$194.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$186.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$114.65
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cigna Commercial |
$199.01
|
| Rate for Payer: Health EOS Commercial |
$192.52
|
| Rate for Payer: HFN Commercial |
$199.01
|
| Rate for Payer: Multiplan Commercial |
$173.06
|
| Rate for Payer: Preferred Network Access Commercial |
$199.01
|
| Rate for Payer: Quartz Beloit One Network |
$106.00
|
| Rate for Payer: Quartz Commercial |
$129.79
|
| Rate for Payer: WEA Trust Commercial |
$118.98
|
| Rate for Payer: WPS Commercial |
$160.22
|
|
|
Cast Sup Long Leg Ped Fbrgl Q4032
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
HCPCS Q4032
|
| Hospital Charge Code |
3279522
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$51.98 |
| Max. Negotiated Rate |
$97.59 |
| Rate for Payer: Aetna Commercial |
$95.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$91.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.22
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$97.59
|
| Rate for Payer: Health EOS Commercial |
$94.41
|
| Rate for Payer: HFN Commercial |
$97.59
|
| Rate for Payer: Multiplan Commercial |
$84.86
|
| Rate for Payer: Preferred Network Access Commercial |
$97.59
|
| Rate for Payer: Quartz Beloit One Network |
$51.98
|
| Rate for Payer: Quartz Commercial |
$63.65
|
| Rate for Payer: WEA Trust Commercial |
$58.34
|
| Rate for Payer: WPS Commercial |
$78.57
|
|
