|
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 |
$13.40 |
| Max. Negotiated Rate |
$51.71 |
| Rate for Payer: Aetna Commercial |
$43.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.14
|
| Rate for Payer: Aetna Managed Medicare |
$13.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.36
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cigna Commercial |
$44.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.77
|
| Rate for Payer: Health EOS Commercial |
$42.58
|
| Rate for Payer: HFN Commercial |
$44.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$35.88
|
| Rate for Payer: Multiplan Commercial |
$38.27
|
| Rate for Payer: NAPHCARE Commercial |
$28.70
|
| Rate for Payer: Preferred Network Access Commercial |
$44.01
|
| Rate for Payer: Quartz Beloit One Network |
$23.44
|
| Rate for Payer: Quartz Commercial |
$31.10
|
| Rate for Payer: Quartz Medicare Advantage |
$28.70
|
| Rate for Payer: The Alliance Commercial |
$51.71
|
| Rate for Payer: WEA Trust Commercial |
$26.31
|
| Rate for Payer: WPS Commercial |
$35.43
|
|
|
Cast Sup Short Arm Ped Fbrgl Q4012
|
Professional
|
Both
|
$46.00
|
|
|
Service Code
|
HCPCS Q4012
|
| Hospital Charge Code |
3133617
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.35 |
| Max. Negotiated Rate |
$45.45 |
| Rate for Payer: Aetna Commercial |
$45.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.14
|
| Rate for Payer: Aetna Managed Medicare |
$12.93
|
| Rate for Payer: Anthem Medicare Advantage |
$12.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.93
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cigna Commercial |
$45.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.93
|
| Rate for Payer: Health EOS Commercial |
$43.53
|
| Rate for Payer: HFN Commercial |
$45.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$37.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.93
|
| Rate for Payer: Multiplan Commercial |
$38.27
|
| Rate for Payer: NAPHCARE Commercial |
$19.39
|
| Rate for Payer: Preferred Network Access Commercial |
$45.45
|
| Rate for Payer: Quartz Beloit One Network |
$21.05
|
| Rate for Payer: Quartz Commercial |
$27.27
|
| Rate for Payer: Quartz Medicare Advantage |
$12.93
|
| Rate for Payer: The Alliance Commercial |
$35.55
|
| Rate for Payer: United Healthcare Medicaid |
$7.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.93
|
| Rate for Payer: WEA Trust Commercial |
$26.31
|
| Rate for Payer: WPS Commercial |
$22.62
|
|
|
Cast Sup Short Arm Ped Fbrgl Q4012
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
HCPCS Q4012
|
| Hospital Charge Code |
3133617
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$23.44 |
| Max. Negotiated Rate |
$44.01 |
| Rate for Payer: Aetna Commercial |
$43.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.36
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cigna Commercial |
$44.01
|
| Rate for Payer: Health EOS Commercial |
$42.58
|
| Rate for Payer: HFN Commercial |
$44.01
|
| Rate for Payer: Multiplan Commercial |
$38.27
|
| Rate for Payer: Preferred Network Access Commercial |
$44.01
|
| Rate for Payer: Quartz Beloit One Network |
$23.44
|
| Rate for Payer: Quartz Commercial |
$28.70
|
| Rate for Payer: WEA Trust Commercial |
$26.31
|
| Rate for Payer: WPS Commercial |
$35.43
|
|
|
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 |
$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 Short Arm Splint Fbrgl Q4022
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
HCPCS Q4022
|
| Hospital Charge Code |
3133647
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.26 |
| Max. Negotiated Rate |
$69.85 |
| 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 |
$64.48
|
| Rate for Payer: WEA Trust Commercial |
$41.76
|
| Rate for Payer: WPS Commercial |
$56.23
|
|
|
Cast Sup Short Arm Splint Fbrgl Q4022
|
Professional
|
Both
|
$73.00
|
|
|
Service Code
|
HCPCS Q4022
|
| Hospital Charge Code |
3133647
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.17 |
| 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 |
$16.12
|
| Rate for Payer: Anthem Medicare Advantage |
$16.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.12
|
| 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 |
$9.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.12
|
| Rate for Payer: Health EOS Commercial |
$69.09
|
| Rate for Payer: HFN Commercial |
$72.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.12
|
| Rate for Payer: Multiplan Commercial |
$60.74
|
| Rate for Payer: NAPHCARE Commercial |
$24.18
|
| 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 |
$16.12
|
| Rate for Payer: The Alliance Commercial |
$44.33
|
| Rate for Payer: United Healthcare Medicaid |
$9.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.12
|
| Rate for Payer: WEA Trust Commercial |
$41.76
|
| Rate for Payer: WPS Commercial |
$28.21
|
|
|
Cast Sup Short Arm Splint Ped Fbrgl Q4024
|
Professional
|
Both
|
$18.00
|
|
|
Service Code
|
HCPCS Q4024
|
| Hospital Charge Code |
3404963
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$4.59 |
| Max. Negotiated Rate |
$23.46 |
| Rate for Payer: Aetna Commercial |
$17.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16.10
|
| Rate for Payer: Aetna Managed Medicare |
$8.07
|
| Rate for Payer: Anthem Medicare Advantage |
$8.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.07
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$17.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.07
|
| Rate for Payer: Health EOS Commercial |
$17.04
|
| Rate for Payer: HFN Commercial |
$17.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$23.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.07
|
| Rate for Payer: Multiplan Commercial |
$14.98
|
| Rate for Payer: NAPHCARE Commercial |
$12.11
|
| Rate for Payer: Preferred Network Access Commercial |
$17.78
|
| Rate for Payer: Quartz Beloit One Network |
$8.24
|
| Rate for Payer: Quartz Commercial |
$10.67
|
| Rate for Payer: Quartz Medicare Advantage |
$8.07
|
| Rate for Payer: The Alliance Commercial |
$22.19
|
| Rate for Payer: United Healthcare Medicaid |
$4.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.07
|
| Rate for Payer: WEA Trust Commercial |
$10.30
|
| Rate for Payer: WPS Commercial |
$14.12
|
|
|
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 |
$5.24 |
| Max. Negotiated Rate |
$32.28 |
| Rate for Payer: Aetna Commercial |
$16.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16.10
|
| Rate for Payer: Aetna Managed Medicare |
$5.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9.92
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$17.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.48
|
| Rate for Payer: Health EOS Commercial |
$16.66
|
| Rate for Payer: HFN Commercial |
$17.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.04
|
| Rate for Payer: Multiplan Commercial |
$14.98
|
| Rate for Payer: NAPHCARE Commercial |
$11.23
|
| Rate for Payer: Preferred Network Access Commercial |
$17.22
|
| Rate for Payer: Quartz Beloit One Network |
$9.17
|
| Rate for Payer: Quartz Commercial |
$12.17
|
| Rate for Payer: Quartz Medicare Advantage |
$11.23
|
| Rate for Payer: The Alliance Commercial |
$32.28
|
| Rate for Payer: WEA Trust Commercial |
$10.30
|
| Rate for Payer: WPS Commercial |
$13.87
|
|
|
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 |
$9.17 |
| Max. Negotiated Rate |
$17.22 |
| Rate for Payer: Aetna Commercial |
$16.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9.92
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$17.22
|
| Rate for Payer: Health EOS Commercial |
$16.66
|
| Rate for Payer: HFN Commercial |
$17.22
|
| Rate for Payer: Multiplan Commercial |
$14.98
|
| Rate for Payer: Preferred Network Access Commercial |
$17.22
|
| Rate for Payer: Quartz Beloit One Network |
$9.17
|
| Rate for Payer: Quartz Commercial |
$11.23
|
| Rate for Payer: WEA Trust Commercial |
$10.30
|
| Rate for Payer: WPS Commercial |
$13.87
|
|
|
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 |
$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 Short Leg Fbrgl Q4038
|
Facility
|
OP
|
$182.00
|
|
|
Service Code
|
HCPCS Q4038
|
| Hospital Charge Code |
3133642
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$218.32 |
| 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 |
$218.32
|
| Rate for Payer: WEA Trust Commercial |
$104.10
|
| Rate for Payer: WPS Commercial |
$140.19
|
|
|
Cast Sup Short Leg Fbrgl Q4038
|
Professional
|
Both
|
$182.00
|
|
|
Service Code
|
HCPCS Q4038
|
| Hospital Charge Code |
3133642
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.09 |
| Max. Negotiated Rate |
$179.82 |
| Rate for Payer: Aetna Commercial |
$179.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$162.78
|
| Rate for Payer: Aetna Managed Medicare |
$54.58
|
| Rate for Payer: Anthem Medicare Advantage |
$54.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$54.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$54.58
|
| 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 |
$31.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.58
|
| Rate for Payer: Health EOS Commercial |
$172.24
|
| Rate for Payer: HFN Commercial |
$179.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$158.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$158.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$54.58
|
| Rate for Payer: Multiplan Commercial |
$151.42
|
| Rate for Payer: NAPHCARE Commercial |
$81.87
|
| 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 |
$54.58
|
| Rate for Payer: The Alliance Commercial |
$150.09
|
| Rate for Payer: United Healthcare Medicaid |
$31.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54.58
|
| Rate for Payer: WEA Trust Commercial |
$104.10
|
| Rate for Payer: WPS Commercial |
$95.51
|
|
|
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 |
$15.14 |
| Max. Negotiated Rate |
$109.12 |
| Rate for Payer: Aetna Commercial |
$48.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.51
|
| Rate for Payer: Aetna Managed Medicare |
$15.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$35.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.66
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$49.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.26
|
| Rate for Payer: Health EOS Commercial |
$48.13
|
| Rate for Payer: HFN Commercial |
$49.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40.56
|
| Rate for Payer: Multiplan Commercial |
$43.26
|
| Rate for Payer: NAPHCARE Commercial |
$32.45
|
| Rate for Payer: Preferred Network Access Commercial |
$49.75
|
| Rate for Payer: Quartz Beloit One Network |
$26.50
|
| Rate for Payer: Quartz Commercial |
$35.15
|
| Rate for Payer: Quartz Medicare Advantage |
$32.45
|
| Rate for Payer: The Alliance Commercial |
$109.12
|
| Rate for Payer: WEA Trust Commercial |
$29.74
|
| Rate for Payer: WPS Commercial |
$40.06
|
|
|
Cast Sup Short Leg Ped Fbrgl Q4040
|
Professional
|
Both
|
$52.00
|
|
|
Service Code
|
HCPCS Q4040
|
| Hospital Charge Code |
3133637
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$15.55 |
| Max. Negotiated Rate |
$79.23 |
| Rate for Payer: Aetna Commercial |
$51.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.51
|
| Rate for Payer: Aetna Managed Medicare |
$27.28
|
| Rate for Payer: Anthem Medicare Advantage |
$27.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27.28
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$51.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.28
|
| Rate for Payer: Health EOS Commercial |
$49.21
|
| Rate for Payer: HFN Commercial |
$51.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$79.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$79.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27.28
|
| Rate for Payer: Multiplan Commercial |
$43.26
|
| Rate for Payer: NAPHCARE Commercial |
$40.92
|
| Rate for Payer: Preferred Network Access Commercial |
$51.38
|
| Rate for Payer: Quartz Beloit One Network |
$23.80
|
| Rate for Payer: Quartz Commercial |
$30.83
|
| Rate for Payer: Quartz Medicare Advantage |
$27.28
|
| Rate for Payer: The Alliance Commercial |
$75.02
|
| Rate for Payer: United Healthcare Medicaid |
$15.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.28
|
| Rate for Payer: WEA Trust Commercial |
$29.74
|
| Rate for Payer: WPS Commercial |
$47.74
|
|
|
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 |
$26.50 |
| Max. Negotiated Rate |
$49.75 |
| Rate for Payer: Aetna Commercial |
$48.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.66
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$49.75
|
| Rate for Payer: Health EOS Commercial |
$48.13
|
| Rate for Payer: HFN Commercial |
$49.75
|
| Rate for Payer: Multiplan Commercial |
$43.26
|
| Rate for Payer: Preferred Network Access Commercial |
$49.75
|
| Rate for Payer: Quartz Beloit One Network |
$26.50
|
| Rate for Payer: Quartz Commercial |
$32.45
|
| Rate for Payer: WEA Trust Commercial |
$29.74
|
| Rate for Payer: WPS Commercial |
$40.06
|
|
|
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 |
$34.14 |
| Max. Negotiated Rate |
$64.11 |
| Rate for Payer: Aetna Commercial |
$62.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$36.93
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$64.11
|
| Rate for Payer: Health EOS Commercial |
$62.02
|
| Rate for Payer: HFN Commercial |
$64.11
|
| Rate for Payer: Multiplan Commercial |
$55.74
|
| Rate for Payer: Preferred Network Access Commercial |
$64.11
|
| Rate for Payer: Quartz Beloit One Network |
$34.14
|
| Rate for Payer: Quartz Commercial |
$41.81
|
| Rate for Payer: WEA Trust Commercial |
$38.32
|
| Rate for Payer: WPS Commercial |
$51.61
|
|
|
Cast Sup Short Leg Splint Fbrgl Q4046
|
Professional
|
Both
|
$67.00
|
|
|
Service Code
|
HCPCS Q4046
|
| Hospital Charge Code |
3133622
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$14.09 |
| Max. Negotiated Rate |
$71.77 |
| Rate for Payer: Aetna Commercial |
$66.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.92
|
| Rate for Payer: Aetna Managed Medicare |
$24.74
|
| Rate for Payer: Anthem Medicare Advantage |
$24.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24.74
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$66.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24.74
|
| Rate for Payer: Health EOS Commercial |
$63.41
|
| Rate for Payer: HFN Commercial |
$66.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$71.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$71.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24.74
|
| Rate for Payer: Multiplan Commercial |
$55.74
|
| Rate for Payer: NAPHCARE Commercial |
$37.11
|
| Rate for Payer: Preferred Network Access Commercial |
$66.20
|
| Rate for Payer: Quartz Beloit One Network |
$30.66
|
| Rate for Payer: Quartz Commercial |
$39.72
|
| Rate for Payer: Quartz Medicare Advantage |
$24.74
|
| Rate for Payer: The Alliance Commercial |
$68.04
|
| Rate for Payer: United Healthcare Medicaid |
$14.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.74
|
| Rate for Payer: WEA Trust Commercial |
$38.32
|
| Rate for Payer: WPS Commercial |
$43.30
|
|
|
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 |
$19.51 |
| Max. Negotiated Rate |
$98.97 |
| Rate for Payer: Aetna Commercial |
$62.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.92
|
| Rate for Payer: Aetna Managed Medicare |
$19.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$34.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$33.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$36.93
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$64.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38.99
|
| Rate for Payer: Health EOS Commercial |
$62.02
|
| Rate for Payer: HFN Commercial |
$64.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$52.26
|
| Rate for Payer: Multiplan Commercial |
$55.74
|
| Rate for Payer: NAPHCARE Commercial |
$41.81
|
| Rate for Payer: Preferred Network Access Commercial |
$64.11
|
| Rate for Payer: Quartz Beloit One Network |
$34.14
|
| Rate for Payer: Quartz Commercial |
$45.29
|
| Rate for Payer: Quartz Medicare Advantage |
$41.81
|
| Rate for Payer: The Alliance Commercial |
$98.97
|
| Rate for Payer: WEA Trust Commercial |
$38.32
|
| Rate for Payer: WPS Commercial |
$51.61
|
|
|
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 |
$12.23 |
| Max. Negotiated Rate |
$22.96 |
| Rate for Payer: Aetna Commercial |
$22.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.23
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$22.96
|
| Rate for Payer: Health EOS Commercial |
$22.21
|
| Rate for Payer: HFN Commercial |
$22.96
|
| Rate for Payer: Multiplan Commercial |
$19.97
|
| Rate for Payer: Preferred Network Access Commercial |
$22.96
|
| Rate for Payer: Quartz Beloit One Network |
$12.23
|
| Rate for Payer: Quartz Commercial |
$14.98
|
| Rate for Payer: WEA Trust Commercial |
$13.73
|
| Rate for Payer: WPS Commercial |
$18.49
|
|
|
Cast Sup Short Leg Splint Ped Fbrgl Q4048
|
Professional
|
Both
|
$24.00
|
|
|
Service Code
|
HCPCS Q4048
|
| Hospital Charge Code |
3142823
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.05 |
| Max. Negotiated Rate |
$35.94 |
| Rate for Payer: Aetna Commercial |
$23.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21.47
|
| Rate for Payer: Aetna Managed Medicare |
$12.38
|
| Rate for Payer: Anthem Medicare Advantage |
$12.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.38
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$23.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.38
|
| Rate for Payer: Health EOS Commercial |
$22.71
|
| Rate for Payer: HFN Commercial |
$23.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$35.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.38
|
| Rate for Payer: Multiplan Commercial |
$19.97
|
| Rate for Payer: NAPHCARE Commercial |
$18.56
|
| Rate for Payer: Preferred Network Access Commercial |
$23.71
|
| Rate for Payer: Quartz Beloit One Network |
$10.98
|
| Rate for Payer: Quartz Commercial |
$14.23
|
| Rate for Payer: Quartz Medicare Advantage |
$12.38
|
| Rate for Payer: The Alliance Commercial |
$34.03
|
| Rate for Payer: United Healthcare Medicaid |
$7.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.38
|
| Rate for Payer: WEA Trust Commercial |
$13.73
|
| Rate for Payer: WPS Commercial |
$21.66
|
|
|
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 |
$6.99 |
| Max. Negotiated Rate |
$49.50 |
| Rate for Payer: Aetna Commercial |
$22.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21.47
|
| Rate for Payer: Aetna Managed Medicare |
$6.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.23
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$22.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.97
|
| Rate for Payer: Health EOS Commercial |
$22.21
|
| Rate for Payer: HFN Commercial |
$22.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.72
|
| Rate for Payer: Multiplan Commercial |
$19.97
|
| Rate for Payer: NAPHCARE Commercial |
$14.98
|
| Rate for Payer: Preferred Network Access Commercial |
$22.96
|
| Rate for Payer: Quartz Beloit One Network |
$12.23
|
| Rate for Payer: Quartz Commercial |
$16.22
|
| Rate for Payer: Quartz Medicare Advantage |
$14.98
|
| Rate for Payer: The Alliance Commercial |
$49.50
|
| Rate for Payer: WEA Trust Commercial |
$13.73
|
| Rate for Payer: WPS Commercial |
$18.49
|
|
|
CAST SYNTH 4X15
|
Facility
|
OP
|
$159.00
|
|
|
Service Code
|
HCPCS A4590
|
| Hospital Charge Code |
2963351
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$46.30 |
| Max. Negotiated Rate |
$152.13 |
| Rate for Payer: Aetna Commercial |
$148.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$142.21
|
| Rate for Payer: Aetna Managed Medicare |
$46.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$107.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$82.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$79.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$87.64
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cigna Commercial |
$152.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$92.54
|
| Rate for Payer: Health EOS Commercial |
$147.17
|
| Rate for Payer: HFN Commercial |
$152.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$124.02
|
| Rate for Payer: Multiplan Commercial |
$132.29
|
| Rate for Payer: NAPHCARE Commercial |
$99.22
|
| Rate for Payer: Preferred Network Access Commercial |
$152.13
|
| Rate for Payer: Quartz Beloit One Network |
$81.03
|
| Rate for Payer: Quartz Commercial |
$107.48
|
| Rate for Payer: Quartz Medicare Advantage |
$99.22
|
| Rate for Payer: The Alliance Commercial |
$82.68
|
| Rate for Payer: WEA Trust Commercial |
$90.95
|
| Rate for Payer: WPS Commercial |
$122.48
|
|
|
CAST SYNTH 4X15
|
Facility
|
IP
|
$159.00
|
|
|
Service Code
|
HCPCS A4590
|
| Hospital Charge Code |
2963351
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$81.03 |
| Max. Negotiated Rate |
$152.13 |
| Rate for Payer: Aetna Commercial |
$148.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$142.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$87.64
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cigna Commercial |
$152.13
|
| Rate for Payer: Health EOS Commercial |
$147.17
|
| Rate for Payer: HFN Commercial |
$152.13
|
| Rate for Payer: Multiplan Commercial |
$132.29
|
| Rate for Payer: Preferred Network Access Commercial |
$152.13
|
| Rate for Payer: Quartz Beloit One Network |
$81.03
|
| Rate for Payer: Quartz Commercial |
$99.22
|
| Rate for Payer: WEA Trust Commercial |
$90.95
|
| Rate for Payer: WPS Commercial |
$122.48
|
|
|
CATARACT EXTRACTION W/ INTRAOCULAR LENS IMPLANT
|
Facility
|
OP
|
$5,660.00
|
|
| Hospital Charge Code |
2960521
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,648.19 |
| Max. Negotiated Rate |
$5,415.49 |
| Rate for Payer: Aetna Commercial |
$5,297.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,062.30
|
| Rate for Payer: Aetna Managed Medicare |
$1,648.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,826.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,943.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,825.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,119.79
|
| Rate for Payer: Cash Price |
$1,698.00
|
| Rate for Payer: Cigna Commercial |
$5,415.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,294.12
|
| Rate for Payer: Health EOS Commercial |
$5,238.90
|
| Rate for Payer: HFN Commercial |
$5,415.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,414.80
|
| Rate for Payer: Multiplan Commercial |
$4,709.12
|
| Rate for Payer: NAPHCARE Commercial |
$3,531.84
|
| Rate for Payer: Preferred Network Access Commercial |
$5,415.49
|
| Rate for Payer: Quartz Beloit One Network |
$2,884.34
|
| Rate for Payer: Quartz Commercial |
$3,826.16
|
| Rate for Payer: Quartz Medicare Advantage |
$3,531.84
|
| Rate for Payer: The Alliance Commercial |
$2,943.20
|
| Rate for Payer: WEA Trust Commercial |
$3,237.52
|
| Rate for Payer: WPS Commercial |
$4,359.90
|
|
|
CATARACT EXTRACTION W/ INTRAOCULAR LENS IMPLANT
|
Facility
|
IP
|
$5,660.00
|
|
| Hospital Charge Code |
2960521
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,884.34 |
| Max. Negotiated Rate |
$5,415.49 |
| Rate for Payer: Aetna Commercial |
$5,297.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,062.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,119.79
|
| Rate for Payer: Cash Price |
$1,698.00
|
| Rate for Payer: Cigna Commercial |
$5,415.49
|
| Rate for Payer: Health EOS Commercial |
$5,238.90
|
| Rate for Payer: HFN Commercial |
$5,415.49
|
| Rate for Payer: Multiplan Commercial |
$4,709.12
|
| Rate for Payer: Preferred Network Access Commercial |
$5,415.49
|
| Rate for Payer: Quartz Beloit One Network |
$2,884.34
|
| Rate for Payer: Quartz Commercial |
$3,531.84
|
| Rate for Payer: WEA Trust Commercial |
$3,237.52
|
| Rate for Payer: WPS Commercial |
$4,359.90
|
|
