|
Closed Treatment of Distal Fibular Fracture (Lateral Malleolus) 27786
|
Professional
|
Both
|
$795.00
|
|
|
Service Code
|
CPT 27786
|
| Hospital Charge Code |
3014150
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$180.80 |
| Max. Negotiated Rate |
$971.46 |
| Rate for Payer: Aetna Commercial |
$755.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$683.70
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Cigna Commercial |
$755.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$180.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$477.00
|
| Rate for Payer: Health EOS Commercial |
$723.45
|
| Rate for Payer: HFN Commercial |
$755.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$971.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$971.46
|
| Rate for Payer: Multiplan Commercial |
$636.00
|
| Rate for Payer: Preferred Network Access Commercial |
$755.25
|
| Rate for Payer: Quartz Beloit One Network |
$349.80
|
| Rate for Payer: Quartz Commercial |
$453.15
|
| Rate for Payer: The Alliance Commercial |
$397.50
|
| Rate for Payer: United Healthcare Medicaid |
$180.80
|
| Rate for Payer: WEA Trust Commercial |
$437.25
|
| Rate for Payer: WPS Commercial |
$588.86
|
|
|
Closed Treatment of†Distal Radial Fracture 25600
|
Professional
|
Both
|
$549.00
|
|
|
Service Code
|
CPT 25600
|
| Hospital Charge Code |
3013903
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$168.48 |
| Max. Negotiated Rate |
$1,085.40 |
| Rate for Payer: Aetna Commercial |
$521.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$472.14
|
| Rate for Payer: Cash Price |
$164.70
|
| Rate for Payer: Cash Price |
$164.70
|
| Rate for Payer: Cigna Commercial |
$521.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$168.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$329.40
|
| Rate for Payer: Health EOS Commercial |
$499.59
|
| Rate for Payer: HFN Commercial |
$521.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,085.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,085.40
|
| Rate for Payer: Multiplan Commercial |
$439.20
|
| Rate for Payer: Preferred Network Access Commercial |
$521.55
|
| Rate for Payer: Quartz Beloit One Network |
$241.56
|
| Rate for Payer: Quartz Commercial |
$312.93
|
| Rate for Payer: The Alliance Commercial |
$274.50
|
| Rate for Payer: United Healthcare Medicaid |
$168.48
|
| Rate for Payer: WEA Trust Commercial |
$301.95
|
| Rate for Payer: WPS Commercial |
$406.64
|
|
|
CLOSED TREATMENT OF DISTAL RADIAL FRACTURE (EG, COLLES OR SMITH TYPE) OR EPIPHYSEAL SEPARATION, INCLUDES CLOSED TREATMENT OF FRACTURE OF ULNAR STYLOID, WHEN PERFORMED; WITH MANIPULATION
|
Facility
|
OP
|
$6,546.14
|
|
|
Service Code
|
CPT 25605
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,588.57 |
| Max. Negotiated Rate |
$6,546.14 |
| Rate for Payer: Aetna Managed Medicare |
$1,588.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1,588.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,588.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,588.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,588.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,588.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,909.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,588.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,588.57
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,588.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,588.57
|
| Rate for Payer: NAPHCARE Commercial |
$2,382.86
|
| Rate for Payer: Quartz Medicare Advantage |
$1,588.57
|
| Rate for Payer: The Alliance Commercial |
$6,354.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,588.57
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$1,588.57
|
|
|
Closed Treatment of†Distal Radioulnar Dislocation 25675
|
Professional
|
Both
|
$1,077.00
|
|
|
Service Code
|
CPT 25675
|
| Hospital Charge Code |
3013920
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$376.66 |
| Max. Negotiated Rate |
$1,345.11 |
| Rate for Payer: Aetna Commercial |
$1,023.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$926.22
|
| Rate for Payer: Cash Price |
$323.10
|
| Rate for Payer: Cash Price |
$323.10
|
| Rate for Payer: Cigna Commercial |
$1,023.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$376.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$646.20
|
| Rate for Payer: Health EOS Commercial |
$980.07
|
| Rate for Payer: HFN Commercial |
$1,023.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,345.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,345.11
|
| Rate for Payer: Multiplan Commercial |
$861.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,023.15
|
| Rate for Payer: Quartz Beloit One Network |
$473.88
|
| Rate for Payer: Quartz Commercial |
$613.89
|
| Rate for Payer: The Alliance Commercial |
$538.50
|
| Rate for Payer: United Healthcare Medicaid |
$376.66
|
| Rate for Payer: WEA Trust Commercial |
$592.35
|
| Rate for Payer: WPS Commercial |
$797.73
|
|
|
Closed Treatment of†Fracture of Phalanx of Great Toe 28490
|
Professional
|
Both
|
$277.00
|
|
|
Service Code
|
CPT 28490
|
| Hospital Charge Code |
3014256
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$83.74 |
| Max. Negotiated Rate |
$416.43 |
| Rate for Payer: Aetna Commercial |
$263.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$238.22
|
| Rate for Payer: Cash Price |
$83.10
|
| Rate for Payer: Cash Price |
$83.10
|
| Rate for Payer: Cigna Commercial |
$263.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$83.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$166.20
|
| Rate for Payer: Health EOS Commercial |
$252.07
|
| Rate for Payer: HFN Commercial |
$263.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$416.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$416.43
|
| Rate for Payer: Multiplan Commercial |
$221.60
|
| Rate for Payer: Preferred Network Access Commercial |
$263.15
|
| Rate for Payer: Quartz Beloit One Network |
$121.88
|
| Rate for Payer: Quartz Commercial |
$157.89
|
| Rate for Payer: The Alliance Commercial |
$138.50
|
| Rate for Payer: United Healthcare Medicaid |
$83.74
|
| Rate for Payer: WEA Trust Commercial |
$152.35
|
| Rate for Payer: WPS Commercial |
$205.17
|
|
|
Closed Treatment of†Fracture of Weight Bearing Articular; Distal Tibia 27824
|
Professional
|
Both
|
$1,238.00
|
|
|
Service Code
|
CPT 27824
|
| Hospital Charge Code |
3014159
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$213.30 |
| Max. Negotiated Rate |
$1,176.10 |
| Rate for Payer: Aetna Commercial |
$1,176.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,064.68
|
| Rate for Payer: Cash Price |
$371.40
|
| Rate for Payer: Cash Price |
$371.40
|
| Rate for Payer: Cigna Commercial |
$1,176.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$213.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$742.80
|
| Rate for Payer: Health EOS Commercial |
$1,126.58
|
| Rate for Payer: HFN Commercial |
$1,176.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,027.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,027.87
|
| Rate for Payer: Multiplan Commercial |
$990.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,176.10
|
| Rate for Payer: Quartz Beloit One Network |
$544.72
|
| Rate for Payer: Quartz Commercial |
$705.66
|
| Rate for Payer: The Alliance Commercial |
$619.00
|
| Rate for Payer: United Healthcare Medicaid |
$213.30
|
| Rate for Payer: WEA Trust Commercial |
$680.90
|
| Rate for Payer: WPS Commercial |
$916.99
|
|
|
CLOSED TREATMENT OF FRACTURE OF WEIGHT BEARING ARTICULAR PORTION OF DISTAL TIBIA (EG, PILON OR TIBIAL PLAFOND), WITH OR WITHOUT ANESTHESIA; WITH SKELETAL TRACTION AND/OR REQUIRING MANIPULATION
|
Facility
|
OP
|
$6,354.28
|
|
|
Service Code
|
CPT 27825
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,588.57 |
| Max. Negotiated Rate |
$6,354.28 |
| Rate for Payer: Aetna Managed Medicare |
$1,588.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1,588.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,588.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,588.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,588.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,588.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,909.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,588.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,588.57
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,588.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,588.57
|
| Rate for Payer: NAPHCARE Commercial |
$2,382.86
|
| Rate for Payer: Quartz Medicare Advantage |
$1,588.57
|
| Rate for Payer: The Alliance Commercial |
$6,354.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,588.57
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$1,588.57
|
|
|
Closed Treatment of†Greater Humeral Tuberosity Fracture 23620
|
Professional
|
Both
|
$529.00
|
|
|
Service Code
|
CPT 23620
|
| Hospital Charge Code |
3013793
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$120.52 |
| Max. Negotiated Rate |
$872.30 |
| Rate for Payer: Aetna Commercial |
$502.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$454.94
|
| Rate for Payer: Cash Price |
$158.70
|
| Rate for Payer: Cash Price |
$158.70
|
| Rate for Payer: Cigna Commercial |
$502.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$120.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$317.40
|
| Rate for Payer: Health EOS Commercial |
$481.39
|
| Rate for Payer: HFN Commercial |
$502.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$872.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$872.30
|
| Rate for Payer: Multiplan Commercial |
$423.20
|
| Rate for Payer: Preferred Network Access Commercial |
$502.55
|
| Rate for Payer: Quartz Beloit One Network |
$232.76
|
| Rate for Payer: Quartz Commercial |
$301.53
|
| Rate for Payer: The Alliance Commercial |
$264.50
|
| Rate for Payer: United Healthcare Medicaid |
$120.52
|
| Rate for Payer: WEA Trust Commercial |
$290.95
|
| Rate for Payer: WPS Commercial |
$391.83
|
|
|
Closed Treatment of†Humeral Condylar Fracture, Medial or Lateral 24576
|
Professional
|
Both
|
$828.00
|
|
|
Service Code
|
CPT 24576
|
| Hospital Charge Code |
3013841
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$180.80 |
| Max. Negotiated Rate |
$1,050.49 |
| Rate for Payer: Aetna Commercial |
$786.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$712.08
|
| Rate for Payer: Cash Price |
$248.40
|
| Rate for Payer: Cash Price |
$248.40
|
| Rate for Payer: Cigna Commercial |
$786.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$180.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$496.80
|
| Rate for Payer: Health EOS Commercial |
$753.48
|
| Rate for Payer: HFN Commercial |
$786.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,050.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,050.49
|
| Rate for Payer: Multiplan Commercial |
$662.40
|
| Rate for Payer: Preferred Network Access Commercial |
$786.60
|
| Rate for Payer: Quartz Beloit One Network |
$364.32
|
| Rate for Payer: Quartz Commercial |
$471.96
|
| Rate for Payer: The Alliance Commercial |
$414.00
|
| Rate for Payer: United Healthcare Medicaid |
$180.80
|
| Rate for Payer: WEA Trust Commercial |
$455.40
|
| Rate for Payer: WPS Commercial |
$613.30
|
|
|
Closed Treatment of†Humeral Epicondylar Fracture, Medial or Lateral 24560
|
Professional
|
Both
|
$864.00
|
|
|
Service Code
|
CPT 24560
|
| Hospital Charge Code |
3013839
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$180.80 |
| Max. Negotiated Rate |
$993.06 |
| Rate for Payer: Aetna Commercial |
$820.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$743.04
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cigna Commercial |
$820.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$180.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$518.40
|
| Rate for Payer: Health EOS Commercial |
$786.24
|
| Rate for Payer: HFN Commercial |
$820.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$993.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$993.06
|
| Rate for Payer: Multiplan Commercial |
$691.20
|
| Rate for Payer: Preferred Network Access Commercial |
$820.80
|
| Rate for Payer: Quartz Beloit One Network |
$380.16
|
| Rate for Payer: Quartz Commercial |
$492.48
|
| Rate for Payer: The Alliance Commercial |
$432.00
|
| Rate for Payer: United Healthcare Medicaid |
$180.80
|
| Rate for Payer: WEA Trust Commercial |
$475.20
|
| Rate for Payer: WPS Commercial |
$639.96
|
|
|
Closed Treatment of†Humeral Shaft Fracture 24500
|
Professional
|
Both
|
$873.00
|
|
|
Service Code
|
CPT 24500
|
| Hospital Charge Code |
3013830
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$228.63 |
| Max. Negotiated Rate |
$1,116.68 |
| Rate for Payer: Aetna Commercial |
$829.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$750.78
|
| Rate for Payer: Cash Price |
$261.90
|
| Rate for Payer: Cash Price |
$261.90
|
| Rate for Payer: Cigna Commercial |
$829.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$228.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$523.80
|
| Rate for Payer: Health EOS Commercial |
$794.43
|
| Rate for Payer: HFN Commercial |
$829.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,116.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,116.68
|
| Rate for Payer: Multiplan Commercial |
$698.40
|
| Rate for Payer: Preferred Network Access Commercial |
$829.35
|
| Rate for Payer: Quartz Beloit One Network |
$384.12
|
| Rate for Payer: Quartz Commercial |
$497.61
|
| Rate for Payer: The Alliance Commercial |
$436.50
|
| Rate for Payer: United Healthcare Medicaid |
$228.63
|
| Rate for Payer: WEA Trust Commercial |
$480.15
|
| Rate for Payer: WPS Commercial |
$646.63
|
|
|
Closed Treatment of†Intercondylar Spine(s) and/or Fracture of Knee 27538
|
Professional
|
Both
|
$1,406.00
|
|
|
Service Code
|
CPT 27538
|
| Hospital Charge Code |
3014099
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$301.31 |
| Max. Negotiated Rate |
$1,502.72 |
| Rate for Payer: Aetna Commercial |
$1,335.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,209.16
|
| Rate for Payer: Cash Price |
$421.80
|
| Rate for Payer: Cash Price |
$421.80
|
| Rate for Payer: Cigna Commercial |
$1,335.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$301.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$843.60
|
| Rate for Payer: Health EOS Commercial |
$1,279.46
|
| Rate for Payer: HFN Commercial |
$1,335.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,502.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,502.72
|
| Rate for Payer: Multiplan Commercial |
$1,124.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,335.70
|
| Rate for Payer: Quartz Beloit One Network |
$618.64
|
| Rate for Payer: Quartz Commercial |
$801.42
|
| Rate for Payer: The Alliance Commercial |
$703.00
|
| Rate for Payer: United Healthcare Medicaid |
$301.31
|
| Rate for Payer: WEA Trust Commercial |
$773.30
|
| Rate for Payer: WPS Commercial |
$1,041.42
|
|
|
Closed Treatment of†Medial Malleolus Fracture 27760
|
Professional
|
Both
|
$828.00
|
|
|
Service Code
|
CPT 27760
|
| Hospital Charge Code |
3014144
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$180.80 |
| Max. Negotiated Rate |
$1,035.38 |
| Rate for Payer: Aetna Commercial |
$786.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$712.08
|
| Rate for Payer: Cash Price |
$248.40
|
| Rate for Payer: Cash Price |
$248.40
|
| Rate for Payer: Cigna Commercial |
$786.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$180.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$496.80
|
| Rate for Payer: Health EOS Commercial |
$753.48
|
| Rate for Payer: HFN Commercial |
$786.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,035.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,035.38
|
| Rate for Payer: Multiplan Commercial |
$662.40
|
| Rate for Payer: Preferred Network Access Commercial |
$786.60
|
| Rate for Payer: Quartz Beloit One Network |
$364.32
|
| Rate for Payer: Quartz Commercial |
$471.96
|
| Rate for Payer: The Alliance Commercial |
$414.00
|
| Rate for Payer: United Healthcare Medicaid |
$180.80
|
| Rate for Payer: WEA Trust Commercial |
$455.40
|
| Rate for Payer: WPS Commercial |
$613.30
|
|
|
Closed Treatment of†Metacarpal Fracture, Single Bone 26600
|
Professional
|
Both
|
$488.00
|
|
|
Service Code
|
CPT 26600
|
| Hospital Charge Code |
3013969
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$152.29 |
| Max. Negotiated Rate |
$960.83 |
| Rate for Payer: Aetna Commercial |
$463.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$419.68
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cigna Commercial |
$463.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$152.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$292.80
|
| Rate for Payer: Health EOS Commercial |
$444.08
|
| Rate for Payer: HFN Commercial |
$463.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$960.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$960.83
|
| Rate for Payer: Multiplan Commercial |
$390.40
|
| Rate for Payer: Preferred Network Access Commercial |
$463.60
|
| Rate for Payer: Quartz Beloit One Network |
$214.72
|
| Rate for Payer: Quartz Commercial |
$278.16
|
| Rate for Payer: The Alliance Commercial |
$244.00
|
| Rate for Payer: United Healthcare Medicaid |
$152.29
|
| Rate for Payer: WEA Trust Commercial |
$268.40
|
| Rate for Payer: WPS Commercial |
$361.46
|
|
|
Closed Treatment of†Metatarsal Fracture; Each 28470
|
Professional
|
Both
|
$582.00
|
|
|
Service Code
|
CPT 28470
|
| Hospital Charge Code |
3014253
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$152.29 |
| Max. Negotiated Rate |
$691.88 |
| Rate for Payer: Aetna Commercial |
$552.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$500.52
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cigna Commercial |
$552.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$152.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$349.20
|
| Rate for Payer: Health EOS Commercial |
$529.62
|
| Rate for Payer: HFN Commercial |
$552.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$691.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$691.88
|
| Rate for Payer: Multiplan Commercial |
$465.60
|
| Rate for Payer: Preferred Network Access Commercial |
$552.90
|
| Rate for Payer: Quartz Beloit One Network |
$256.08
|
| Rate for Payer: Quartz Commercial |
$331.74
|
| Rate for Payer: The Alliance Commercial |
$291.00
|
| Rate for Payer: United Healthcare Medicaid |
$152.29
|
| Rate for Payer: WEA Trust Commercial |
$320.10
|
| Rate for Payer: WPS Commercial |
$431.09
|
|
|
CLOSED TREATMENT OF NASAL BONE FRACTURE WITH MANIPULATION; WITH STABILIZATION
|
Facility
|
OP
|
$12,729.16
|
|
|
Service Code
|
CPT 21320
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,726.00 |
| Max. Negotiated Rate |
$12,729.16 |
| Rate for Payer: Aetna Managed Medicare |
$3,182.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,182.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,182.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,182.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,182.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,182.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,838.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,182.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,182.29
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,182.29
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,182.29
|
| Rate for Payer: NAPHCARE Commercial |
$4,773.44
|
| Rate for Payer: Quartz Medicare Advantage |
$3,182.29
|
| Rate for Payer: The Alliance Commercial |
$12,729.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,182.29
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$3,182.29
|
|
|
Closed Treatment of†Patellar Fracture 27520
|
Professional
|
Both
|
$905.00
|
|
|
Service Code
|
CPT 27520
|
| Hospital Charge Code |
3014093
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$191.44 |
| Max. Negotiated Rate |
$1,008.59 |
| Rate for Payer: Aetna Commercial |
$859.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$778.30
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cigna Commercial |
$859.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$191.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$543.00
|
| Rate for Payer: Health EOS Commercial |
$823.55
|
| Rate for Payer: HFN Commercial |
$859.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,008.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,008.59
|
| Rate for Payer: Multiplan Commercial |
$724.00
|
| Rate for Payer: Preferred Network Access Commercial |
$859.75
|
| Rate for Payer: Quartz Beloit One Network |
$398.20
|
| Rate for Payer: Quartz Commercial |
$515.85
|
| Rate for Payer: The Alliance Commercial |
$452.50
|
| Rate for Payer: United Healthcare Medicaid |
$191.44
|
| Rate for Payer: WEA Trust Commercial |
$497.75
|
| Rate for Payer: WPS Commercial |
$670.33
|
|
|
Closed Treatment of Phalangeal Shaft Fracture, Finger or Thumb 26725
|
Professional
|
Both
|
$796.00
|
|
|
Service Code
|
CPT 26725
|
| Hospital Charge Code |
3013982
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$129.56 |
| Max. Negotiated Rate |
$1,020.52 |
| Rate for Payer: Aetna Commercial |
$756.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$684.56
|
| Rate for Payer: Cash Price |
$238.80
|
| Rate for Payer: Cash Price |
$238.80
|
| Rate for Payer: Cigna Commercial |
$756.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$129.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$477.60
|
| Rate for Payer: Health EOS Commercial |
$724.36
|
| Rate for Payer: HFN Commercial |
$756.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,020.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,020.52
|
| Rate for Payer: Multiplan Commercial |
$636.80
|
| Rate for Payer: Preferred Network Access Commercial |
$756.20
|
| Rate for Payer: Quartz Beloit One Network |
$350.24
|
| Rate for Payer: Quartz Commercial |
$453.72
|
| Rate for Payer: The Alliance Commercial |
$398.00
|
| Rate for Payer: United Healthcare Medicaid |
$129.56
|
| Rate for Payer: WEA Trust Commercial |
$437.80
|
| Rate for Payer: WPS Commercial |
$589.60
|
|
|
Closed Treatment of Phalanx or Phalanges Fractures 28510
|
Professional
|
Both
|
$218.00
|
|
|
Service Code
|
CPT 28510
|
| Hospital Charge Code |
3014260
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$60.27 |
| Max. Negotiated Rate |
$403.30 |
| Rate for Payer: Aetna Commercial |
$207.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$187.48
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cigna Commercial |
$207.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$60.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$130.80
|
| Rate for Payer: Health EOS Commercial |
$198.38
|
| Rate for Payer: HFN Commercial |
$207.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$403.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$403.30
|
| Rate for Payer: Multiplan Commercial |
$174.40
|
| Rate for Payer: Preferred Network Access Commercial |
$207.10
|
| Rate for Payer: Quartz Beloit One Network |
$95.92
|
| Rate for Payer: Quartz Commercial |
$124.26
|
| Rate for Payer: The Alliance Commercial |
$109.00
|
| Rate for Payer: United Healthcare Medicaid |
$60.27
|
| Rate for Payer: WEA Trust Commercial |
$119.90
|
| Rate for Payer: WPS Commercial |
$161.47
|
|
|
CLOSED TREATMENT OF POST HIP ARTHROPLASTY DISLOCATION; REQUIRING REGIONAL OR GENERAL ANESTHESIA
|
Facility
|
OP
|
$6,354.28
|
|
|
Service Code
|
CPT 27266
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,588.57 |
| Max. Negotiated Rate |
$6,354.28 |
| Rate for Payer: Aetna Managed Medicare |
$1,588.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1,588.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,588.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,588.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,588.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,588.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,909.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,588.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,588.57
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,588.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,588.57
|
| Rate for Payer: NAPHCARE Commercial |
$2,382.86
|
| Rate for Payer: Quartz Medicare Advantage |
$1,588.57
|
| Rate for Payer: The Alliance Commercial |
$6,354.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,588.57
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$1,588.57
|
|
|
Closed Treatment of Proximal Fibula or Shaft Fracture 27780
|
Professional
|
Both
|
$645.00
|
|
|
Service Code
|
CPT 27780
|
| Hospital Charge Code |
3014148
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$186.81 |
| Max. Negotiated Rate |
$957.34 |
| Rate for Payer: Aetna Commercial |
$612.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$554.70
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cigna Commercial |
$612.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$186.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$387.00
|
| Rate for Payer: Health EOS Commercial |
$586.95
|
| Rate for Payer: HFN Commercial |
$612.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$957.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$957.34
|
| Rate for Payer: Multiplan Commercial |
$516.00
|
| Rate for Payer: Preferred Network Access Commercial |
$612.75
|
| Rate for Payer: Quartz Beloit One Network |
$283.80
|
| Rate for Payer: Quartz Commercial |
$367.65
|
| Rate for Payer: The Alliance Commercial |
$322.50
|
| Rate for Payer: United Healthcare Medicaid |
$186.81
|
| Rate for Payer: WEA Trust Commercial |
$354.75
|
| Rate for Payer: WPS Commercial |
$477.75
|
|
|
CLOSED TREATMENT OF PROXIMAL FIBULA OR SHAFT FRACTURE; WITH MANIPULATION
|
Facility
|
OP
|
$6,354.28
|
|
|
Service Code
|
CPT 27781
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,588.57 |
| Max. Negotiated Rate |
$6,354.28 |
| Rate for Payer: Aetna Managed Medicare |
$1,588.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1,588.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,588.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,588.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,588.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,588.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,909.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,588.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,588.57
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,588.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,588.57
|
| Rate for Payer: NAPHCARE Commercial |
$2,382.86
|
| Rate for Payer: Quartz Medicare Advantage |
$1,588.57
|
| Rate for Payer: The Alliance Commercial |
$6,354.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,588.57
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$1,588.57
|
|
|
Closed Treatment of†Proximal Humeral Fracture 23600
|
Professional
|
Both
|
$849.00
|
|
|
Service Code
|
CPT 23600
|
| Hospital Charge Code |
3013789
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$241.07 |
| Max. Negotiated Rate |
$1,059.35 |
| Rate for Payer: Aetna Commercial |
$806.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$730.14
|
| Rate for Payer: Cash Price |
$254.70
|
| Rate for Payer: Cash Price |
$254.70
|
| Rate for Payer: Cigna Commercial |
$806.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$241.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$509.40
|
| Rate for Payer: Health EOS Commercial |
$772.59
|
| Rate for Payer: HFN Commercial |
$806.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,059.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,059.35
|
| Rate for Payer: Multiplan Commercial |
$679.20
|
| Rate for Payer: Preferred Network Access Commercial |
$806.55
|
| Rate for Payer: Quartz Beloit One Network |
$373.56
|
| Rate for Payer: Quartz Commercial |
$483.93
|
| Rate for Payer: The Alliance Commercial |
$424.50
|
| Rate for Payer: United Healthcare Medicaid |
$241.07
|
| Rate for Payer: WEA Trust Commercial |
$466.95
|
| Rate for Payer: WPS Commercial |
$628.85
|
|
|
Closed Treatment of†Radial and Ulnar Shaft Fractures 25560
|
Professional
|
Both
|
$843.00
|
|
|
Service Code
|
CPT 25560
|
| Hospital Charge Code |
3013899
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$198.19 |
| Max. Negotiated Rate |
$867.92 |
| Rate for Payer: Aetna Commercial |
$800.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$724.98
|
| Rate for Payer: Cash Price |
$252.90
|
| Rate for Payer: Cash Price |
$252.90
|
| Rate for Payer: Cigna Commercial |
$800.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$198.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$505.80
|
| Rate for Payer: Health EOS Commercial |
$767.13
|
| Rate for Payer: HFN Commercial |
$800.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$867.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$867.92
|
| Rate for Payer: Multiplan Commercial |
$674.40
|
| Rate for Payer: Preferred Network Access Commercial |
$800.85
|
| Rate for Payer: Quartz Beloit One Network |
$370.92
|
| Rate for Payer: Quartz Commercial |
$480.51
|
| Rate for Payer: The Alliance Commercial |
$421.50
|
| Rate for Payer: United Healthcare Medicaid |
$198.19
|
| Rate for Payer: WEA Trust Commercial |
$463.65
|
| Rate for Payer: WPS Commercial |
$624.41
|
|
|
CLOSED TREATMENT OF RADIAL AND ULNAR SHAFT FRACTURES; WITH MANIPULATION
|
Facility
|
OP
|
$6,354.28
|
|
|
Service Code
|
CPT 25565
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,588.57 |
| Max. Negotiated Rate |
$6,354.28 |
| Rate for Payer: Aetna Managed Medicare |
$1,588.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1,588.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,588.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,588.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,588.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,588.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,909.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,588.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,588.57
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,588.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,588.57
|
| Rate for Payer: NAPHCARE Commercial |
$2,382.86
|
| Rate for Payer: Quartz Medicare Advantage |
$1,588.57
|
| Rate for Payer: The Alliance Commercial |
$6,354.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,588.57
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$1,588.57
|
|
