|
Closed Treatment of Radial Head or Neck Fracture 24650
|
Professional
|
Both
|
$647.00
|
|
|
Service Code
|
CPT 24650
|
| Hospital Charge Code |
3013848
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$190.57 |
| Max. Negotiated Rate |
$826.20 |
| Rate for Payer: Aetna Commercial |
$614.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$556.42
|
| Rate for Payer: Cash Price |
$194.10
|
| Rate for Payer: Cash Price |
$194.10
|
| Rate for Payer: Cigna Commercial |
$614.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$190.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$388.20
|
| Rate for Payer: Health EOS Commercial |
$588.77
|
| Rate for Payer: HFN Commercial |
$614.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$826.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$826.20
|
| Rate for Payer: Multiplan Commercial |
$517.60
|
| Rate for Payer: Preferred Network Access Commercial |
$614.65
|
| Rate for Payer: Quartz Beloit One Network |
$284.68
|
| Rate for Payer: Quartz Commercial |
$368.79
|
| Rate for Payer: The Alliance Commercial |
$323.50
|
| Rate for Payer: United Healthcare Medicaid |
$190.57
|
| Rate for Payer: WEA Trust Commercial |
$355.85
|
| Rate for Payer: WPS Commercial |
$479.23
|
|
|
CLOSED TREATMENT OF RADIAL SHAFT FRACTURE; WITH MANIPULATION
|
Facility
|
OP
|
$6,354.28
|
|
|
Service Code
|
CPT 25505
|
|
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†Radiocarpal or Intercarpal, 1 or More Bone 25660
|
Professional
|
Both
|
$1,106.00
|
|
|
Service Code
|
CPT 25660
|
| Hospital Charge Code |
3013918
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$105.45 |
| Max. Negotiated Rate |
$1,495.70 |
| Rate for Payer: Aetna Commercial |
$1,050.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$951.16
|
| Rate for Payer: Cash Price |
$331.80
|
| Rate for Payer: Cash Price |
$331.80
|
| Rate for Payer: Cigna Commercial |
$1,050.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$105.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$663.60
|
| Rate for Payer: Health EOS Commercial |
$1,006.46
|
| Rate for Payer: HFN Commercial |
$1,050.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,495.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,495.70
|
| Rate for Payer: Multiplan Commercial |
$884.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,050.70
|
| Rate for Payer: Quartz Beloit One Network |
$486.64
|
| Rate for Payer: Quartz Commercial |
$630.42
|
| Rate for Payer: The Alliance Commercial |
$553.00
|
| Rate for Payer: United Healthcare Medicaid |
$105.45
|
| Rate for Payer: WEA Trust Commercial |
$608.30
|
| Rate for Payer: WPS Commercial |
$819.21
|
|
|
Closed Treatment of Supracondylar or Transcondylar Humeral Fracture 24530
|
Professional
|
Both
|
$916.00
|
|
|
Service Code
|
CPT 24530
|
| Hospital Charge Code |
3013834
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$241.07 |
| Max. Negotiated Rate |
$1,175.42 |
| Rate for Payer: Aetna Commercial |
$870.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$787.76
|
| Rate for Payer: Cash Price |
$274.80
|
| Rate for Payer: Cash Price |
$274.80
|
| Rate for Payer: Cigna Commercial |
$870.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$241.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$549.60
|
| Rate for Payer: Health EOS Commercial |
$833.56
|
| Rate for Payer: HFN Commercial |
$870.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,175.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,175.42
|
| Rate for Payer: Multiplan Commercial |
$732.80
|
| Rate for Payer: Preferred Network Access Commercial |
$870.20
|
| Rate for Payer: Quartz Beloit One Network |
$403.04
|
| Rate for Payer: Quartz Commercial |
$522.12
|
| Rate for Payer: The Alliance Commercial |
$458.00
|
| Rate for Payer: United Healthcare Medicaid |
$241.07
|
| Rate for Payer: WEA Trust Commercial |
$503.80
|
| Rate for Payer: WPS Commercial |
$678.48
|
|
|
Closed Treatment of Talus Fracture 28430
|
Professional
|
Both
|
$816.00
|
|
|
Service Code
|
CPT 28430
|
| Hospital Charge Code |
3014247
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$226.00 |
| Max. Negotiated Rate |
$775.20 |
| Rate for Payer: Aetna Commercial |
$775.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$701.76
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cigna Commercial |
$775.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$226.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$489.60
|
| Rate for Payer: Health EOS Commercial |
$742.56
|
| Rate for Payer: HFN Commercial |
$775.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$710.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$710.52
|
| Rate for Payer: Multiplan Commercial |
$652.80
|
| Rate for Payer: Preferred Network Access Commercial |
$775.20
|
| Rate for Payer: Quartz Beloit One Network |
$359.04
|
| Rate for Payer: Quartz Commercial |
$465.12
|
| Rate for Payer: The Alliance Commercial |
$408.00
|
| Rate for Payer: United Healthcare Medicaid |
$226.00
|
| Rate for Payer: WEA Trust Commercial |
$448.80
|
| Rate for Payer: WPS Commercial |
$604.41
|
|
|
Closed Treatment of Tarsal Bone Fracture† 28450
|
Professional
|
Both
|
$669.00
|
|
|
Service Code
|
CPT 28450
|
| Hospital Charge Code |
3014250
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$141.34 |
| Max. Negotiated Rate |
$644.72 |
| Rate for Payer: Aetna Commercial |
$635.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$575.34
|
| Rate for Payer: Cash Price |
$200.70
|
| Rate for Payer: Cash Price |
$200.70
|
| Rate for Payer: Cigna Commercial |
$635.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$141.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$401.40
|
| Rate for Payer: Health EOS Commercial |
$608.79
|
| Rate for Payer: HFN Commercial |
$635.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$644.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$644.72
|
| Rate for Payer: Multiplan Commercial |
$535.20
|
| Rate for Payer: Preferred Network Access Commercial |
$635.55
|
| Rate for Payer: Quartz Beloit One Network |
$294.36
|
| Rate for Payer: Quartz Commercial |
$381.33
|
| Rate for Payer: The Alliance Commercial |
$334.50
|
| Rate for Payer: United Healthcare Medicaid |
$141.34
|
| Rate for Payer: WEA Trust Commercial |
$367.95
|
| Rate for Payer: WPS Commercial |
$495.53
|
|
|
Closed Treatment of†Tibial Fracture Proximal (Plateau) 27530
|
Professional
|
Both
|
$1,218.00
|
|
|
Service Code
|
CPT 27530
|
| Hospital Charge Code |
3014095
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$161.69 |
| Max. Negotiated Rate |
$1,157.10 |
| Rate for Payer: Aetna Commercial |
$1,157.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,047.48
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cigna Commercial |
$1,157.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$161.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$730.80
|
| Rate for Payer: Health EOS Commercial |
$1,108.38
|
| Rate for Payer: HFN Commercial |
$1,157.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$969.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$969.23
|
| Rate for Payer: Multiplan Commercial |
$974.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,157.10
|
| Rate for Payer: Quartz Beloit One Network |
$535.92
|
| Rate for Payer: Quartz Commercial |
$694.26
|
| Rate for Payer: The Alliance Commercial |
$609.00
|
| Rate for Payer: United Healthcare Medicaid |
$161.69
|
| Rate for Payer: WEA Trust Commercial |
$669.90
|
| Rate for Payer: WPS Commercial |
$902.17
|
|
|
Closed Treatment of Tibial Shaft Fracture (w or w/o Fibular Fracture) 27750
|
Professional
|
Both
|
$1,133.00
|
|
|
Service Code
|
CPT 27750
|
| Hospital Charge Code |
3014139
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$153.33 |
| Max. Negotiated Rate |
$1,082.37 |
| Rate for Payer: Aetna Commercial |
$1,076.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$974.38
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cigna Commercial |
$1,076.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$153.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$679.80
|
| Rate for Payer: Health EOS Commercial |
$1,031.03
|
| Rate for Payer: HFN Commercial |
$1,076.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,082.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,082.37
|
| Rate for Payer: Multiplan Commercial |
$906.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,076.35
|
| Rate for Payer: Quartz Beloit One Network |
$498.52
|
| Rate for Payer: Quartz Commercial |
$645.81
|
| Rate for Payer: The Alliance Commercial |
$566.50
|
| Rate for Payer: United Healthcare Medicaid |
$153.33
|
| Rate for Payer: WEA Trust Commercial |
$623.15
|
| Rate for Payer: WPS Commercial |
$839.21
|
|
|
Closed Treatment of†Ulnar Fracture, Proximal End 24670
|
Professional
|
Both
|
$679.00
|
|
|
Service Code
|
CPT 24670
|
| Hospital Charge Code |
3013852
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$190.57 |
| Max. Negotiated Rate |
$898.74 |
| Rate for Payer: Aetna Commercial |
$645.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$583.94
|
| Rate for Payer: Cash Price |
$203.70
|
| Rate for Payer: Cash Price |
$203.70
|
| Rate for Payer: Cigna Commercial |
$645.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$190.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$407.40
|
| Rate for Payer: Health EOS Commercial |
$617.89
|
| Rate for Payer: HFN Commercial |
$645.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$898.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$898.74
|
| Rate for Payer: Multiplan Commercial |
$543.20
|
| Rate for Payer: Preferred Network Access Commercial |
$645.05
|
| Rate for Payer: Quartz Beloit One Network |
$298.76
|
| Rate for Payer: Quartz Commercial |
$387.03
|
| Rate for Payer: The Alliance Commercial |
$339.50
|
| Rate for Payer: United Healthcare Medicaid |
$190.57
|
| Rate for Payer: WEA Trust Commercial |
$373.45
|
| Rate for Payer: WPS Commercial |
$502.94
|
|
|
Closed Treatment of Ulnar Shaft Fracture 25530
|
Professional
|
Both
|
$719.00
|
|
|
Service Code
|
CPT 25530
|
| Hospital Charge Code |
3013896
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$151.78 |
| Max. Negotiated Rate |
$817.20 |
| Rate for Payer: Aetna Commercial |
$683.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$618.34
|
| Rate for Payer: Cash Price |
$215.70
|
| Rate for Payer: Cash Price |
$215.70
|
| Rate for Payer: Cigna Commercial |
$683.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$151.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$431.40
|
| Rate for Payer: Health EOS Commercial |
$654.29
|
| Rate for Payer: HFN Commercial |
$683.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$817.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$817.20
|
| Rate for Payer: Multiplan Commercial |
$575.20
|
| Rate for Payer: Preferred Network Access Commercial |
$683.05
|
| Rate for Payer: Quartz Beloit One Network |
$316.36
|
| Rate for Payer: Quartz Commercial |
$409.83
|
| Rate for Payer: The Alliance Commercial |
$359.50
|
| Rate for Payer: United Healthcare Medicaid |
$151.78
|
| Rate for Payer: WEA Trust Commercial |
$395.45
|
| Rate for Payer: WPS Commercial |
$532.56
|
|
|
CLOSED TREATMENT OF ULNAR SHAFT FRACTURE; WITH MANIPULATION
|
Facility
|
OP
|
$4,218.22
|
|
|
Service Code
|
CPT 25535
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$233.09 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Managed Medicare |
$233.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,914.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,297.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,183.00
|
| Rate for Payer: Anthem Medicare Advantage |
$233.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$233.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$233.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$233.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$233.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$867.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$233.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$233.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$233.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$233.09
|
| Rate for Payer: NAPHCARE Commercial |
$349.64
|
| Rate for Payer: Quartz Medicare Advantage |
$233.09
|
| Rate for Payer: The Alliance Commercial |
$932.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$233.09
|
| Rate for Payer: United Healthcare PPO |
$2,257.00
|
| Rate for Payer: Wellcare Medicare |
$233.09
|
|
|
Closed Treatment of†Ulnar Styloid Fracture 25650
|
Professional
|
Both
|
$1,075.00
|
|
|
Service Code
|
CPT 25650
|
| Hospital Charge Code |
3013915
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$148.24 |
| Max. Negotiated Rate |
$1,026.14 |
| Rate for Payer: Aetna Commercial |
$1,021.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$924.50
|
| Rate for Payer: Cash Price |
$322.50
|
| Rate for Payer: Cash Price |
$322.50
|
| Rate for Payer: Cigna Commercial |
$1,021.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$148.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$645.00
|
| Rate for Payer: Health EOS Commercial |
$978.25
|
| Rate for Payer: HFN Commercial |
$1,021.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,026.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,026.14
|
| Rate for Payer: Multiplan Commercial |
$860.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,021.25
|
| Rate for Payer: Quartz Beloit One Network |
$473.00
|
| Rate for Payer: Quartz Commercial |
$612.75
|
| Rate for Payer: The Alliance Commercial |
$537.50
|
| Rate for Payer: United Healthcare Medicaid |
$148.24
|
| Rate for Payer: WEA Trust Commercial |
$591.25
|
| Rate for Payer: WPS Commercial |
$796.25
|
|
|
CLOSED TX TARSOMETATARSAL DISLOCATION W/ANES 28605
|
Professional
|
Both
|
$946.00
|
|
|
Service Code
|
CPT 28605
|
| Hospital Charge Code |
6230825
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$105.45 |
| Max. Negotiated Rate |
$1,013.32 |
| Rate for Payer: Aetna Commercial |
$898.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$813.56
|
| Rate for Payer: Cash Price |
$283.80
|
| Rate for Payer: Cash Price |
$283.80
|
| Rate for Payer: Cigna Commercial |
$898.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$105.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$567.60
|
| Rate for Payer: Health EOS Commercial |
$860.86
|
| Rate for Payer: HFN Commercial |
$898.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,013.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,013.32
|
| Rate for Payer: Multiplan Commercial |
$756.80
|
| Rate for Payer: Preferred Network Access Commercial |
$898.70
|
| Rate for Payer: Quartz Beloit One Network |
$416.24
|
| Rate for Payer: Quartz Commercial |
$539.22
|
| Rate for Payer: The Alliance Commercial |
$473.00
|
| Rate for Payer: United Healthcare Medicaid |
$105.45
|
| Rate for Payer: WEA Trust Commercial |
$520.30
|
| Rate for Payer: WPS Commercial |
$700.70
|
|
|
CLOSE TEAR DUCT OPENING 68760
|
Professional
|
Both
|
$531.00
|
|
|
Service Code
|
CPT 68760
|
| Hospital Charge Code |
3015256
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$60.27 |
| Max. Negotiated Rate |
$504.45 |
| Rate for Payer: Aetna Commercial |
$504.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$456.66
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Cigna Commercial |
$504.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$60.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$318.60
|
| Rate for Payer: Health EOS Commercial |
$483.21
|
| Rate for Payer: HFN Commercial |
$504.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$488.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$488.91
|
| Rate for Payer: Multiplan Commercial |
$424.80
|
| Rate for Payer: Preferred Network Access Commercial |
$504.45
|
| Rate for Payer: Quartz Beloit One Network |
$233.64
|
| Rate for Payer: Quartz Commercial |
$302.67
|
| Rate for Payer: The Alliance Commercial |
$265.50
|
| Rate for Payer: United Healthcare Medicaid |
$60.27
|
| Rate for Payer: WEA Trust Commercial |
$292.05
|
| Rate for Payer: WPS Commercial |
$393.31
|
|
|
Clostridium difficile Antibody Neutralization
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
CPT 87230
|
| Hospital Charge Code |
5502671
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.74 |
| Max. Negotiated Rate |
$111.32 |
| Rate for Payer: Aetna Commercial |
$108.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$104.06
|
| Rate for Payer: Aetna Managed Medicare |
$19.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$74.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$34.54
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.77
|
| Rate for Payer: Anthem Medicaid |
$20.40
|
| Rate for Payer: Anthem Medicare Advantage |
$19.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$64.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.74
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$111.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$20.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$67.71
|
| Rate for Payer: Dean Health Medicaid |
$20.40
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.74
|
| Rate for Payer: Health EOS Commercial |
$107.69
|
| Rate for Payer: HFN Commercial |
$111.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$73.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.74
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$20.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.74
|
| Rate for Payer: Managed Health Services Medicaid |
$21.22
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.74
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.74
|
| Rate for Payer: Multiplan Commercial |
$96.80
|
| Rate for Payer: NAPHCARE Commercial |
$29.61
|
| Rate for Payer: Preferred Network Access Commercial |
$111.32
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$20.40
|
| Rate for Payer: Quartz Beloit One Network |
$59.29
|
| Rate for Payer: Quartz Commercial |
$78.65
|
| Rate for Payer: Quartz Medicare Advantage |
$19.74
|
| Rate for Payer: The Alliance Commercial |
$78.96
|
| Rate for Payer: United Healthcare Medicaid |
$20.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.74
|
| Rate for Payer: United Healthcare PPO |
$90.75
|
| Rate for Payer: WEA Trust Commercial |
$66.55
|
| Rate for Payer: Wellcare Medicare |
$19.74
|
| Rate for Payer: WMAP Medicaid |
$20.40
|
| Rate for Payer: WPS Commercial |
$89.62
|
|
|
Clostridium difficile Antibody Neutralization
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
CPT 87230
|
| Hospital Charge Code |
5502671
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.24 |
| Max. Negotiated Rate |
$114.95 |
| Rate for Payer: Aetna Commercial |
$114.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$104.06
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$114.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$60.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$72.60
|
| Rate for Payer: Health EOS Commercial |
$110.11
|
| Rate for Payer: HFN Commercial |
$114.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$69.68
|
| Rate for Payer: Multiplan Commercial |
$96.80
|
| Rate for Payer: Preferred Network Access Commercial |
$114.95
|
| Rate for Payer: Quartz Beloit One Network |
$53.24
|
| Rate for Payer: Quartz Commercial |
$68.97
|
| Rate for Payer: The Alliance Commercial |
$60.50
|
| Rate for Payer: WEA Trust Commercial |
$66.55
|
| Rate for Payer: WPS Commercial |
$89.62
|
|
|
Clostridium difficile Antibody Neutralization
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
CPT 87230
|
| Hospital Charge Code |
5502671
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.29 |
| Max. Negotiated Rate |
$111.32 |
| Rate for Payer: Aetna Commercial |
$108.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$104.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$64.13
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$111.32
|
| Rate for Payer: Health EOS Commercial |
$107.69
|
| Rate for Payer: HFN Commercial |
$111.32
|
| Rate for Payer: Multiplan Commercial |
$96.80
|
| Rate for Payer: NAPHCARE Commercial |
$72.60
|
| Rate for Payer: Preferred Network Access Commercial |
$111.32
|
| Rate for Payer: Quartz Beloit One Network |
$59.29
|
| Rate for Payer: Quartz Commercial |
$72.60
|
| Rate for Payer: WEA Trust Commercial |
$66.55
|
| Rate for Payer: WPS Commercial |
$89.62
|
|
|
Clostridium difficile Toxin B, Qualitative PCR
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT 87493
|
| Hospital Charge Code |
1214799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.27 |
| Max. Negotiated Rate |
$163.76 |
| Rate for Payer: Aetna Commercial |
$160.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$153.08
|
| Rate for Payer: Aetna Managed Medicare |
$37.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$139.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$65.22
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$61.87
|
| Rate for Payer: Anthem Medicaid |
$38.51
|
| Rate for Payer: Anthem Medicare Advantage |
$37.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$94.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$37.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$37.27
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$163.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$37.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$38.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$99.61
|
| Rate for Payer: Dean Health Medicaid |
$38.51
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$37.27
|
| Rate for Payer: Health EOS Commercial |
$158.42
|
| Rate for Payer: HFN Commercial |
$163.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$138.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$37.27
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$38.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$37.27
|
| Rate for Payer: Managed Health Services Medicaid |
$40.05
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$37.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$37.27
|
| Rate for Payer: Multiplan Commercial |
$142.40
|
| Rate for Payer: NAPHCARE Commercial |
$55.90
|
| Rate for Payer: Preferred Network Access Commercial |
$163.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$38.51
|
| Rate for Payer: Quartz Beloit One Network |
$87.22
|
| Rate for Payer: Quartz Commercial |
$115.70
|
| Rate for Payer: Quartz Medicare Advantage |
$37.27
|
| Rate for Payer: The Alliance Commercial |
$149.08
|
| Rate for Payer: United Healthcare Medicaid |
$38.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.27
|
| Rate for Payer: United Healthcare PPO |
$133.50
|
| Rate for Payer: WEA Trust Commercial |
$97.90
|
| Rate for Payer: Wellcare Medicare |
$37.27
|
| Rate for Payer: WMAP Medicaid |
$38.51
|
| Rate for Payer: WPS Commercial |
$131.84
|
|
|
Clostridium difficile Toxin B, Qualitative PCR
|
Professional
|
Both
|
$178.00
|
|
|
Service Code
|
CPT 87493
|
| Hospital Charge Code |
1214799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$78.32 |
| Max. Negotiated Rate |
$169.10 |
| Rate for Payer: Aetna Commercial |
$169.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$153.08
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$169.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$89.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$106.80
|
| Rate for Payer: Health EOS Commercial |
$161.98
|
| Rate for Payer: HFN Commercial |
$169.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$131.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$131.56
|
| Rate for Payer: Multiplan Commercial |
$142.40
|
| Rate for Payer: Preferred Network Access Commercial |
$169.10
|
| Rate for Payer: Quartz Beloit One Network |
$78.32
|
| Rate for Payer: Quartz Commercial |
$101.46
|
| Rate for Payer: The Alliance Commercial |
$89.00
|
| Rate for Payer: WEA Trust Commercial |
$97.90
|
| Rate for Payer: WPS Commercial |
$131.84
|
|
|
Clostridium difficile Toxin B, Qualitative PCR
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT 87493
|
| Hospital Charge Code |
1214799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$87.22 |
| Max. Negotiated Rate |
$163.76 |
| Rate for Payer: Aetna Commercial |
$160.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$153.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$94.34
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$163.76
|
| Rate for Payer: Health EOS Commercial |
$158.42
|
| Rate for Payer: HFN Commercial |
$163.76
|
| Rate for Payer: Multiplan Commercial |
$142.40
|
| Rate for Payer: NAPHCARE Commercial |
$106.80
|
| Rate for Payer: Preferred Network Access Commercial |
$163.76
|
| Rate for Payer: Quartz Beloit One Network |
$87.22
|
| Rate for Payer: Quartz Commercial |
$106.80
|
| Rate for Payer: WEA Trust Commercial |
$97.90
|
| Rate for Payer: WPS Commercial |
$131.84
|
|
|
Clostridium difficile Toxin/GDH w/Rfx PCR
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
5228608
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.02 |
| Max. Negotiated Rate |
$90.16 |
| Rate for Payer: Aetna Commercial |
$88.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$84.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.94
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cigna Commercial |
$90.16
|
| Rate for Payer: Health EOS Commercial |
$87.22
|
| Rate for Payer: HFN Commercial |
$90.16
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: NAPHCARE Commercial |
$58.80
|
| Rate for Payer: Preferred Network Access Commercial |
$90.16
|
| Rate for Payer: Quartz Beloit One Network |
$48.02
|
| Rate for Payer: Quartz Commercial |
$58.80
|
| Rate for Payer: WEA Trust Commercial |
$53.90
|
| Rate for Payer: WPS Commercial |
$72.59
|
|
|
Clostridium difficile Toxin/GDH w/Rfx PCR
|
Professional
|
Both
|
$98.00
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
5228608
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.29 |
| Max. Negotiated Rate |
$93.10 |
| Rate for Payer: Aetna Commercial |
$93.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$84.28
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cigna Commercial |
$93.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$49.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$58.80
|
| Rate for Payer: Health EOS Commercial |
$89.18
|
| Rate for Payer: HFN Commercial |
$93.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.29
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: Preferred Network Access Commercial |
$93.10
|
| Rate for Payer: Quartz Beloit One Network |
$43.12
|
| Rate for Payer: Quartz Commercial |
$55.86
|
| Rate for Payer: The Alliance Commercial |
$49.00
|
| Rate for Payer: WEA Trust Commercial |
$53.90
|
| Rate for Payer: WPS Commercial |
$72.59
|
|
|
Clostridium difficile Toxin/GDH w/Rfx PCR
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
5228608
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$90.16 |
| Rate for Payer: Aetna Commercial |
$88.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$84.28
|
| Rate for Payer: Aetna Managed Medicare |
$11.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.89
|
| Rate for Payer: Anthem Medicaid |
$12.38
|
| Rate for Payer: Anthem Medicare Advantage |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.98
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cigna Commercial |
$90.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.84
|
| Rate for Payer: Dean Health Medicaid |
$12.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.98
|
| Rate for Payer: Health EOS Commercial |
$87.22
|
| Rate for Payer: HFN Commercial |
$90.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.98
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.98
|
| Rate for Payer: Managed Health Services Medicaid |
$12.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.98
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.98
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: NAPHCARE Commercial |
$17.97
|
| Rate for Payer: Preferred Network Access Commercial |
$90.16
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12.38
|
| Rate for Payer: Quartz Beloit One Network |
$48.02
|
| Rate for Payer: Quartz Commercial |
$63.70
|
| Rate for Payer: Quartz Medicare Advantage |
$11.98
|
| Rate for Payer: The Alliance Commercial |
$47.92
|
| Rate for Payer: United Healthcare Medicaid |
$12.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.98
|
| Rate for Payer: United Healthcare PPO |
$73.50
|
| Rate for Payer: WEA Trust Commercial |
$53.90
|
| Rate for Payer: Wellcare Medicare |
$11.98
|
| Rate for Payer: WMAP Medicaid |
$12.38
|
| Rate for Payer: WPS Commercial |
$72.59
|
|
|
CLOSURE DEVICE MYNX 5F MX5060 **ACCESS CLOSURE
|
Facility
|
OP
|
$2,793.00
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
3613525
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$782.04 |
| Max. Negotiated Rate |
$11,172.00 |
| Rate for Payer: Aetna Commercial |
$2,513.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,401.98
|
| Rate for Payer: Aetna Managed Medicare |
$782.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,815.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,396.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,340.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,480.29
|
| Rate for Payer: Cash Price |
$837.90
|
| Rate for Payer: Cigna Commercial |
$2,569.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,562.96
|
| Rate for Payer: Health EOS Commercial |
$2,485.77
|
| Rate for Payer: HFN Commercial |
$2,569.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,094.75
|
| Rate for Payer: Multiplan Commercial |
$2,234.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,675.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,569.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,368.57
|
| Rate for Payer: Quartz Commercial |
$1,815.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,675.80
|
| Rate for Payer: The Alliance Commercial |
$11,172.00
|
| Rate for Payer: WEA Trust Commercial |
$1,536.15
|
| Rate for Payer: WPS Commercial |
$2,068.78
|
|
|
CLOSURE DEVICE MYNX 5F MX5060 **ACCESS CLOSURE
|
Facility
|
IP
|
$2,793.00
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
3613525
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,368.57 |
| Max. Negotiated Rate |
$2,569.56 |
| Rate for Payer: Aetna Commercial |
$2,513.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,401.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,480.29
|
| Rate for Payer: Cash Price |
$837.90
|
| Rate for Payer: Cigna Commercial |
$2,569.56
|
| Rate for Payer: Health EOS Commercial |
$2,485.77
|
| Rate for Payer: HFN Commercial |
$2,569.56
|
| Rate for Payer: Multiplan Commercial |
$2,234.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,675.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,569.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,368.57
|
| Rate for Payer: Quartz Commercial |
$1,675.80
|
| Rate for Payer: WEA Trust Commercial |
$1,536.15
|
| Rate for Payer: WPS Commercial |
$2,068.78
|
|
