|
CLOSED REDUCTION FEMUR FRACTURE
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2959959
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$512.66 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$627.74
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
CLOSED REDUCTION HIP FRACTURE
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2959963
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$552.41 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$676.42
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
CLOSED REDUCTION HIP FRACTURE
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2959963
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$315.66 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Aetna Managed Medicare |
$315.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$732.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$563.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$541.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$630.89
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.52
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: NAPHCARE Commercial |
$676.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$732.78
|
| Rate for Payer: Quartz Medicare Advantage |
$676.42
|
| Rate for Payer: The Alliance Commercial |
$563.68
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
CLOSED REDUCTION KNEE FRACTURE
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2959964
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$512.66 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$627.74
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
CLOSED REDUCTION KNEE FRACTURE
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2959964
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$292.95 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Aetna Managed Medicare |
$292.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$680.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$523.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$502.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$585.49
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.68
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: NAPHCARE Commercial |
$627.74
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$680.06
|
| Rate for Payer: Quartz Medicare Advantage |
$627.74
|
| Rate for Payer: The Alliance Commercial |
$523.12
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
CLOSED REDUCTION MANDIBLE FRACTURE
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2959965
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$292.95 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Aetna Managed Medicare |
$292.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$680.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$523.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$502.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$585.49
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.68
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: NAPHCARE Commercial |
$627.74
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$680.06
|
| Rate for Payer: Quartz Medicare Advantage |
$627.74
|
| Rate for Payer: The Alliance Commercial |
$523.12
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
CLOSED REDUCTION MANDIBLE FRACTURE
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2959965
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$512.66 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$627.74
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
CLOSED REDUCTION MAXILLA FRACTURE
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2959966
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$512.66 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$627.74
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
CLOSED REDUCTION MAXILLA FRACTURE
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2959966
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$292.95 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Aetna Managed Medicare |
$292.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$680.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$523.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$502.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$585.49
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.68
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: NAPHCARE Commercial |
$627.74
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$680.06
|
| Rate for Payer: Quartz Medicare Advantage |
$627.74
|
| Rate for Payer: The Alliance Commercial |
$523.12
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
CLOSED REDUCTION NASAL FRACTURE
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2959967
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$512.66 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$627.74
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
CLOSED REDUCTION NASAL FRACTURE
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2959967
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$292.95 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Aetna Managed Medicare |
$292.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$680.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$523.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$502.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$585.49
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.68
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: NAPHCARE Commercial |
$627.74
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$680.06
|
| Rate for Payer: Quartz Medicare Advantage |
$627.74
|
| Rate for Payer: The Alliance Commercial |
$523.12
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
CLOSED REDUCTION SHOULDER FRACTURE
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2950343
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$315.66 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Aetna Managed Medicare |
$315.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$732.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$563.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$541.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$630.89
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.52
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: NAPHCARE Commercial |
$676.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$732.78
|
| Rate for Payer: Quartz Medicare Advantage |
$676.42
|
| Rate for Payer: The Alliance Commercial |
$563.68
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
CLOSED REDUCTION SHOULDER FRACTURE
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2950343
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$552.41 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$676.42
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
CLOSED REDUCTION WRIST/HAND/FINGER FRACTURE
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2959960
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$552.41 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$676.42
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
CLOSED REDUCTION WRIST/HAND/FINGER FRACTURE
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2959960
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$315.66 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Aetna Managed Medicare |
$315.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$732.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$563.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$541.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$630.89
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.52
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: NAPHCARE Commercial |
$676.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$732.78
|
| Rate for Payer: Quartz Medicare Advantage |
$676.42
|
| Rate for Payer: The Alliance Commercial |
$563.68
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
CLOSED TREATMENT FX AND DISLOCATION
|
Facility
|
OP
|
$359.02
|
|
|
Service Code
|
EAPG 00041
|
| Min. Negotiated Rate |
$345.21 |
| Max. Negotiated Rate |
$359.02 |
| Rate for Payer: Anthem Medicaid |
$345.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$345.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$345.21
|
| Rate for Payer: Dean Health Medicaid |
$345.21
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$345.21
|
| Rate for Payer: Managed Health Services Medicaid |
$359.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$345.21
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$345.21
|
| Rate for Payer: United Healthcare Medicaid |
$345.21
|
|
|
Closed Treatment of Bimalleolar Ankle Fracture 27808
|
Professional
|
Both
|
$882.00
|
|
|
Service Code
|
CPT 27808
|
| Hospital Charge Code |
3014153
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$194.28 |
| Max. Negotiated Rate |
$1,395.06 |
| Rate for Payer: Aetna Commercial |
$871.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$788.86
|
| Rate for Payer: Aetna Managed Medicare |
$310.01
|
| Rate for Payer: Anthem Medicare Advantage |
$310.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$310.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$310.01
|
| Rate for Payer: Cash Price |
$264.60
|
| Rate for Payer: Cash Price |
$264.60
|
| Rate for Payer: Cash Price |
$264.60
|
| Rate for Payer: Cigna Commercial |
$871.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$194.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$310.01
|
| Rate for Payer: Health EOS Commercial |
$834.72
|
| Rate for Payer: HFN Commercial |
$871.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,070.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,070.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$310.01
|
| Rate for Payer: Multiplan Commercial |
$733.82
|
| Rate for Payer: NAPHCARE Commercial |
$465.02
|
| Rate for Payer: Preferred Network Access Commercial |
$871.42
|
| Rate for Payer: Quartz Beloit One Network |
$403.60
|
| Rate for Payer: Quartz Commercial |
$522.85
|
| Rate for Payer: Quartz Medicare Advantage |
$310.01
|
| Rate for Payer: The Alliance Commercial |
$1,317.56
|
| Rate for Payer: United Healthcare Medicaid |
$194.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$310.01
|
| Rate for Payer: WEA Trust Commercial |
$504.50
|
| Rate for Payer: WPS Commercial |
$1,395.06
|
|
|
CLOSED TREATMENT OF BIMALLEOLAR ANKLE FRACTURE (EG, LATERAL AND MEDIAL MALLEOLI, OR LATERAL AND POSTERIOR MALLEOLI OR MEDIAL AND POSTERIOR MALLEOLI); WITH MANIPULATION
|
Facility
|
OP
|
$6,768.94
|
|
|
Service Code
|
CPT 27810
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,692.24 |
| Max. Negotiated Rate |
$6,768.94 |
| Rate for Payer: Aetna Managed Medicare |
$1,692.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$1,692.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,692.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,692.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,692.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,692.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,295.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,692.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,692.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,692.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,692.24
|
| Rate for Payer: NAPHCARE Commercial |
$2,538.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,692.24
|
| Rate for Payer: The Alliance Commercial |
$6,768.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,692.24
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$1,692.24
|
|
|
Closed Treatment of Broken Finger or Thumb 26720
|
Professional
|
Both
|
$378.00
|
|
|
Service Code
|
CPT 26720
|
| Hospital Charge Code |
3013981
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$75.67 |
| Max. Negotiated Rate |
$894.21 |
| Rate for Payer: Aetna Commercial |
$373.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$338.08
|
| Rate for Payer: Aetna Managed Medicare |
$198.71
|
| Rate for Payer: Anthem Medicare Advantage |
$198.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$198.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$198.71
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cigna Commercial |
$373.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$75.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$198.71
|
| Rate for Payer: Health EOS Commercial |
$357.74
|
| Rate for Payer: HFN Commercial |
$373.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$655.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$655.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$198.71
|
| Rate for Payer: Multiplan Commercial |
$314.50
|
| Rate for Payer: NAPHCARE Commercial |
$298.07
|
| Rate for Payer: Preferred Network Access Commercial |
$373.46
|
| Rate for Payer: Quartz Beloit One Network |
$172.97
|
| Rate for Payer: Quartz Commercial |
$224.08
|
| Rate for Payer: Quartz Medicare Advantage |
$198.71
|
| Rate for Payer: The Alliance Commercial |
$844.53
|
| Rate for Payer: United Healthcare Medicaid |
$75.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$198.71
|
| Rate for Payer: WEA Trust Commercial |
$216.22
|
| Rate for Payer: WPS Commercial |
$894.21
|
|
|
Closed Treatment of†Broken Forearm Bone 25500
|
Professional
|
Both
|
$723.00
|
|
|
Service Code
|
CPT 25500
|
| Hospital Charge Code |
3013890
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$173.76 |
| Max. Negotiated Rate |
$1,188.30 |
| Rate for Payer: Aetna Commercial |
$714.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$646.65
|
| Rate for Payer: Aetna Managed Medicare |
$264.07
|
| Rate for Payer: Anthem Medicare Advantage |
$264.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$264.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$264.07
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Cigna Commercial |
$714.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$173.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$264.07
|
| Rate for Payer: Health EOS Commercial |
$684.25
|
| Rate for Payer: HFN Commercial |
$714.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$897.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$897.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$264.07
|
| Rate for Payer: Multiplan Commercial |
$601.54
|
| Rate for Payer: NAPHCARE Commercial |
$396.10
|
| Rate for Payer: Preferred Network Access Commercial |
$714.32
|
| Rate for Payer: Quartz Beloit One Network |
$330.84
|
| Rate for Payer: Quartz Commercial |
$428.59
|
| Rate for Payer: Quartz Medicare Advantage |
$264.07
|
| Rate for Payer: The Alliance Commercial |
$1,122.28
|
| Rate for Payer: United Healthcare Medicaid |
$173.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$264.07
|
| Rate for Payer: WEA Trust Commercial |
$413.56
|
| Rate for Payer: WPS Commercial |
$1,188.30
|
|
|
Closed Treatment of Broken Hand or Finger 26740
|
Professional
|
Both
|
$531.00
|
|
|
Service Code
|
CPT 26740
|
| Hospital Charge Code |
3013985
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$128.81 |
| Max. Negotiated Rate |
$987.43 |
| Rate for Payer: Aetna Commercial |
$524.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$474.93
|
| Rate for Payer: Aetna Managed Medicare |
$219.43
|
| Rate for Payer: Anthem Medicare Advantage |
$219.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$219.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$219.43
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Cigna Commercial |
$524.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$128.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$219.43
|
| Rate for Payer: Health EOS Commercial |
$502.54
|
| Rate for Payer: HFN Commercial |
$524.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$771.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$771.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$219.43
|
| Rate for Payer: Multiplan Commercial |
$441.79
|
| Rate for Payer: NAPHCARE Commercial |
$329.14
|
| Rate for Payer: Preferred Network Access Commercial |
$524.63
|
| Rate for Payer: Quartz Beloit One Network |
$242.99
|
| Rate for Payer: Quartz Commercial |
$314.78
|
| Rate for Payer: Quartz Medicare Advantage |
$219.43
|
| Rate for Payer: The Alliance Commercial |
$932.58
|
| Rate for Payer: United Healthcare Medicaid |
$128.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$219.43
|
| Rate for Payer: WEA Trust Commercial |
$303.73
|
| Rate for Payer: WPS Commercial |
$987.43
|
|
|
Closed Treatment of Calcaneal Fracture 28400
|
Professional
|
Both
|
$691.00
|
|
|
Service Code
|
CPT 28400
|
| Hospital Charge Code |
3014245
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$228.21 |
| Max. Negotiated Rate |
$1,026.93 |
| Rate for Payer: Aetna Commercial |
$682.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$618.03
|
| Rate for Payer: Aetna Managed Medicare |
$228.21
|
| Rate for Payer: Anthem Medicare Advantage |
$228.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$228.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$228.21
|
| Rate for Payer: Cash Price |
$207.30
|
| Rate for Payer: Cash Price |
$207.30
|
| Rate for Payer: Cash Price |
$207.30
|
| Rate for Payer: Cigna Commercial |
$682.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$235.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$228.21
|
| Rate for Payer: Health EOS Commercial |
$653.96
|
| Rate for Payer: HFN Commercial |
$682.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$801.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$801.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$228.21
|
| Rate for Payer: Multiplan Commercial |
$574.91
|
| Rate for Payer: NAPHCARE Commercial |
$342.31
|
| Rate for Payer: Preferred Network Access Commercial |
$682.71
|
| Rate for Payer: Quartz Beloit One Network |
$316.20
|
| Rate for Payer: Quartz Commercial |
$409.62
|
| Rate for Payer: Quartz Medicare Advantage |
$228.21
|
| Rate for Payer: The Alliance Commercial |
$969.88
|
| Rate for Payer: United Healthcare Medicaid |
$235.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$228.21
|
| Rate for Payer: WEA Trust Commercial |
$395.25
|
| Rate for Payer: WPS Commercial |
$1,026.93
|
|
|
Closed Treatment of†Carpal Bone Fracture 25630
|
Professional
|
Both
|
$752.00
|
|
|
Service Code
|
CPT 25630
|
| Hospital Charge Code |
3013913
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$210.24 |
| Max. Negotiated Rate |
$1,263.27 |
| Rate for Payer: Aetna Commercial |
$742.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$672.59
|
| Rate for Payer: Aetna Managed Medicare |
$280.73
|
| Rate for Payer: Anthem Medicare Advantage |
$280.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$280.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$280.73
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cigna Commercial |
$742.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$210.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$280.73
|
| Rate for Payer: Health EOS Commercial |
$711.69
|
| Rate for Payer: HFN Commercial |
$742.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$994.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$994.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$280.73
|
| Rate for Payer: Multiplan Commercial |
$625.66
|
| Rate for Payer: NAPHCARE Commercial |
$421.09
|
| Rate for Payer: Preferred Network Access Commercial |
$742.98
|
| Rate for Payer: Quartz Beloit One Network |
$344.12
|
| Rate for Payer: Quartz Commercial |
$445.79
|
| Rate for Payer: Quartz Medicare Advantage |
$280.73
|
| Rate for Payer: The Alliance Commercial |
$1,193.09
|
| Rate for Payer: United Healthcare Medicaid |
$210.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$280.73
|
| Rate for Payer: WEA Trust Commercial |
$430.14
|
| Rate for Payer: WPS Commercial |
$1,263.27
|
|
|
Closed Treatment of†Carpal Scaphoid (Navicular) Fracture 25622
|
Professional
|
Both
|
$889.00
|
|
|
Service Code
|
CPT 25622
|
| Hospital Charge Code |
3013910
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$210.24 |
| Max. Negotiated Rate |
$1,289.76 |
| Rate for Payer: Aetna Commercial |
$878.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$795.12
|
| Rate for Payer: Aetna Managed Medicare |
$286.61
|
| Rate for Payer: Anthem Medicare Advantage |
$286.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$286.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$286.61
|
| Rate for Payer: Cash Price |
$266.70
|
| Rate for Payer: Cash Price |
$266.70
|
| Rate for Payer: Cash Price |
$266.70
|
| Rate for Payer: Cigna Commercial |
$878.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$210.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$286.61
|
| Rate for Payer: Health EOS Commercial |
$841.35
|
| Rate for Payer: HFN Commercial |
$878.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$992.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$992.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$286.61
|
| Rate for Payer: Multiplan Commercial |
$739.65
|
| Rate for Payer: NAPHCARE Commercial |
$429.92
|
| Rate for Payer: Preferred Network Access Commercial |
$878.33
|
| Rate for Payer: Quartz Beloit One Network |
$406.81
|
| Rate for Payer: Quartz Commercial |
$527.00
|
| Rate for Payer: Quartz Medicare Advantage |
$286.61
|
| Rate for Payer: The Alliance Commercial |
$1,218.11
|
| Rate for Payer: United Healthcare Medicaid |
$210.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$286.61
|
| Rate for Payer: WEA Trust Commercial |
$508.51
|
| Rate for Payer: WPS Commercial |
$1,289.76
|
|
|
Closed Treatment of Clavicular Fracture 23500
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
CPT 23500
|
| Hospital Charge Code |
3013781
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$71.25 |
| Max. Negotiated Rate |
$1,067.55 |
| Rate for Payer: Aetna Commercial |
$543.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$491.92
|
| Rate for Payer: Aetna Managed Medicare |
$237.23
|
| Rate for Payer: Anthem Medicare Advantage |
$237.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$237.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$237.23
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna Commercial |
$543.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$71.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$237.23
|
| Rate for Payer: Health EOS Commercial |
$520.52
|
| Rate for Payer: HFN Commercial |
$543.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$792.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$792.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$237.23
|
| Rate for Payer: Multiplan Commercial |
$457.60
|
| Rate for Payer: NAPHCARE Commercial |
$355.85
|
| Rate for Payer: Preferred Network Access Commercial |
$543.40
|
| Rate for Payer: Quartz Beloit One Network |
$251.68
|
| Rate for Payer: Quartz Commercial |
$326.04
|
| Rate for Payer: Quartz Medicare Advantage |
$237.23
|
| Rate for Payer: The Alliance Commercial |
$1,008.25
|
| Rate for Payer: United Healthcare Medicaid |
$71.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$237.23
|
| Rate for Payer: WEA Trust Commercial |
$314.60
|
| Rate for Payer: WPS Commercial |
$1,067.55
|
|
