|
CLOSED TREATMENT OF DISTAL EXTENSOR TENDON INSERTION, WITH OR WITHOUT PERCUTANEOUS PINNING (EG, MALLET FINGER)
|
Facility
|
OP
|
$6,807.99
|
|
|
Service Code
|
CPT 26432
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,692.24 |
| Max. Negotiated Rate |
$6,807.99 |
| 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 |
$6,807.99
|
| 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 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 |
$188.03 |
| Max. Negotiated Rate |
$1,280.73 |
| Rate for Payer: Aetna Commercial |
$785.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$711.05
|
| Rate for Payer: Aetna Managed Medicare |
$284.61
|
| Rate for Payer: Anthem Medicare Advantage |
$284.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$284.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$284.61
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Cigna Commercial |
$785.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$188.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$284.61
|
| Rate for Payer: Health EOS Commercial |
$752.39
|
| Rate for Payer: HFN Commercial |
$785.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,010.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,010.32
|
| Rate for Payer: Independent Care Health Plan Medicare |
$284.61
|
| Rate for Payer: Multiplan Commercial |
$661.44
|
| Rate for Payer: NAPHCARE Commercial |
$426.91
|
| Rate for Payer: Preferred Network Access Commercial |
$785.46
|
| Rate for Payer: Quartz Beloit One Network |
$363.79
|
| Rate for Payer: Quartz Commercial |
$471.28
|
| Rate for Payer: Quartz Medicare Advantage |
$284.61
|
| Rate for Payer: The Alliance Commercial |
$1,209.58
|
| Rate for Payer: United Healthcare Medicaid |
$188.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$284.61
|
| Rate for Payer: WEA Trust Commercial |
$454.74
|
| Rate for Payer: WPS Commercial |
$1,280.73
|
|
|
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 |
$175.22 |
| Max. Negotiated Rate |
$1,495.35 |
| Rate for Payer: Aetna Commercial |
$542.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$491.03
|
| Rate for Payer: Aetna Managed Medicare |
$332.30
|
| Rate for Payer: Anthem Medicare Advantage |
$332.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$332.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$332.30
|
| Rate for Payer: Cash Price |
$164.70
|
| Rate for Payer: Cash Price |
$164.70
|
| Rate for Payer: Cash Price |
$164.70
|
| Rate for Payer: Cigna Commercial |
$542.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$175.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$332.30
|
| Rate for Payer: Health EOS Commercial |
$519.57
|
| Rate for Payer: HFN Commercial |
$542.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,128.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,128.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$332.30
|
| Rate for Payer: Multiplan Commercial |
$456.77
|
| Rate for Payer: NAPHCARE Commercial |
$498.45
|
| Rate for Payer: Preferred Network Access Commercial |
$542.41
|
| Rate for Payer: Quartz Beloit One Network |
$251.22
|
| Rate for Payer: Quartz Commercial |
$325.45
|
| Rate for Payer: Quartz Medicare Advantage |
$332.30
|
| Rate for Payer: The Alliance Commercial |
$1,412.28
|
| Rate for Payer: United Healthcare Medicaid |
$175.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$332.30
|
| Rate for Payer: WEA Trust Commercial |
$314.03
|
| Rate for Payer: WPS Commercial |
$1,495.35
|
|
|
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
|
$6,807.99
|
|
|
Service Code
|
CPT 25605
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,692.24 |
| Max. Negotiated Rate |
$6,807.99 |
| 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 |
$6,807.99
|
| 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†Distal Radioulnar Dislocation 25675
|
Professional
|
Both
|
$1,077.00
|
|
|
Service Code
|
CPT 25675
|
| Hospital Charge Code |
3013920
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$391.73 |
| Max. Negotiated Rate |
$2,110.35 |
| Rate for Payer: Aetna Commercial |
$1,064.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$963.27
|
| Rate for Payer: Aetna Managed Medicare |
$468.97
|
| Rate for Payer: Anthem Medicare Advantage |
$468.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$468.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$468.97
|
| Rate for Payer: Cash Price |
$323.10
|
| Rate for Payer: Cash Price |
$323.10
|
| Rate for Payer: Cash Price |
$323.10
|
| Rate for Payer: Cigna Commercial |
$1,064.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$391.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$468.97
|
| Rate for Payer: Health EOS Commercial |
$1,019.27
|
| Rate for Payer: HFN Commercial |
$1,064.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,398.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,398.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$468.97
|
| Rate for Payer: Multiplan Commercial |
$896.06
|
| Rate for Payer: NAPHCARE Commercial |
$703.45
|
| Rate for Payer: Preferred Network Access Commercial |
$1,064.08
|
| Rate for Payer: Quartz Beloit One Network |
$492.84
|
| Rate for Payer: Quartz Commercial |
$638.45
|
| Rate for Payer: Quartz Medicare Advantage |
$468.97
|
| Rate for Payer: The Alliance Commercial |
$1,993.11
|
| Rate for Payer: United Healthcare Medicaid |
$391.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$468.97
|
| Rate for Payer: WEA Trust Commercial |
$616.04
|
| Rate for Payer: WPS Commercial |
$2,110.35
|
|
|
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 |
$87.09 |
| Max. Negotiated Rate |
$583.22 |
| Rate for Payer: Aetna Commercial |
$273.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$247.75
|
| Rate for Payer: Aetna Managed Medicare |
$129.60
|
| Rate for Payer: Anthem Medicare Advantage |
$129.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$129.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$129.60
|
| Rate for Payer: Cash Price |
$83.10
|
| Rate for Payer: Cash Price |
$83.10
|
| Rate for Payer: Cash Price |
$83.10
|
| Rate for Payer: Cigna Commercial |
$273.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$87.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$129.60
|
| Rate for Payer: Health EOS Commercial |
$262.15
|
| Rate for Payer: HFN Commercial |
$273.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$433.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$433.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$129.60
|
| Rate for Payer: Multiplan Commercial |
$230.46
|
| Rate for Payer: NAPHCARE Commercial |
$194.41
|
| Rate for Payer: Preferred Network Access Commercial |
$273.68
|
| Rate for Payer: Quartz Beloit One Network |
$126.76
|
| Rate for Payer: Quartz Commercial |
$164.21
|
| Rate for Payer: Quartz Medicare Advantage |
$129.60
|
| Rate for Payer: The Alliance Commercial |
$550.82
|
| Rate for Payer: United Healthcare Medicaid |
$87.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$129.60
|
| Rate for Payer: WEA Trust Commercial |
$158.44
|
| Rate for Payer: WPS Commercial |
$583.22
|
|
|
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 |
$221.83 |
| Max. Negotiated Rate |
$1,379.29 |
| Rate for Payer: Aetna Commercial |
$1,223.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,107.27
|
| Rate for Payer: Aetna Managed Medicare |
$306.51
|
| Rate for Payer: Anthem Medicare Advantage |
$306.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$306.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$306.51
|
| Rate for Payer: Cash Price |
$371.40
|
| Rate for Payer: Cash Price |
$371.40
|
| Rate for Payer: Cash Price |
$371.40
|
| Rate for Payer: Cigna Commercial |
$1,223.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$221.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$306.51
|
| Rate for Payer: Health EOS Commercial |
$1,171.64
|
| Rate for Payer: HFN Commercial |
$1,223.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,068.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,068.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$306.51
|
| Rate for Payer: Multiplan Commercial |
$1,030.02
|
| Rate for Payer: NAPHCARE Commercial |
$459.76
|
| Rate for Payer: Preferred Network Access Commercial |
$1,223.14
|
| Rate for Payer: Quartz Beloit One Network |
$566.51
|
| Rate for Payer: Quartz Commercial |
$733.89
|
| Rate for Payer: Quartz Medicare Advantage |
$306.51
|
| Rate for Payer: The Alliance Commercial |
$1,302.66
|
| Rate for Payer: United Healthcare Medicaid |
$221.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$306.51
|
| Rate for Payer: WEA Trust Commercial |
$708.14
|
| Rate for Payer: WPS Commercial |
$1,379.29
|
|
|
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
|
$6,768.94
|
|
|
Service Code
|
CPT 27825
|
|
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 |
$4,947.89
|
| 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†Greater Humeral Tuberosity Fracture 23620
|
Professional
|
Both
|
$529.00
|
|
|
Service Code
|
CPT 23620
|
| Hospital Charge Code |
3013793
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$125.34 |
| Max. Negotiated Rate |
$1,183.01 |
| Rate for Payer: Aetna Commercial |
$522.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$473.14
|
| Rate for Payer: Aetna Managed Medicare |
$262.89
|
| Rate for Payer: Anthem Medicare Advantage |
$262.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$262.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$262.89
|
| Rate for Payer: Cash Price |
$158.70
|
| Rate for Payer: Cash Price |
$158.70
|
| Rate for Payer: Cash Price |
$158.70
|
| Rate for Payer: Cigna Commercial |
$522.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$125.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$262.89
|
| Rate for Payer: Health EOS Commercial |
$500.65
|
| Rate for Payer: HFN Commercial |
$522.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$907.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$907.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$262.89
|
| Rate for Payer: Multiplan Commercial |
$440.13
|
| Rate for Payer: NAPHCARE Commercial |
$394.34
|
| Rate for Payer: Preferred Network Access Commercial |
$522.65
|
| Rate for Payer: Quartz Beloit One Network |
$242.07
|
| Rate for Payer: Quartz Commercial |
$313.59
|
| Rate for Payer: Quartz Medicare Advantage |
$262.89
|
| Rate for Payer: The Alliance Commercial |
$1,117.29
|
| Rate for Payer: United Healthcare Medicaid |
$125.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$262.89
|
| Rate for Payer: WEA Trust Commercial |
$302.59
|
| Rate for Payer: WPS Commercial |
$1,183.01
|
|
|
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 |
$188.03 |
| Max. Negotiated Rate |
$1,468.54 |
| Rate for Payer: Aetna Commercial |
$818.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$740.56
|
| Rate for Payer: Aetna Managed Medicare |
$326.34
|
| Rate for Payer: Anthem Medicare Advantage |
$326.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$326.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$326.34
|
| Rate for Payer: Cash Price |
$248.40
|
| Rate for Payer: Cash Price |
$248.40
|
| Rate for Payer: Cash Price |
$248.40
|
| Rate for Payer: Cigna Commercial |
$818.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$188.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$326.34
|
| Rate for Payer: Health EOS Commercial |
$783.62
|
| Rate for Payer: HFN Commercial |
$818.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,092.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,092.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$326.34
|
| Rate for Payer: Multiplan Commercial |
$688.90
|
| Rate for Payer: NAPHCARE Commercial |
$489.51
|
| Rate for Payer: Preferred Network Access Commercial |
$818.06
|
| Rate for Payer: Quartz Beloit One Network |
$378.89
|
| Rate for Payer: Quartz Commercial |
$490.84
|
| Rate for Payer: Quartz Medicare Advantage |
$326.34
|
| Rate for Payer: The Alliance Commercial |
$1,386.95
|
| Rate for Payer: United Healthcare Medicaid |
$188.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$326.34
|
| Rate for Payer: WEA Trust Commercial |
$473.62
|
| Rate for Payer: WPS Commercial |
$1,468.54
|
|
|
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 |
$188.03 |
| Max. Negotiated Rate |
$1,390.71 |
| Rate for Payer: Aetna Commercial |
$853.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$772.76
|
| Rate for Payer: Aetna Managed Medicare |
$309.05
|
| Rate for Payer: Anthem Medicare Advantage |
$309.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$309.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$309.05
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cigna Commercial |
$853.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$188.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$309.05
|
| Rate for Payer: Health EOS Commercial |
$817.69
|
| Rate for Payer: HFN Commercial |
$853.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,032.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,032.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$309.05
|
| Rate for Payer: Multiplan Commercial |
$718.85
|
| Rate for Payer: NAPHCARE Commercial |
$463.57
|
| Rate for Payer: Preferred Network Access Commercial |
$853.63
|
| Rate for Payer: Quartz Beloit One Network |
$395.37
|
| Rate for Payer: Quartz Commercial |
$512.18
|
| Rate for Payer: Quartz Medicare Advantage |
$309.05
|
| Rate for Payer: The Alliance Commercial |
$1,313.45
|
| Rate for Payer: United Healthcare Medicaid |
$188.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$309.05
|
| Rate for Payer: WEA Trust Commercial |
$494.21
|
| Rate for Payer: WPS Commercial |
$1,390.71
|
|
|
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 |
$237.78 |
| Max. Negotiated Rate |
$1,514.07 |
| Rate for Payer: Aetna Commercial |
$862.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$780.81
|
| Rate for Payer: Aetna Managed Medicare |
$336.46
|
| Rate for Payer: Anthem Medicare Advantage |
$336.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$336.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$336.46
|
| Rate for Payer: Cash Price |
$261.90
|
| Rate for Payer: Cash Price |
$261.90
|
| Rate for Payer: Cash Price |
$261.90
|
| Rate for Payer: Cigna Commercial |
$862.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$237.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$336.46
|
| Rate for Payer: Health EOS Commercial |
$826.21
|
| Rate for Payer: HFN Commercial |
$862.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,161.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,161.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$336.46
|
| Rate for Payer: Multiplan Commercial |
$726.34
|
| Rate for Payer: NAPHCARE Commercial |
$504.69
|
| Rate for Payer: Preferred Network Access Commercial |
$862.52
|
| Rate for Payer: Quartz Beloit One Network |
$399.48
|
| Rate for Payer: Quartz Commercial |
$517.51
|
| Rate for Payer: Quartz Medicare Advantage |
$336.46
|
| Rate for Payer: The Alliance Commercial |
$1,429.96
|
| Rate for Payer: United Healthcare Medicaid |
$237.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$336.46
|
| Rate for Payer: WEA Trust Commercial |
$499.36
|
| Rate for Payer: WPS Commercial |
$1,514.07
|
|
|
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 |
$313.36 |
| Max. Negotiated Rate |
$1,945.01 |
| Rate for Payer: Aetna Commercial |
$1,389.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,257.53
|
| Rate for Payer: Aetna Managed Medicare |
$432.22
|
| Rate for Payer: Anthem Medicare Advantage |
$432.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$432.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$432.22
|
| Rate for Payer: Cash Price |
$421.80
|
| Rate for Payer: Cash Price |
$421.80
|
| Rate for Payer: Cash Price |
$421.80
|
| Rate for Payer: Cigna Commercial |
$1,389.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$313.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$432.22
|
| Rate for Payer: Health EOS Commercial |
$1,330.64
|
| Rate for Payer: HFN Commercial |
$1,389.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,562.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,562.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$432.22
|
| Rate for Payer: Multiplan Commercial |
$1,169.79
|
| Rate for Payer: NAPHCARE Commercial |
$648.34
|
| Rate for Payer: Preferred Network Access Commercial |
$1,389.13
|
| Rate for Payer: Quartz Beloit One Network |
$643.39
|
| Rate for Payer: Quartz Commercial |
$833.48
|
| Rate for Payer: Quartz Medicare Advantage |
$432.22
|
| Rate for Payer: The Alliance Commercial |
$1,836.95
|
| Rate for Payer: United Healthcare Medicaid |
$313.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$432.22
|
| Rate for Payer: WEA Trust Commercial |
$804.23
|
| Rate for Payer: WPS Commercial |
$1,945.01
|
|
|
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 |
$188.03 |
| Max. Negotiated Rate |
$1,393.70 |
| Rate for Payer: Aetna Commercial |
$818.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$740.56
|
| Rate for Payer: Aetna Managed Medicare |
$309.71
|
| Rate for Payer: Anthem Medicare Advantage |
$309.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$309.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$309.71
|
| Rate for Payer: Cash Price |
$248.40
|
| Rate for Payer: Cash Price |
$248.40
|
| Rate for Payer: Cash Price |
$248.40
|
| Rate for Payer: Cigna Commercial |
$818.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$188.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$309.71
|
| Rate for Payer: Health EOS Commercial |
$783.62
|
| Rate for Payer: HFN Commercial |
$818.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,076.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,076.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$309.71
|
| Rate for Payer: Multiplan Commercial |
$688.90
|
| Rate for Payer: NAPHCARE Commercial |
$464.57
|
| Rate for Payer: Preferred Network Access Commercial |
$818.06
|
| Rate for Payer: Quartz Beloit One Network |
$378.89
|
| Rate for Payer: Quartz Commercial |
$490.84
|
| Rate for Payer: Quartz Medicare Advantage |
$309.71
|
| Rate for Payer: The Alliance Commercial |
$1,316.28
|
| Rate for Payer: United Healthcare Medicaid |
$188.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$309.71
|
| Rate for Payer: WEA Trust Commercial |
$473.62
|
| Rate for Payer: WPS Commercial |
$1,393.70
|
|
|
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 |
$158.38 |
| Max. Negotiated Rate |
$1,314.66 |
| Rate for Payer: Aetna Commercial |
$482.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$436.47
|
| Rate for Payer: Aetna Managed Medicare |
$292.15
|
| Rate for Payer: Anthem Medicare Advantage |
$292.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$292.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$292.15
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cigna Commercial |
$482.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$158.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$292.15
|
| Rate for Payer: Health EOS Commercial |
$461.84
|
| Rate for Payer: HFN Commercial |
$482.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$999.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$999.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$292.15
|
| Rate for Payer: Multiplan Commercial |
$406.02
|
| Rate for Payer: NAPHCARE Commercial |
$438.22
|
| Rate for Payer: Preferred Network Access Commercial |
$482.14
|
| Rate for Payer: Quartz Beloit One Network |
$223.31
|
| Rate for Payer: Quartz Commercial |
$289.29
|
| Rate for Payer: Quartz Medicare Advantage |
$292.15
|
| Rate for Payer: The Alliance Commercial |
$1,241.62
|
| Rate for Payer: United Healthcare Medicaid |
$158.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$292.15
|
| Rate for Payer: WEA Trust Commercial |
$279.14
|
| Rate for Payer: WPS Commercial |
$1,314.66
|
|
|
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 |
$158.38 |
| Max. Negotiated Rate |
$919.48 |
| Rate for Payer: Aetna Commercial |
$575.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$520.54
|
| Rate for Payer: Aetna Managed Medicare |
$204.33
|
| Rate for Payer: Anthem Medicare Advantage |
$204.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$204.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$204.33
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cigna Commercial |
$575.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$158.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$204.33
|
| Rate for Payer: Health EOS Commercial |
$550.80
|
| Rate for Payer: HFN Commercial |
$575.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$719.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$719.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$204.33
|
| Rate for Payer: Multiplan Commercial |
$484.22
|
| Rate for Payer: NAPHCARE Commercial |
$306.49
|
| Rate for Payer: Preferred Network Access Commercial |
$575.02
|
| Rate for Payer: Quartz Beloit One Network |
$266.32
|
| Rate for Payer: Quartz Commercial |
$345.01
|
| Rate for Payer: Quartz Medicare Advantage |
$204.33
|
| Rate for Payer: The Alliance Commercial |
$868.40
|
| Rate for Payer: United Healthcare Medicaid |
$158.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$204.33
|
| Rate for Payer: WEA Trust Commercial |
$332.90
|
| Rate for Payer: WPS Commercial |
$919.48
|
|
|
CLOSED TREATMENT OF NASAL BONE FRACTURE WITH MANIPULATION; WITH STABILIZATION
|
Facility
|
OP
|
$13,956.63
|
|
|
Service Code
|
CPT 21320
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,835.04 |
| Max. Negotiated Rate |
$13,956.63 |
| Rate for Payer: Aetna Managed Medicare |
$3,489.16
|
| 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 |
$3,489.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,489.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,489.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,489.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,489.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,979.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,489.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,489.16
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,489.16
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,489.16
|
| Rate for Payer: NAPHCARE Commercial |
$5,233.74
|
| Rate for Payer: Quartz Medicare Advantage |
$3,489.16
|
| Rate for Payer: The Alliance Commercial |
$13,956.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,489.16
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$3,489.16
|
|
|
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 |
$199.10 |
| Max. Negotiated Rate |
$1,351.63 |
| Rate for Payer: Aetna Commercial |
$894.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$809.43
|
| Rate for Payer: Aetna Managed Medicare |
$300.36
|
| Rate for Payer: Anthem Medicare Advantage |
$300.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$300.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$300.36
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cigna Commercial |
$894.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$199.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$300.36
|
| Rate for Payer: Health EOS Commercial |
$856.49
|
| Rate for Payer: HFN Commercial |
$894.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,048.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,048.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$300.36
|
| Rate for Payer: Multiplan Commercial |
$752.96
|
| Rate for Payer: NAPHCARE Commercial |
$450.54
|
| Rate for Payer: Preferred Network Access Commercial |
$894.14
|
| Rate for Payer: Quartz Beloit One Network |
$414.13
|
| Rate for Payer: Quartz Commercial |
$536.48
|
| Rate for Payer: Quartz Medicare Advantage |
$300.36
|
| Rate for Payer: The Alliance Commercial |
$1,276.54
|
| Rate for Payer: United Healthcare Medicaid |
$199.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$300.36
|
| Rate for Payer: WEA Trust Commercial |
$517.66
|
| Rate for Payer: WPS Commercial |
$1,351.63
|
|
|
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 |
$134.74 |
| Max. Negotiated Rate |
$1,392.72 |
| Rate for Payer: Aetna Commercial |
$786.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$711.94
|
| Rate for Payer: Aetna Managed Medicare |
$309.49
|
| Rate for Payer: Anthem Medicare Advantage |
$309.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$309.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$309.49
|
| Rate for Payer: Cash Price |
$238.80
|
| Rate for Payer: Cash Price |
$238.80
|
| Rate for Payer: Cash Price |
$238.80
|
| Rate for Payer: Cigna Commercial |
$786.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$134.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$309.49
|
| Rate for Payer: Health EOS Commercial |
$753.33
|
| Rate for Payer: HFN Commercial |
$786.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,061.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,061.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$309.49
|
| Rate for Payer: Multiplan Commercial |
$662.27
|
| Rate for Payer: NAPHCARE Commercial |
$464.24
|
| Rate for Payer: Preferred Network Access Commercial |
$786.45
|
| Rate for Payer: Quartz Beloit One Network |
$364.25
|
| Rate for Payer: Quartz Commercial |
$471.87
|
| Rate for Payer: Quartz Medicare Advantage |
$309.49
|
| Rate for Payer: The Alliance Commercial |
$1,315.35
|
| Rate for Payer: United Healthcare Medicaid |
$134.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$309.49
|
| Rate for Payer: WEA Trust Commercial |
$455.31
|
| Rate for Payer: WPS Commercial |
$1,392.72
|
|
|
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 |
$62.68 |
| Max. Negotiated Rate |
$552.33 |
| Rate for Payer: Aetna Commercial |
$215.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$194.98
|
| Rate for Payer: Aetna Managed Medicare |
$122.74
|
| Rate for Payer: Anthem Medicare Advantage |
$122.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$122.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$122.74
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cigna Commercial |
$215.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$62.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$122.74
|
| Rate for Payer: Health EOS Commercial |
$206.32
|
| Rate for Payer: HFN Commercial |
$215.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$419.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$419.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$122.74
|
| Rate for Payer: Multiplan Commercial |
$181.38
|
| Rate for Payer: NAPHCARE Commercial |
$184.11
|
| Rate for Payer: Preferred Network Access Commercial |
$215.38
|
| Rate for Payer: Quartz Beloit One Network |
$99.76
|
| Rate for Payer: Quartz Commercial |
$129.23
|
| Rate for Payer: Quartz Medicare Advantage |
$122.74
|
| Rate for Payer: The Alliance Commercial |
$521.65
|
| Rate for Payer: United Healthcare Medicaid |
$62.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.74
|
| Rate for Payer: WEA Trust Commercial |
$124.70
|
| Rate for Payer: WPS Commercial |
$552.33
|
|
|
CLOSED TREATMENT OF POST HIP ARTHROPLASTY DISLOCATION; REQUIRING REGIONAL OR GENERAL ANESTHESIA
|
Facility
|
OP
|
$6,768.94
|
|
|
Service Code
|
CPT 27266
|
|
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 |
$4,947.89
|
| 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 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 |
$194.28 |
| Max. Negotiated Rate |
$1,297.02 |
| Rate for Payer: Aetna Commercial |
$637.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$576.89
|
| Rate for Payer: Aetna Managed Medicare |
$288.23
|
| Rate for Payer: Anthem Medicare Advantage |
$288.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$288.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$288.23
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cigna Commercial |
$637.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$194.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$288.23
|
| Rate for Payer: Health EOS Commercial |
$610.43
|
| Rate for Payer: HFN Commercial |
$637.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$995.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$995.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$288.23
|
| Rate for Payer: Multiplan Commercial |
$536.64
|
| Rate for Payer: NAPHCARE Commercial |
$432.34
|
| Rate for Payer: Preferred Network Access Commercial |
$637.26
|
| Rate for Payer: Quartz Beloit One Network |
$295.15
|
| Rate for Payer: Quartz Commercial |
$382.36
|
| Rate for Payer: Quartz Medicare Advantage |
$288.23
|
| Rate for Payer: The Alliance Commercial |
$1,224.96
|
| Rate for Payer: United Healthcare Medicaid |
$194.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$288.23
|
| Rate for Payer: WEA Trust Commercial |
$368.94
|
| Rate for Payer: WPS Commercial |
$1,297.02
|
|
|
CLOSED TREATMENT OF PROXIMAL FIBULA OR SHAFT FRACTURE; WITH MANIPULATION
|
Facility
|
OP
|
$6,768.94
|
|
|
Service Code
|
CPT 27781
|
|
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†Proximal Humeral Fracture 23600
|
Professional
|
Both
|
$849.00
|
|
|
Service Code
|
CPT 23600
|
| Hospital Charge Code |
3013789
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$250.71 |
| Max. Negotiated Rate |
$1,445.79 |
| Rate for Payer: Aetna Commercial |
$838.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$759.35
|
| Rate for Payer: Aetna Managed Medicare |
$321.29
|
| Rate for Payer: Anthem Medicare Advantage |
$321.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$321.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$321.29
|
| Rate for Payer: Cash Price |
$254.70
|
| Rate for Payer: Cash Price |
$254.70
|
| Rate for Payer: Cash Price |
$254.70
|
| Rate for Payer: Cigna Commercial |
$838.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$250.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$321.29
|
| Rate for Payer: Health EOS Commercial |
$803.49
|
| Rate for Payer: HFN Commercial |
$838.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,101.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,101.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$321.29
|
| Rate for Payer: Multiplan Commercial |
$706.37
|
| Rate for Payer: NAPHCARE Commercial |
$481.93
|
| Rate for Payer: Preferred Network Access Commercial |
$838.81
|
| Rate for Payer: Quartz Beloit One Network |
$388.50
|
| Rate for Payer: Quartz Commercial |
$503.29
|
| Rate for Payer: Quartz Medicare Advantage |
$321.29
|
| Rate for Payer: The Alliance Commercial |
$1,365.47
|
| Rate for Payer: United Healthcare Medicaid |
$250.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$321.29
|
| Rate for Payer: WEA Trust Commercial |
$485.63
|
| Rate for Payer: WPS Commercial |
$1,445.79
|
|
|
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 |
$206.12 |
| Max. Negotiated Rate |
$1,191.25 |
| Rate for Payer: Aetna Commercial |
$832.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$753.98
|
| Rate for Payer: Aetna Managed Medicare |
$264.72
|
| Rate for Payer: Anthem Medicare Advantage |
$264.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$264.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$264.72
|
| Rate for Payer: Cash Price |
$252.90
|
| Rate for Payer: Cash Price |
$252.90
|
| Rate for Payer: Cash Price |
$252.90
|
| Rate for Payer: Cigna Commercial |
$832.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$206.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$264.72
|
| Rate for Payer: Health EOS Commercial |
$797.82
|
| Rate for Payer: HFN Commercial |
$832.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$902.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$902.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$264.72
|
| Rate for Payer: Multiplan Commercial |
$701.38
|
| Rate for Payer: NAPHCARE Commercial |
$397.08
|
| Rate for Payer: Preferred Network Access Commercial |
$832.88
|
| Rate for Payer: Quartz Beloit One Network |
$385.76
|
| Rate for Payer: Quartz Commercial |
$499.73
|
| Rate for Payer: Quartz Medicare Advantage |
$264.72
|
| Rate for Payer: The Alliance Commercial |
$1,125.07
|
| Rate for Payer: United Healthcare Medicaid |
$206.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$264.72
|
| Rate for Payer: WEA Trust Commercial |
$482.20
|
| Rate for Payer: WPS Commercial |
$1,191.25
|
|
