|
CLOSED TREATMENT OF RADIAL AND ULNAR SHAFT FRACTURES; WITH MANIPULATION
|
Facility
|
OP
|
$6,768.94
|
|
|
Service Code
|
CPT 25565
|
|
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 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 |
$198.19 |
| Max. Negotiated Rate |
$1,128.11 |
| Rate for Payer: Aetna Commercial |
$639.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$578.68
|
| Rate for Payer: Aetna Managed Medicare |
$250.69
|
| Rate for Payer: Anthem Medicare Advantage |
$250.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$250.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$250.69
|
| Rate for Payer: Cash Price |
$194.10
|
| Rate for Payer: Cash Price |
$194.10
|
| Rate for Payer: Cash Price |
$194.10
|
| Rate for Payer: Cigna Commercial |
$639.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$198.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$250.69
|
| Rate for Payer: Health EOS Commercial |
$612.32
|
| Rate for Payer: HFN Commercial |
$639.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$859.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$859.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$250.69
|
| Rate for Payer: Multiplan Commercial |
$538.30
|
| Rate for Payer: NAPHCARE Commercial |
$376.04
|
| Rate for Payer: Preferred Network Access Commercial |
$639.24
|
| Rate for Payer: Quartz Beloit One Network |
$296.07
|
| Rate for Payer: Quartz Commercial |
$383.54
|
| Rate for Payer: Quartz Medicare Advantage |
$250.69
|
| Rate for Payer: The Alliance Commercial |
$1,065.44
|
| Rate for Payer: United Healthcare Medicaid |
$198.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$250.69
|
| Rate for Payer: WEA Trust Commercial |
$370.08
|
| Rate for Payer: WPS Commercial |
$1,128.11
|
|
|
CLOSED TREATMENT OF RADIAL SHAFT FRACTURE; WITH MANIPULATION
|
Facility
|
OP
|
$6,768.94
|
|
|
Service Code
|
CPT 25505
|
|
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†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 |
$109.67 |
| Max. Negotiated Rate |
$1,924.42 |
| Rate for Payer: Aetna Commercial |
$1,092.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$989.21
|
| Rate for Payer: Aetna Managed Medicare |
$427.65
|
| Rate for Payer: Anthem Medicare Advantage |
$427.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$427.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$427.65
|
| Rate for Payer: Cash Price |
$331.80
|
| Rate for Payer: Cash Price |
$331.80
|
| Rate for Payer: Cash Price |
$331.80
|
| Rate for Payer: Cigna Commercial |
$1,092.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$109.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$427.65
|
| Rate for Payer: Health EOS Commercial |
$1,046.72
|
| Rate for Payer: HFN Commercial |
$1,092.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,555.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,555.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$427.65
|
| Rate for Payer: Multiplan Commercial |
$920.19
|
| Rate for Payer: NAPHCARE Commercial |
$641.47
|
| Rate for Payer: Preferred Network Access Commercial |
$1,092.73
|
| Rate for Payer: Quartz Beloit One Network |
$506.11
|
| Rate for Payer: Quartz Commercial |
$655.64
|
| Rate for Payer: Quartz Medicare Advantage |
$427.65
|
| Rate for Payer: The Alliance Commercial |
$1,817.50
|
| Rate for Payer: United Healthcare Medicaid |
$109.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$427.65
|
| Rate for Payer: WEA Trust Commercial |
$632.63
|
| Rate for Payer: WPS Commercial |
$1,924.42
|
|
|
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 |
$250.71 |
| Max. Negotiated Rate |
$1,558.77 |
| Rate for Payer: Aetna Commercial |
$905.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$819.27
|
| Rate for Payer: Aetna Managed Medicare |
$346.39
|
| Rate for Payer: Anthem Medicare Advantage |
$346.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$346.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$346.39
|
| Rate for Payer: Cash Price |
$274.80
|
| Rate for Payer: Cash Price |
$274.80
|
| Rate for Payer: Cash Price |
$274.80
|
| Rate for Payer: Cigna Commercial |
$905.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$250.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$346.39
|
| Rate for Payer: Health EOS Commercial |
$866.90
|
| Rate for Payer: HFN Commercial |
$905.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,222.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,222.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$346.39
|
| Rate for Payer: Multiplan Commercial |
$762.11
|
| Rate for Payer: NAPHCARE Commercial |
$519.59
|
| Rate for Payer: Preferred Network Access Commercial |
$905.01
|
| Rate for Payer: Quartz Beloit One Network |
$419.16
|
| Rate for Payer: Quartz Commercial |
$543.00
|
| Rate for Payer: Quartz Medicare Advantage |
$346.39
|
| Rate for Payer: The Alliance Commercial |
$1,472.17
|
| Rate for Payer: United Healthcare Medicaid |
$250.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$346.39
|
| Rate for Payer: WEA Trust Commercial |
$523.95
|
| Rate for Payer: WPS Commercial |
$1,558.77
|
|
|
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 |
$210.77 |
| Max. Negotiated Rate |
$948.45 |
| Rate for Payer: Aetna Commercial |
$806.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$729.83
|
| Rate for Payer: Aetna Managed Medicare |
$210.77
|
| Rate for Payer: Anthem Medicare Advantage |
$210.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$210.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$210.77
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cigna Commercial |
$806.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$235.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$210.77
|
| Rate for Payer: Health EOS Commercial |
$772.26
|
| Rate for Payer: HFN Commercial |
$806.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$738.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$738.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$210.77
|
| Rate for Payer: Multiplan Commercial |
$678.91
|
| Rate for Payer: NAPHCARE Commercial |
$316.15
|
| Rate for Payer: Preferred Network Access Commercial |
$806.21
|
| Rate for Payer: Quartz Beloit One Network |
$373.40
|
| Rate for Payer: Quartz Commercial |
$483.72
|
| Rate for Payer: Quartz Medicare Advantage |
$210.77
|
| Rate for Payer: The Alliance Commercial |
$895.76
|
| Rate for Payer: United Healthcare Medicaid |
$235.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$210.77
|
| Rate for Payer: WEA Trust Commercial |
$466.75
|
| Rate for Payer: WPS Commercial |
$948.45
|
|
|
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 |
$146.99 |
| Max. Negotiated Rate |
$856.11 |
| Rate for Payer: Aetna Commercial |
$660.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$598.35
|
| Rate for Payer: Aetna Managed Medicare |
$190.25
|
| Rate for Payer: Anthem Medicare Advantage |
$190.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$190.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$190.25
|
| Rate for Payer: Cash Price |
$200.70
|
| Rate for Payer: Cash Price |
$200.70
|
| Rate for Payer: Cash Price |
$200.70
|
| Rate for Payer: Cigna Commercial |
$660.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$146.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$190.25
|
| Rate for Payer: Health EOS Commercial |
$633.14
|
| Rate for Payer: HFN Commercial |
$660.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$670.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$670.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$190.25
|
| Rate for Payer: Multiplan Commercial |
$556.61
|
| Rate for Payer: NAPHCARE Commercial |
$285.37
|
| Rate for Payer: Preferred Network Access Commercial |
$660.97
|
| Rate for Payer: Quartz Beloit One Network |
$306.13
|
| Rate for Payer: Quartz Commercial |
$396.58
|
| Rate for Payer: Quartz Medicare Advantage |
$190.25
|
| Rate for Payer: The Alliance Commercial |
$808.55
|
| Rate for Payer: United Healthcare Medicaid |
$146.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$190.25
|
| Rate for Payer: WEA Trust Commercial |
$382.67
|
| Rate for Payer: WPS Commercial |
$856.11
|
|
|
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 |
$168.16 |
| Max. Negotiated Rate |
$1,312.37 |
| Rate for Payer: Aetna Commercial |
$1,203.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,089.38
|
| Rate for Payer: Aetna Managed Medicare |
$291.64
|
| Rate for Payer: Anthem Medicare Advantage |
$291.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$291.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$291.64
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cigna Commercial |
$1,203.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$168.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$291.64
|
| Rate for Payer: Health EOS Commercial |
$1,152.72
|
| Rate for Payer: HFN Commercial |
$1,203.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,008.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,008.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$291.64
|
| Rate for Payer: Multiplan Commercial |
$1,013.38
|
| Rate for Payer: NAPHCARE Commercial |
$437.46
|
| Rate for Payer: Preferred Network Access Commercial |
$1,203.38
|
| Rate for Payer: Quartz Beloit One Network |
$557.36
|
| Rate for Payer: Quartz Commercial |
$722.03
|
| Rate for Payer: Quartz Medicare Advantage |
$291.64
|
| Rate for Payer: The Alliance Commercial |
$1,239.46
|
| Rate for Payer: United Healthcare Medicaid |
$168.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$291.64
|
| Rate for Payer: WEA Trust Commercial |
$696.70
|
| Rate for Payer: WPS Commercial |
$1,312.37
|
|
|
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 |
$159.46 |
| Max. Negotiated Rate |
$1,448.51 |
| Rate for Payer: Aetna Commercial |
$1,119.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,013.36
|
| Rate for Payer: Aetna Managed Medicare |
$321.89
|
| Rate for Payer: Anthem Medicare Advantage |
$321.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$321.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$321.89
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cigna Commercial |
$1,119.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$159.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$321.89
|
| Rate for Payer: Health EOS Commercial |
$1,072.27
|
| Rate for Payer: HFN Commercial |
$1,119.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,125.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,125.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$321.89
|
| Rate for Payer: Multiplan Commercial |
$942.66
|
| Rate for Payer: NAPHCARE Commercial |
$482.84
|
| Rate for Payer: Preferred Network Access Commercial |
$1,119.40
|
| Rate for Payer: Quartz Beloit One Network |
$518.46
|
| Rate for Payer: Quartz Commercial |
$671.64
|
| Rate for Payer: Quartz Medicare Advantage |
$321.89
|
| Rate for Payer: The Alliance Commercial |
$1,368.03
|
| Rate for Payer: United Healthcare Medicaid |
$159.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$321.89
|
| Rate for Payer: WEA Trust Commercial |
$648.08
|
| Rate for Payer: WPS Commercial |
$1,448.51
|
|
|
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 |
$198.19 |
| Max. Negotiated Rate |
$1,224.76 |
| Rate for Payer: Aetna Commercial |
$670.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$607.30
|
| Rate for Payer: Aetna Managed Medicare |
$272.17
|
| Rate for Payer: Anthem Medicare Advantage |
$272.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$272.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$272.17
|
| Rate for Payer: Cash Price |
$203.70
|
| Rate for Payer: Cash Price |
$203.70
|
| Rate for Payer: Cash Price |
$203.70
|
| Rate for Payer: Cigna Commercial |
$670.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$198.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$272.17
|
| Rate for Payer: Health EOS Commercial |
$642.61
|
| Rate for Payer: HFN Commercial |
$670.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$934.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$934.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$272.17
|
| Rate for Payer: Multiplan Commercial |
$564.93
|
| Rate for Payer: NAPHCARE Commercial |
$408.25
|
| Rate for Payer: Preferred Network Access Commercial |
$670.85
|
| Rate for Payer: Quartz Beloit One Network |
$310.71
|
| Rate for Payer: Quartz Commercial |
$402.51
|
| Rate for Payer: Quartz Medicare Advantage |
$272.17
|
| Rate for Payer: The Alliance Commercial |
$1,156.71
|
| Rate for Payer: United Healthcare Medicaid |
$198.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$272.17
|
| Rate for Payer: WEA Trust Commercial |
$388.39
|
| Rate for Payer: WPS Commercial |
$1,224.76
|
|
|
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 |
$157.85 |
| Max. Negotiated Rate |
$1,109.21 |
| Rate for Payer: Aetna Commercial |
$710.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$643.07
|
| Rate for Payer: Aetna Managed Medicare |
$246.49
|
| Rate for Payer: Anthem Medicare Advantage |
$246.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$246.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$246.49
|
| Rate for Payer: Cash Price |
$215.70
|
| Rate for Payer: Cash Price |
$215.70
|
| Rate for Payer: Cash Price |
$215.70
|
| Rate for Payer: Cigna Commercial |
$710.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$157.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$246.49
|
| Rate for Payer: Health EOS Commercial |
$680.46
|
| Rate for Payer: HFN Commercial |
$710.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$849.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$849.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$246.49
|
| Rate for Payer: Multiplan Commercial |
$598.21
|
| Rate for Payer: NAPHCARE Commercial |
$369.74
|
| Rate for Payer: Preferred Network Access Commercial |
$710.37
|
| Rate for Payer: Quartz Beloit One Network |
$329.01
|
| Rate for Payer: Quartz Commercial |
$426.22
|
| Rate for Payer: Quartz Medicare Advantage |
$246.49
|
| Rate for Payer: The Alliance Commercial |
$1,047.58
|
| Rate for Payer: United Healthcare Medicaid |
$157.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$246.49
|
| Rate for Payer: WEA Trust Commercial |
$411.27
|
| Rate for Payer: WPS Commercial |
$1,109.21
|
|
|
CLOSED TREATMENT OF ULNAR SHAFT FRACTURE; WITH MANIPULATION
|
Facility
|
OP
|
$4,386.95
|
|
|
Service Code
|
CPT 25535
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$259.59 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Managed Medicare |
$259.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,030.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,388.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,270.32
|
| Rate for Payer: Anthem Medicare Advantage |
$259.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$259.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$259.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$259.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$259.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$965.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$259.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$259.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$259.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$259.59
|
| Rate for Payer: NAPHCARE Commercial |
$389.39
|
| Rate for Payer: Quartz Medicare Advantage |
$259.59
|
| Rate for Payer: The Alliance Commercial |
$1,038.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$259.59
|
| Rate for Payer: United Healthcare PPO |
$2,347.28
|
| Rate for Payer: Wellcare Medicare |
$259.59
|
|
|
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 |
$154.17 |
| Max. Negotiated Rate |
$1,410.69 |
| Rate for Payer: Aetna Commercial |
$1,062.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$961.48
|
| Rate for Payer: Aetna Managed Medicare |
$313.49
|
| Rate for Payer: Anthem Medicare Advantage |
$313.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$313.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$313.49
|
| Rate for Payer: Cash Price |
$322.50
|
| Rate for Payer: Cash Price |
$322.50
|
| Rate for Payer: Cash Price |
$322.50
|
| Rate for Payer: Cigna Commercial |
$1,062.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$154.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$313.49
|
| Rate for Payer: Health EOS Commercial |
$1,017.38
|
| Rate for Payer: HFN Commercial |
$1,062.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,067.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,067.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$313.49
|
| Rate for Payer: Multiplan Commercial |
$894.40
|
| Rate for Payer: NAPHCARE Commercial |
$470.23
|
| Rate for Payer: Preferred Network Access Commercial |
$1,062.10
|
| Rate for Payer: Quartz Beloit One Network |
$491.92
|
| Rate for Payer: Quartz Commercial |
$637.26
|
| Rate for Payer: Quartz Medicare Advantage |
$313.49
|
| Rate for Payer: The Alliance Commercial |
$1,332.32
|
| Rate for Payer: United Healthcare Medicaid |
$154.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$313.49
|
| Rate for Payer: WEA Trust Commercial |
$614.90
|
| Rate for Payer: WPS Commercial |
$1,410.69
|
|
|
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 |
$109.67 |
| Max. Negotiated Rate |
$1,358.74 |
| Rate for Payer: Aetna Commercial |
$934.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$846.10
|
| Rate for Payer: Aetna Managed Medicare |
$301.94
|
| Rate for Payer: Anthem Medicare Advantage |
$301.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$301.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$301.94
|
| Rate for Payer: Cash Price |
$283.80
|
| Rate for Payer: Cash Price |
$283.80
|
| Rate for Payer: Cash Price |
$283.80
|
| Rate for Payer: Cigna Commercial |
$934.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$109.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$301.94
|
| Rate for Payer: Health EOS Commercial |
$895.29
|
| Rate for Payer: HFN Commercial |
$934.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,053.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,053.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$301.94
|
| Rate for Payer: Multiplan Commercial |
$787.07
|
| Rate for Payer: NAPHCARE Commercial |
$452.91
|
| Rate for Payer: Preferred Network Access Commercial |
$934.65
|
| Rate for Payer: Quartz Beloit One Network |
$432.89
|
| Rate for Payer: Quartz Commercial |
$560.79
|
| Rate for Payer: Quartz Medicare Advantage |
$301.94
|
| Rate for Payer: The Alliance Commercial |
$1,283.26
|
| Rate for Payer: United Healthcare Medicaid |
$109.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$301.94
|
| Rate for Payer: WEA Trust Commercial |
$541.11
|
| Rate for Payer: WPS Commercial |
$1,358.74
|
|
|
CLOSE TEAR DUCT OPENING 68760
|
Professional
|
Both
|
$531.00
|
|
|
Service Code
|
CPT 68760
|
| Hospital Charge Code |
3015256
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$62.68 |
| Max. Negotiated Rate |
$569.23 |
| Rate for Payer: Aetna Commercial |
$524.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$474.93
|
| Rate for Payer: Aetna Managed Medicare |
$126.50
|
| Rate for Payer: Anthem Medicare Advantage |
$126.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$126.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$126.50
|
| 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 |
$62.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$126.50
|
| Rate for Payer: Health EOS Commercial |
$502.54
|
| Rate for Payer: HFN Commercial |
$524.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$508.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$508.47
|
| Rate for Payer: Independent Care Health Plan Medicare |
$126.50
|
| Rate for Payer: Multiplan Commercial |
$441.79
|
| Rate for Payer: NAPHCARE Commercial |
$189.74
|
| 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 |
$126.50
|
| Rate for Payer: The Alliance Commercial |
$537.60
|
| Rate for Payer: United Healthcare Medicaid |
$62.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.50
|
| Rate for Payer: WEA Trust Commercial |
$303.73
|
| Rate for Payer: WPS Commercial |
$569.23
|
|
|
Clostridium difficile Antibody Neutralization
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
CPT 87230
|
| Hospital Charge Code |
5502671
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$61.66 |
| Max. Negotiated Rate |
$115.77 |
| Rate for Payer: Aetna Commercial |
$113.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$108.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.70
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$115.77
|
| Rate for Payer: Health EOS Commercial |
$112.00
|
| Rate for Payer: HFN Commercial |
$115.77
|
| Rate for Payer: Multiplan Commercial |
$100.67
|
| Rate for Payer: Preferred Network Access Commercial |
$115.77
|
| Rate for Payer: Quartz Beloit One Network |
$61.66
|
| Rate for Payer: Quartz Commercial |
$75.50
|
| Rate for Payer: WEA Trust Commercial |
$69.21
|
| Rate for Payer: WPS Commercial |
$93.21
|
|
|
Clostridium difficile Antibody Neutralization
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
CPT 87230
|
| Hospital Charge Code |
5502671
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.53 |
| Max. Negotiated Rate |
$119.55 |
| Rate for Payer: Aetna Commercial |
$119.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$108.22
|
| Rate for Payer: Aetna Managed Medicare |
$20.53
|
| Rate for Payer: Anthem Medicare Advantage |
$20.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.53
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$119.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$62.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.53
|
| Rate for Payer: Health EOS Commercial |
$114.51
|
| Rate for Payer: HFN Commercial |
$119.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$72.47
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.53
|
| Rate for Payer: Multiplan Commercial |
$100.67
|
| Rate for Payer: NAPHCARE Commercial |
$30.79
|
| Rate for Payer: Preferred Network Access Commercial |
$119.55
|
| Rate for Payer: Quartz Beloit One Network |
$55.37
|
| Rate for Payer: Quartz Commercial |
$71.73
|
| Rate for Payer: Quartz Medicare Advantage |
$20.53
|
| Rate for Payer: The Alliance Commercial |
$81.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.53
|
| Rate for Payer: WEA Trust Commercial |
$69.21
|
| Rate for Payer: WPS Commercial |
$90.33
|
|
|
Clostridium difficile Antibody Neutralization
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
CPT 87230
|
| Hospital Charge Code |
5502671
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.53 |
| Max. Negotiated Rate |
$115.77 |
| Rate for Payer: Aetna Commercial |
$113.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$108.22
|
| Rate for Payer: Aetna Managed Medicare |
$20.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$76.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$35.93
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34.08
|
| Rate for Payer: Anthem Medicare Advantage |
$20.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.53
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$115.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$20.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$70.42
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$20.53
|
| Rate for Payer: Health EOS Commercial |
$112.00
|
| Rate for Payer: HFN Commercial |
$115.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$76.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$20.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$20.53
|
| Rate for Payer: Multiplan Commercial |
$100.67
|
| Rate for Payer: NAPHCARE Commercial |
$30.79
|
| Rate for Payer: Preferred Network Access Commercial |
$115.77
|
| Rate for Payer: Quartz Beloit One Network |
$61.66
|
| Rate for Payer: Quartz Commercial |
$81.80
|
| Rate for Payer: Quartz Medicare Advantage |
$20.53
|
| Rate for Payer: The Alliance Commercial |
$82.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.53
|
| Rate for Payer: United Healthcare PPO |
$94.38
|
| Rate for Payer: WEA Trust Commercial |
$69.21
|
| Rate for Payer: Wellcare Medicare |
$20.53
|
| Rate for Payer: WPS Commercial |
$93.21
|
|
|
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 |
$38.76 |
| Max. Negotiated Rate |
$170.31 |
| Rate for Payer: Aetna Commercial |
$166.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.20
|
| Rate for Payer: Aetna Managed Medicare |
$38.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$145.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$67.83
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$64.34
|
| Rate for Payer: Anthem Medicare Advantage |
$38.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$38.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$38.76
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$170.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$38.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$103.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$38.76
|
| Rate for Payer: Health EOS Commercial |
$164.76
|
| Rate for Payer: HFN Commercial |
$170.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$144.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$38.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$38.76
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$38.76
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$38.76
|
| Rate for Payer: Multiplan Commercial |
$148.10
|
| Rate for Payer: NAPHCARE Commercial |
$58.14
|
| Rate for Payer: Preferred Network Access Commercial |
$170.31
|
| Rate for Payer: Quartz Beloit One Network |
$90.71
|
| Rate for Payer: Quartz Commercial |
$120.33
|
| Rate for Payer: Quartz Medicare Advantage |
$38.76
|
| Rate for Payer: The Alliance Commercial |
$155.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.76
|
| Rate for Payer: United Healthcare PPO |
$138.84
|
| Rate for Payer: WEA Trust Commercial |
$101.82
|
| Rate for Payer: Wellcare Medicare |
$38.76
|
| Rate for Payer: WPS Commercial |
$137.11
|
|
|
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 |
$38.76 |
| Max. Negotiated Rate |
$175.86 |
| Rate for Payer: Aetna Commercial |
$175.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.20
|
| Rate for Payer: Aetna Managed Medicare |
$38.76
|
| Rate for Payer: Anthem Medicare Advantage |
$38.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$38.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$38.76
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$175.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$92.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38.76
|
| Rate for Payer: Health EOS Commercial |
$168.46
|
| Rate for Payer: HFN Commercial |
$175.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$136.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$136.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$38.76
|
| Rate for Payer: Multiplan Commercial |
$148.10
|
| Rate for Payer: NAPHCARE Commercial |
$58.14
|
| Rate for Payer: Preferred Network Access Commercial |
$175.86
|
| Rate for Payer: Quartz Beloit One Network |
$81.45
|
| Rate for Payer: Quartz Commercial |
$105.52
|
| Rate for Payer: Quartz Medicare Advantage |
$38.76
|
| Rate for Payer: The Alliance Commercial |
$153.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.76
|
| Rate for Payer: WEA Trust Commercial |
$101.82
|
| Rate for Payer: WPS Commercial |
$170.55
|
|
|
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 |
$90.71 |
| Max. Negotiated Rate |
$170.31 |
| Rate for Payer: Aetna Commercial |
$166.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.11
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$170.31
|
| Rate for Payer: Health EOS Commercial |
$164.76
|
| Rate for Payer: HFN Commercial |
$170.31
|
| Rate for Payer: Multiplan Commercial |
$148.10
|
| Rate for Payer: Preferred Network Access Commercial |
$170.31
|
| Rate for Payer: Quartz Beloit One Network |
$90.71
|
| Rate for Payer: Quartz Commercial |
$111.07
|
| Rate for Payer: WEA Trust Commercial |
$101.82
|
| Rate for Payer: WPS Commercial |
$137.11
|
|
|
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 |
$49.94 |
| Max. Negotiated Rate |
$93.77 |
| Rate for Payer: Aetna Commercial |
$91.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.02
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cigna Commercial |
$93.77
|
| Rate for Payer: Health EOS Commercial |
$90.71
|
| Rate for Payer: HFN Commercial |
$93.77
|
| Rate for Payer: Multiplan Commercial |
$81.54
|
| Rate for Payer: Preferred Network Access Commercial |
$93.77
|
| Rate for Payer: Quartz Beloit One Network |
$49.94
|
| Rate for Payer: Quartz Commercial |
$61.15
|
| Rate for Payer: WEA Trust Commercial |
$56.06
|
| Rate for Payer: WPS Commercial |
$75.49
|
|
|
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 |
$12.46 |
| Max. Negotiated Rate |
$96.82 |
| Rate for Payer: Aetna Commercial |
$96.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.65
|
| Rate for Payer: Aetna Managed Medicare |
$12.46
|
| Rate for Payer: Anthem Medicare Advantage |
$12.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.46
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cigna Commercial |
$96.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$50.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.46
|
| Rate for Payer: Health EOS Commercial |
$92.75
|
| Rate for Payer: HFN Commercial |
$96.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$43.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.46
|
| Rate for Payer: Multiplan Commercial |
$81.54
|
| Rate for Payer: NAPHCARE Commercial |
$18.69
|
| Rate for Payer: Preferred Network Access Commercial |
$96.82
|
| Rate for Payer: Quartz Beloit One Network |
$44.84
|
| Rate for Payer: Quartz Commercial |
$58.09
|
| Rate for Payer: Quartz Medicare Advantage |
$12.46
|
| Rate for Payer: The Alliance Commercial |
$49.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.46
|
| Rate for Payer: WEA Trust Commercial |
$56.06
|
| Rate for Payer: WPS Commercial |
$54.82
|
|
|
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 |
$12.46 |
| Max. Negotiated Rate |
$93.77 |
| Rate for Payer: Aetna Commercial |
$91.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.65
|
| Rate for Payer: Aetna Managed Medicare |
$12.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.68
|
| Rate for Payer: Anthem Medicare Advantage |
$12.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.46
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cigna Commercial |
$93.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$57.04
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.46
|
| Rate for Payer: Health EOS Commercial |
$90.71
|
| Rate for Payer: HFN Commercial |
$93.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.46
|
| Rate for Payer: Multiplan Commercial |
$81.54
|
| Rate for Payer: NAPHCARE Commercial |
$18.69
|
| Rate for Payer: Preferred Network Access Commercial |
$93.77
|
| Rate for Payer: Quartz Beloit One Network |
$49.94
|
| Rate for Payer: Quartz Commercial |
$66.25
|
| Rate for Payer: Quartz Medicare Advantage |
$12.46
|
| Rate for Payer: The Alliance Commercial |
$49.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.46
|
| Rate for Payer: United Healthcare PPO |
$76.44
|
| Rate for Payer: WEA Trust Commercial |
$56.06
|
| Rate for Payer: Wellcare Medicare |
$12.46
|
| Rate for Payer: WPS Commercial |
$75.49
|
|
|
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 |
$813.32 |
| Max. Negotiated Rate |
$2,672.34 |
| Rate for Payer: Aetna Commercial |
$2,614.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,498.06
|
| Rate for Payer: Aetna Managed Medicare |
$813.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,888.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,452.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,394.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,539.50
|
| Rate for Payer: Cash Price |
$837.90
|
| Rate for Payer: Cigna Commercial |
$2,672.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,625.53
|
| Rate for Payer: Health EOS Commercial |
$2,585.20
|
| Rate for Payer: HFN Commercial |
$2,672.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,178.54
|
| Rate for Payer: Multiplan Commercial |
$2,323.78
|
| Rate for Payer: NAPHCARE Commercial |
$1,742.83
|
| Rate for Payer: Preferred Network Access Commercial |
$2,672.34
|
| Rate for Payer: Quartz Beloit One Network |
$1,423.31
|
| Rate for Payer: Quartz Commercial |
$1,888.07
|
| Rate for Payer: Quartz Medicare Advantage |
$1,742.83
|
| Rate for Payer: The Alliance Commercial |
$1,452.36
|
| Rate for Payer: WEA Trust Commercial |
$1,597.60
|
| Rate for Payer: WPS Commercial |
$2,151.45
|
|
