|
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
|
$104.92
|
|
|
Service Code
|
EAPG 00041
|
| Min. Negotiated Rate |
$100.88 |
| Max. Negotiated Rate |
$104.92 |
| Rate for Payer: Anthem Medicaid |
$100.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$100.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$100.88
|
| Rate for Payer: Dean Health Medicaid |
$100.88
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$100.88
|
| Rate for Payer: Managed Health Services Medicaid |
$104.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$100.88
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$100.88
|
| Rate for Payer: United Healthcare Medicaid |
$100.88
|
|
|
Closed treatment of ankle dislocation; requiring anesthesia, with or without percutaneous skeletal fixation
|
Facility
|
OP
|
$6,768.94
|
|
|
Service Code
|
CPT 27842
|
|
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 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 (e.g., 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
|
|
|
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 phalangeal fracture, finger or thumb; without manipulation, each
|
Facility
|
OP
|
$4,386.95
|
|
|
Service Code
|
CPT 26750
|
|
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†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 (e.g., 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 (e.g., 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
|
|
