|
ED Change Of Gastrostomy Tube, Percutaneous, Without Imaging Or Contrast
|
Facility
OP
|
$225.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
6174083
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$10,700.96 |
| Rate for Payer: Aetna Commercial |
$202.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$193.50
|
| Rate for Payer: Aetna Managed Medicare |
$244.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$146.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$112.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$108.00
|
| Rate for Payer: Anthem Medicare Advantage |
$244.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$119.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$244.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$244.28
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$207.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$244.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$244.28
|
| Rate for Payer: Health EOS Commercial |
$200.25
|
| Rate for Payer: HFN Commercial |
$207.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$908.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$244.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$244.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$244.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$244.28
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: NAPHCARE Commercial |
$366.42
|
| Rate for Payer: Preferred Network Access Commercial |
$207.00
|
| Rate for Payer: Quartz Beloit One Network |
$110.25
|
| Rate for Payer: Quartz Commercial |
$146.25
|
| Rate for Payer: Quartz Medicare Advantage |
$244.28
|
| Rate for Payer: The Alliance Commercial |
$10,700.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$244.28
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$123.75
|
| Rate for Payer: Wellcare Medicare |
$244.28
|
| Rate for Payer: WPS Commercial |
$166.66
|
|
|
ED Change Of Gastrostomy Tube, Percutaneous, Without Imaging Or Contrast
|
Facility
IP
|
$225.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
6174083
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$110.25 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Aetna Commercial |
$202.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$119.25
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$207.00
|
| Rate for Payer: Health EOS Commercial |
$200.25
|
| Rate for Payer: HFN Commercial |
$207.00
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: NAPHCARE Commercial |
$135.00
|
| Rate for Payer: Preferred Network Access Commercial |
$207.00
|
| Rate for Payer: Quartz Beloit One Network |
$110.25
|
| Rate for Payer: Quartz Commercial |
$135.00
|
| Rate for Payer: WEA Trust Commercial |
$123.75
|
| Rate for Payer: WPS Commercial |
$166.66
|
|
|
ED Chemical Cauterizaion of Granulation Tissue
|
Facility
IP
|
$194.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
6173184
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$95.06 |
| Max. Negotiated Rate |
$178.48 |
| Rate for Payer: Aetna Commercial |
$174.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$102.82
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cigna Commercial |
$178.48
|
| Rate for Payer: Health EOS Commercial |
$172.66
|
| Rate for Payer: HFN Commercial |
$178.48
|
| Rate for Payer: Multiplan Commercial |
$155.20
|
| Rate for Payer: NAPHCARE Commercial |
$116.40
|
| Rate for Payer: Preferred Network Access Commercial |
$178.48
|
| Rate for Payer: Quartz Beloit One Network |
$95.06
|
| Rate for Payer: Quartz Commercial |
$116.40
|
| Rate for Payer: WEA Trust Commercial |
$106.70
|
| Rate for Payer: WPS Commercial |
$143.70
|
|
|
ED Chemical Cauterizaion of Granulation Tissue
|
Facility
OP
|
$194.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
6173184
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$93.12 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$174.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$166.84
|
| Rate for Payer: Aetna Managed Medicare |
$197.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$126.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$97.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$93.12
|
| Rate for Payer: Anthem Medicare Advantage |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$102.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$197.88
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cigna Commercial |
$178.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$197.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$197.88
|
| Rate for Payer: Health EOS Commercial |
$172.66
|
| Rate for Payer: HFN Commercial |
$178.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$736.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$197.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$197.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$197.88
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$197.88
|
| Rate for Payer: Multiplan Commercial |
$155.20
|
| Rate for Payer: NAPHCARE Commercial |
$296.82
|
| Rate for Payer: Preferred Network Access Commercial |
$178.48
|
| Rate for Payer: Quartz Beloit One Network |
$95.06
|
| Rate for Payer: Quartz Commercial |
$126.10
|
| Rate for Payer: Quartz Medicare Advantage |
$197.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$197.88
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$106.70
|
| Rate for Payer: Wellcare Medicare |
$197.88
|
| Rate for Payer: WPS Commercial |
$143.70
|
|
|
ED Closed treatment fracture radius shaft
|
Facility
IP
|
$1,858.00
|
|
|
Service Code
|
CPT 25505
|
| Hospital Charge Code |
6173550
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$910.42 |
| Max. Negotiated Rate |
$1,709.36 |
| Rate for Payer: Aetna Commercial |
$1,672.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$984.74
|
| Rate for Payer: Cash Price |
$557.40
|
| Rate for Payer: Cigna Commercial |
$1,709.36
|
| Rate for Payer: Health EOS Commercial |
$1,653.62
|
| Rate for Payer: HFN Commercial |
$1,709.36
|
| Rate for Payer: Multiplan Commercial |
$1,486.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,114.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,709.36
|
| Rate for Payer: Quartz Beloit One Network |
$910.42
|
| Rate for Payer: Quartz Commercial |
$1,114.80
|
| Rate for Payer: WEA Trust Commercial |
$1,021.90
|
| Rate for Payer: WPS Commercial |
$1,376.22
|
|
|
ED Closed treatment fracture radius shaft
|
Facility
OP
|
$1,858.00
|
|
|
Service Code
|
CPT 25505
|
| Hospital Charge Code |
6173550
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$22,318.84 |
| Rate for Payer: Aetna Commercial |
$1,672.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,597.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,588.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,207.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$929.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$891.84
|
| Rate for Payer: Anthem Medicare Advantage |
$1,588.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$984.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,588.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,588.57
|
| Rate for Payer: Cash Price |
$557.40
|
| Rate for Payer: Cash Price |
$557.40
|
| Rate for Payer: Cash Price |
$557.40
|
| Rate for Payer: Cigna Commercial |
$1,709.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,588.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,588.57
|
| Rate for Payer: Health EOS Commercial |
$1,653.62
|
| Rate for Payer: HFN Commercial |
$1,709.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,909.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,588.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,588.57
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,588.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,588.57
|
| Rate for Payer: Multiplan Commercial |
$1,486.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,382.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,709.36
|
| Rate for Payer: Quartz Beloit One Network |
$910.42
|
| Rate for Payer: Quartz Commercial |
$1,207.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,588.57
|
| Rate for Payer: The Alliance Commercial |
$22,318.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,588.57
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$1,021.90
|
| Rate for Payer: Wellcare Medicare |
$1,588.57
|
| Rate for Payer: WPS Commercial |
$1,376.22
|
|
|
ED Closed treatment greater tuberosity fracture with manipulation
|
Facility
IP
|
$1,202.00
|
|
|
Service Code
|
CPT 23625
|
| Hospital Charge Code |
6173472
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$588.98 |
| Max. Negotiated Rate |
$1,105.84 |
| Rate for Payer: Aetna Commercial |
$1,081.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$637.06
|
| Rate for Payer: Cash Price |
$360.60
|
| Rate for Payer: Cigna Commercial |
$1,105.84
|
| Rate for Payer: Health EOS Commercial |
$1,069.78
|
| Rate for Payer: HFN Commercial |
$1,105.84
|
| Rate for Payer: Multiplan Commercial |
$961.60
|
| Rate for Payer: NAPHCARE Commercial |
$721.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,105.84
|
| Rate for Payer: Quartz Beloit One Network |
$588.98
|
| Rate for Payer: Quartz Commercial |
$721.20
|
| Rate for Payer: WEA Trust Commercial |
$661.10
|
| Rate for Payer: WPS Commercial |
$890.32
|
|
|
ED Closed treatment greater tuberosity fracture with manipulation
|
Facility
OP
|
$1,202.00
|
|
|
Service Code
|
CPT 23625
|
| Hospital Charge Code |
6173472
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$12,967.60 |
| Rate for Payer: Aetna Commercial |
$1,081.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,033.72
|
| Rate for Payer: Aetna Managed Medicare |
$1,588.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$781.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$601.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$576.96
|
| Rate for Payer: Anthem Medicare Advantage |
$1,588.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$637.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,588.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,588.57
|
| Rate for Payer: Cash Price |
$360.60
|
| Rate for Payer: Cash Price |
$360.60
|
| Rate for Payer: Cash Price |
$360.60
|
| Rate for Payer: Cigna Commercial |
$1,105.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,588.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,588.57
|
| Rate for Payer: Health EOS Commercial |
$1,069.78
|
| Rate for Payer: HFN Commercial |
$1,105.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,909.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,588.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,588.57
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,588.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,588.57
|
| Rate for Payer: Multiplan Commercial |
$961.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,382.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,105.84
|
| Rate for Payer: Quartz Beloit One Network |
$588.98
|
| Rate for Payer: Quartz Commercial |
$781.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,588.57
|
| Rate for Payer: The Alliance Commercial |
$12,967.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,588.57
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$661.10
|
| Rate for Payer: Wellcare Medicare |
$1,588.57
|
| Rate for Payer: WPS Commercial |
$890.32
|
|
|
ED Closed treatment interphalangeal joint dislocation req anes
|
Facility
OP
|
$315.00
|
|
|
Service Code
|
CPT 28665
|
| Hospital Charge Code |
6180116
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$151.20 |
| Max. Negotiated Rate |
$50,159.28 |
| Rate for Payer: Aetna Commercial |
$283.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$270.90
|
| Rate for Payer: Aetna Managed Medicare |
$265.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$204.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$157.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$151.20
|
| Rate for Payer: Anthem Medicare Advantage |
$265.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$166.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$265.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$265.44
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna Commercial |
$289.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$265.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$265.44
|
| Rate for Payer: Health EOS Commercial |
$280.35
|
| Rate for Payer: HFN Commercial |
$289.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$987.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$265.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$265.44
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$265.44
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$265.44
|
| Rate for Payer: Multiplan Commercial |
$252.00
|
| Rate for Payer: NAPHCARE Commercial |
$398.16
|
| Rate for Payer: Preferred Network Access Commercial |
$289.80
|
| Rate for Payer: Quartz Beloit One Network |
$154.35
|
| Rate for Payer: Quartz Commercial |
$204.75
|
| Rate for Payer: Quartz Medicare Advantage |
$265.44
|
| Rate for Payer: The Alliance Commercial |
$50,159.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$265.44
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$173.25
|
| Rate for Payer: Wellcare Medicare |
$265.44
|
| Rate for Payer: WPS Commercial |
$233.32
|
|
|
ED Closed treatment interphalangeal joint dislocation req anes
|
Facility
IP
|
$315.00
|
|
|
Service Code
|
CPT 28665
|
| Hospital Charge Code |
6180116
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$154.35 |
| Max. Negotiated Rate |
$289.80 |
| Rate for Payer: Aetna Commercial |
$283.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$166.95
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna Commercial |
$289.80
|
| Rate for Payer: Health EOS Commercial |
$280.35
|
| Rate for Payer: HFN Commercial |
$289.80
|
| Rate for Payer: Multiplan Commercial |
$252.00
|
| Rate for Payer: NAPHCARE Commercial |
$189.00
|
| Rate for Payer: Preferred Network Access Commercial |
$289.80
|
| Rate for Payer: Quartz Beloit One Network |
$154.35
|
| Rate for Payer: Quartz Commercial |
$189.00
|
| Rate for Payer: WEA Trust Commercial |
$173.25
|
| Rate for Payer: WPS Commercial |
$233.32
|
|
|
ED Closed treatment of bimalleolar ankle fracture; with manipulation
|
Facility
IP
|
$1,436.00
|
|
|
Service Code
|
CPT 27810
|
| Hospital Charge Code |
6174070
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$703.64 |
| Max. Negotiated Rate |
$1,321.12 |
| Rate for Payer: Aetna Commercial |
$1,292.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$761.08
|
| Rate for Payer: Cash Price |
$430.80
|
| Rate for Payer: Cigna Commercial |
$1,321.12
|
| Rate for Payer: Health EOS Commercial |
$1,278.04
|
| Rate for Payer: HFN Commercial |
$1,321.12
|
| Rate for Payer: Multiplan Commercial |
$1,148.80
|
| Rate for Payer: NAPHCARE Commercial |
$861.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,321.12
|
| Rate for Payer: Quartz Beloit One Network |
$703.64
|
| Rate for Payer: Quartz Commercial |
$861.60
|
| Rate for Payer: WEA Trust Commercial |
$789.80
|
| Rate for Payer: WPS Commercial |
$1,063.65
|
|
|
ED Closed treatment of bimalleolar ankle fracture; with manipulation
|
Facility
OP
|
$1,436.00
|
|
|
Service Code
|
CPT 27810
|
| Hospital Charge Code |
6174070
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$12,336.12 |
| Rate for Payer: Aetna Commercial |
$1,292.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,234.96
|
| Rate for Payer: Aetna Managed Medicare |
$1,588.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$933.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$718.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$689.28
|
| Rate for Payer: Anthem Medicare Advantage |
$1,588.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$761.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,588.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,588.57
|
| Rate for Payer: Cash Price |
$430.80
|
| Rate for Payer: Cash Price |
$430.80
|
| Rate for Payer: Cash Price |
$430.80
|
| Rate for Payer: Cigna Commercial |
$1,321.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,588.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,588.57
|
| Rate for Payer: Health EOS Commercial |
$1,278.04
|
| Rate for Payer: HFN Commercial |
$1,321.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,909.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,588.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,588.57
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,588.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,588.57
|
| Rate for Payer: Multiplan Commercial |
$1,148.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,382.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,321.12
|
| Rate for Payer: Quartz Beloit One Network |
$703.64
|
| Rate for Payer: Quartz Commercial |
$933.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,588.57
|
| Rate for Payer: The Alliance Commercial |
$12,336.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,588.57
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$789.80
|
| Rate for Payer: Wellcare Medicare |
$1,588.57
|
| Rate for Payer: WPS Commercial |
$1,063.65
|
|
|
ED Closed treatment of broken or growth plate separate of forearm bone at wrist / manipulation
|
Facility
OP
|
$913.00
|
|
|
Service Code
|
CPT 25605
|
| Hospital Charge Code |
6172928
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$22,318.84 |
| Rate for Payer: Aetna Commercial |
$821.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$785.18
|
| Rate for Payer: Aetna Managed Medicare |
$1,588.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$593.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$456.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$438.24
|
| Rate for Payer: Anthem Medicare Advantage |
$1,588.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$483.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,588.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,588.57
|
| Rate for Payer: Cash Price |
$273.90
|
| Rate for Payer: Cash Price |
$273.90
|
| Rate for Payer: Cash Price |
$273.90
|
| Rate for Payer: Cigna Commercial |
$839.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,588.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,588.57
|
| Rate for Payer: Health EOS Commercial |
$812.57
|
| Rate for Payer: HFN Commercial |
$839.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,909.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,588.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,588.57
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,588.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,588.57
|
| Rate for Payer: Multiplan Commercial |
$730.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,382.86
|
| Rate for Payer: Preferred Network Access Commercial |
$839.96
|
| Rate for Payer: Quartz Beloit One Network |
$447.37
|
| Rate for Payer: Quartz Commercial |
$593.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,588.57
|
| Rate for Payer: The Alliance Commercial |
$22,318.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,588.57
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$502.15
|
| Rate for Payer: Wellcare Medicare |
$1,588.57
|
| Rate for Payer: WPS Commercial |
$676.26
|
|
|
ED Closed treatment of broken or growth plate separate of forearm bone at wrist / manipulation
|
Facility
IP
|
$913.00
|
|
|
Service Code
|
CPT 25605
|
| Hospital Charge Code |
6172928
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$447.37 |
| Max. Negotiated Rate |
$839.96 |
| Rate for Payer: Aetna Commercial |
$821.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$483.89
|
| Rate for Payer: Cash Price |
$273.90
|
| Rate for Payer: Cigna Commercial |
$839.96
|
| Rate for Payer: Health EOS Commercial |
$812.57
|
| Rate for Payer: HFN Commercial |
$839.96
|
| Rate for Payer: Multiplan Commercial |
$730.40
|
| Rate for Payer: NAPHCARE Commercial |
$547.80
|
| Rate for Payer: Preferred Network Access Commercial |
$839.96
|
| Rate for Payer: Quartz Beloit One Network |
$447.37
|
| Rate for Payer: Quartz Commercial |
$547.80
|
| Rate for Payer: WEA Trust Commercial |
$502.15
|
| Rate for Payer: WPS Commercial |
$676.26
|
|
|
ED Closed treatment of broken thigh bone with manipulation
|
Facility
OP
|
$2,692.00
|
|
|
Service Code
|
CPT 27503
|
| Hospital Charge Code |
6172937
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$12,336.12 |
| Rate for Payer: Aetna Commercial |
$2,422.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,315.12
|
| Rate for Payer: Aetna Managed Medicare |
$1,588.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,749.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,346.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,292.16
|
| Rate for Payer: Anthem Medicare Advantage |
$1,588.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,426.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,588.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,588.57
|
| Rate for Payer: Cash Price |
$807.60
|
| Rate for Payer: Cash Price |
$807.60
|
| Rate for Payer: Cash Price |
$807.60
|
| Rate for Payer: Cigna Commercial |
$2,476.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,588.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,588.57
|
| Rate for Payer: Health EOS Commercial |
$2,395.88
|
| Rate for Payer: HFN Commercial |
$2,476.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,909.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,588.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,588.57
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,588.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,588.57
|
| Rate for Payer: Multiplan Commercial |
$2,153.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,382.86
|
| Rate for Payer: Preferred Network Access Commercial |
$2,476.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,319.08
|
| Rate for Payer: Quartz Commercial |
$1,749.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,588.57
|
| Rate for Payer: The Alliance Commercial |
$12,336.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,588.57
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$1,480.60
|
| Rate for Payer: Wellcare Medicare |
$1,588.57
|
| Rate for Payer: WPS Commercial |
$1,993.96
|
|
|
ED Closed treatment of broken thigh bone with manipulation
|
Facility
IP
|
$2,692.00
|
|
|
Service Code
|
CPT 27503
|
| Hospital Charge Code |
6172937
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,319.08 |
| Max. Negotiated Rate |
$2,476.64 |
| Rate for Payer: Aetna Commercial |
$2,422.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,426.76
|
| Rate for Payer: Cash Price |
$807.60
|
| Rate for Payer: Cigna Commercial |
$2,476.64
|
| Rate for Payer: Health EOS Commercial |
$2,395.88
|
| Rate for Payer: HFN Commercial |
$2,476.64
|
| Rate for Payer: Multiplan Commercial |
$2,153.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,615.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,476.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,319.08
|
| Rate for Payer: Quartz Commercial |
$1,615.20
|
| Rate for Payer: WEA Trust Commercial |
$1,480.60
|
| Rate for Payer: WPS Commercial |
$1,993.96
|
|
|
ED Closed treatment of dislocated finger joint with manipulation
|
Facility
IP
|
$580.00
|
|
|
Service Code
|
CPT 26770
|
| Hospital Charge Code |
6172919
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$284.20 |
| Max. Negotiated Rate |
$533.60 |
| Rate for Payer: Aetna Commercial |
$522.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$307.40
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$533.60
|
| Rate for Payer: Health EOS Commercial |
$516.20
|
| Rate for Payer: HFN Commercial |
$533.60
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: NAPHCARE Commercial |
$348.00
|
| Rate for Payer: Preferred Network Access Commercial |
$533.60
|
| Rate for Payer: Quartz Beloit One Network |
$284.20
|
| Rate for Payer: Quartz Commercial |
$348.00
|
| Rate for Payer: WEA Trust Commercial |
$319.00
|
| Rate for Payer: WPS Commercial |
$429.61
|
|
|
ED Closed treatment of dislocated finger joint with manipulation
|
Facility
OP
|
$580.00
|
|
|
Service Code
|
CPT 26770
|
| Hospital Charge Code |
6172919
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$233.09 |
| Max. Negotiated Rate |
$27,265.32 |
| Rate for Payer: Aetna Commercial |
$522.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$498.80
|
| Rate for Payer: Aetna Managed Medicare |
$233.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$377.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$290.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$278.40
|
| Rate for Payer: Anthem Medicare Advantage |
$233.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$307.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$233.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$233.09
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$533.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$233.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$233.09
|
| Rate for Payer: Health EOS Commercial |
$516.20
|
| Rate for Payer: HFN Commercial |
$533.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$867.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$233.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$233.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$233.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$233.09
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: NAPHCARE Commercial |
$349.64
|
| Rate for Payer: Preferred Network Access Commercial |
$533.60
|
| Rate for Payer: Quartz Beloit One Network |
$284.20
|
| Rate for Payer: Quartz Commercial |
$377.00
|
| Rate for Payer: Quartz Medicare Advantage |
$233.09
|
| Rate for Payer: The Alliance Commercial |
$27,265.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$233.09
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$319.00
|
| Rate for Payer: Wellcare Medicare |
$233.09
|
| Rate for Payer: WPS Commercial |
$429.61
|
|
|
ED Closed treatment of kneecap dislocation
|
Facility
OP
|
$725.00
|
|
|
Service Code
|
CPT 27560
|
| Hospital Charge Code |
6175421
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$233.09 |
| Max. Negotiated Rate |
$27,265.32 |
| Rate for Payer: Aetna Commercial |
$652.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$623.50
|
| Rate for Payer: Aetna Managed Medicare |
$233.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$471.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$362.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$348.00
|
| Rate for Payer: Anthem Medicare Advantage |
$233.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$384.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$233.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$233.09
|
| Rate for Payer: Cash Price |
$217.50
|
| Rate for Payer: Cash Price |
$217.50
|
| Rate for Payer: Cash Price |
$217.50
|
| Rate for Payer: Cigna Commercial |
$667.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$233.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$233.09
|
| Rate for Payer: Health EOS Commercial |
$645.25
|
| Rate for Payer: HFN Commercial |
$667.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$867.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$233.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$233.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$233.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$233.09
|
| Rate for Payer: Multiplan Commercial |
$580.00
|
| Rate for Payer: NAPHCARE Commercial |
$349.64
|
| Rate for Payer: Preferred Network Access Commercial |
$667.00
|
| Rate for Payer: Quartz Beloit One Network |
$355.25
|
| Rate for Payer: Quartz Commercial |
$471.25
|
| Rate for Payer: Quartz Medicare Advantage |
$233.09
|
| Rate for Payer: The Alliance Commercial |
$27,265.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$233.09
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$398.75
|
| Rate for Payer: Wellcare Medicare |
$233.09
|
| Rate for Payer: WPS Commercial |
$537.01
|
|
|
ED Closed treatment of kneecap dislocation
|
Facility
IP
|
$725.00
|
|
|
Service Code
|
CPT 27560
|
| Hospital Charge Code |
6175421
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$355.25 |
| Max. Negotiated Rate |
$667.00 |
| Rate for Payer: Aetna Commercial |
$652.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$384.25
|
| Rate for Payer: Cash Price |
$217.50
|
| Rate for Payer: Cigna Commercial |
$667.00
|
| Rate for Payer: Health EOS Commercial |
$645.25
|
| Rate for Payer: HFN Commercial |
$667.00
|
| Rate for Payer: Multiplan Commercial |
$580.00
|
| Rate for Payer: NAPHCARE Commercial |
$435.00
|
| Rate for Payer: Preferred Network Access Commercial |
$667.00
|
| Rate for Payer: Quartz Beloit One Network |
$355.25
|
| Rate for Payer: Quartz Commercial |
$435.00
|
| Rate for Payer: WEA Trust Commercial |
$398.75
|
| Rate for Payer: WPS Commercial |
$537.01
|
|
|
ED Closed treatment of metatarsophalangeal joint dislocation; without anesthesia
|
Facility
OP
|
$250.00
|
|
|
Service Code
|
CPT 28630
|
| Hospital Charge Code |
6209960
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$27,265.32 |
| Rate for Payer: Aetna Commercial |
$225.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$215.00
|
| Rate for Payer: Aetna Managed Medicare |
$233.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$162.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$125.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$120.00
|
| Rate for Payer: Anthem Medicare Advantage |
$233.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$132.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$233.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$233.09
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$230.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$233.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$233.09
|
| Rate for Payer: Health EOS Commercial |
$222.50
|
| Rate for Payer: HFN Commercial |
$230.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$867.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$233.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$233.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$233.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$233.09
|
| Rate for Payer: Multiplan Commercial |
$200.00
|
| Rate for Payer: NAPHCARE Commercial |
$349.64
|
| Rate for Payer: Preferred Network Access Commercial |
$230.00
|
| Rate for Payer: Quartz Beloit One Network |
$122.50
|
| Rate for Payer: Quartz Commercial |
$162.50
|
| Rate for Payer: Quartz Medicare Advantage |
$233.09
|
| Rate for Payer: The Alliance Commercial |
$27,265.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$233.09
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$137.50
|
| Rate for Payer: Wellcare Medicare |
$233.09
|
| Rate for Payer: WPS Commercial |
$185.18
|
|
|
ED Closed treatment of metatarsophalangeal joint dislocation; without anesthesia
|
Facility
IP
|
$250.00
|
|
|
Service Code
|
CPT 28630
|
| Hospital Charge Code |
6209960
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$122.50 |
| Max. Negotiated Rate |
$230.00 |
| Rate for Payer: Aetna Commercial |
$225.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$132.50
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$230.00
|
| Rate for Payer: Health EOS Commercial |
$222.50
|
| Rate for Payer: HFN Commercial |
$230.00
|
| Rate for Payer: Multiplan Commercial |
$200.00
|
| Rate for Payer: NAPHCARE Commercial |
$150.00
|
| Rate for Payer: Preferred Network Access Commercial |
$230.00
|
| Rate for Payer: Quartz Beloit One Network |
$122.50
|
| Rate for Payer: Quartz Commercial |
$150.00
|
| Rate for Payer: WEA Trust Commercial |
$137.50
|
| Rate for Payer: WPS Commercial |
$185.18
|
|
|
ED Closed Treatment of patellar dislocation; requiring anesthesia
|
Facility
OP
|
$832.00
|
|
|
Service Code
|
CPT 27562
|
| Hospital Charge Code |
6209959
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$233.09 |
| Max. Negotiated Rate |
$6,125.32 |
| Rate for Payer: Aetna Commercial |
$748.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$715.52
|
| Rate for Payer: Aetna Managed Medicare |
$233.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$540.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$416.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$399.36
|
| Rate for Payer: Anthem Medicare Advantage |
$233.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$440.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$233.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$233.09
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cigna Commercial |
$765.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$233.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$233.09
|
| Rate for Payer: Health EOS Commercial |
$740.48
|
| Rate for Payer: HFN Commercial |
$765.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$867.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$233.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$233.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$233.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$233.09
|
| Rate for Payer: Multiplan Commercial |
$665.60
|
| Rate for Payer: NAPHCARE Commercial |
$349.64
|
| Rate for Payer: Preferred Network Access Commercial |
$765.44
|
| Rate for Payer: Quartz Beloit One Network |
$407.68
|
| Rate for Payer: Quartz Commercial |
$540.80
|
| Rate for Payer: Quartz Medicare Advantage |
$233.09
|
| Rate for Payer: The Alliance Commercial |
$6,125.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$233.09
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$457.60
|
| Rate for Payer: Wellcare Medicare |
$233.09
|
| Rate for Payer: WPS Commercial |
$616.26
|
|
|
ED Closed Treatment of patellar dislocation; requiring anesthesia
|
Facility
IP
|
$832.00
|
|
|
Service Code
|
CPT 27562
|
| Hospital Charge Code |
6209959
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$407.68 |
| Max. Negotiated Rate |
$765.44 |
| Rate for Payer: Aetna Commercial |
$748.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$440.96
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cigna Commercial |
$765.44
|
| Rate for Payer: Health EOS Commercial |
$740.48
|
| Rate for Payer: HFN Commercial |
$765.44
|
| Rate for Payer: Multiplan Commercial |
$665.60
|
| Rate for Payer: NAPHCARE Commercial |
$499.20
|
| Rate for Payer: Preferred Network Access Commercial |
$765.44
|
| Rate for Payer: Quartz Beloit One Network |
$407.68
|
| Rate for Payer: Quartz Commercial |
$499.20
|
| Rate for Payer: WEA Trust Commercial |
$457.60
|
| Rate for Payer: WPS Commercial |
$616.26
|
|
|
ED Closed treatment of post hip arthroplasty dislocation; req regional or gen anesthesia
|
Facility
OP
|
$1,294.00
|
|
|
Service Code
|
CPT 27266
|
| Hospital Charge Code |
6172936
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$12,336.12 |
| Rate for Payer: Aetna Commercial |
$1,164.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,112.84
|
| Rate for Payer: Aetna Managed Medicare |
$1,588.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$841.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$647.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$621.12
|
| Rate for Payer: Anthem Medicare Advantage |
$1,588.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$685.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,588.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,588.57
|
| Rate for Payer: Cash Price |
$388.20
|
| Rate for Payer: Cash Price |
$388.20
|
| Rate for Payer: Cash Price |
$388.20
|
| Rate for Payer: Cigna Commercial |
$1,190.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,588.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,588.57
|
| Rate for Payer: Health EOS Commercial |
$1,151.66
|
| Rate for Payer: HFN Commercial |
$1,190.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,909.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,588.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,588.57
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,588.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,588.57
|
| Rate for Payer: Multiplan Commercial |
$1,035.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,382.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,190.48
|
| Rate for Payer: Quartz Beloit One Network |
$634.06
|
| Rate for Payer: Quartz Commercial |
$841.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,588.57
|
| Rate for Payer: The Alliance Commercial |
$12,336.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,588.57
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$711.70
|
| Rate for Payer: Wellcare Medicare |
$1,588.57
|
| Rate for Payer: WPS Commercial |
$958.47
|
|
