|
ED Closed treatment of post hip arthroplasty dislocation; req regional or gen anesthesia
|
Facility
IP
|
$1,294.00
|
|
|
Service Code
|
CPT 27266
|
| Hospital Charge Code |
6172936
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$634.06 |
| Max. Negotiated Rate |
$1,190.48 |
| Rate for Payer: Aetna Commercial |
$1,164.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$685.82
|
| Rate for Payer: Cash Price |
$388.20
|
| Rate for Payer: Cigna Commercial |
$1,190.48
|
| Rate for Payer: Health EOS Commercial |
$1,151.66
|
| Rate for Payer: HFN Commercial |
$1,190.48
|
| Rate for Payer: Multiplan Commercial |
$1,035.20
|
| Rate for Payer: NAPHCARE Commercial |
$776.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,190.48
|
| Rate for Payer: Quartz Beloit One Network |
$634.06
|
| Rate for Payer: Quartz Commercial |
$776.40
|
| Rate for Payer: WEA Trust Commercial |
$711.70
|
| Rate for Payer: WPS Commercial |
$958.47
|
|
|
ED Closed treatment of proximal humeral fracture, with manipulation
|
Facility
IP
|
$1,482.00
|
|
|
Service Code
|
CPT 23605
|
| Hospital Charge Code |
6173471
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$726.18 |
| Max. Negotiated Rate |
$1,363.44 |
| Rate for Payer: Aetna Commercial |
$1,333.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$785.46
|
| Rate for Payer: Cash Price |
$444.60
|
| Rate for Payer: Cigna Commercial |
$1,363.44
|
| Rate for Payer: Health EOS Commercial |
$1,318.98
|
| Rate for Payer: HFN Commercial |
$1,363.44
|
| Rate for Payer: Multiplan Commercial |
$1,185.60
|
| Rate for Payer: NAPHCARE Commercial |
$889.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,363.44
|
| Rate for Payer: Quartz Beloit One Network |
$726.18
|
| Rate for Payer: Quartz Commercial |
$889.20
|
| Rate for Payer: WEA Trust Commercial |
$815.10
|
| Rate for Payer: WPS Commercial |
$1,097.72
|
|
|
ED Closed treatment of proximal humeral fracture, with manipulation
|
Facility
OP
|
$1,482.00
|
|
|
Service Code
|
CPT 23605
|
| Hospital Charge Code |
6173471
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$74,261.40 |
| Rate for Payer: Aetna Commercial |
$1,333.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,274.52
|
| Rate for Payer: Aetna Managed Medicare |
$1,588.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$963.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$741.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$711.36
|
| Rate for Payer: Anthem Medicare Advantage |
$1,588.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$785.46
|
| 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 |
$444.60
|
| Rate for Payer: Cash Price |
$444.60
|
| Rate for Payer: Cash Price |
$444.60
|
| Rate for Payer: Cigna Commercial |
$1,363.44
|
| 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 |
$1,318.98
|
| Rate for Payer: HFN Commercial |
$1,363.44
|
| 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 |
$1,185.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,382.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,363.44
|
| Rate for Payer: Quartz Beloit One Network |
$726.18
|
| Rate for Payer: Quartz Commercial |
$963.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,588.57
|
| Rate for Payer: The Alliance Commercial |
$74,261.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,588.57
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$815.10
|
| Rate for Payer: Wellcare Medicare |
$1,588.57
|
| Rate for Payer: WPS Commercial |
$1,097.72
|
|
|
ED Closed treatment of radial head subluxation in child, nursemaid elbow, w/ manipulation
|
Facility
IP
|
$260.00
|
|
|
Service Code
|
CPT 24640
|
| Hospital Charge Code |
6172935
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$127.40 |
| Max. Negotiated Rate |
$239.20 |
| Rate for Payer: Aetna Commercial |
$234.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$137.80
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$239.20
|
| Rate for Payer: Health EOS Commercial |
$231.40
|
| Rate for Payer: HFN Commercial |
$239.20
|
| Rate for Payer: Multiplan Commercial |
$208.00
|
| Rate for Payer: NAPHCARE Commercial |
$156.00
|
| Rate for Payer: Preferred Network Access Commercial |
$239.20
|
| Rate for Payer: Quartz Beloit One Network |
$127.40
|
| Rate for Payer: Quartz Commercial |
$156.00
|
| Rate for Payer: WEA Trust Commercial |
$143.00
|
| Rate for Payer: WPS Commercial |
$192.58
|
|
|
ED Closed treatment of radial head subluxation in child, nursemaid elbow, w/ manipulation
|
Facility
OP
|
$260.00
|
|
|
Service Code
|
CPT 24640
|
| Hospital Charge Code |
6172935
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$124.80 |
| Max. Negotiated Rate |
$27,265.32 |
| Rate for Payer: Aetna Commercial |
$234.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$223.60
|
| Rate for Payer: Aetna Managed Medicare |
$233.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$169.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$130.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$124.80
|
| Rate for Payer: Anthem Medicare Advantage |
$233.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$137.80
|
| 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 |
$78.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$239.20
|
| 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 |
$231.40
|
| Rate for Payer: HFN Commercial |
$239.20
|
| 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 |
$208.00
|
| Rate for Payer: NAPHCARE Commercial |
$349.64
|
| Rate for Payer: Preferred Network Access Commercial |
$239.20
|
| Rate for Payer: Quartz Beloit One Network |
$127.40
|
| Rate for Payer: Quartz Commercial |
$169.00
|
| 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 |
$143.00
|
| Rate for Payer: Wellcare Medicare |
$233.09
|
| Rate for Payer: WPS Commercial |
$192.58
|
|
|
ED Closed treatment of shoulder dislocation, with manipulation; requiring anesthesia
|
Facility
OP
|
$790.00
|
|
|
Service Code
|
CPT 23655
|
| Hospital Charge Code |
6173863
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$12,148.04 |
| Rate for Payer: Aetna Commercial |
$711.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$679.40
|
| Rate for Payer: Aetna Managed Medicare |
$1,588.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$513.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$395.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$379.20
|
| Rate for Payer: Anthem Medicare Advantage |
$1,588.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$418.70
|
| 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 |
$237.00
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cigna Commercial |
$726.80
|
| 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 |
$703.10
|
| Rate for Payer: HFN Commercial |
$726.80
|
| 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 |
$632.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,382.86
|
| Rate for Payer: Preferred Network Access Commercial |
$726.80
|
| Rate for Payer: Quartz Beloit One Network |
$387.10
|
| Rate for Payer: Quartz Commercial |
$513.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,588.57
|
| Rate for Payer: The Alliance Commercial |
$12,148.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,588.57
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$434.50
|
| Rate for Payer: Wellcare Medicare |
$1,588.57
|
| Rate for Payer: WPS Commercial |
$585.15
|
|
|
ED Closed treatment of shoulder dislocation, with manipulation; requiring anesthesia
|
Facility
IP
|
$790.00
|
|
|
Service Code
|
CPT 23655
|
| Hospital Charge Code |
6173863
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$387.10 |
| Max. Negotiated Rate |
$726.80 |
| Rate for Payer: Aetna Commercial |
$711.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$418.70
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cigna Commercial |
$726.80
|
| Rate for Payer: Health EOS Commercial |
$703.10
|
| Rate for Payer: HFN Commercial |
$726.80
|
| Rate for Payer: Multiplan Commercial |
$632.00
|
| Rate for Payer: NAPHCARE Commercial |
$474.00
|
| Rate for Payer: Preferred Network Access Commercial |
$726.80
|
| Rate for Payer: Quartz Beloit One Network |
$387.10
|
| Rate for Payer: Quartz Commercial |
$474.00
|
| Rate for Payer: WEA Trust Commercial |
$434.50
|
| Rate for Payer: WPS Commercial |
$585.15
|
|
|
ED Closed treatment of shoulder dislocation, with manipulation; w/o anesthesia
|
Facility
OP
|
$801.00
|
|
|
Service Code
|
CPT 23650
|
| Hospital Charge Code |
6172918
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$233.09 |
| Max. Negotiated Rate |
$74,261.40 |
| Rate for Payer: Aetna Commercial |
$720.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$688.86
|
| Rate for Payer: Aetna Managed Medicare |
$233.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$520.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$400.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$384.48
|
| Rate for Payer: Anthem Medicare Advantage |
$233.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$424.53
|
| 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 |
$240.30
|
| Rate for Payer: Cash Price |
$240.30
|
| Rate for Payer: Cash Price |
$240.30
|
| Rate for Payer: Cigna Commercial |
$736.92
|
| 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 |
$712.89
|
| Rate for Payer: HFN Commercial |
$736.92
|
| 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 |
$640.80
|
| Rate for Payer: NAPHCARE Commercial |
$349.64
|
| Rate for Payer: Preferred Network Access Commercial |
$736.92
|
| Rate for Payer: Quartz Beloit One Network |
$392.49
|
| Rate for Payer: Quartz Commercial |
$520.65
|
| Rate for Payer: Quartz Medicare Advantage |
$233.09
|
| Rate for Payer: The Alliance Commercial |
$74,261.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$233.09
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$440.55
|
| Rate for Payer: Wellcare Medicare |
$233.09
|
| Rate for Payer: WPS Commercial |
$593.30
|
|
|
ED Closed treatment of shoulder dislocation, with manipulation; w/o anesthesia
|
Facility
IP
|
$801.00
|
|
|
Service Code
|
CPT 23650
|
| Hospital Charge Code |
6172918
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$392.49 |
| Max. Negotiated Rate |
$736.92 |
| Rate for Payer: Aetna Commercial |
$720.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$424.53
|
| Rate for Payer: Cash Price |
$240.30
|
| Rate for Payer: Cigna Commercial |
$736.92
|
| Rate for Payer: Health EOS Commercial |
$712.89
|
| Rate for Payer: HFN Commercial |
$736.92
|
| Rate for Payer: Multiplan Commercial |
$640.80
|
| Rate for Payer: NAPHCARE Commercial |
$480.60
|
| Rate for Payer: Preferred Network Access Commercial |
$736.92
|
| Rate for Payer: Quartz Beloit One Network |
$392.49
|
| Rate for Payer: Quartz Commercial |
$480.60
|
| Rate for Payer: WEA Trust Commercial |
$440.55
|
| Rate for Payer: WPS Commercial |
$593.30
|
|
|
ED Closed treatment of trimalleolar ankle fracture; with manipulation
|
Facility
OP
|
$2,286.00
|
|
|
Service Code
|
CPT 27818
|
| Hospital Charge Code |
6174071
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$12,336.12 |
| Rate for Payer: Aetna Commercial |
$2,057.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,965.96
|
| Rate for Payer: Aetna Managed Medicare |
$1,588.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,485.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,143.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,097.28
|
| Rate for Payer: Anthem Medicare Advantage |
$1,588.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,211.58
|
| 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 |
$685.80
|
| Rate for Payer: Cash Price |
$685.80
|
| Rate for Payer: Cash Price |
$685.80
|
| Rate for Payer: Cigna Commercial |
$2,103.12
|
| 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 |
$2,034.54
|
| Rate for Payer: HFN Commercial |
$2,103.12
|
| 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 |
$1,828.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,382.86
|
| Rate for Payer: Preferred Network Access Commercial |
$2,103.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,120.14
|
| Rate for Payer: Quartz Commercial |
$1,485.90
|
| 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 |
$1,257.30
|
| Rate for Payer: Wellcare Medicare |
$1,588.57
|
| Rate for Payer: WPS Commercial |
$1,693.24
|
|
|
ED Closed treatment of trimalleolar ankle fracture; with manipulation
|
Facility
IP
|
$2,286.00
|
|
|
Service Code
|
CPT 27818
|
| Hospital Charge Code |
6174071
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,120.14 |
| Max. Negotiated Rate |
$2,103.12 |
| Rate for Payer: Aetna Commercial |
$2,057.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,211.58
|
| Rate for Payer: Cash Price |
$685.80
|
| Rate for Payer: Cigna Commercial |
$2,103.12
|
| Rate for Payer: Health EOS Commercial |
$2,034.54
|
| Rate for Payer: HFN Commercial |
$2,103.12
|
| Rate for Payer: Multiplan Commercial |
$1,828.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,371.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,103.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,120.14
|
| Rate for Payer: Quartz Commercial |
$1,371.60
|
| Rate for Payer: WEA Trust Commercial |
$1,257.30
|
| Rate for Payer: WPS Commercial |
$1,693.24
|
|
|
ED Closed Treatment of ulnar fracture, proximal end; with manipulation
|
Facility
OP
|
$757.00
|
|
|
Service Code
|
CPT 24675
|
| Hospital Charge Code |
6230218
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$27,265.32 |
| Rate for Payer: Aetna Commercial |
$681.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$651.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,588.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$492.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$378.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$363.36
|
| Rate for Payer: Anthem Medicare Advantage |
$1,588.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$401.21
|
| 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 |
$227.10
|
| Rate for Payer: Cash Price |
$227.10
|
| Rate for Payer: Cash Price |
$227.10
|
| Rate for Payer: Cigna Commercial |
$696.44
|
| 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 |
$673.73
|
| Rate for Payer: HFN Commercial |
$696.44
|
| 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 |
$605.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,382.86
|
| Rate for Payer: Preferred Network Access Commercial |
$696.44
|
| Rate for Payer: Quartz Beloit One Network |
$370.93
|
| Rate for Payer: Quartz Commercial |
$492.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,588.57
|
| Rate for Payer: The Alliance Commercial |
$27,265.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,588.57
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$416.35
|
| Rate for Payer: Wellcare Medicare |
$1,588.57
|
| Rate for Payer: WPS Commercial |
$560.71
|
|
|
ED Closed Treatment of ulnar fracture, proximal end; with manipulation
|
Facility
IP
|
$757.00
|
|
|
Service Code
|
CPT 24675
|
| Hospital Charge Code |
6230218
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$370.93 |
| Max. Negotiated Rate |
$696.44 |
| Rate for Payer: Aetna Commercial |
$681.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$401.21
|
| Rate for Payer: Cash Price |
$227.10
|
| Rate for Payer: Cigna Commercial |
$696.44
|
| Rate for Payer: Health EOS Commercial |
$673.73
|
| Rate for Payer: HFN Commercial |
$696.44
|
| Rate for Payer: Multiplan Commercial |
$605.60
|
| Rate for Payer: NAPHCARE Commercial |
$454.20
|
| Rate for Payer: Preferred Network Access Commercial |
$696.44
|
| Rate for Payer: Quartz Beloit One Network |
$370.93
|
| Rate for Payer: Quartz Commercial |
$454.20
|
| Rate for Payer: WEA Trust Commercial |
$416.35
|
| Rate for Payer: WPS Commercial |
$560.71
|
|
|
ED Closed Treatment, Radial & Ulnar Shaft Fractures with manipulation
|
Facility
OP
|
$988.00
|
|
|
Service Code
|
CPT 25565
|
| Hospital Charge Code |
6182859
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$22,318.84 |
| Rate for Payer: Aetna Commercial |
$889.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$849.68
|
| Rate for Payer: Aetna Managed Medicare |
$1,588.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$642.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$494.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$474.24
|
| Rate for Payer: Anthem Medicare Advantage |
$1,588.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$523.64
|
| 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 |
$296.40
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cigna Commercial |
$908.96
|
| 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 |
$879.32
|
| Rate for Payer: HFN Commercial |
$908.96
|
| 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 |
$790.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,382.86
|
| Rate for Payer: Preferred Network Access Commercial |
$908.96
|
| Rate for Payer: Quartz Beloit One Network |
$484.12
|
| Rate for Payer: Quartz Commercial |
$642.20
|
| 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 |
$543.40
|
| Rate for Payer: Wellcare Medicare |
$1,588.57
|
| Rate for Payer: WPS Commercial |
$731.81
|
|
|
ED Closed Treatment, Radial & Ulnar Shaft Fractures with manipulation
|
Facility
IP
|
$988.00
|
|
|
Service Code
|
CPT 25565
|
| Hospital Charge Code |
6182859
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$484.12 |
| Max. Negotiated Rate |
$908.96 |
| Rate for Payer: Aetna Commercial |
$889.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$523.64
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cigna Commercial |
$908.96
|
| Rate for Payer: Health EOS Commercial |
$879.32
|
| Rate for Payer: HFN Commercial |
$908.96
|
| Rate for Payer: Multiplan Commercial |
$790.40
|
| Rate for Payer: NAPHCARE Commercial |
$592.80
|
| Rate for Payer: Preferred Network Access Commercial |
$908.96
|
| Rate for Payer: Quartz Beloit One Network |
$484.12
|
| Rate for Payer: Quartz Commercial |
$592.80
|
| Rate for Payer: WEA Trust Commercial |
$543.40
|
| Rate for Payer: WPS Commercial |
$731.81
|
|
|
ED Closed TX Nasal Bone FX W/MNPJ w/o Stabilization
|
Facility
IP
|
$751.00
|
|
|
Service Code
|
CPT 21315
|
| Hospital Charge Code |
6210174
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$367.99 |
| Max. Negotiated Rate |
$690.92 |
| Rate for Payer: Aetna Commercial |
$675.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$398.03
|
| Rate for Payer: Cash Price |
$225.30
|
| Rate for Payer: Cigna Commercial |
$690.92
|
| Rate for Payer: Health EOS Commercial |
$668.39
|
| Rate for Payer: HFN Commercial |
$690.92
|
| Rate for Payer: Multiplan Commercial |
$600.80
|
| Rate for Payer: NAPHCARE Commercial |
$450.60
|
| Rate for Payer: Preferred Network Access Commercial |
$690.92
|
| Rate for Payer: Quartz Beloit One Network |
$367.99
|
| Rate for Payer: Quartz Commercial |
$450.60
|
| Rate for Payer: WEA Trust Commercial |
$413.05
|
| Rate for Payer: WPS Commercial |
$556.27
|
|
|
ED Closed TX Nasal Bone FX W/MNPJ w/o Stabilization
|
Facility
OP
|
$751.00
|
|
|
Service Code
|
CPT 21315
|
| Hospital Charge Code |
6210174
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$128.28 |
| Max. Negotiated Rate |
$5,607.42 |
| Rate for Payer: Aetna Commercial |
$675.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$645.86
|
| Rate for Payer: Aetna Managed Medicare |
$1,507.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$488.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$375.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$360.48
|
| Rate for Payer: Anthem Medicare Advantage |
$1,507.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$398.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,507.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,507.37
|
| Rate for Payer: Cash Price |
$225.30
|
| Rate for Payer: Cash Price |
$225.30
|
| Rate for Payer: Cash Price |
$225.30
|
| Rate for Payer: Cigna Commercial |
$690.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,507.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,507.37
|
| Rate for Payer: Health EOS Commercial |
$668.39
|
| Rate for Payer: HFN Commercial |
$690.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,607.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,507.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,507.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,507.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,507.37
|
| Rate for Payer: Multiplan Commercial |
$600.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,261.06
|
| Rate for Payer: Preferred Network Access Commercial |
$690.92
|
| Rate for Payer: Quartz Beloit One Network |
$367.99
|
| Rate for Payer: Quartz Commercial |
$488.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,507.37
|
| Rate for Payer: The Alliance Commercial |
$128.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,507.37
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$413.05
|
| Rate for Payer: Wellcare Medicare |
$1,507.37
|
| Rate for Payer: WPS Commercial |
$556.27
|
|
|
ED Closure of Laceration, Vestibule of Mouth; 2.5 cm or less
|
Facility
IP
|
$333.00
|
|
|
Service Code
|
CPT 40830
|
| Hospital Charge Code |
6174795
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$163.17 |
| Max. Negotiated Rate |
$306.36 |
| Rate for Payer: Aetna Commercial |
$299.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$176.49
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cigna Commercial |
$306.36
|
| Rate for Payer: Health EOS Commercial |
$296.37
|
| Rate for Payer: HFN Commercial |
$306.36
|
| Rate for Payer: Multiplan Commercial |
$266.40
|
| Rate for Payer: NAPHCARE Commercial |
$199.80
|
| Rate for Payer: Preferred Network Access Commercial |
$306.36
|
| Rate for Payer: Quartz Beloit One Network |
$163.17
|
| Rate for Payer: Quartz Commercial |
$199.80
|
| Rate for Payer: WEA Trust Commercial |
$183.15
|
| Rate for Payer: WPS Commercial |
$246.65
|
|
|
ED Closure of Laceration, Vestibule of Mouth; 2.5 cm or less
|
Facility
OP
|
$333.00
|
|
|
Service Code
|
CPT 40830
|
| Hospital Charge Code |
6174795
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$159.84 |
| Max. Negotiated Rate |
$5,812.20 |
| Rate for Payer: Aetna Commercial |
$299.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$286.38
|
| Rate for Payer: Aetna Managed Medicare |
$241.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$216.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$166.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$159.84
|
| Rate for Payer: Anthem Medicare Advantage |
$241.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$176.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$241.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$241.43
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cigna Commercial |
$306.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$241.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$241.43
|
| Rate for Payer: Health EOS Commercial |
$296.37
|
| Rate for Payer: HFN Commercial |
$306.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$898.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$241.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$241.43
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$241.43
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$241.43
|
| Rate for Payer: Multiplan Commercial |
$266.40
|
| Rate for Payer: NAPHCARE Commercial |
$362.14
|
| Rate for Payer: Preferred Network Access Commercial |
$306.36
|
| Rate for Payer: Quartz Beloit One Network |
$163.17
|
| Rate for Payer: Quartz Commercial |
$216.45
|
| Rate for Payer: Quartz Medicare Advantage |
$241.43
|
| Rate for Payer: The Alliance Commercial |
$5,812.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$241.43
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$183.15
|
| Rate for Payer: Wellcare Medicare |
$241.43
|
| Rate for Payer: WPS Commercial |
$246.65
|
|
|
ED CLTX HIP DISLOCATION TRAUMATIC REQ ANESTHESIA
|
Facility
IP
|
$1,290.00
|
|
|
Service Code
|
CPT 27252
|
| Hospital Charge Code |
6224199
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$632.10 |
| Max. Negotiated Rate |
$1,186.80 |
| Rate for Payer: Aetna Commercial |
$1,161.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$683.70
|
| Rate for Payer: Cash Price |
$387.00
|
| Rate for Payer: Cigna Commercial |
$1,186.80
|
| Rate for Payer: Health EOS Commercial |
$1,148.10
|
| Rate for Payer: HFN Commercial |
$1,186.80
|
| Rate for Payer: Multiplan Commercial |
$1,032.00
|
| Rate for Payer: NAPHCARE Commercial |
$774.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,186.80
|
| Rate for Payer: Quartz Beloit One Network |
$632.10
|
| Rate for Payer: Quartz Commercial |
$774.00
|
| Rate for Payer: WEA Trust Commercial |
$709.50
|
| Rate for Payer: WPS Commercial |
$955.50
|
|
|
ED CLTX HIP DISLOCATION TRAUMATIC REQ ANESTHESIA
|
Facility
OP
|
$1,290.00
|
|
|
Service Code
|
CPT 27252
|
| Hospital Charge Code |
6224199
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$12,336.12 |
| Rate for Payer: Aetna Commercial |
$1,161.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,109.40
|
| Rate for Payer: Aetna Managed Medicare |
$1,588.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$838.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$645.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$619.20
|
| Rate for Payer: Anthem Medicare Advantage |
$1,588.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$683.70
|
| 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 |
$387.00
|
| Rate for Payer: Cash Price |
$387.00
|
| Rate for Payer: Cash Price |
$387.00
|
| Rate for Payer: Cigna Commercial |
$1,186.80
|
| 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 |
$1,148.10
|
| Rate for Payer: HFN Commercial |
$1,186.80
|
| 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 |
$1,032.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,382.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,186.80
|
| Rate for Payer: Quartz Beloit One Network |
$632.10
|
| Rate for Payer: Quartz Commercial |
$838.50
|
| 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 |
$709.50
|
| Rate for Payer: Wellcare Medicare |
$1,588.57
|
| Rate for Payer: WPS Commercial |
$955.50
|
|
|
ED CLTX IPHAL JT DISLC W/MANJ REQ ANES
|
Facility
IP
|
$866.00
|
|
|
Service Code
|
CPT 26775
|
| Hospital Charge Code |
6210425
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$424.34 |
| Max. Negotiated Rate |
$796.72 |
| Rate for Payer: Aetna Commercial |
$779.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$458.98
|
| Rate for Payer: Cash Price |
$259.80
|
| Rate for Payer: Cigna Commercial |
$796.72
|
| Rate for Payer: Health EOS Commercial |
$770.74
|
| Rate for Payer: HFN Commercial |
$796.72
|
| Rate for Payer: Multiplan Commercial |
$692.80
|
| Rate for Payer: NAPHCARE Commercial |
$519.60
|
| Rate for Payer: Preferred Network Access Commercial |
$796.72
|
| Rate for Payer: Quartz Beloit One Network |
$424.34
|
| Rate for Payer: Quartz Commercial |
$519.60
|
| Rate for Payer: WEA Trust Commercial |
$476.30
|
| Rate for Payer: WPS Commercial |
$641.45
|
|
|
ED CLTX IPHAL JT DISLC W/MANJ REQ ANES
|
Facility
OP
|
$866.00
|
|
|
Service Code
|
CPT 26775
|
| Hospital Charge Code |
6210425
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$265.44 |
| Max. Negotiated Rate |
$50,159.28 |
| Rate for Payer: Aetna Commercial |
$779.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$744.76
|
| Rate for Payer: Aetna Managed Medicare |
$265.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$562.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$433.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$415.68
|
| Rate for Payer: Anthem Medicare Advantage |
$265.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$458.98
|
| 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 |
$259.80
|
| Rate for Payer: Cash Price |
$259.80
|
| Rate for Payer: Cash Price |
$259.80
|
| Rate for Payer: Cigna Commercial |
$796.72
|
| 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 |
$770.74
|
| Rate for Payer: HFN Commercial |
$796.72
|
| 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 |
$692.80
|
| Rate for Payer: NAPHCARE Commercial |
$398.16
|
| Rate for Payer: Preferred Network Access Commercial |
$796.72
|
| Rate for Payer: Quartz Beloit One Network |
$424.34
|
| Rate for Payer: Quartz Commercial |
$562.90
|
| 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 |
$476.30
|
| Rate for Payer: Wellcare Medicare |
$265.44
|
| Rate for Payer: WPS Commercial |
$641.45
|
|
|
ED Colorectal Cancer Screening: Flexible Sigmoidoscopy
|
Facility
IP
|
$297.00
|
|
|
Service Code
|
CPT 45330
|
| Hospital Charge Code |
6174791
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$145.53 |
| Max. Negotiated Rate |
$273.24 |
| Rate for Payer: Aetna Commercial |
$267.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$157.41
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cigna Commercial |
$273.24
|
| Rate for Payer: Health EOS Commercial |
$264.33
|
| Rate for Payer: HFN Commercial |
$273.24
|
| Rate for Payer: Multiplan Commercial |
$237.60
|
| Rate for Payer: NAPHCARE Commercial |
$178.20
|
| Rate for Payer: Preferred Network Access Commercial |
$273.24
|
| Rate for Payer: Quartz Beloit One Network |
$145.53
|
| Rate for Payer: Quartz Commercial |
$178.20
|
| Rate for Payer: WEA Trust Commercial |
$163.35
|
| Rate for Payer: WPS Commercial |
$219.99
|
|
|
ED Colorectal Cancer Screening: Flexible Sigmoidoscopy
|
Facility
OP
|
$297.00
|
|
|
Service Code
|
CPT 45330
|
| Hospital Charge Code |
6174791
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$142.56 |
| Max. Negotiated Rate |
$13,185.36 |
| Rate for Payer: Aetna Commercial |
$267.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$255.42
|
| Rate for Payer: Aetna Managed Medicare |
$903.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$193.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$148.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$142.56
|
| Rate for Payer: Anthem Medicare Advantage |
$903.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$157.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$903.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$903.36
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cigna Commercial |
$273.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$903.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$636.03
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$903.36
|
| Rate for Payer: Health EOS Commercial |
$264.33
|
| Rate for Payer: HFN Commercial |
$273.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,360.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$903.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$903.36
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$903.36
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$903.36
|
| Rate for Payer: Multiplan Commercial |
$237.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,355.04
|
| Rate for Payer: Preferred Network Access Commercial |
$273.24
|
| Rate for Payer: Quartz Beloit One Network |
$145.53
|
| Rate for Payer: Quartz Commercial |
$193.05
|
| Rate for Payer: Quartz Medicare Advantage |
$903.36
|
| Rate for Payer: The Alliance Commercial |
$13,185.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$903.36
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$163.35
|
| Rate for Payer: Wellcare Medicare |
$903.36
|
| Rate for Payer: WPS Commercial |
$219.99
|
|
