|
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 |
$612.54 |
| Max. Negotiated Rate |
$1,150.07 |
| Rate for Payer: Aetna Commercial |
$1,125.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,075.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$662.54
|
| Rate for Payer: Cash Price |
$360.60
|
| Rate for Payer: Cigna Commercial |
$1,150.07
|
| Rate for Payer: Health EOS Commercial |
$1,112.57
|
| Rate for Payer: HFN Commercial |
$1,150.07
|
| Rate for Payer: Multiplan Commercial |
$1,000.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,150.07
|
| Rate for Payer: Quartz Beloit One Network |
$612.54
|
| Rate for Payer: Quartz Commercial |
$750.05
|
| Rate for Payer: WEA Trust Commercial |
$687.54
|
| Rate for Payer: WPS Commercial |
$925.90
|
|
|
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 |
$313.04 |
| Max. Negotiated Rate |
$6,768.94 |
| Rate for Payer: Aetna Commercial |
$1,125.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,075.07
|
| Rate for Payer: Aetna Managed Medicare |
$1,692.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$812.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$625.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$600.04
|
| Rate for Payer: Anthem Medicare Advantage |
$1,692.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$662.54
|
| 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: Cash Price |
$360.60
|
| Rate for Payer: Cash Price |
$360.60
|
| Rate for Payer: Cash Price |
$360.60
|
| Rate for Payer: Cigna Commercial |
$1,150.07
|
| 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: Health EOS Commercial |
$1,112.57
|
| Rate for Payer: HFN Commercial |
$1,150.07
|
| 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: Multiplan Commercial |
$1,000.06
|
| Rate for Payer: NAPHCARE Commercial |
$2,538.35
|
| Rate for Payer: Preferred Network Access Commercial |
$1,150.07
|
| Rate for Payer: Quartz Beloit One Network |
$612.54
|
| Rate for Payer: Quartz Commercial |
$812.55
|
| 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 |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$687.54
|
| Rate for Payer: Wellcare Medicare |
$1,692.24
|
| Rate for Payer: WPS Commercial |
$925.90
|
|
|
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 |
$157.25 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$294.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$281.74
|
| Rate for Payer: Aetna Managed Medicare |
$294.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$212.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$163.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$157.25
|
| Rate for Payer: Anthem Medicare Advantage |
$294.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$173.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$294.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$294.34
|
| 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 |
$301.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$294.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$294.34
|
| Rate for Payer: Health EOS Commercial |
$291.56
|
| Rate for Payer: HFN Commercial |
$301.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,094.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$294.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$294.34
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$294.34
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$294.34
|
| Rate for Payer: Multiplan Commercial |
$262.08
|
| Rate for Payer: NAPHCARE Commercial |
$441.51
|
| Rate for Payer: Preferred Network Access Commercial |
$301.39
|
| Rate for Payer: Quartz Beloit One Network |
$160.52
|
| Rate for Payer: Quartz Commercial |
$212.94
|
| Rate for Payer: Quartz Medicare Advantage |
$294.34
|
| Rate for Payer: The Alliance Commercial |
$1,177.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$294.34
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$180.18
|
| Rate for Payer: Wellcare Medicare |
$294.34
|
| Rate for Payer: WPS Commercial |
$242.64
|
|
|
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 |
$160.52 |
| Max. Negotiated Rate |
$301.39 |
| Rate for Payer: Aetna Commercial |
$294.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$281.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$173.63
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna Commercial |
$301.39
|
| Rate for Payer: Health EOS Commercial |
$291.56
|
| Rate for Payer: HFN Commercial |
$301.39
|
| Rate for Payer: Multiplan Commercial |
$262.08
|
| Rate for Payer: Preferred Network Access Commercial |
$301.39
|
| Rate for Payer: Quartz Beloit One Network |
$160.52
|
| Rate for Payer: Quartz Commercial |
$196.56
|
| Rate for Payer: WEA Trust Commercial |
$180.18
|
| Rate for Payer: WPS Commercial |
$242.64
|
|
|
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 |
$313.04 |
| Max. Negotiated Rate |
$6,768.94 |
| Rate for Payer: Aetna Commercial |
$1,344.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,284.36
|
| Rate for Payer: Aetna Managed Medicare |
$1,692.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$970.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$746.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$716.85
|
| Rate for Payer: Anthem Medicare Advantage |
$1,692.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$791.52
|
| 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: Cash Price |
$430.80
|
| Rate for Payer: Cash Price |
$430.80
|
| Rate for Payer: Cash Price |
$430.80
|
| Rate for Payer: Cigna Commercial |
$1,373.96
|
| 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: Health EOS Commercial |
$1,329.16
|
| Rate for Payer: HFN Commercial |
$1,373.96
|
| 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: Multiplan Commercial |
$1,194.75
|
| Rate for Payer: NAPHCARE Commercial |
$2,538.35
|
| Rate for Payer: Preferred Network Access Commercial |
$1,373.96
|
| Rate for Payer: Quartz Beloit One Network |
$731.79
|
| Rate for Payer: Quartz Commercial |
$970.74
|
| 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 |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$821.39
|
| Rate for Payer: Wellcare Medicare |
$1,692.24
|
| Rate for Payer: WPS Commercial |
$1,106.15
|
|
|
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 |
$731.79 |
| Max. Negotiated Rate |
$1,373.96 |
| Rate for Payer: Aetna Commercial |
$1,344.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,284.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$791.52
|
| Rate for Payer: Cash Price |
$430.80
|
| Rate for Payer: Cigna Commercial |
$1,373.96
|
| Rate for Payer: Health EOS Commercial |
$1,329.16
|
| Rate for Payer: HFN Commercial |
$1,373.96
|
| Rate for Payer: Multiplan Commercial |
$1,194.75
|
| Rate for Payer: Preferred Network Access Commercial |
$1,373.96
|
| Rate for Payer: Quartz Beloit One Network |
$731.79
|
| Rate for Payer: Quartz Commercial |
$896.06
|
| Rate for Payer: WEA Trust Commercial |
$821.39
|
| Rate for Payer: WPS Commercial |
$1,106.15
|
|
|
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 |
$465.26 |
| Max. Negotiated Rate |
$873.56 |
| Rate for Payer: Aetna Commercial |
$854.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$816.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$503.25
|
| Rate for Payer: Cash Price |
$273.90
|
| Rate for Payer: Cigna Commercial |
$873.56
|
| Rate for Payer: Health EOS Commercial |
$845.07
|
| Rate for Payer: HFN Commercial |
$873.56
|
| Rate for Payer: Multiplan Commercial |
$759.62
|
| Rate for Payer: Preferred Network Access Commercial |
$873.56
|
| Rate for Payer: Quartz Beloit One Network |
$465.26
|
| Rate for Payer: Quartz Commercial |
$569.71
|
| Rate for Payer: WEA Trust Commercial |
$522.24
|
| Rate for Payer: WPS Commercial |
$703.28
|
|
|
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 |
$313.04 |
| Max. Negotiated Rate |
$6,807.99 |
| Rate for Payer: Aetna Commercial |
$854.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$816.59
|
| Rate for Payer: Aetna Managed Medicare |
$1,692.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$617.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$474.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$455.77
|
| Rate for Payer: Anthem Medicare Advantage |
$1,692.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$503.25
|
| 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: Cash Price |
$273.90
|
| Rate for Payer: Cash Price |
$273.90
|
| Rate for Payer: Cash Price |
$273.90
|
| Rate for Payer: Cigna Commercial |
$873.56
|
| 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: Health EOS Commercial |
$845.07
|
| Rate for Payer: HFN Commercial |
$873.56
|
| 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: Multiplan Commercial |
$759.62
|
| Rate for Payer: NAPHCARE Commercial |
$2,538.35
|
| Rate for Payer: Preferred Network Access Commercial |
$873.56
|
| Rate for Payer: Quartz Beloit One Network |
$465.26
|
| Rate for Payer: Quartz Commercial |
$617.19
|
| 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 |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$522.24
|
| Rate for Payer: Wellcare Medicare |
$1,692.24
|
| Rate for Payer: WPS Commercial |
$703.28
|
|
|
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 |
$313.04 |
| Max. Negotiated Rate |
$6,807.99 |
| Rate for Payer: Aetna Commercial |
$2,519.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,407.72
|
| Rate for Payer: Aetna Managed Medicare |
$1,692.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,819.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,399.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,343.85
|
| Rate for Payer: Anthem Medicare Advantage |
$1,692.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,483.83
|
| 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: Cash Price |
$807.60
|
| Rate for Payer: Cash Price |
$807.60
|
| Rate for Payer: Cash Price |
$807.60
|
| Rate for Payer: Cigna Commercial |
$2,575.71
|
| 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: Health EOS Commercial |
$2,491.72
|
| Rate for Payer: HFN Commercial |
$2,575.71
|
| 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: Multiplan Commercial |
$2,239.74
|
| Rate for Payer: NAPHCARE Commercial |
$2,538.35
|
| Rate for Payer: Preferred Network Access Commercial |
$2,575.71
|
| Rate for Payer: Quartz Beloit One Network |
$1,371.84
|
| Rate for Payer: Quartz Commercial |
$1,819.79
|
| 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 |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$1,539.82
|
| Rate for Payer: Wellcare Medicare |
$1,692.24
|
| Rate for Payer: WPS Commercial |
$2,073.65
|
|
|
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 |
$1,371.84 |
| Max. Negotiated Rate |
$2,575.71 |
| Rate for Payer: Aetna Commercial |
$2,519.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,407.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,483.83
|
| Rate for Payer: Cash Price |
$807.60
|
| Rate for Payer: Cigna Commercial |
$2,575.71
|
| Rate for Payer: Health EOS Commercial |
$2,491.72
|
| Rate for Payer: HFN Commercial |
$2,575.71
|
| Rate for Payer: Multiplan Commercial |
$2,239.74
|
| Rate for Payer: Preferred Network Access Commercial |
$2,575.71
|
| Rate for Payer: Quartz Beloit One Network |
$1,371.84
|
| Rate for Payer: Quartz Commercial |
$1,679.81
|
| Rate for Payer: WEA Trust Commercial |
$1,539.82
|
| Rate for Payer: WPS Commercial |
$2,073.65
|
|
|
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 |
$295.57 |
| Max. Negotiated Rate |
$554.94 |
| Rate for Payer: Aetna Commercial |
$542.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$518.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$319.70
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$554.94
|
| Rate for Payer: Health EOS Commercial |
$536.85
|
| Rate for Payer: HFN Commercial |
$554.94
|
| Rate for Payer: Multiplan Commercial |
$482.56
|
| Rate for Payer: Preferred Network Access Commercial |
$554.94
|
| Rate for Payer: Quartz Beloit One Network |
$295.57
|
| Rate for Payer: Quartz Commercial |
$361.92
|
| Rate for Payer: WEA Trust Commercial |
$331.76
|
| Rate for Payer: WPS Commercial |
$446.77
|
|
|
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 |
$259.59 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$542.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$518.75
|
| Rate for Payer: Aetna Managed Medicare |
$259.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$392.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$301.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$289.54
|
| Rate for Payer: Anthem Medicare Advantage |
$259.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$319.70
|
| 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: Cash Price |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$554.94
|
| 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: Health EOS Commercial |
$536.85
|
| Rate for Payer: HFN Commercial |
$554.94
|
| 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: Multiplan Commercial |
$482.56
|
| Rate for Payer: NAPHCARE Commercial |
$389.39
|
| Rate for Payer: Preferred Network Access Commercial |
$554.94
|
| Rate for Payer: Quartz Beloit One Network |
$295.57
|
| Rate for Payer: Quartz Commercial |
$392.08
|
| 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 |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$331.76
|
| Rate for Payer: Wellcare Medicare |
$259.59
|
| Rate for Payer: WPS Commercial |
$446.77
|
|
|
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 |
$369.46 |
| Max. Negotiated Rate |
$693.68 |
| Rate for Payer: Aetna Commercial |
$678.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$648.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$399.62
|
| Rate for Payer: Cash Price |
$217.50
|
| Rate for Payer: Cigna Commercial |
$693.68
|
| Rate for Payer: Health EOS Commercial |
$671.06
|
| Rate for Payer: HFN Commercial |
$693.68
|
| Rate for Payer: Multiplan Commercial |
$603.20
|
| Rate for Payer: Preferred Network Access Commercial |
$693.68
|
| Rate for Payer: Quartz Beloit One Network |
$369.46
|
| Rate for Payer: Quartz Commercial |
$452.40
|
| Rate for Payer: WEA Trust Commercial |
$414.70
|
| Rate for Payer: WPS Commercial |
$558.47
|
|
|
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 |
$259.59 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$678.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$648.44
|
| Rate for Payer: Aetna Managed Medicare |
$259.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$490.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$377.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$361.92
|
| Rate for Payer: Anthem Medicare Advantage |
$259.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$399.62
|
| 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: Cash Price |
$217.50
|
| Rate for Payer: Cash Price |
$217.50
|
| Rate for Payer: Cash Price |
$217.50
|
| Rate for Payer: Cigna Commercial |
$693.68
|
| 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: Health EOS Commercial |
$671.06
|
| Rate for Payer: HFN Commercial |
$693.68
|
| 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: Multiplan Commercial |
$603.20
|
| Rate for Payer: NAPHCARE Commercial |
$389.39
|
| Rate for Payer: Preferred Network Access Commercial |
$693.68
|
| Rate for Payer: Quartz Beloit One Network |
$369.46
|
| Rate for Payer: Quartz Commercial |
$490.10
|
| 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 |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$414.70
|
| Rate for Payer: Wellcare Medicare |
$259.59
|
| Rate for Payer: WPS Commercial |
$558.47
|
|
|
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 |
$127.40 |
| Max. Negotiated Rate |
$239.20 |
| Rate for Payer: Aetna Commercial |
$234.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$223.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$137.80
|
| Rate for Payer: Cash Price |
$75.00
|
| 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: 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 |
$192.57
|
|
|
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 |
$124.80 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$234.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$223.60
|
| Rate for Payer: Aetna Managed Medicare |
$259.59
|
| 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 |
$259.59
|
| 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 |
$259.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$259.59
|
| 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 |
$239.20
|
| 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: Health EOS Commercial |
$231.40
|
| Rate for Payer: HFN Commercial |
$239.20
|
| 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: Multiplan Commercial |
$208.00
|
| Rate for Payer: NAPHCARE Commercial |
$389.39
|
| 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 |
$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 |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$143.00
|
| Rate for Payer: Wellcare Medicare |
$259.59
|
| Rate for Payer: WPS Commercial |
$192.57
|
|
|
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 |
$423.99 |
| Max. Negotiated Rate |
$796.06 |
| Rate for Payer: Aetna Commercial |
$778.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$744.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$458.60
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cigna Commercial |
$796.06
|
| Rate for Payer: Health EOS Commercial |
$770.10
|
| Rate for Payer: HFN Commercial |
$796.06
|
| Rate for Payer: Multiplan Commercial |
$692.22
|
| Rate for Payer: Preferred Network Access Commercial |
$796.06
|
| Rate for Payer: Quartz Beloit One Network |
$423.99
|
| Rate for Payer: Quartz Commercial |
$519.17
|
| Rate for Payer: WEA Trust Commercial |
$475.90
|
| Rate for Payer: WPS Commercial |
$640.89
|
|
|
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 |
$259.59 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$778.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$744.14
|
| Rate for Payer: Aetna Managed Medicare |
$259.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$562.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$432.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$415.33
|
| Rate for Payer: Anthem Medicare Advantage |
$259.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$458.60
|
| 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: Cash Price |
$249.60
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cigna Commercial |
$796.06
|
| 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: Health EOS Commercial |
$770.10
|
| Rate for Payer: HFN Commercial |
$796.06
|
| 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: Multiplan Commercial |
$692.22
|
| Rate for Payer: NAPHCARE Commercial |
$389.39
|
| Rate for Payer: Preferred Network Access Commercial |
$796.06
|
| Rate for Payer: Quartz Beloit One Network |
$423.99
|
| Rate for Payer: Quartz Commercial |
$562.43
|
| 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 |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$475.90
|
| Rate for Payer: Wellcare Medicare |
$259.59
|
| Rate for Payer: WPS Commercial |
$640.89
|
|
|
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 |
$313.04 |
| Max. Negotiated Rate |
$6,768.94 |
| Rate for Payer: Aetna Commercial |
$1,211.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,157.35
|
| Rate for Payer: Aetna Managed Medicare |
$1,692.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$874.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$672.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$645.96
|
| Rate for Payer: Anthem Medicare Advantage |
$1,692.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$713.25
|
| 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: Cash Price |
$388.20
|
| Rate for Payer: Cash Price |
$388.20
|
| Rate for Payer: Cash Price |
$388.20
|
| Rate for Payer: Cigna Commercial |
$1,238.10
|
| 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: Health EOS Commercial |
$1,197.73
|
| Rate for Payer: HFN Commercial |
$1,238.10
|
| 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: Multiplan Commercial |
$1,076.61
|
| Rate for Payer: NAPHCARE Commercial |
$2,538.35
|
| Rate for Payer: Preferred Network Access Commercial |
$1,238.10
|
| Rate for Payer: Quartz Beloit One Network |
$659.42
|
| Rate for Payer: Quartz Commercial |
$874.74
|
| 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 |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$740.17
|
| Rate for Payer: Wellcare Medicare |
$1,692.24
|
| Rate for Payer: WPS Commercial |
$996.77
|
|
|
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 |
$659.42 |
| Max. Negotiated Rate |
$1,238.10 |
| Rate for Payer: Aetna Commercial |
$1,211.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,157.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$713.25
|
| Rate for Payer: Cash Price |
$388.20
|
| Rate for Payer: Cigna Commercial |
$1,238.10
|
| Rate for Payer: Health EOS Commercial |
$1,197.73
|
| Rate for Payer: HFN Commercial |
$1,238.10
|
| Rate for Payer: Multiplan Commercial |
$1,076.61
|
| Rate for Payer: Preferred Network Access Commercial |
$1,238.10
|
| Rate for Payer: Quartz Beloit One Network |
$659.42
|
| Rate for Payer: Quartz Commercial |
$807.46
|
| Rate for Payer: WEA Trust Commercial |
$740.17
|
| Rate for Payer: WPS Commercial |
$996.77
|
|
|
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 |
$313.04 |
| Max. Negotiated Rate |
$6,768.94 |
| Rate for Payer: Aetna Commercial |
$1,387.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,325.50
|
| Rate for Payer: Aetna Managed Medicare |
$1,692.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,001.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$770.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$739.81
|
| Rate for Payer: Anthem Medicare Advantage |
$1,692.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$816.88
|
| 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: Cash Price |
$444.60
|
| Rate for Payer: Cash Price |
$444.60
|
| Rate for Payer: Cash Price |
$444.60
|
| Rate for Payer: Cigna Commercial |
$1,417.98
|
| 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: Health EOS Commercial |
$1,371.74
|
| Rate for Payer: HFN Commercial |
$1,417.98
|
| 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: Multiplan Commercial |
$1,233.02
|
| Rate for Payer: NAPHCARE Commercial |
$2,538.35
|
| Rate for Payer: Preferred Network Access Commercial |
$1,417.98
|
| Rate for Payer: Quartz Beloit One Network |
$755.23
|
| Rate for Payer: Quartz Commercial |
$1,001.83
|
| 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 |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$847.70
|
| Rate for Payer: Wellcare Medicare |
$1,692.24
|
| Rate for Payer: WPS Commercial |
$1,141.58
|
|
|
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 |
$755.23 |
| Max. Negotiated Rate |
$1,417.98 |
| Rate for Payer: Aetna Commercial |
$1,387.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,325.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$816.88
|
| Rate for Payer: Cash Price |
$444.60
|
| Rate for Payer: Cigna Commercial |
$1,417.98
|
| Rate for Payer: Health EOS Commercial |
$1,371.74
|
| Rate for Payer: HFN Commercial |
$1,417.98
|
| Rate for Payer: Multiplan Commercial |
$1,233.02
|
| Rate for Payer: Preferred Network Access Commercial |
$1,417.98
|
| Rate for Payer: Quartz Beloit One Network |
$755.23
|
| Rate for Payer: Quartz Commercial |
$924.77
|
| Rate for Payer: WEA Trust Commercial |
$847.70
|
| Rate for Payer: WPS Commercial |
$1,141.58
|
|
|
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 |
$129.79 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$243.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$232.54
|
| Rate for Payer: Aetna Managed Medicare |
$259.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$175.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$135.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$129.79
|
| Rate for Payer: Anthem Medicare Advantage |
$259.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.31
|
| 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: Cash Price |
$78.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$248.77
|
| 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: Health EOS Commercial |
$240.66
|
| Rate for Payer: HFN Commercial |
$248.77
|
| 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: Multiplan Commercial |
$216.32
|
| Rate for Payer: NAPHCARE Commercial |
$389.39
|
| Rate for Payer: Preferred Network Access Commercial |
$248.77
|
| Rate for Payer: Quartz Beloit One Network |
$132.50
|
| Rate for Payer: Quartz Commercial |
$175.76
|
| 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 |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$148.72
|
| Rate for Payer: Wellcare Medicare |
$259.59
|
| Rate for Payer: WPS Commercial |
$200.28
|
|
|
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 |
$132.50 |
| Max. Negotiated Rate |
$248.77 |
| Rate for Payer: Aetna Commercial |
$243.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$232.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.31
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$248.77
|
| Rate for Payer: Health EOS Commercial |
$240.66
|
| Rate for Payer: HFN Commercial |
$248.77
|
| Rate for Payer: Multiplan Commercial |
$216.32
|
| Rate for Payer: Preferred Network Access Commercial |
$248.77
|
| Rate for Payer: Quartz Beloit One Network |
$132.50
|
| Rate for Payer: Quartz Commercial |
$162.24
|
| Rate for Payer: WEA Trust Commercial |
$148.72
|
| Rate for Payer: WPS Commercial |
$200.28
|
|
|
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 |
$313.04 |
| Max. Negotiated Rate |
$6,768.94 |
| Rate for Payer: Aetna Commercial |
$739.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$706.58
|
| Rate for Payer: Aetna Managed Medicare |
$1,692.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$534.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$410.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$394.37
|
| Rate for Payer: Anthem Medicare Advantage |
$1,692.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$435.45
|
| 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: Cash Price |
$237.00
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cigna Commercial |
$755.87
|
| 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: Health EOS Commercial |
$731.22
|
| Rate for Payer: HFN Commercial |
$755.87
|
| 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: Multiplan Commercial |
$657.28
|
| Rate for Payer: NAPHCARE Commercial |
$2,538.35
|
| Rate for Payer: Preferred Network Access Commercial |
$755.87
|
| Rate for Payer: Quartz Beloit One Network |
$402.58
|
| Rate for Payer: Quartz Commercial |
$534.04
|
| 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 |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$451.88
|
| Rate for Payer: Wellcare Medicare |
$1,692.24
|
| Rate for Payer: WPS Commercial |
$608.54
|
|
