ED Bone Marrow Bipsy, Needle or Trocar
|
Facility
|
OP
|
$387.00
|
|
Service Code
|
CPT 38221
|
Hospital Charge Code |
6173895
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$185.76 |
Max. Negotiated Rate |
$6,409.96 |
Rate for Payer: Aetna Commercial |
$348.30
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$332.82
|
Rate for Payer: Aetna Managed Medicare |
$1,602.49
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$251.55
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$193.50
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$185.76
|
Rate for Payer: Anthem Medicare Advantage |
$1,602.49
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$205.11
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,602.49
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,602.49
|
Rate for Payer: Cash Price |
$116.10
|
Rate for Payer: Cash Price |
$116.10
|
Rate for Payer: Cash Price |
$116.10
|
Rate for Payer: Cigna Commercial |
$356.04
|
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,602.49
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,602.49
|
Rate for Payer: Health EOS Commercial |
$344.43
|
Rate for Payer: HFN Commercial |
$356.04
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,961.26
|
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,602.49
|
Rate for Payer: Independent Care Health Plan Medicare |
$1,602.49
|
Rate for Payer: Managed Health Services Medicare Advantage |
$1,602.49
|
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,602.49
|
Rate for Payer: Multiplan Commercial |
$309.60
|
Rate for Payer: NAPHCARE Commercial |
$2,403.74
|
Rate for Payer: Preferred Network Access Commercial |
$356.04
|
Rate for Payer: Quartz Beloit One Network |
$189.63
|
Rate for Payer: Quartz Commercial |
$251.55
|
Rate for Payer: Quartz Medicare Advantage |
$1,602.49
|
Rate for Payer: The Alliance Commercial |
$6,409.96
|
Rate for Payer: United Healthcare Medicare Advantage |
$1,602.49
|
Rate for Payer: United Healthcare PPO |
$301.00
|
Rate for Payer: WEA Trust Commercial |
$212.85
|
Rate for Payer: Wellcare Medicare |
$1,602.49
|
Rate for Payer: WPS Commercial |
$286.65
|
|
ED Bone Marrow Bipsy, Needle or Trocar
|
Facility
|
IP
|
$387.00
|
|
Service Code
|
CPT 38221
|
Hospital Charge Code |
6173895
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$189.63 |
Max. Negotiated Rate |
$356.04 |
Rate for Payer: Aetna Commercial |
$348.30
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$332.82
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$205.11
|
Rate for Payer: Cash Price |
$116.10
|
Rate for Payer: Cigna Commercial |
$356.04
|
Rate for Payer: Health EOS Commercial |
$344.43
|
Rate for Payer: HFN Commercial |
$356.04
|
Rate for Payer: Multiplan Commercial |
$309.60
|
Rate for Payer: NAPHCARE Commercial |
$232.20
|
Rate for Payer: Preferred Network Access Commercial |
$356.04
|
Rate for Payer: Quartz Beloit One Network |
$189.63
|
Rate for Payer: Quartz Commercial |
$232.20
|
Rate for Payer: WEA Trust Commercial |
$212.85
|
Rate for Payer: WPS Commercial |
$286.65
|
|
ED CANTHOTOMY SEPARATE PROCEDURE
|
Facility
|
OP
|
$684.00
|
|
Service Code
|
CPT 67715
|
Hospital Charge Code |
6209815
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$301.00 |
Max. Negotiated Rate |
$9,238.84 |
Rate for Payer: Aetna Commercial |
$615.60
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$588.24
|
Rate for Payer: Aetna Managed Medicare |
$2,309.71
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$444.60
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$342.00
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$328.32
|
Rate for Payer: Anthem Medicare Advantage |
$2,309.71
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$362.52
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,309.71
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,309.71
|
Rate for Payer: Cash Price |
$205.20
|
Rate for Payer: Cash Price |
$205.20
|
Rate for Payer: Cash Price |
$205.20
|
Rate for Payer: Cigna Commercial |
$629.28
|
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,309.71
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,309.71
|
Rate for Payer: Health EOS Commercial |
$608.76
|
Rate for Payer: HFN Commercial |
$629.28
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,592.12
|
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,309.71
|
Rate for Payer: Independent Care Health Plan Medicare |
$2,309.71
|
Rate for Payer: Managed Health Services Medicare Advantage |
$2,309.71
|
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,309.71
|
Rate for Payer: Multiplan Commercial |
$547.20
|
Rate for Payer: NAPHCARE Commercial |
$3,464.56
|
Rate for Payer: Preferred Network Access Commercial |
$629.28
|
Rate for Payer: Quartz Beloit One Network |
$335.16
|
Rate for Payer: Quartz Commercial |
$444.60
|
Rate for Payer: Quartz Medicare Advantage |
$2,309.71
|
Rate for Payer: The Alliance Commercial |
$9,238.84
|
Rate for Payer: United Healthcare Medicare Advantage |
$2,309.71
|
Rate for Payer: United Healthcare PPO |
$301.00
|
Rate for Payer: WEA Trust Commercial |
$376.20
|
Rate for Payer: Wellcare Medicare |
$2,309.71
|
Rate for Payer: WPS Commercial |
$506.64
|
|
ED CANTHOTOMY SEPARATE PROCEDURE
|
Facility
|
IP
|
$684.00
|
|
Service Code
|
CPT 67715
|
Hospital Charge Code |
6209815
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$335.16 |
Max. Negotiated Rate |
$629.28 |
Rate for Payer: Aetna Commercial |
$615.60
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$588.24
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$362.52
|
Rate for Payer: Cash Price |
$205.20
|
Rate for Payer: Cigna Commercial |
$629.28
|
Rate for Payer: Health EOS Commercial |
$608.76
|
Rate for Payer: HFN Commercial |
$629.28
|
Rate for Payer: Multiplan Commercial |
$547.20
|
Rate for Payer: NAPHCARE Commercial |
$410.40
|
Rate for Payer: Preferred Network Access Commercial |
$629.28
|
Rate for Payer: Quartz Beloit One Network |
$335.16
|
Rate for Payer: Quartz Commercial |
$410.40
|
Rate for Payer: WEA Trust Commercial |
$376.20
|
Rate for Payer: WPS Commercial |
$506.64
|
|
ED Cardioversion, elective arrhythmia; external
|
Facility
|
IP
|
$519.00
|
|
Service Code
|
CPT 92960
|
Hospital Charge Code |
6172949
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$254.31 |
Max. Negotiated Rate |
$477.48 |
Rate for Payer: Aetna Commercial |
$467.10
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$446.34
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$275.07
|
Rate for Payer: Cash Price |
$155.70
|
Rate for Payer: Cigna Commercial |
$477.48
|
Rate for Payer: Health EOS Commercial |
$461.91
|
Rate for Payer: HFN Commercial |
$477.48
|
Rate for Payer: Multiplan Commercial |
$415.20
|
Rate for Payer: NAPHCARE Commercial |
$311.40
|
Rate for Payer: Preferred Network Access Commercial |
$477.48
|
Rate for Payer: Quartz Beloit One Network |
$254.31
|
Rate for Payer: Quartz Commercial |
$311.40
|
Rate for Payer: WEA Trust Commercial |
$285.45
|
Rate for Payer: WPS Commercial |
$384.42
|
|
ED Cardioversion, elective arrhythmia; external
|
Facility
|
OP
|
$519.00
|
|
Service Code
|
CPT 92960
|
Hospital Charge Code |
6172949
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$249.12 |
Max. Negotiated Rate |
$2,573.12 |
Rate for Payer: Aetna Commercial |
$467.10
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$446.34
|
Rate for Payer: Aetna Managed Medicare |
$643.28
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$337.35
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$259.50
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$249.12
|
Rate for Payer: Anthem Medicare Advantage |
$643.28
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$275.07
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$643.28
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$643.28
|
Rate for Payer: Cash Price |
$155.70
|
Rate for Payer: Cash Price |
$155.70
|
Rate for Payer: Cash Price |
$155.70
|
Rate for Payer: Cigna Commercial |
$477.48
|
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$643.28
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$290.43
|
Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$643.28
|
Rate for Payer: Health EOS Commercial |
$461.91
|
Rate for Payer: HFN Commercial |
$477.48
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,393.00
|
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$643.28
|
Rate for Payer: Independent Care Health Plan Medicare |
$643.28
|
Rate for Payer: Managed Health Services Medicare Advantage |
$643.28
|
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$643.28
|
Rate for Payer: Multiplan Commercial |
$415.20
|
Rate for Payer: NAPHCARE Commercial |
$964.92
|
Rate for Payer: Preferred Network Access Commercial |
$477.48
|
Rate for Payer: Quartz Beloit One Network |
$254.31
|
Rate for Payer: Quartz Commercial |
$337.35
|
Rate for Payer: Quartz Medicare Advantage |
$643.28
|
Rate for Payer: The Alliance Commercial |
$2,573.12
|
Rate for Payer: United Healthcare Medicare Advantage |
$643.28
|
Rate for Payer: United Healthcare PPO |
$301.00
|
Rate for Payer: WEA Trust Commercial |
$285.45
|
Rate for Payer: Wellcare Medicare |
$643.28
|
Rate for Payer: WPS Commercial |
$384.42
|
|
ED Cautery Of Cervix
|
Facility
|
IP
|
$297.00
|
|
Service Code
|
CPT 57510
|
Hospital Charge Code |
6174403
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$145.53 |
Max. Negotiated Rate |
$273.24 |
Rate for Payer: Aetna Commercial |
$267.30
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$255.42
|
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 Cautery Of Cervix
|
Facility
|
OP
|
$297.00
|
|
Service Code
|
CPT 57510
|
Hospital Charge Code |
6174403
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$142.56 |
Max. Negotiated Rate |
$12,360.48 |
Rate for Payer: Aetna Commercial |
$267.30
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$255.42
|
Rate for Payer: Aetna Managed Medicare |
$3,090.12
|
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 |
$3,090.12
|
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 |
$3,090.12
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,090.12
|
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 |
$3,090.12
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,090.12
|
Rate for Payer: Health EOS Commercial |
$264.33
|
Rate for Payer: HFN Commercial |
$273.24
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,495.25
|
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,090.12
|
Rate for Payer: Independent Care Health Plan Medicare |
$3,090.12
|
Rate for Payer: Managed Health Services Medicare Advantage |
$3,090.12
|
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,090.12
|
Rate for Payer: Multiplan Commercial |
$237.60
|
Rate for Payer: NAPHCARE Commercial |
$4,635.18
|
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 |
$3,090.12
|
Rate for Payer: The Alliance Commercial |
$12,360.48
|
Rate for Payer: United Healthcare Medicare Advantage |
$3,090.12
|
Rate for Payer: United Healthcare PPO |
$301.00
|
Rate for Payer: WEA Trust Commercial |
$163.35
|
Rate for Payer: Wellcare Medicare |
$3,090.12
|
Rate for Payer: WPS Commercial |
$219.99
|
|
ED Change of Cystostomy Tube; Complicated
|
Facility
|
OP
|
$697.00
|
|
Service Code
|
CPT 51710
|
Hospital Charge Code |
6174094
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$301.00 |
Max. Negotiated Rate |
$4,218.22 |
Rate for Payer: Aetna Commercial |
$627.30
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$599.42
|
Rate for Payer: Aetna Managed Medicare |
$675.19
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$453.05
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$348.50
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$334.56
|
Rate for Payer: Anthem Medicare Advantage |
$675.19
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$369.41
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$675.19
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$675.19
|
Rate for Payer: Cash Price |
$209.10
|
Rate for Payer: Cash Price |
$209.10
|
Rate for Payer: Cash Price |
$209.10
|
Rate for Payer: Cigna Commercial |
$641.24
|
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$675.19
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$675.19
|
Rate for Payer: Health EOS Commercial |
$620.33
|
Rate for Payer: HFN Commercial |
$641.24
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,511.71
|
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$675.19
|
Rate for Payer: Independent Care Health Plan Medicare |
$675.19
|
Rate for Payer: Managed Health Services Medicare Advantage |
$675.19
|
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$675.19
|
Rate for Payer: Multiplan Commercial |
$557.60
|
Rate for Payer: NAPHCARE Commercial |
$1,012.78
|
Rate for Payer: Preferred Network Access Commercial |
$641.24
|
Rate for Payer: Quartz Beloit One Network |
$341.53
|
Rate for Payer: Quartz Commercial |
$453.05
|
Rate for Payer: Quartz Medicare Advantage |
$675.19
|
Rate for Payer: The Alliance Commercial |
$2,700.76
|
Rate for Payer: United Healthcare Medicare Advantage |
$675.19
|
Rate for Payer: United Healthcare PPO |
$301.00
|
Rate for Payer: WEA Trust Commercial |
$383.35
|
Rate for Payer: Wellcare Medicare |
$675.19
|
Rate for Payer: WPS Commercial |
$516.27
|
|
ED Change of Cystostomy Tube; Complicated
|
Facility
|
IP
|
$697.00
|
|
Service Code
|
CPT 51710
|
Hospital Charge Code |
6174094
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$341.53 |
Max. Negotiated Rate |
$641.24 |
Rate for Payer: Aetna Commercial |
$627.30
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$599.42
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$369.41
|
Rate for Payer: Cash Price |
$209.10
|
Rate for Payer: Cigna Commercial |
$641.24
|
Rate for Payer: Health EOS Commercial |
$620.33
|
Rate for Payer: HFN Commercial |
$641.24
|
Rate for Payer: Multiplan Commercial |
$557.60
|
Rate for Payer: NAPHCARE Commercial |
$418.20
|
Rate for Payer: Preferred Network Access Commercial |
$641.24
|
Rate for Payer: Quartz Beloit One Network |
$341.53
|
Rate for Payer: Quartz Commercial |
$418.20
|
Rate for Payer: WEA Trust Commercial |
$383.35
|
Rate for Payer: WPS Commercial |
$516.27
|
|
ED Change of Cystostomy Tube; simple
|
Facility
|
IP
|
$324.00
|
|
Service Code
|
CPT 51705
|
Hospital Charge Code |
6172945
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$158.76 |
Max. Negotiated Rate |
$298.08 |
Rate for Payer: Aetna Commercial |
$291.60
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$278.64
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$171.72
|
Rate for Payer: Cash Price |
$97.20
|
Rate for Payer: Cigna Commercial |
$298.08
|
Rate for Payer: Health EOS Commercial |
$288.36
|
Rate for Payer: HFN Commercial |
$298.08
|
Rate for Payer: Multiplan Commercial |
$259.20
|
Rate for Payer: NAPHCARE Commercial |
$194.40
|
Rate for Payer: Preferred Network Access Commercial |
$298.08
|
Rate for Payer: Quartz Beloit One Network |
$158.76
|
Rate for Payer: Quartz Commercial |
$194.40
|
Rate for Payer: WEA Trust Commercial |
$178.20
|
Rate for Payer: WPS Commercial |
$239.99
|
|
ED Change of Cystostomy Tube; simple
|
Facility
|
OP
|
$324.00
|
|
Service Code
|
CPT 51705
|
Hospital Charge Code |
6172945
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$155.52 |
Max. Negotiated Rate |
$4,218.22 |
Rate for Payer: Aetna Commercial |
$291.60
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$278.64
|
Rate for Payer: Aetna Managed Medicare |
$244.28
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$210.60
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$162.00
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$155.52
|
Rate for Payer: Anthem Medicare Advantage |
$244.28
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$171.72
|
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 |
$97.20
|
Rate for Payer: Cash Price |
$97.20
|
Rate for Payer: Cash Price |
$97.20
|
Rate for Payer: Cigna Commercial |
$298.08
|
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 |
$288.36
|
Rate for Payer: HFN Commercial |
$298.08
|
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 |
$259.20
|
Rate for Payer: NAPHCARE Commercial |
$366.42
|
Rate for Payer: Preferred Network Access Commercial |
$298.08
|
Rate for Payer: Quartz Beloit One Network |
$158.76
|
Rate for Payer: Quartz Commercial |
$210.60
|
Rate for Payer: Quartz Medicare Advantage |
$244.28
|
Rate for Payer: The Alliance Commercial |
$977.12
|
Rate for Payer: United Healthcare Medicare Advantage |
$244.28
|
Rate for Payer: United Healthcare PPO |
$301.00
|
Rate for Payer: WEA Trust Commercial |
$178.20
|
Rate for Payer: Wellcare Medicare |
$244.28
|
Rate for Payer: WPS Commercial |
$239.99
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$193.50
|
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 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 |
$4,218.22 |
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 |
$977.12
|
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 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: Aetna Gatekeeper/Not Gatekeeper |
$166.84
|
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: The Alliance Commercial |
$791.52
|
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: Aetna Gatekeeper/Not Gatekeeper |
$1,597.88
|
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 |
$6,354.28 |
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 |
$6,354.28
|
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: Aetna Gatekeeper/Not Gatekeeper |
$1,033.72
|
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 |
$6,354.28 |
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 |
$6,354.28
|
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 |
$4,218.22 |
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 |
$1,061.76
|
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: Aetna Gatekeeper/Not Gatekeeper |
$270.90
|
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: Aetna Gatekeeper/Not Gatekeeper |
$1,234.96
|
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 |
$6,354.28 |
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 |
$6,354.28
|
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
|
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: Aetna Gatekeeper/Not Gatekeeper |
$785.18
|
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
|
|