|
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
|
|
|
ED Closed treatment of broken thigh bone with manipulation
|
Facility
|
OP
|
$2,692.00
|
|
|
Service Code
|
CPT 27503
|
| Hospital Charge Code |
6172937
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$6,546.14 |
| Rate for Payer: Aetna Commercial |
$2,422.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,315.12
|
| Rate for Payer: Aetna Managed Medicare |
$1,588.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,749.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,346.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,292.16
|
| Rate for Payer: Anthem Medicare Advantage |
$1,588.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,426.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,588.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,588.57
|
| Rate for Payer: Cash Price |
$807.60
|
| Rate for Payer: Cash Price |
$807.60
|
| Rate for Payer: Cash Price |
$807.60
|
| Rate for Payer: Cigna Commercial |
$2,476.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,588.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,588.57
|
| Rate for Payer: Health EOS Commercial |
$2,395.88
|
| Rate for Payer: HFN Commercial |
$2,476.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,909.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,588.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,588.57
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,588.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,588.57
|
| Rate for Payer: Multiplan Commercial |
$2,153.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,382.86
|
| Rate for Payer: Preferred Network Access Commercial |
$2,476.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,319.08
|
| Rate for Payer: Quartz Commercial |
$1,749.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,588.57
|
| Rate for Payer: The Alliance Commercial |
$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 |
$1,480.60
|
| Rate for Payer: Wellcare Medicare |
$1,588.57
|
| Rate for Payer: WPS Commercial |
$1,993.96
|
|
|
ED Closed treatment of broken thigh bone with manipulation
|
Facility
|
IP
|
$2,692.00
|
|
|
Service Code
|
CPT 27503
|
| Hospital Charge Code |
6172937
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,319.08 |
| Max. Negotiated Rate |
$2,476.64 |
| Rate for Payer: Aetna Commercial |
$2,422.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,315.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,426.76
|
| Rate for Payer: Cash Price |
$807.60
|
| Rate for Payer: Cigna Commercial |
$2,476.64
|
| Rate for Payer: Health EOS Commercial |
$2,395.88
|
| Rate for Payer: HFN Commercial |
$2,476.64
|
| Rate for Payer: Multiplan Commercial |
$2,153.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,615.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,476.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,319.08
|
| Rate for Payer: Quartz Commercial |
$1,615.20
|
| Rate for Payer: WEA Trust Commercial |
$1,480.60
|
| Rate for Payer: WPS Commercial |
$1,993.96
|
|
|
ED Closed treatment of dislocated finger joint with manipulation
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT 26770
|
| Hospital Charge Code |
6172919
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$284.20 |
| Max. Negotiated Rate |
$533.60 |
| Rate for Payer: Aetna Commercial |
$522.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$498.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$307.40
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$533.60
|
| Rate for Payer: Health EOS Commercial |
$516.20
|
| Rate for Payer: HFN Commercial |
$533.60
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: NAPHCARE Commercial |
$348.00
|
| Rate for Payer: Preferred Network Access Commercial |
$533.60
|
| Rate for Payer: Quartz Beloit One Network |
$284.20
|
| Rate for Payer: Quartz Commercial |
$348.00
|
| Rate for Payer: WEA Trust Commercial |
$319.00
|
| Rate for Payer: WPS Commercial |
$429.61
|
|
|
ED Closed treatment of dislocated finger joint with manipulation
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT 26770
|
| Hospital Charge Code |
6172919
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$233.09 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$522.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$498.80
|
| Rate for Payer: Aetna Managed Medicare |
$233.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$377.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$290.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$278.40
|
| Rate for Payer: Anthem Medicare Advantage |
$233.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$307.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$233.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$233.09
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$533.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$233.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$233.09
|
| Rate for Payer: Health EOS Commercial |
$516.20
|
| Rate for Payer: HFN Commercial |
$533.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$867.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$233.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$233.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$233.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$233.09
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: NAPHCARE Commercial |
$349.64
|
| Rate for Payer: Preferred Network Access Commercial |
$533.60
|
| Rate for Payer: Quartz Beloit One Network |
$284.20
|
| Rate for Payer: Quartz Commercial |
$377.00
|
| Rate for Payer: Quartz Medicare Advantage |
$233.09
|
| Rate for Payer: The Alliance Commercial |
$932.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$233.09
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$319.00
|
| Rate for Payer: Wellcare Medicare |
$233.09
|
| Rate for Payer: WPS Commercial |
$429.61
|
|
|
ED Closed treatment of kneecap dislocation
|
Facility
|
IP
|
$725.00
|
|
|
Service Code
|
CPT 27560
|
| Hospital Charge Code |
6175421
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$355.25 |
| Max. Negotiated Rate |
$667.00 |
| Rate for Payer: Aetna Commercial |
$652.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$623.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$384.25
|
| Rate for Payer: Cash Price |
$217.50
|
| Rate for Payer: Cigna Commercial |
$667.00
|
| Rate for Payer: Health EOS Commercial |
$645.25
|
| Rate for Payer: HFN Commercial |
$667.00
|
| Rate for Payer: Multiplan Commercial |
$580.00
|
| Rate for Payer: NAPHCARE Commercial |
$435.00
|
| Rate for Payer: Preferred Network Access Commercial |
$667.00
|
| Rate for Payer: Quartz Beloit One Network |
$355.25
|
| Rate for Payer: Quartz Commercial |
$435.00
|
| Rate for Payer: WEA Trust Commercial |
$398.75
|
| Rate for Payer: WPS Commercial |
$537.01
|
|
|
ED Closed treatment of kneecap dislocation
|
Facility
|
OP
|
$725.00
|
|
|
Service Code
|
CPT 27560
|
| Hospital Charge Code |
6175421
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$233.09 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$652.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$623.50
|
| Rate for Payer: Aetna Managed Medicare |
$233.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$471.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$362.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$348.00
|
| Rate for Payer: Anthem Medicare Advantage |
$233.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$384.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$233.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$233.09
|
| Rate for Payer: Cash Price |
$217.50
|
| Rate for Payer: Cash Price |
$217.50
|
| Rate for Payer: Cash Price |
$217.50
|
| Rate for Payer: Cigna Commercial |
$667.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$233.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$233.09
|
| Rate for Payer: Health EOS Commercial |
$645.25
|
| Rate for Payer: HFN Commercial |
$667.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$867.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$233.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$233.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$233.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$233.09
|
| Rate for Payer: Multiplan Commercial |
$580.00
|
| Rate for Payer: NAPHCARE Commercial |
$349.64
|
| Rate for Payer: Preferred Network Access Commercial |
$667.00
|
| Rate for Payer: Quartz Beloit One Network |
$355.25
|
| Rate for Payer: Quartz Commercial |
$471.25
|
| Rate for Payer: Quartz Medicare Advantage |
$233.09
|
| Rate for Payer: The Alliance Commercial |
$932.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$233.09
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$398.75
|
| Rate for Payer: Wellcare Medicare |
$233.09
|
| Rate for Payer: WPS Commercial |
$537.01
|
|
|
ED Closed treatment of metatarsophalangeal joint dislocation; without anesthesia
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
CPT 28630
|
| Hospital Charge Code |
6209960
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$122.50 |
| Max. Negotiated Rate |
$230.00 |
| Rate for Payer: Aetna Commercial |
$225.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$215.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$132.50
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$230.00
|
| Rate for Payer: Health EOS Commercial |
$222.50
|
| Rate for Payer: HFN Commercial |
$230.00
|
| Rate for Payer: Multiplan Commercial |
$200.00
|
| Rate for Payer: NAPHCARE Commercial |
$150.00
|
| Rate for Payer: Preferred Network Access Commercial |
$230.00
|
| Rate for Payer: Quartz Beloit One Network |
$122.50
|
| Rate for Payer: Quartz Commercial |
$150.00
|
| Rate for Payer: WEA Trust Commercial |
$137.50
|
| Rate for Payer: WPS Commercial |
$185.18
|
|
|
ED Closed treatment of metatarsophalangeal joint dislocation; without anesthesia
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
CPT 28630
|
| Hospital Charge Code |
6209960
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$225.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$215.00
|
| Rate for Payer: Aetna Managed Medicare |
$233.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$162.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$125.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$120.00
|
| Rate for Payer: Anthem Medicare Advantage |
$233.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$132.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$233.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$233.09
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$230.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$233.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$233.09
|
| Rate for Payer: Health EOS Commercial |
$222.50
|
| Rate for Payer: HFN Commercial |
$230.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$867.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$233.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$233.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$233.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$233.09
|
| Rate for Payer: Multiplan Commercial |
$200.00
|
| Rate for Payer: NAPHCARE Commercial |
$349.64
|
| Rate for Payer: Preferred Network Access Commercial |
$230.00
|
| Rate for Payer: Quartz Beloit One Network |
$122.50
|
| Rate for Payer: Quartz Commercial |
$162.50
|
| Rate for Payer: Quartz Medicare Advantage |
$233.09
|
| Rate for Payer: The Alliance Commercial |
$932.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$233.09
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$137.50
|
| Rate for Payer: Wellcare Medicare |
$233.09
|
| Rate for Payer: WPS Commercial |
$185.18
|
|
|
ED Closed Treatment of patellar dislocation; requiring anesthesia
|
Facility
|
OP
|
$832.00
|
|
|
Service Code
|
CPT 27562
|
| Hospital Charge Code |
6209959
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$233.09 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$748.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$715.52
|
| Rate for Payer: Aetna Managed Medicare |
$233.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$540.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$416.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$399.36
|
| Rate for Payer: Anthem Medicare Advantage |
$233.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$440.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$233.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$233.09
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cigna Commercial |
$765.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$233.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$233.09
|
| Rate for Payer: Health EOS Commercial |
$740.48
|
| Rate for Payer: HFN Commercial |
$765.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$867.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$233.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$233.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$233.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$233.09
|
| Rate for Payer: Multiplan Commercial |
$665.60
|
| Rate for Payer: NAPHCARE Commercial |
$349.64
|
| Rate for Payer: Preferred Network Access Commercial |
$765.44
|
| Rate for Payer: Quartz Beloit One Network |
$407.68
|
| Rate for Payer: Quartz Commercial |
$540.80
|
| Rate for Payer: Quartz Medicare Advantage |
$233.09
|
| Rate for Payer: The Alliance Commercial |
$932.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$233.09
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$457.60
|
| Rate for Payer: Wellcare Medicare |
$233.09
|
| Rate for Payer: WPS Commercial |
$616.26
|
|
|
ED Closed Treatment of patellar dislocation; requiring anesthesia
|
Facility
|
IP
|
$832.00
|
|
|
Service Code
|
CPT 27562
|
| Hospital Charge Code |
6209959
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$407.68 |
| Max. Negotiated Rate |
$765.44 |
| Rate for Payer: Aetna Commercial |
$748.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$715.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$440.96
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cigna Commercial |
$765.44
|
| Rate for Payer: Health EOS Commercial |
$740.48
|
| Rate for Payer: HFN Commercial |
$765.44
|
| Rate for Payer: Multiplan Commercial |
$665.60
|
| Rate for Payer: NAPHCARE Commercial |
$499.20
|
| Rate for Payer: Preferred Network Access Commercial |
$765.44
|
| Rate for Payer: Quartz Beloit One Network |
$407.68
|
| Rate for Payer: Quartz Commercial |
$499.20
|
| Rate for Payer: WEA Trust Commercial |
$457.60
|
| Rate for Payer: WPS Commercial |
$616.26
|
|
|
ED Closed treatment of post hip arthroplasty dislocation; req regional or gen anesthesia
|
Facility
|
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: Aetna Gatekeeper/Not Gatekeeper |
$1,112.84
|
| 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 post hip arthroplasty dislocation; req regional or gen anesthesia
|
Facility
|
OP
|
$1,294.00
|
|
|
Service Code
|
CPT 27266
|
| Hospital Charge Code |
6172936
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$6,354.28 |
| Rate for Payer: Aetna Commercial |
$1,164.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,112.84
|
| Rate for Payer: Aetna Managed Medicare |
$1,588.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$841.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$647.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$621.12
|
| Rate for Payer: Anthem Medicare Advantage |
$1,588.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$685.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,588.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,588.57
|
| Rate for Payer: Cash Price |
$388.20
|
| Rate for Payer: Cash Price |
$388.20
|
| Rate for Payer: Cash Price |
$388.20
|
| Rate for Payer: Cigna Commercial |
$1,190.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,588.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,588.57
|
| Rate for Payer: Health EOS Commercial |
$1,151.66
|
| Rate for Payer: HFN Commercial |
$1,190.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,909.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,588.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,588.57
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,588.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,588.57
|
| Rate for Payer: Multiplan Commercial |
$1,035.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,382.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,190.48
|
| Rate for Payer: Quartz Beloit One Network |
$634.06
|
| Rate for Payer: Quartz Commercial |
$841.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,588.57
|
| Rate for Payer: The Alliance Commercial |
$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 |
$711.70
|
| Rate for Payer: Wellcare Medicare |
$1,588.57
|
| 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: Aetna Gatekeeper/Not Gatekeeper |
$1,274.52
|
| 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 |
$6,354.28 |
| 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 |
$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 |
$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: 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 |
$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 |
$4,218.22 |
| 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 |
$932.36
|
| 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 |
$6,354.28 |
| 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 |
$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 |
$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: Aetna Gatekeeper/Not Gatekeeper |
$679.40
|
| 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 |
$4,218.22 |
| 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 |
$932.36
|
| 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: Aetna Gatekeeper/Not Gatekeeper |
$688.86
|
| 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
|
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: Aetna Gatekeeper/Not Gatekeeper |
$1,965.96
|
| 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 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 |
$6,354.28 |
| 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 |
$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 |
$1,257.30
|
| Rate for Payer: Wellcare Medicare |
$1,588.57
|
| 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 |
$6,354.28 |
| 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 |
$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 |
$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: Aetna Gatekeeper/Not Gatekeeper |
$651.02
|
| 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
|
|
