|
SHOULDER ARTHROSCOPY
|
Facility
OP
|
$8,726.00
|
|
| Hospital Charge Code |
2959830
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,443.28 |
| Max. Negotiated Rate |
$34,904.00 |
| Rate for Payer: Aetna Commercial |
$7,853.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,504.36
|
| Rate for Payer: Aetna Managed Medicare |
$2,443.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,671.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,363.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,188.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,624.78
|
| Rate for Payer: Cash Price |
$2,617.80
|
| Rate for Payer: Cigna Commercial |
$8,027.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,883.07
|
| Rate for Payer: Health EOS Commercial |
$7,766.14
|
| Rate for Payer: HFN Commercial |
$8,027.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,544.50
|
| Rate for Payer: Multiplan Commercial |
$6,980.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,235.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,027.92
|
| Rate for Payer: Quartz Beloit One Network |
$4,275.74
|
| Rate for Payer: Quartz Commercial |
$5,671.90
|
| Rate for Payer: Quartz Medicare Advantage |
$5,235.60
|
| Rate for Payer: The Alliance Commercial |
$34,904.00
|
| Rate for Payer: WEA Trust Commercial |
$4,799.30
|
| Rate for Payer: WPS Commercial |
$6,463.35
|
|
|
SHOULDER ARTHROSCOPY
|
Facility
IP
|
$8,726.00
|
|
| Hospital Charge Code |
2959830
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,275.74 |
| Max. Negotiated Rate |
$8,027.92 |
| Rate for Payer: Aetna Commercial |
$7,853.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,624.78
|
| Rate for Payer: Cash Price |
$2,617.80
|
| Rate for Payer: Cigna Commercial |
$8,027.92
|
| Rate for Payer: Health EOS Commercial |
$7,766.14
|
| Rate for Payer: HFN Commercial |
$8,027.92
|
| Rate for Payer: Multiplan Commercial |
$6,980.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,235.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,027.92
|
| Rate for Payer: Quartz Beloit One Network |
$4,275.74
|
| Rate for Payer: Quartz Commercial |
$5,235.60
|
| Rate for Payer: WEA Trust Commercial |
$4,799.30
|
| Rate for Payer: WPS Commercial |
$6,463.35
|
|
|
SHOULDER BONE GRAFTING
|
Facility
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2959865
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,928.15 |
| Max. Negotiated Rate |
$3,620.20 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,361.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
SHOULDER BONE GRAFTING
|
Facility
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2959865
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,101.80 |
| Max. Negotiated Rate |
$15,740.00 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,101.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,557.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,967.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,888.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,202.03
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,951.25
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,557.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,361.00
|
| Rate for Payer: The Alliance Commercial |
$15,740.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
SHOULDER CAPSULORRAPHY
|
Facility
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2959905
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,101.80 |
| Max. Negotiated Rate |
$15,740.00 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,101.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,557.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,967.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,888.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,202.03
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,951.25
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,557.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,361.00
|
| Rate for Payer: The Alliance Commercial |
$15,740.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
SHOULDER CAPSULORRAPHY
|
Facility
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2959905
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,928.15 |
| Max. Negotiated Rate |
$3,620.20 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,361.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH CC
|
Facility
IP
|
$53,328.00
|
|
|
Service Code
|
MS-DRG 511
|
| Min. Negotiated Rate |
$19,182.56 |
| Max. Negotiated Rate |
$53,328.00 |
| Rate for Payer: Aetna Managed Medicare |
$19,182.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$41,750.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32,001.19
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30,403.22
|
| Rate for Payer: Anthem Medicare Advantage |
$19,182.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19,182.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19,182.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19,182.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33,750.36
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19,182.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$38,879.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19,182.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19,182.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19,182.56
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19,182.56
|
| Rate for Payer: NAPHCARE Commercial |
$28,773.84
|
| Rate for Payer: Quartz Medicare Advantage |
$19,182.56
|
| Rate for Payer: The Alliance Commercial |
$53,328.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19,182.56
|
| Rate for Payer: United Healthcare PPO |
$30,267.88
|
| Rate for Payer: Wellcare Medicare |
$19,182.56
|
|
|
SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH MCC
|
Facility
IP
|
$72,650.00
|
|
|
Service Code
|
MS-DRG 510
|
| Min. Negotiated Rate |
$26,133.16 |
| Max. Negotiated Rate |
$72,650.00 |
| Rate for Payer: Aetna Managed Medicare |
$26,133.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$57,065.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$43,740.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$41,556.16
|
| Rate for Payer: Anthem Medicare Advantage |
$26,133.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26,133.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26,133.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$26,133.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$46,131.15
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$26,133.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53,051.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$26,133.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26,133.16
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$26,133.16
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$26,133.16
|
| Rate for Payer: NAPHCARE Commercial |
$39,199.74
|
| Rate for Payer: Quartz Medicare Advantage |
$26,133.16
|
| Rate for Payer: The Alliance Commercial |
$72,650.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26,133.16
|
| Rate for Payer: United Healthcare PPO |
$41,301.43
|
| Rate for Payer: Wellcare Medicare |
$26,133.16
|
|
|
SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC
|
Facility
IP
|
$43,225.00
|
|
|
Service Code
|
MS-DRG 512
|
| Min. Negotiated Rate |
$15,548.51 |
| Max. Negotiated Rate |
$43,225.00 |
| Rate for Payer: Aetna Managed Medicare |
$15,548.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33,777.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25,890.41
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24,597.58
|
| Rate for Payer: Anthem Medicare Advantage |
$15,548.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15,548.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15,548.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15,548.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27,305.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15,548.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31,469.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15,548.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15,548.51
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15,548.51
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15,548.51
|
| Rate for Payer: NAPHCARE Commercial |
$23,322.76
|
| Rate for Payer: Quartz Medicare Advantage |
$15,548.51
|
| Rate for Payer: The Alliance Commercial |
$43,225.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15,548.51
|
| Rate for Payer: United Healthcare PPO |
$24,499.10
|
| Rate for Payer: Wellcare Medicare |
$15,548.51
|
|
|
SHOULDER IMMBL MED TX9023-02
|
Facility
OP
|
$151.00
|
|
| Hospital Charge Code |
2974263
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$42.28 |
| Max. Negotiated Rate |
$604.00 |
| Rate for Payer: Aetna Commercial |
$135.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$129.86
|
| Rate for Payer: Aetna Managed Medicare |
$42.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$98.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$75.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$72.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.03
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$138.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$84.50
|
| Rate for Payer: Health EOS Commercial |
$134.39
|
| Rate for Payer: HFN Commercial |
$138.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.25
|
| Rate for Payer: Multiplan Commercial |
$120.80
|
| Rate for Payer: NAPHCARE Commercial |
$90.60
|
| Rate for Payer: Preferred Network Access Commercial |
$138.92
|
| Rate for Payer: Quartz Beloit One Network |
$73.99
|
| Rate for Payer: Quartz Commercial |
$98.15
|
| Rate for Payer: Quartz Medicare Advantage |
$90.60
|
| Rate for Payer: The Alliance Commercial |
$604.00
|
| Rate for Payer: WEA Trust Commercial |
$83.05
|
| Rate for Payer: WPS Commercial |
$111.85
|
|
|
SHOULDER IMMBL MED TX9023-02
|
Facility
IP
|
$151.00
|
|
| Hospital Charge Code |
2974263
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$73.99 |
| Max. Negotiated Rate |
$138.92 |
| Rate for Payer: Aetna Commercial |
$135.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.03
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$138.92
|
| Rate for Payer: Health EOS Commercial |
$134.39
|
| Rate for Payer: HFN Commercial |
$138.92
|
| Rate for Payer: Multiplan Commercial |
$120.80
|
| Rate for Payer: NAPHCARE Commercial |
$90.60
|
| Rate for Payer: Preferred Network Access Commercial |
$138.92
|
| Rate for Payer: Quartz Beloit One Network |
$73.99
|
| Rate for Payer: Quartz Commercial |
$90.60
|
| Rate for Payer: WEA Trust Commercial |
$83.05
|
| Rate for Payer: WPS Commercial |
$111.85
|
|
|
SHOULDER IMMOBILIZER L3670
|
Facility
IP
|
$1,882.00
|
|
| Hospital Charge Code |
2974044
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$922.18 |
| Max. Negotiated Rate |
$1,731.44 |
| Rate for Payer: Aetna Commercial |
$1,693.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$997.46
|
| Rate for Payer: Cash Price |
$564.60
|
| Rate for Payer: Cigna Commercial |
$1,731.44
|
| Rate for Payer: Health EOS Commercial |
$1,674.98
|
| Rate for Payer: HFN Commercial |
$1,731.44
|
| Rate for Payer: Multiplan Commercial |
$1,505.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,129.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,731.44
|
| Rate for Payer: Quartz Beloit One Network |
$922.18
|
| Rate for Payer: Quartz Commercial |
$1,129.20
|
| Rate for Payer: WEA Trust Commercial |
$1,035.10
|
| Rate for Payer: WPS Commercial |
$1,394.00
|
|
|
SHOULDER IMMOBILIZER L3670
|
Facility
OP
|
$1,882.00
|
|
| Hospital Charge Code |
2974044
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$526.96 |
| Max. Negotiated Rate |
$7,528.00 |
| Rate for Payer: Aetna Commercial |
$1,693.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,618.52
|
| Rate for Payer: Aetna Managed Medicare |
$526.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,223.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$941.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$903.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$997.46
|
| Rate for Payer: Cash Price |
$564.60
|
| Rate for Payer: Cigna Commercial |
$1,731.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,053.17
|
| Rate for Payer: Health EOS Commercial |
$1,674.98
|
| Rate for Payer: HFN Commercial |
$1,731.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,411.50
|
| Rate for Payer: Multiplan Commercial |
$1,505.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,129.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,731.44
|
| Rate for Payer: Quartz Beloit One Network |
$922.18
|
| Rate for Payer: Quartz Commercial |
$1,223.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,129.20
|
| Rate for Payer: The Alliance Commercial |
$7,528.00
|
| Rate for Payer: WEA Trust Commercial |
$1,035.10
|
| Rate for Payer: WPS Commercial |
$1,394.00
|
|
|
SHOULDER IMMOBILIZER SMALL A111015
|
Facility
IP
|
$108.00
|
|
| Hospital Charge Code |
2964038
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$52.92 |
| Max. Negotiated Rate |
$99.36 |
| Rate for Payer: Aetna Commercial |
$97.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.24
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna Commercial |
$99.36
|
| Rate for Payer: Health EOS Commercial |
$96.12
|
| Rate for Payer: HFN Commercial |
$99.36
|
| Rate for Payer: Multiplan Commercial |
$86.40
|
| Rate for Payer: NAPHCARE Commercial |
$64.80
|
| Rate for Payer: Preferred Network Access Commercial |
$99.36
|
| Rate for Payer: Quartz Beloit One Network |
$52.92
|
| Rate for Payer: Quartz Commercial |
$64.80
|
| Rate for Payer: WEA Trust Commercial |
$59.40
|
| Rate for Payer: WPS Commercial |
$80.00
|
|
|
SHOULDER IMMOBILIZER SMALL A111015
|
Facility
OP
|
$108.00
|
|
| Hospital Charge Code |
2964038
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$30.24 |
| Max. Negotiated Rate |
$432.00 |
| Rate for Payer: Aetna Commercial |
$97.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.88
|
| Rate for Payer: Aetna Managed Medicare |
$30.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$70.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$54.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$51.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.24
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna Commercial |
$99.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$60.44
|
| Rate for Payer: Health EOS Commercial |
$96.12
|
| Rate for Payer: HFN Commercial |
$99.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$81.00
|
| Rate for Payer: Multiplan Commercial |
$86.40
|
| Rate for Payer: NAPHCARE Commercial |
$64.80
|
| Rate for Payer: Preferred Network Access Commercial |
$99.36
|
| Rate for Payer: Quartz Beloit One Network |
$52.92
|
| Rate for Payer: Quartz Commercial |
$70.20
|
| Rate for Payer: Quartz Medicare Advantage |
$64.80
|
| Rate for Payer: The Alliance Commercial |
$432.00
|
| Rate for Payer: WEA Trust Commercial |
$59.40
|
| Rate for Payer: WPS Commercial |
$80.00
|
|
|
SHOULDER IMMOBL SM TX9023-01
|
Facility
OP
|
$151.00
|
|
| Hospital Charge Code |
2974262
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$42.28 |
| Max. Negotiated Rate |
$604.00 |
| Rate for Payer: Aetna Commercial |
$135.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$129.86
|
| Rate for Payer: Aetna Managed Medicare |
$42.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$98.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$75.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$72.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.03
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$138.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$84.50
|
| Rate for Payer: Health EOS Commercial |
$134.39
|
| Rate for Payer: HFN Commercial |
$138.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.25
|
| Rate for Payer: Multiplan Commercial |
$120.80
|
| Rate for Payer: NAPHCARE Commercial |
$90.60
|
| Rate for Payer: Preferred Network Access Commercial |
$138.92
|
| Rate for Payer: Quartz Beloit One Network |
$73.99
|
| Rate for Payer: Quartz Commercial |
$98.15
|
| Rate for Payer: Quartz Medicare Advantage |
$90.60
|
| Rate for Payer: The Alliance Commercial |
$604.00
|
| Rate for Payer: WEA Trust Commercial |
$83.05
|
| Rate for Payer: WPS Commercial |
$111.85
|
|
|
SHOULDER IMMOBL SM TX9023-01
|
Facility
IP
|
$151.00
|
|
| Hospital Charge Code |
2974262
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$73.99 |
| Max. Negotiated Rate |
$138.92 |
| Rate for Payer: Aetna Commercial |
$135.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.03
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$138.92
|
| Rate for Payer: Health EOS Commercial |
$134.39
|
| Rate for Payer: HFN Commercial |
$138.92
|
| Rate for Payer: Multiplan Commercial |
$120.80
|
| Rate for Payer: NAPHCARE Commercial |
$90.60
|
| Rate for Payer: Preferred Network Access Commercial |
$138.92
|
| Rate for Payer: Quartz Beloit One Network |
$73.99
|
| Rate for Payer: Quartz Commercial |
$90.60
|
| Rate for Payer: WEA Trust Commercial |
$83.05
|
| Rate for Payer: WPS Commercial |
$111.85
|
|
|
SHOULDER IMMOBL XL TX9023-04
|
Facility
IP
|
$151.00
|
|
| Hospital Charge Code |
2974265
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$73.99 |
| Max. Negotiated Rate |
$138.92 |
| Rate for Payer: Aetna Commercial |
$135.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.03
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$138.92
|
| Rate for Payer: Health EOS Commercial |
$134.39
|
| Rate for Payer: HFN Commercial |
$138.92
|
| Rate for Payer: Multiplan Commercial |
$120.80
|
| Rate for Payer: NAPHCARE Commercial |
$90.60
|
| Rate for Payer: Preferred Network Access Commercial |
$138.92
|
| Rate for Payer: Quartz Beloit One Network |
$73.99
|
| Rate for Payer: Quartz Commercial |
$90.60
|
| Rate for Payer: WEA Trust Commercial |
$83.05
|
| Rate for Payer: WPS Commercial |
$111.85
|
|
|
SHOULDER IMMOBL XL TX9023-04
|
Facility
OP
|
$151.00
|
|
| Hospital Charge Code |
2974265
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$42.28 |
| Max. Negotiated Rate |
$604.00 |
| Rate for Payer: Aetna Commercial |
$135.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$129.86
|
| Rate for Payer: Aetna Managed Medicare |
$42.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$98.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$75.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$72.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.03
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$138.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$84.50
|
| Rate for Payer: Health EOS Commercial |
$134.39
|
| Rate for Payer: HFN Commercial |
$138.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.25
|
| Rate for Payer: Multiplan Commercial |
$120.80
|
| Rate for Payer: NAPHCARE Commercial |
$90.60
|
| Rate for Payer: Preferred Network Access Commercial |
$138.92
|
| Rate for Payer: Quartz Beloit One Network |
$73.99
|
| Rate for Payer: Quartz Commercial |
$98.15
|
| Rate for Payer: Quartz Medicare Advantage |
$90.60
|
| Rate for Payer: The Alliance Commercial |
$604.00
|
| Rate for Payer: WEA Trust Commercial |
$83.05
|
| Rate for Payer: WPS Commercial |
$111.85
|
|
|
SHOULDER, LATERJET
|
Facility
IP
|
$13,037.00
|
|
| Hospital Charge Code |
4494583
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,388.13 |
| Max. Negotiated Rate |
$11,994.04 |
| Rate for Payer: Aetna Commercial |
$11,733.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,909.61
|
| Rate for Payer: Cash Price |
$3,911.10
|
| Rate for Payer: Cigna Commercial |
$11,994.04
|
| Rate for Payer: Health EOS Commercial |
$11,602.93
|
| Rate for Payer: HFN Commercial |
$11,994.04
|
| Rate for Payer: Multiplan Commercial |
$10,429.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,822.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11,994.04
|
| Rate for Payer: Quartz Beloit One Network |
$6,388.13
|
| Rate for Payer: Quartz Commercial |
$7,822.20
|
| Rate for Payer: WEA Trust Commercial |
$7,170.35
|
| Rate for Payer: WPS Commercial |
$9,656.51
|
|
|
SHOULDER, LATERJET
|
Facility
OP
|
$13,037.00
|
|
| Hospital Charge Code |
4494583
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,650.36 |
| Max. Negotiated Rate |
$52,148.00 |
| Rate for Payer: Aetna Commercial |
$11,733.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,211.82
|
| Rate for Payer: Aetna Managed Medicare |
$3,650.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,474.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,518.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,257.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,909.61
|
| Rate for Payer: Cash Price |
$3,911.10
|
| Rate for Payer: Cigna Commercial |
$11,994.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,295.51
|
| Rate for Payer: Health EOS Commercial |
$11,602.93
|
| Rate for Payer: HFN Commercial |
$11,994.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,777.75
|
| Rate for Payer: Multiplan Commercial |
$10,429.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,822.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11,994.04
|
| Rate for Payer: Quartz Beloit One Network |
$6,388.13
|
| Rate for Payer: Quartz Commercial |
$8,474.05
|
| Rate for Payer: Quartz Medicare Advantage |
$7,822.20
|
| Rate for Payer: The Alliance Commercial |
$52,148.00
|
| Rate for Payer: WEA Trust Commercial |
$7,170.35
|
| Rate for Payer: WPS Commercial |
$9,656.51
|
|
|
SHOULDER OSTEOTOMY/ARTHRODESIS
|
Facility
IP
|
$4,324.00
|
|
| Hospital Charge Code |
2960295
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,118.76 |
| Max. Negotiated Rate |
$3,978.08 |
| Rate for Payer: Aetna Commercial |
$3,891.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,291.72
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$3,978.08
|
| Rate for Payer: Health EOS Commercial |
$3,848.36
|
| Rate for Payer: HFN Commercial |
$3,978.08
|
| Rate for Payer: Multiplan Commercial |
$3,459.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,594.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,978.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,118.76
|
| Rate for Payer: Quartz Commercial |
$2,594.40
|
| Rate for Payer: WEA Trust Commercial |
$2,378.20
|
| Rate for Payer: WPS Commercial |
$3,202.79
|
|
|
SHOULDER OSTEOTOMY/ARTHRODESIS
|
Facility
OP
|
$4,324.00
|
|
| Hospital Charge Code |
2960295
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,210.72 |
| Max. Negotiated Rate |
$17,296.00 |
| Rate for Payer: Aetna Commercial |
$3,891.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,718.64
|
| Rate for Payer: Aetna Managed Medicare |
$1,210.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,810.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,162.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,075.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,291.72
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$3,978.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,419.71
|
| Rate for Payer: Health EOS Commercial |
$3,848.36
|
| Rate for Payer: HFN Commercial |
$3,978.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,243.00
|
| Rate for Payer: Multiplan Commercial |
$3,459.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,594.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,978.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,118.76
|
| Rate for Payer: Quartz Commercial |
$2,810.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2,594.40
|
| Rate for Payer: The Alliance Commercial |
$17,296.00
|
| Rate for Payer: WEA Trust Commercial |
$2,378.20
|
| Rate for Payer: WPS Commercial |
$3,202.79
|
|
|
SHOULDER, REVERSE
|
Facility
OP
|
$11,792.00
|
|
| Hospital Charge Code |
4494580
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,301.76 |
| Max. Negotiated Rate |
$47,168.00 |
| Rate for Payer: Aetna Commercial |
$10,612.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,141.12
|
| Rate for Payer: Aetna Managed Medicare |
$3,301.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,664.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,896.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,660.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,249.76
|
| Rate for Payer: Cash Price |
$3,537.60
|
| Rate for Payer: Cigna Commercial |
$10,848.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,598.80
|
| Rate for Payer: Health EOS Commercial |
$10,494.88
|
| Rate for Payer: HFN Commercial |
$10,848.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,844.00
|
| Rate for Payer: Multiplan Commercial |
$9,433.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,075.20
|
| Rate for Payer: Preferred Network Access Commercial |
$10,848.64
|
| Rate for Payer: Quartz Beloit One Network |
$5,778.08
|
| Rate for Payer: Quartz Commercial |
$7,664.80
|
| Rate for Payer: Quartz Medicare Advantage |
$7,075.20
|
| Rate for Payer: The Alliance Commercial |
$47,168.00
|
| Rate for Payer: WEA Trust Commercial |
$6,485.60
|
| Rate for Payer: WPS Commercial |
$8,734.33
|
|
|
SHOULDER, REVERSE
|
Facility
IP
|
$11,792.00
|
|
| Hospital Charge Code |
4494580
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,778.08 |
| Max. Negotiated Rate |
$10,848.64 |
| Rate for Payer: Aetna Commercial |
$10,612.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,249.76
|
| Rate for Payer: Cash Price |
$3,537.60
|
| Rate for Payer: Cigna Commercial |
$10,848.64
|
| Rate for Payer: Health EOS Commercial |
$10,494.88
|
| Rate for Payer: HFN Commercial |
$10,848.64
|
| Rate for Payer: Multiplan Commercial |
$9,433.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,075.20
|
| Rate for Payer: Preferred Network Access Commercial |
$10,848.64
|
| Rate for Payer: Quartz Beloit One Network |
$5,778.08
|
| Rate for Payer: Quartz Commercial |
$7,075.20
|
| Rate for Payer: WEA Trust Commercial |
$6,485.60
|
| Rate for Payer: WPS Commercial |
$8,734.33
|
|
