|
SHOE POST-OP MALE XL 12.5-14 DS1014-16
|
Facility
|
OP
|
$184.00
|
|
| Hospital Charge Code |
2963923
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$53.58 |
| Max. Negotiated Rate |
$176.05 |
| Rate for Payer: Aetna Commercial |
$172.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$164.57
|
| Rate for Payer: Aetna Managed Medicare |
$53.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$124.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$95.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$91.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$101.42
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cigna Commercial |
$176.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$107.09
|
| Rate for Payer: Health EOS Commercial |
$170.31
|
| Rate for Payer: HFN Commercial |
$176.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$143.52
|
| Rate for Payer: Multiplan Commercial |
$153.09
|
| Rate for Payer: NAPHCARE Commercial |
$114.82
|
| Rate for Payer: Preferred Network Access Commercial |
$176.05
|
| Rate for Payer: Quartz Beloit One Network |
$93.77
|
| Rate for Payer: Quartz Commercial |
$124.38
|
| Rate for Payer: Quartz Medicare Advantage |
$114.82
|
| Rate for Payer: The Alliance Commercial |
$95.68
|
| Rate for Payer: WEA Trust Commercial |
$105.25
|
| Rate for Payer: WPS Commercial |
$141.74
|
|
|
SHOE SWEDISH AFO LEFT BLACK
|
Facility
|
IP
|
$525.00
|
|
| Hospital Charge Code |
2971357
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$267.54 |
| Max. Negotiated Rate |
$502.32 |
| Rate for Payer: Aetna Commercial |
$491.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$469.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$289.38
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna Commercial |
$502.32
|
| Rate for Payer: Health EOS Commercial |
$485.94
|
| Rate for Payer: HFN Commercial |
$502.32
|
| Rate for Payer: Multiplan Commercial |
$436.80
|
| Rate for Payer: Preferred Network Access Commercial |
$502.32
|
| Rate for Payer: Quartz Beloit One Network |
$267.54
|
| Rate for Payer: Quartz Commercial |
$327.60
|
| Rate for Payer: WEA Trust Commercial |
$300.30
|
| Rate for Payer: WPS Commercial |
$404.41
|
|
|
SHOE SWEDISH AFO LEFT BLACK
|
Facility
|
OP
|
$525.00
|
|
| Hospital Charge Code |
2971357
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$152.88 |
| Max. Negotiated Rate |
$502.32 |
| Rate for Payer: Aetna Commercial |
$491.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$469.56
|
| Rate for Payer: Aetna Managed Medicare |
$152.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$354.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$273.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$262.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$289.38
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna Commercial |
$502.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$305.55
|
| Rate for Payer: Health EOS Commercial |
$485.94
|
| Rate for Payer: HFN Commercial |
$502.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$409.50
|
| Rate for Payer: Multiplan Commercial |
$436.80
|
| Rate for Payer: NAPHCARE Commercial |
$327.60
|
| Rate for Payer: Preferred Network Access Commercial |
$502.32
|
| Rate for Payer: Quartz Beloit One Network |
$267.54
|
| Rate for Payer: Quartz Commercial |
$354.90
|
| Rate for Payer: Quartz Medicare Advantage |
$327.60
|
| Rate for Payer: The Alliance Commercial |
$273.00
|
| Rate for Payer: WEA Trust Commercial |
$300.30
|
| Rate for Payer: WPS Commercial |
$404.41
|
|
|
Short Increment Sensitivity Index
|
Facility
|
IP
|
$148.00
|
|
| Hospital Charge Code |
1188817
|
| Min. Negotiated Rate |
$75.42 |
| Max. Negotiated Rate |
$141.61 |
| Rate for Payer: Aetna Commercial |
$138.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$132.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.58
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cigna Commercial |
$141.61
|
| Rate for Payer: Health EOS Commercial |
$136.99
|
| Rate for Payer: HFN Commercial |
$141.61
|
| Rate for Payer: Multiplan Commercial |
$123.14
|
| Rate for Payer: Preferred Network Access Commercial |
$141.61
|
| Rate for Payer: Quartz Beloit One Network |
$75.42
|
| Rate for Payer: Quartz Commercial |
$92.35
|
| Rate for Payer: WEA Trust Commercial |
$84.66
|
| Rate for Payer: WPS Commercial |
$114.00
|
|
|
Short Increment Sensitivity Index
|
Facility
|
OP
|
$148.00
|
|
| Hospital Charge Code |
1188817
|
| Min. Negotiated Rate |
$43.10 |
| Max. Negotiated Rate |
$141.61 |
| Rate for Payer: Aetna Commercial |
$138.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$132.37
|
| Rate for Payer: Aetna Managed Medicare |
$43.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$100.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$76.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$73.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.58
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cigna Commercial |
$141.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$86.14
|
| Rate for Payer: Health EOS Commercial |
$136.99
|
| Rate for Payer: HFN Commercial |
$141.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$115.44
|
| Rate for Payer: Multiplan Commercial |
$123.14
|
| Rate for Payer: NAPHCARE Commercial |
$92.35
|
| Rate for Payer: Preferred Network Access Commercial |
$141.61
|
| Rate for Payer: Quartz Beloit One Network |
$75.42
|
| Rate for Payer: Quartz Commercial |
$100.05
|
| Rate for Payer: Quartz Medicare Advantage |
$92.35
|
| Rate for Payer: The Alliance Commercial |
$76.96
|
| Rate for Payer: WEA Trust Commercial |
$84.66
|
| Rate for Payer: WPS Commercial |
$114.00
|
|
|
Short Increment Sensitivity Index
|
Professional
|
Both
|
$148.00
|
|
| Hospital Charge Code |
1188817
|
| Min. Negotiated Rate |
$67.72 |
| Max. Negotiated Rate |
$146.22 |
| Rate for Payer: Aetna Commercial |
$146.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$132.37
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cigna Commercial |
$146.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$76.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$92.35
|
| Rate for Payer: Health EOS Commercial |
$140.07
|
| Rate for Payer: HFN Commercial |
$146.22
|
| Rate for Payer: Multiplan Commercial |
$123.14
|
| Rate for Payer: Preferred Network Access Commercial |
$146.22
|
| Rate for Payer: Quartz Beloit One Network |
$67.72
|
| Rate for Payer: Quartz Commercial |
$87.73
|
| Rate for Payer: The Alliance Commercial |
$76.96
|
| Rate for Payer: WEA Trust Commercial |
$84.66
|
| Rate for Payer: WPS Commercial |
$114.00
|
|
|
Short Increment Sensity. Index
|
Facility
|
IP
|
$148.00
|
|
| Hospital Charge Code |
3203500
|
| Min. Negotiated Rate |
$75.42 |
| Max. Negotiated Rate |
$141.61 |
| Rate for Payer: Aetna Commercial |
$138.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$132.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.58
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cigna Commercial |
$141.61
|
| Rate for Payer: Health EOS Commercial |
$136.99
|
| Rate for Payer: HFN Commercial |
$141.61
|
| Rate for Payer: Multiplan Commercial |
$123.14
|
| Rate for Payer: Preferred Network Access Commercial |
$141.61
|
| Rate for Payer: Quartz Beloit One Network |
$75.42
|
| Rate for Payer: Quartz Commercial |
$92.35
|
| Rate for Payer: WEA Trust Commercial |
$84.66
|
| Rate for Payer: WPS Commercial |
$114.00
|
|
|
Short Increment Sensity. Index
|
Facility
|
OP
|
$148.00
|
|
| Hospital Charge Code |
3203500
|
| Min. Negotiated Rate |
$43.10 |
| Max. Negotiated Rate |
$141.61 |
| Rate for Payer: Aetna Commercial |
$138.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$132.37
|
| Rate for Payer: Aetna Managed Medicare |
$43.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$100.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$76.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$73.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.58
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cigna Commercial |
$141.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$86.14
|
| Rate for Payer: Health EOS Commercial |
$136.99
|
| Rate for Payer: HFN Commercial |
$141.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$115.44
|
| Rate for Payer: Multiplan Commercial |
$123.14
|
| Rate for Payer: NAPHCARE Commercial |
$92.35
|
| Rate for Payer: Preferred Network Access Commercial |
$141.61
|
| Rate for Payer: Quartz Beloit One Network |
$75.42
|
| Rate for Payer: Quartz Commercial |
$100.05
|
| Rate for Payer: Quartz Medicare Advantage |
$92.35
|
| Rate for Payer: The Alliance Commercial |
$76.96
|
| Rate for Payer: WEA Trust Commercial |
$84.66
|
| Rate for Payer: WPS Commercial |
$114.00
|
|
|
Short Increment Sensity. Index
|
Professional
|
Both
|
$148.00
|
|
| Hospital Charge Code |
3203500
|
| Min. Negotiated Rate |
$67.72 |
| Max. Negotiated Rate |
$146.22 |
| Rate for Payer: Aetna Commercial |
$146.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$132.37
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cigna Commercial |
$146.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$76.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$92.35
|
| Rate for Payer: Health EOS Commercial |
$140.07
|
| Rate for Payer: HFN Commercial |
$146.22
|
| Rate for Payer: Multiplan Commercial |
$123.14
|
| Rate for Payer: Preferred Network Access Commercial |
$146.22
|
| Rate for Payer: Quartz Beloit One Network |
$67.72
|
| Rate for Payer: Quartz Commercial |
$87.73
|
| Rate for Payer: The Alliance Commercial |
$76.96
|
| Rate for Payer: WEA Trust Commercial |
$84.66
|
| Rate for Payer: WPS Commercial |
$114.00
|
|
|
SHOULDER AND ELBOW JOINT REPLACEMENT
|
Facility
|
IP
|
$16,922.84
|
|
|
Service Code
|
APR-DRG 3222
|
| Min. Negotiated Rate |
$15,031.92 |
| Max. Negotiated Rate |
$16,922.84 |
| Rate for Payer: Anthem Medicaid |
$16,204.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$16,204.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16,204.55
|
| Rate for Payer: Dean Health Medicaid |
$16,204.55
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15,031.92
|
| Rate for Payer: Managed Health Services Medicaid |
$16,922.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$16,204.55
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$16,204.55
|
| Rate for Payer: United Healthcare Medicaid |
$16,204.55
|
|
|
SHOULDER AND ELBOW JOINT REPLACEMENT
|
Facility
|
IP
|
$29,549.20
|
|
|
Service Code
|
APR-DRG 3224
|
| Min. Negotiated Rate |
$26,247.45 |
| Max. Negotiated Rate |
$29,549.20 |
| Rate for Payer: Anthem Medicaid |
$28,294.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$28,294.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$28,294.99
|
| Rate for Payer: Dean Health Medicaid |
$28,294.99
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$26,247.45
|
| Rate for Payer: Managed Health Services Medicaid |
$29,549.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,294.99
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$28,294.99
|
| Rate for Payer: United Healthcare Medicaid |
$28,294.99
|
|
|
SHOULDER AND ELBOW JOINT REPLACEMENT
|
Facility
|
IP
|
$23,060.66
|
|
|
Service Code
|
APR-DRG 3223
|
| Min. Negotiated Rate |
$20,483.91 |
| Max. Negotiated Rate |
$23,060.66 |
| Rate for Payer: Anthem Medicaid |
$22,081.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$22,081.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$22,081.85
|
| Rate for Payer: Dean Health Medicaid |
$22,081.85
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$20,483.91
|
| Rate for Payer: Managed Health Services Medicaid |
$23,060.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$22,081.85
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$22,081.85
|
| Rate for Payer: United Healthcare Medicaid |
$22,081.85
|
|
|
SHOULDER AND ELBOW JOINT REPLACEMENT
|
Facility
|
IP
|
$13,941.61
|
|
|
Service Code
|
APR-DRG 3221
|
| Min. Negotiated Rate |
$12,383.81 |
| Max. Negotiated Rate |
$13,941.61 |
| Rate for Payer: Anthem Medicaid |
$13,349.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$13,349.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13,349.86
|
| Rate for Payer: Dean Health Medicaid |
$13,349.86
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12,383.81
|
| Rate for Payer: Managed Health Services Medicaid |
$13,941.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,349.86
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13,349.86
|
| Rate for Payer: United Healthcare Medicaid |
$13,349.86
|
|
|
SHOULDER AND UPPER ARM PROCEDURES
|
Facility
|
OP
|
$1,628.70
|
|
|
Service Code
|
EAPG 00025
|
| Min. Negotiated Rate |
$1,566.06 |
| Max. Negotiated Rate |
$1,628.70 |
| Rate for Payer: Anthem Medicaid |
$1,566.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$1,566.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,566.06
|
| Rate for Payer: Dean Health Medicaid |
$1,566.06
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$1,566.06
|
| Rate for Payer: Managed Health Services Medicaid |
$1,628.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,566.06
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$1,566.06
|
| Rate for Payer: United Healthcare Medicaid |
$1,566.06
|
|
|
Shoulder Arthrogram XR Left
|
Facility
|
IP
|
$1,133.00
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
3072707
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$577.38 |
| Max. Negotiated Rate |
$1,084.05 |
| Rate for Payer: Aetna Commercial |
$1,060.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,013.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$624.51
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cigna Commercial |
$1,084.05
|
| Rate for Payer: Health EOS Commercial |
$1,048.70
|
| Rate for Payer: HFN Commercial |
$1,084.05
|
| Rate for Payer: Multiplan Commercial |
$942.66
|
| Rate for Payer: Preferred Network Access Commercial |
$1,084.05
|
| Rate for Payer: Quartz Beloit One Network |
$577.38
|
| Rate for Payer: Quartz Commercial |
$706.99
|
| Rate for Payer: WEA Trust Commercial |
$648.08
|
| Rate for Payer: WPS Commercial |
$872.75
|
|
|
Shoulder Arthrogram XR Left
|
Professional
|
Both
|
$1,133.00
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
3072707
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.67 |
| Max. Negotiated Rate |
$1,119.40 |
| Rate for Payer: Aetna Commercial |
$1,119.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,013.36
|
| Rate for Payer: Aetna Managed Medicare |
$120.67
|
| Rate for Payer: Anthem Medicare Advantage |
$120.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$120.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$120.67
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cigna Commercial |
$1,119.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$589.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$120.67
|
| Rate for Payer: Health EOS Commercial |
$1,072.27
|
| Rate for Payer: HFN Commercial |
$1,119.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$411.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$411.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$120.67
|
| Rate for Payer: Multiplan Commercial |
$942.66
|
| Rate for Payer: NAPHCARE Commercial |
$181.01
|
| Rate for Payer: Preferred Network Access Commercial |
$1,119.40
|
| Rate for Payer: Quartz Beloit One Network |
$518.46
|
| Rate for Payer: Quartz Commercial |
$671.64
|
| Rate for Payer: Quartz Medicare Advantage |
$120.67
|
| Rate for Payer: The Alliance Commercial |
$458.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$120.67
|
| Rate for Payer: WEA Trust Commercial |
$648.08
|
| Rate for Payer: WPS Commercial |
$603.36
|
|
|
Shoulder Arthrogram XR Left
|
Facility
|
OP
|
$1,133.00
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
3072707
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$1,084.05 |
| Rate for Payer: Aetna Commercial |
$1,060.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,013.36
|
| Rate for Payer: Aetna Managed Medicare |
$329.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$765.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$589.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$565.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$624.51
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cigna Commercial |
$1,084.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$659.41
|
| Rate for Payer: Health EOS Commercial |
$1,048.70
|
| Rate for Payer: HFN Commercial |
$1,084.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$883.74
|
| Rate for Payer: Multiplan Commercial |
$942.66
|
| Rate for Payer: NAPHCARE Commercial |
$706.99
|
| Rate for Payer: Preferred Network Access Commercial |
$1,084.05
|
| Rate for Payer: Quartz Beloit One Network |
$577.38
|
| Rate for Payer: Quartz Commercial |
$765.91
|
| Rate for Payer: Quartz Medicare Advantage |
$706.99
|
| Rate for Payer: The Alliance Commercial |
$482.68
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$648.08
|
| Rate for Payer: WPS Commercial |
$872.75
|
|
|
Shoulder Arthrogram XR Right
|
Facility
|
IP
|
$1,133.00
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
3072708
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$577.38 |
| Max. Negotiated Rate |
$1,084.05 |
| Rate for Payer: Aetna Commercial |
$1,060.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,013.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$624.51
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cigna Commercial |
$1,084.05
|
| Rate for Payer: Health EOS Commercial |
$1,048.70
|
| Rate for Payer: HFN Commercial |
$1,084.05
|
| Rate for Payer: Multiplan Commercial |
$942.66
|
| Rate for Payer: Preferred Network Access Commercial |
$1,084.05
|
| Rate for Payer: Quartz Beloit One Network |
$577.38
|
| Rate for Payer: Quartz Commercial |
$706.99
|
| Rate for Payer: WEA Trust Commercial |
$648.08
|
| Rate for Payer: WPS Commercial |
$872.75
|
|
|
Shoulder Arthrogram XR Right
|
Facility
|
OP
|
$1,133.00
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
3072708
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$1,084.05 |
| Rate for Payer: Aetna Commercial |
$1,060.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,013.36
|
| Rate for Payer: Aetna Managed Medicare |
$329.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$765.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$589.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$565.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$624.51
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cigna Commercial |
$1,084.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$659.41
|
| Rate for Payer: Health EOS Commercial |
$1,048.70
|
| Rate for Payer: HFN Commercial |
$1,084.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$883.74
|
| Rate for Payer: Multiplan Commercial |
$942.66
|
| Rate for Payer: NAPHCARE Commercial |
$706.99
|
| Rate for Payer: Preferred Network Access Commercial |
$1,084.05
|
| Rate for Payer: Quartz Beloit One Network |
$577.38
|
| Rate for Payer: Quartz Commercial |
$765.91
|
| Rate for Payer: Quartz Medicare Advantage |
$706.99
|
| Rate for Payer: The Alliance Commercial |
$482.68
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$648.08
|
| Rate for Payer: WPS Commercial |
$872.75
|
|
|
Shoulder Arthrogram XR Right
|
Professional
|
Both
|
$1,133.00
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
3072708
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.67 |
| Max. Negotiated Rate |
$1,119.40 |
| Rate for Payer: Aetna Commercial |
$1,119.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,013.36
|
| Rate for Payer: Aetna Managed Medicare |
$120.67
|
| Rate for Payer: Anthem Medicare Advantage |
$120.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$120.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$120.67
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cigna Commercial |
$1,119.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$589.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$120.67
|
| Rate for Payer: Health EOS Commercial |
$1,072.27
|
| Rate for Payer: HFN Commercial |
$1,119.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$411.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$411.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$120.67
|
| Rate for Payer: Multiplan Commercial |
$942.66
|
| Rate for Payer: NAPHCARE Commercial |
$181.01
|
| Rate for Payer: Preferred Network Access Commercial |
$1,119.40
|
| Rate for Payer: Quartz Beloit One Network |
$518.46
|
| Rate for Payer: Quartz Commercial |
$671.64
|
| Rate for Payer: Quartz Medicare Advantage |
$120.67
|
| Rate for Payer: The Alliance Commercial |
$458.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$120.67
|
| Rate for Payer: WEA Trust Commercial |
$648.08
|
| Rate for Payer: WPS Commercial |
$603.36
|
|
|
SHOULDER ARTHROPLASTY/HEMIARTHROPLASTY
|
Facility
|
IP
|
$13,037.00
|
|
| Hospital Charge Code |
2960444
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,643.66 |
| Max. Negotiated Rate |
$12,473.80 |
| Rate for Payer: Aetna Commercial |
$12,202.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,660.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,185.99
|
| Rate for Payer: Cash Price |
$3,911.10
|
| Rate for Payer: Cigna Commercial |
$12,473.80
|
| Rate for Payer: Health EOS Commercial |
$12,067.05
|
| Rate for Payer: HFN Commercial |
$12,473.80
|
| Rate for Payer: Multiplan Commercial |
$10,846.78
|
| Rate for Payer: Preferred Network Access Commercial |
$12,473.80
|
| Rate for Payer: Quartz Beloit One Network |
$6,643.66
|
| Rate for Payer: Quartz Commercial |
$8,135.09
|
| Rate for Payer: WEA Trust Commercial |
$7,457.16
|
| Rate for Payer: WPS Commercial |
$10,042.40
|
|
|
SHOULDER ARTHROPLASTY/HEMIARTHROPLASTY
|
Facility
|
OP
|
$13,037.00
|
|
| Hospital Charge Code |
2960444
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,796.37 |
| Max. Negotiated Rate |
$12,473.80 |
| Rate for Payer: Aetna Commercial |
$12,202.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,660.29
|
| Rate for Payer: Aetna Managed Medicare |
$3,796.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,813.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,779.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,508.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,185.99
|
| Rate for Payer: Cash Price |
$3,911.10
|
| Rate for Payer: Cigna Commercial |
$12,473.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,587.53
|
| Rate for Payer: Health EOS Commercial |
$12,067.05
|
| Rate for Payer: HFN Commercial |
$12,473.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,168.86
|
| Rate for Payer: Multiplan Commercial |
$10,846.78
|
| Rate for Payer: NAPHCARE Commercial |
$8,135.09
|
| Rate for Payer: Preferred Network Access Commercial |
$12,473.80
|
| Rate for Payer: Quartz Beloit One Network |
$6,643.66
|
| Rate for Payer: Quartz Commercial |
$8,813.01
|
| Rate for Payer: Quartz Medicare Advantage |
$8,135.09
|
| Rate for Payer: The Alliance Commercial |
$6,779.24
|
| Rate for Payer: WEA Trust Commercial |
$7,457.16
|
| Rate for Payer: WPS Commercial |
$10,042.40
|
|
|
SHOULDER ARTHROSCOPY
|
Facility
|
IP
|
$8,726.00
|
|
| Hospital Charge Code |
2959830
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,446.77 |
| Max. Negotiated Rate |
$8,349.04 |
| Rate for Payer: Aetna Commercial |
$8,167.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,804.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,809.77
|
| Rate for Payer: Cash Price |
$2,617.80
|
| Rate for Payer: Cigna Commercial |
$8,349.04
|
| Rate for Payer: Health EOS Commercial |
$8,076.79
|
| Rate for Payer: HFN Commercial |
$8,349.04
|
| Rate for Payer: Multiplan Commercial |
$7,260.03
|
| Rate for Payer: Preferred Network Access Commercial |
$8,349.04
|
| Rate for Payer: Quartz Beloit One Network |
$4,446.77
|
| Rate for Payer: Quartz Commercial |
$5,445.02
|
| Rate for Payer: WEA Trust Commercial |
$4,991.27
|
| Rate for Payer: WPS Commercial |
$6,721.64
|
|
|
SHOULDER ARTHROSCOPY
|
Facility
|
OP
|
$8,726.00
|
|
| Hospital Charge Code |
2959830
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,541.01 |
| Max. Negotiated Rate |
$8,349.04 |
| Rate for Payer: Aetna Commercial |
$8,167.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,804.53
|
| Rate for Payer: Aetna Managed Medicare |
$2,541.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,898.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,537.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,356.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,809.77
|
| Rate for Payer: Cash Price |
$2,617.80
|
| Rate for Payer: Cigna Commercial |
$8,349.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,078.53
|
| Rate for Payer: Health EOS Commercial |
$8,076.79
|
| Rate for Payer: HFN Commercial |
$8,349.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,806.28
|
| Rate for Payer: Multiplan Commercial |
$7,260.03
|
| Rate for Payer: NAPHCARE Commercial |
$5,445.02
|
| Rate for Payer: Preferred Network Access Commercial |
$8,349.04
|
| Rate for Payer: Quartz Beloit One Network |
$4,446.77
|
| Rate for Payer: Quartz Commercial |
$5,898.78
|
| Rate for Payer: Quartz Medicare Advantage |
$5,445.02
|
| Rate for Payer: The Alliance Commercial |
$4,537.52
|
| Rate for Payer: WEA Trust Commercial |
$4,991.27
|
| Rate for Payer: WPS Commercial |
$6,721.64
|
|
|
SHOULDER BONE GRAFTING
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2959865
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,145.87 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,145.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,660.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,046.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,964.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,290.17
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,069.30
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,455.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,660.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,455.44
|
| Rate for Payer: The Alliance Commercial |
$2,046.20
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
