|
SHOULDER BONE GRAFTING
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2959865
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,005.28 |
| 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: 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: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| 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 |
$2,455.44
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
SHOULDER CAPSULORRAPHY
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2959905
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,005.28 |
| 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: 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: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| 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 |
$2,455.44
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
SHOULDER CAPSULORRAPHY
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2959905
|
|
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
|
|
|
SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH CC
|
Facility
|
IP
|
$55,461.12
|
|
|
Service Code
|
MSDRG 511
|
| Min. Negotiated Rate |
$16,431.23 |
| Max. Negotiated Rate |
$55,461.12 |
| Rate for Payer: Aetna Managed Medicare |
$16,431.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45,370.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$34,776.38
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$33,039.84
|
| Rate for Payer: Anthem Medicare Advantage |
$16,431.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16,431.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16,431.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16,431.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36,677.25
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16,431.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40,434.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16,431.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16,431.23
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16,431.23
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16,431.23
|
| Rate for Payer: NAPHCARE Commercial |
$24,646.85
|
| Rate for Payer: Quartz Medicare Advantage |
$16,431.23
|
| Rate for Payer: The Alliance Commercial |
$55,461.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16,431.23
|
| Rate for Payer: United Healthcare PPO |
$31,478.60
|
| Rate for Payer: Wellcare Medicare |
$16,431.23
|
|
|
SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH MCC
|
Facility
|
IP
|
$75,556.00
|
|
|
Service Code
|
MSDRG 510
|
| Min. Negotiated Rate |
$23,638.36 |
| Max. Negotiated Rate |
$75,556.00 |
| Rate for Payer: Aetna Managed Medicare |
$23,638.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$65,904.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$50,515.57
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$47,993.09
|
| Rate for Payer: Anthem Medicare Advantage |
$23,638.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23,638.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23,638.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$23,638.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$53,276.73
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$23,638.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55,173.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$23,638.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23,638.36
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$23,638.36
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$23,638.36
|
| Rate for Payer: NAPHCARE Commercial |
$35,457.54
|
| Rate for Payer: Quartz Medicare Advantage |
$23,638.36
|
| Rate for Payer: The Alliance Commercial |
$75,556.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23,638.36
|
| Rate for Payer: United Healthcare PPO |
$42,953.49
|
| Rate for Payer: Wellcare Medicare |
$23,638.36
|
|
|
SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$44,954.00
|
|
|
Service Code
|
MSDRG 512
|
| Min. Negotiated Rate |
$13,184.17 |
| Max. Negotiated Rate |
$44,954.00 |
| Rate for Payer: Aetna Managed Medicare |
$13,184.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$36,119.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27,685.31
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26,302.85
|
| Rate for Payer: Anthem Medicare Advantage |
$13,184.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,184.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,184.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,184.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29,198.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,184.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32,727.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,184.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,184.17
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,184.17
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,184.17
|
| Rate for Payer: NAPHCARE Commercial |
$19,776.26
|
| Rate for Payer: Quartz Medicare Advantage |
$13,184.17
|
| Rate for Payer: The Alliance Commercial |
$44,954.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,184.17
|
| Rate for Payer: United Healthcare PPO |
$25,479.06
|
| Rate for Payer: Wellcare Medicare |
$13,184.17
|
|
|
SHOULDER IMMBL MED TX9023-02
|
Facility
|
OP
|
$151.00
|
|
| Hospital Charge Code |
2974263
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$43.97 |
| Max. Negotiated Rate |
$144.48 |
| Rate for Payer: Aetna Commercial |
$141.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.05
|
| Rate for Payer: Aetna Managed Medicare |
$43.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$102.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$78.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$75.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.23
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$144.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$87.88
|
| Rate for Payer: Health EOS Commercial |
$139.77
|
| Rate for Payer: HFN Commercial |
$144.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$117.78
|
| Rate for Payer: Multiplan Commercial |
$125.63
|
| Rate for Payer: NAPHCARE Commercial |
$94.22
|
| Rate for Payer: Preferred Network Access Commercial |
$144.48
|
| Rate for Payer: Quartz Beloit One Network |
$76.95
|
| Rate for Payer: Quartz Commercial |
$102.08
|
| Rate for Payer: Quartz Medicare Advantage |
$94.22
|
| Rate for Payer: The Alliance Commercial |
$78.52
|
| Rate for Payer: WEA Trust Commercial |
$86.37
|
| Rate for Payer: WPS Commercial |
$116.32
|
|
|
SHOULDER IMMBL MED TX9023-02
|
Facility
|
IP
|
$151.00
|
|
| Hospital Charge Code |
2974263
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$76.95 |
| Max. Negotiated Rate |
$144.48 |
| Rate for Payer: Aetna Commercial |
$141.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.23
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$144.48
|
| Rate for Payer: Health EOS Commercial |
$139.77
|
| Rate for Payer: HFN Commercial |
$144.48
|
| Rate for Payer: Multiplan Commercial |
$125.63
|
| Rate for Payer: Preferred Network Access Commercial |
$144.48
|
| Rate for Payer: Quartz Beloit One Network |
$76.95
|
| Rate for Payer: Quartz Commercial |
$94.22
|
| Rate for Payer: WEA Trust Commercial |
$86.37
|
| Rate for Payer: WPS Commercial |
$116.32
|
|
|
SHOULDER IMMOBILIZER L3670
|
Facility
|
OP
|
$1,882.00
|
|
| Hospital Charge Code |
2974044
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$548.04 |
| Max. Negotiated Rate |
$1,800.70 |
| Rate for Payer: Aetna Commercial |
$1,761.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,683.26
|
| Rate for Payer: Aetna Managed Medicare |
$548.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,272.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$978.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$939.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,037.36
|
| Rate for Payer: Cash Price |
$564.60
|
| Rate for Payer: Cigna Commercial |
$1,800.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,095.32
|
| Rate for Payer: Health EOS Commercial |
$1,741.98
|
| Rate for Payer: HFN Commercial |
$1,800.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,467.96
|
| Rate for Payer: Multiplan Commercial |
$1,565.82
|
| Rate for Payer: NAPHCARE Commercial |
$1,174.37
|
| Rate for Payer: Preferred Network Access Commercial |
$1,800.70
|
| Rate for Payer: Quartz Beloit One Network |
$959.07
|
| Rate for Payer: Quartz Commercial |
$1,272.23
|
| Rate for Payer: Quartz Medicare Advantage |
$1,174.37
|
| Rate for Payer: The Alliance Commercial |
$978.64
|
| Rate for Payer: WEA Trust Commercial |
$1,076.50
|
| Rate for Payer: WPS Commercial |
$1,449.70
|
|
|
SHOULDER IMMOBILIZER L3670
|
Facility
|
IP
|
$1,882.00
|
|
| Hospital Charge Code |
2974044
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$959.07 |
| Max. Negotiated Rate |
$1,800.70 |
| Rate for Payer: Aetna Commercial |
$1,761.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,683.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,037.36
|
| Rate for Payer: Cash Price |
$564.60
|
| Rate for Payer: Cigna Commercial |
$1,800.70
|
| Rate for Payer: Health EOS Commercial |
$1,741.98
|
| Rate for Payer: HFN Commercial |
$1,800.70
|
| Rate for Payer: Multiplan Commercial |
$1,565.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,800.70
|
| Rate for Payer: Quartz Beloit One Network |
$959.07
|
| Rate for Payer: Quartz Commercial |
$1,174.37
|
| Rate for Payer: WEA Trust Commercial |
$1,076.50
|
| Rate for Payer: WPS Commercial |
$1,449.70
|
|
|
SHOULDER IMMOBILIZER SMALL A111015
|
Facility
|
IP
|
$108.00
|
|
| Hospital Charge Code |
2964038
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$55.04 |
| Max. Negotiated Rate |
$103.33 |
| Rate for Payer: Aetna Commercial |
$101.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$96.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$59.53
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna Commercial |
$103.33
|
| Rate for Payer: Health EOS Commercial |
$99.96
|
| Rate for Payer: HFN Commercial |
$103.33
|
| Rate for Payer: Multiplan Commercial |
$89.86
|
| Rate for Payer: Preferred Network Access Commercial |
$103.33
|
| Rate for Payer: Quartz Beloit One Network |
$55.04
|
| Rate for Payer: Quartz Commercial |
$67.39
|
| Rate for Payer: WEA Trust Commercial |
$61.78
|
| Rate for Payer: WPS Commercial |
$83.19
|
|
|
SHOULDER IMMOBILIZER SMALL A111015
|
Facility
|
OP
|
$108.00
|
|
| Hospital Charge Code |
2964038
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$31.45 |
| Max. Negotiated Rate |
$103.33 |
| Rate for Payer: Aetna Commercial |
$101.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$96.60
|
| Rate for Payer: Aetna Managed Medicare |
$31.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$73.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$56.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$53.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$59.53
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna Commercial |
$103.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$62.86
|
| Rate for Payer: Health EOS Commercial |
$99.96
|
| Rate for Payer: HFN Commercial |
$103.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$84.24
|
| Rate for Payer: Multiplan Commercial |
$89.86
|
| Rate for Payer: NAPHCARE Commercial |
$67.39
|
| Rate for Payer: Preferred Network Access Commercial |
$103.33
|
| Rate for Payer: Quartz Beloit One Network |
$55.04
|
| Rate for Payer: Quartz Commercial |
$73.01
|
| Rate for Payer: Quartz Medicare Advantage |
$67.39
|
| Rate for Payer: The Alliance Commercial |
$56.16
|
| Rate for Payer: WEA Trust Commercial |
$61.78
|
| Rate for Payer: WPS Commercial |
$83.19
|
|
|
SHOULDER IMMOBL SM TX9023-01
|
Facility
|
IP
|
$151.00
|
|
| Hospital Charge Code |
2974262
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$76.95 |
| Max. Negotiated Rate |
$144.48 |
| Rate for Payer: Aetna Commercial |
$141.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.23
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$144.48
|
| Rate for Payer: Health EOS Commercial |
$139.77
|
| Rate for Payer: HFN Commercial |
$144.48
|
| Rate for Payer: Multiplan Commercial |
$125.63
|
| Rate for Payer: Preferred Network Access Commercial |
$144.48
|
| Rate for Payer: Quartz Beloit One Network |
$76.95
|
| Rate for Payer: Quartz Commercial |
$94.22
|
| Rate for Payer: WEA Trust Commercial |
$86.37
|
| Rate for Payer: WPS Commercial |
$116.32
|
|
|
SHOULDER IMMOBL SM TX9023-01
|
Facility
|
OP
|
$151.00
|
|
| Hospital Charge Code |
2974262
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$43.97 |
| Max. Negotiated Rate |
$144.48 |
| Rate for Payer: Aetna Commercial |
$141.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.05
|
| Rate for Payer: Aetna Managed Medicare |
$43.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$102.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$78.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$75.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.23
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$144.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$87.88
|
| Rate for Payer: Health EOS Commercial |
$139.77
|
| Rate for Payer: HFN Commercial |
$144.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$117.78
|
| Rate for Payer: Multiplan Commercial |
$125.63
|
| Rate for Payer: NAPHCARE Commercial |
$94.22
|
| Rate for Payer: Preferred Network Access Commercial |
$144.48
|
| Rate for Payer: Quartz Beloit One Network |
$76.95
|
| Rate for Payer: Quartz Commercial |
$102.08
|
| Rate for Payer: Quartz Medicare Advantage |
$94.22
|
| Rate for Payer: The Alliance Commercial |
$78.52
|
| Rate for Payer: WEA Trust Commercial |
$86.37
|
| Rate for Payer: WPS Commercial |
$116.32
|
|
|
SHOULDER IMMOBL XL TX9023-04
|
Facility
|
IP
|
$151.00
|
|
| Hospital Charge Code |
2974265
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$76.95 |
| Max. Negotiated Rate |
$144.48 |
| Rate for Payer: Aetna Commercial |
$141.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.23
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$144.48
|
| Rate for Payer: Health EOS Commercial |
$139.77
|
| Rate for Payer: HFN Commercial |
$144.48
|
| Rate for Payer: Multiplan Commercial |
$125.63
|
| Rate for Payer: Preferred Network Access Commercial |
$144.48
|
| Rate for Payer: Quartz Beloit One Network |
$76.95
|
| Rate for Payer: Quartz Commercial |
$94.22
|
| Rate for Payer: WEA Trust Commercial |
$86.37
|
| Rate for Payer: WPS Commercial |
$116.32
|
|
|
SHOULDER IMMOBL XL TX9023-04
|
Facility
|
OP
|
$151.00
|
|
| Hospital Charge Code |
2974265
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$43.97 |
| Max. Negotiated Rate |
$144.48 |
| Rate for Payer: Aetna Commercial |
$141.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.05
|
| Rate for Payer: Aetna Managed Medicare |
$43.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$102.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$78.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$75.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.23
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$144.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$87.88
|
| Rate for Payer: Health EOS Commercial |
$139.77
|
| Rate for Payer: HFN Commercial |
$144.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$117.78
|
| Rate for Payer: Multiplan Commercial |
$125.63
|
| Rate for Payer: NAPHCARE Commercial |
$94.22
|
| Rate for Payer: Preferred Network Access Commercial |
$144.48
|
| Rate for Payer: Quartz Beloit One Network |
$76.95
|
| Rate for Payer: Quartz Commercial |
$102.08
|
| Rate for Payer: Quartz Medicare Advantage |
$94.22
|
| Rate for Payer: The Alliance Commercial |
$78.52
|
| Rate for Payer: WEA Trust Commercial |
$86.37
|
| Rate for Payer: WPS Commercial |
$116.32
|
|
|
SHOULDER, LATERJET
|
Facility
|
IP
|
$13,037.00
|
|
| Hospital Charge Code |
4494583
|
|
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, LATERJET
|
Facility
|
OP
|
$13,037.00
|
|
| Hospital Charge Code |
4494583
|
|
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 OSTEOTOMY/ARTHRODESIS
|
Facility
|
IP
|
$4,324.00
|
|
| Hospital Charge Code |
2960295
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,203.51 |
| Max. Negotiated Rate |
$4,137.20 |
| Rate for Payer: Aetna Commercial |
$4,047.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,867.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,383.39
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$4,137.20
|
| Rate for Payer: Health EOS Commercial |
$4,002.29
|
| Rate for Payer: HFN Commercial |
$4,137.20
|
| Rate for Payer: Multiplan Commercial |
$3,597.57
|
| Rate for Payer: Preferred Network Access Commercial |
$4,137.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,203.51
|
| Rate for Payer: Quartz Commercial |
$2,698.18
|
| Rate for Payer: WEA Trust Commercial |
$2,473.33
|
| Rate for Payer: WPS Commercial |
$3,330.78
|
|
|
SHOULDER OSTEOTOMY/ARTHRODESIS
|
Facility
|
OP
|
$4,324.00
|
|
| Hospital Charge Code |
2960295
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,259.15 |
| Max. Negotiated Rate |
$4,137.20 |
| Rate for Payer: Aetna Commercial |
$4,047.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,867.39
|
| Rate for Payer: Aetna Managed Medicare |
$1,259.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,923.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,248.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,158.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,383.39
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$4,137.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,516.57
|
| Rate for Payer: Health EOS Commercial |
$4,002.29
|
| Rate for Payer: HFN Commercial |
$4,137.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,372.72
|
| Rate for Payer: Multiplan Commercial |
$3,597.57
|
| Rate for Payer: NAPHCARE Commercial |
$2,698.18
|
| Rate for Payer: Preferred Network Access Commercial |
$4,137.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,203.51
|
| Rate for Payer: Quartz Commercial |
$2,923.02
|
| Rate for Payer: Quartz Medicare Advantage |
$2,698.18
|
| Rate for Payer: The Alliance Commercial |
$2,248.48
|
| Rate for Payer: WEA Trust Commercial |
$2,473.33
|
| Rate for Payer: WPS Commercial |
$3,330.78
|
|
|
SHOULDER, REVERSE
|
Facility
|
IP
|
$11,792.00
|
|
| Hospital Charge Code |
4494580
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,009.20 |
| Max. Negotiated Rate |
$11,282.59 |
| Rate for Payer: Aetna Commercial |
$11,037.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,546.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,499.75
|
| Rate for Payer: Cash Price |
$3,537.60
|
| Rate for Payer: Cigna Commercial |
$11,282.59
|
| Rate for Payer: Health EOS Commercial |
$10,914.68
|
| Rate for Payer: HFN Commercial |
$11,282.59
|
| Rate for Payer: Multiplan Commercial |
$9,810.94
|
| Rate for Payer: Preferred Network Access Commercial |
$11,282.59
|
| Rate for Payer: Quartz Beloit One Network |
$6,009.20
|
| Rate for Payer: Quartz Commercial |
$7,358.21
|
| Rate for Payer: WEA Trust Commercial |
$6,745.02
|
| Rate for Payer: WPS Commercial |
$9,083.38
|
|
|
SHOULDER, REVERSE
|
Facility
|
OP
|
$11,792.00
|
|
| Hospital Charge Code |
4494580
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,433.83 |
| Max. Negotiated Rate |
$11,282.59 |
| Rate for Payer: Aetna Commercial |
$11,037.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,546.76
|
| Rate for Payer: Aetna Managed Medicare |
$3,433.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,971.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,131.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,886.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,499.75
|
| Rate for Payer: Cash Price |
$3,537.60
|
| Rate for Payer: Cigna Commercial |
$11,282.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,862.94
|
| Rate for Payer: Health EOS Commercial |
$10,914.68
|
| Rate for Payer: HFN Commercial |
$11,282.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,197.76
|
| Rate for Payer: Multiplan Commercial |
$9,810.94
|
| Rate for Payer: NAPHCARE Commercial |
$7,358.21
|
| Rate for Payer: Preferred Network Access Commercial |
$11,282.59
|
| Rate for Payer: Quartz Beloit One Network |
$6,009.20
|
| Rate for Payer: Quartz Commercial |
$7,971.39
|
| Rate for Payer: Quartz Medicare Advantage |
$7,358.21
|
| Rate for Payer: The Alliance Commercial |
$6,131.84
|
| Rate for Payer: WEA Trust Commercial |
$6,745.02
|
| Rate for Payer: WPS Commercial |
$9,083.38
|
|
|
SHOULDER, UPPER ARM AND FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT
|
Facility
|
IP
|
$16,133.69
|
|
|
Service Code
|
APR-DRG 3152
|
| Min. Negotiated Rate |
$14,330.95 |
| Max. Negotiated Rate |
$16,133.69 |
| Rate for Payer: Anthem Medicaid |
$15,448.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$15,448.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15,448.90
|
| Rate for Payer: Dean Health Medicaid |
$15,448.90
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14,330.95
|
| Rate for Payer: Managed Health Services Medicaid |
$16,133.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$15,448.90
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$15,448.90
|
| Rate for Payer: United Healthcare Medicaid |
$15,448.90
|
|
|
SHOULDER, UPPER ARM AND FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT
|
Facility
|
IP
|
$21,833.09
|
|
|
Service Code
|
APR-DRG 3153
|
| Min. Negotiated Rate |
$19,393.51 |
| Max. Negotiated Rate |
$21,833.09 |
| Rate for Payer: Anthem Medicaid |
$20,906.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$20,906.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$20,906.39
|
| Rate for Payer: Dean Health Medicaid |
$20,906.39
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19,393.51
|
| Rate for Payer: Managed Health Services Medicaid |
$21,833.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$20,906.39
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$20,906.39
|
| Rate for Payer: United Healthcare Medicaid |
$20,906.39
|
|
|
SHOULDER, UPPER ARM AND FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT
|
Facility
|
IP
|
$11,048.07
|
|
|
Service Code
|
APR-DRG 3151
|
| Min. Negotiated Rate |
$9,813.59 |
| Max. Negotiated Rate |
$11,048.07 |
| Rate for Payer: Anthem Medicaid |
$10,579.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$10,579.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10,579.14
|
| Rate for Payer: Dean Health Medicaid |
$10,579.14
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9,813.59
|
| Rate for Payer: Managed Health Services Medicaid |
$11,048.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,579.14
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$10,579.14
|
| Rate for Payer: United Healthcare Medicaid |
$10,579.14
|
|
