|
Hip Abduction Brace - PT Equipment Issued Rehab
|
Facility
|
IP
|
$3,663.00
|
|
|
Service Code
|
HCPCS L1686
|
| Hospital Charge Code |
2989874
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,866.66 |
| Max. Negotiated Rate |
$3,504.76 |
| Rate for Payer: Aetna Commercial |
$3,428.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,276.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,019.05
|
| Rate for Payer: Cash Price |
$1,098.90
|
| Rate for Payer: Cigna Commercial |
$3,504.76
|
| Rate for Payer: Health EOS Commercial |
$3,390.47
|
| Rate for Payer: HFN Commercial |
$3,504.76
|
| Rate for Payer: Multiplan Commercial |
$3,047.62
|
| Rate for Payer: Preferred Network Access Commercial |
$3,504.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,866.66
|
| Rate for Payer: Quartz Commercial |
$2,285.71
|
| Rate for Payer: WEA Trust Commercial |
$2,095.24
|
| Rate for Payer: WPS Commercial |
$2,821.61
|
|
|
Hip Abduction Brace - PT Equipment Issued Rehab
|
Facility
|
OP
|
$3,663.00
|
|
|
Service Code
|
HCPCS L1686
|
| Hospital Charge Code |
2989874
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$800.31 |
| Max. Negotiated Rate |
$4,790.49 |
| Rate for Payer: Aetna Commercial |
$3,428.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,276.19
|
| Rate for Payer: Aetna Managed Medicare |
$1,066.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$800.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$800.31
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$800.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,019.05
|
| Rate for Payer: Cash Price |
$1,098.90
|
| Rate for Payer: Cash Price |
$1,098.90
|
| Rate for Payer: Cigna Commercial |
$3,504.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,131.87
|
| Rate for Payer: Health EOS Commercial |
$3,390.47
|
| Rate for Payer: HFN Commercial |
$3,504.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,857.14
|
| Rate for Payer: Multiplan Commercial |
$3,047.62
|
| Rate for Payer: NAPHCARE Commercial |
$2,285.71
|
| Rate for Payer: Preferred Network Access Commercial |
$3,504.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,866.66
|
| Rate for Payer: Quartz Commercial |
$2,476.19
|
| Rate for Payer: Quartz Medicare Advantage |
$2,285.71
|
| Rate for Payer: The Alliance Commercial |
$4,790.49
|
| Rate for Payer: WEA Trust Commercial |
$2,095.24
|
| Rate for Payer: WPS Commercial |
$2,821.61
|
|
|
HIP AND FEMUR FRACTURE REPAIR
|
Facility
|
IP
|
$11,574.17
|
|
|
Service Code
|
APR-DRG 3081
|
| Min. Negotiated Rate |
$10,280.90 |
| Max. Negotiated Rate |
$11,574.17 |
| Rate for Payer: Anthem Medicaid |
$11,082.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$11,082.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11,082.90
|
| Rate for Payer: Dean Health Medicaid |
$11,082.90
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$10,280.90
|
| Rate for Payer: Managed Health Services Medicaid |
$11,574.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,082.90
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11,082.90
|
| Rate for Payer: United Healthcare Medicaid |
$11,082.90
|
|
|
HIP AND FEMUR FRACTURE REPAIR
|
Facility
|
IP
|
$14,906.13
|
|
|
Service Code
|
APR-DRG 3082
|
| Min. Negotiated Rate |
$13,240.55 |
| Max. Negotiated Rate |
$14,906.13 |
| Rate for Payer: Anthem Medicaid |
$14,273.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$14,273.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14,273.44
|
| Rate for Payer: Dean Health Medicaid |
$14,273.44
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13,240.55
|
| Rate for Payer: Managed Health Services Medicaid |
$14,906.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,273.44
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14,273.44
|
| Rate for Payer: United Healthcare Medicaid |
$14,273.44
|
|
|
HIP AND FEMUR FRACTURE REPAIR
|
Facility
|
IP
|
$27,269.44
|
|
|
Service Code
|
APR-DRG 3084
|
| Min. Negotiated Rate |
$24,222.42 |
| Max. Negotiated Rate |
$27,269.44 |
| Rate for Payer: Anthem Medicaid |
$26,112.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$26,112.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$26,112.00
|
| Rate for Payer: Dean Health Medicaid |
$26,112.00
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$24,222.42
|
| Rate for Payer: Managed Health Services Medicaid |
$27,269.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,112.00
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$26,112.00
|
| Rate for Payer: United Healthcare Medicaid |
$26,112.00
|
|
|
HIP AND FEMUR FRACTURE REPAIR
|
Facility
|
IP
|
$18,939.55
|
|
|
Service Code
|
APR-DRG 3083
|
| Min. Negotiated Rate |
$16,823.29 |
| Max. Negotiated Rate |
$18,939.55 |
| Rate for Payer: Anthem Medicaid |
$18,135.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$18,135.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18,135.66
|
| Rate for Payer: Dean Health Medicaid |
$18,135.66
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$16,823.29
|
| Rate for Payer: Managed Health Services Medicaid |
$18,939.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$18,135.66
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$18,135.66
|
| Rate for Payer: United Healthcare Medicaid |
$18,135.66
|
|
|
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC
|
Facility
|
IP
|
$57,703.36
|
|
|
Service Code
|
MSDRG 481
|
| Min. Negotiated Rate |
$16,546.88 |
| Max. Negotiated Rate |
$57,703.36 |
| Rate for Payer: Aetna Managed Medicare |
$16,546.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45,700.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$35,028.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$33,279.76
|
| Rate for Payer: Anthem Medicare Advantage |
$16,546.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16,546.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16,546.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16,546.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36,943.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16,546.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42,078.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16,546.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16,546.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16,546.88
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16,546.88
|
| Rate for Payer: NAPHCARE Commercial |
$24,820.32
|
| Rate for Payer: Quartz Medicare Advantage |
$16,546.88
|
| Rate for Payer: The Alliance Commercial |
$57,703.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16,546.88
|
| Rate for Payer: United Healthcare PPO |
$32,759.02
|
| Rate for Payer: Wellcare Medicare |
$16,546.88
|
|
|
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC
|
Facility
|
IP
|
$81,868.80
|
|
|
Service Code
|
MSDRG 480
|
| Min. Negotiated Rate |
$22,809.75 |
| Max. Negotiated Rate |
$81,868.80 |
| Rate for Payer: Aetna Managed Medicare |
$22,809.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63,544.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$48,706.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46,273.88
|
| Rate for Payer: Anthem Medicare Advantage |
$22,809.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22,809.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22,809.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$22,809.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51,368.25
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$22,809.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59,803.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22,809.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22,809.75
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$22,809.75
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$22,809.75
|
| Rate for Payer: NAPHCARE Commercial |
$34,214.62
|
| Rate for Payer: Quartz Medicare Advantage |
$22,809.75
|
| Rate for Payer: The Alliance Commercial |
$81,868.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22,809.75
|
| Rate for Payer: United Healthcare PPO |
$46,557.94
|
| Rate for Payer: Wellcare Medicare |
$22,809.75
|
|
|
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC
|
Facility
|
IP
|
$44,252.00
|
|
|
Service Code
|
MSDRG 482
|
| Min. Negotiated Rate |
$12,997.32 |
| Max. Negotiated Rate |
$44,252.00 |
| Rate for Payer: Aetna Managed Medicare |
$12,997.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$35,587.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27,277.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25,915.15
|
| Rate for Payer: Anthem Medicare Advantage |
$12,997.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12,997.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12,997.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12,997.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28,768.20
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12,997.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32,212.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12,997.32
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12,997.32
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12,997.32
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12,997.32
|
| Rate for Payer: NAPHCARE Commercial |
$19,495.98
|
| Rate for Payer: Quartz Medicare Advantage |
$12,997.32
|
| Rate for Payer: The Alliance Commercial |
$44,252.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,997.32
|
| Rate for Payer: United Healthcare PPO |
$25,078.04
|
| Rate for Payer: Wellcare Medicare |
$12,997.32
|
|
|
HIP ARTHROPLASTY, BIPOLAR/HEMI ARTHROPLASTY
|
Facility
|
IP
|
$11,792.00
|
|
| Hospital Charge Code |
2959843
|
|
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
|
|
|
HIP ARTHROPLASTY, BIPOLAR/HEMI ARTHROPLASTY
|
Facility
|
OP
|
$11,792.00
|
|
| Hospital Charge Code |
2959843
|
|
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
|
|
|
HIP ARTHROPLASTY, TOTAL, ANTERIOR APROACH
|
Facility
|
OP
|
$13,037.00
|
|
| Hospital Charge Code |
5532668
|
|
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
|
|
|
HIP ARTHROPLASTY, TOTAL, ANTERIOR APROACH
|
Facility
|
IP
|
$13,037.00
|
|
| Hospital Charge Code |
5532668
|
|
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
|
|
|
HIP ARTHROPLASTY, TOTAL, BILATERAL
|
Facility
|
IP
|
$19,494.00
|
|
| Hospital Charge Code |
2950339
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,934.14 |
| Max. Negotiated Rate |
$18,651.86 |
| Rate for Payer: Aetna Commercial |
$18,246.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,435.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,745.09
|
| Rate for Payer: Cash Price |
$5,848.20
|
| Rate for Payer: Cigna Commercial |
$18,651.86
|
| Rate for Payer: Health EOS Commercial |
$18,043.65
|
| Rate for Payer: HFN Commercial |
$18,651.86
|
| Rate for Payer: Multiplan Commercial |
$16,219.01
|
| Rate for Payer: Preferred Network Access Commercial |
$18,651.86
|
| Rate for Payer: Quartz Beloit One Network |
$9,934.14
|
| Rate for Payer: Quartz Commercial |
$12,164.26
|
| Rate for Payer: WEA Trust Commercial |
$11,150.57
|
| Rate for Payer: WPS Commercial |
$15,016.23
|
|
|
HIP ARTHROPLASTY, TOTAL, BILATERAL
|
Facility
|
OP
|
$19,494.00
|
|
| Hospital Charge Code |
2950339
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,676.65 |
| Max. Negotiated Rate |
$18,651.86 |
| Rate for Payer: Aetna Commercial |
$18,246.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,435.43
|
| Rate for Payer: Aetna Managed Medicare |
$5,676.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,177.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,136.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,731.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,745.09
|
| Rate for Payer: Cash Price |
$5,848.20
|
| Rate for Payer: Cigna Commercial |
$18,651.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,345.51
|
| Rate for Payer: Health EOS Commercial |
$18,043.65
|
| Rate for Payer: HFN Commercial |
$18,651.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,205.32
|
| Rate for Payer: Multiplan Commercial |
$16,219.01
|
| Rate for Payer: NAPHCARE Commercial |
$12,164.26
|
| Rate for Payer: Preferred Network Access Commercial |
$18,651.86
|
| Rate for Payer: Quartz Beloit One Network |
$9,934.14
|
| Rate for Payer: Quartz Commercial |
$13,177.94
|
| Rate for Payer: Quartz Medicare Advantage |
$12,164.26
|
| Rate for Payer: The Alliance Commercial |
$10,136.88
|
| Rate for Payer: WEA Trust Commercial |
$11,150.57
|
| Rate for Payer: WPS Commercial |
$15,016.23
|
|
|
HIP ARTHROPLASTY, TOTAL, CEMENTLESS
|
Facility
|
OP
|
$13,037.00
|
|
| Hospital Charge Code |
2960529
|
|
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
|
|
|
HIP ARTHROPLASTY, TOTAL, CEMENTLESS
|
Facility
|
IP
|
$13,037.00
|
|
| Hospital Charge Code |
2960529
|
|
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
|
|
|
HIP ARTHROPLASTY, TOTAL, REVISION
|
Facility
|
IP
|
$13,037.00
|
|
| Hospital Charge Code |
2960352
|
|
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
|
|
|
HIP ARTHROPLASTY, TOTAL, REVISION
|
Facility
|
OP
|
$13,037.00
|
|
| Hospital Charge Code |
2960352
|
|
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
|
|
|
HIP ARTHROSCOPY/ARTHRODESIS
|
Facility
|
OP
|
$4,657.00
|
|
| Hospital Charge Code |
2959819
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,356.12 |
| Max. Negotiated Rate |
$4,455.82 |
| Rate for Payer: Aetna Commercial |
$4,358.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,165.22
|
| Rate for Payer: Aetna Managed Medicare |
$1,356.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,148.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,421.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,324.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,566.94
|
| Rate for Payer: Cash Price |
$1,397.10
|
| Rate for Payer: Cigna Commercial |
$4,455.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,710.37
|
| Rate for Payer: Health EOS Commercial |
$4,310.52
|
| Rate for Payer: HFN Commercial |
$4,455.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,632.46
|
| Rate for Payer: Multiplan Commercial |
$3,874.62
|
| Rate for Payer: NAPHCARE Commercial |
$2,905.97
|
| Rate for Payer: Preferred Network Access Commercial |
$4,455.82
|
| Rate for Payer: Quartz Beloit One Network |
$2,373.21
|
| Rate for Payer: Quartz Commercial |
$3,148.13
|
| Rate for Payer: Quartz Medicare Advantage |
$2,905.97
|
| Rate for Payer: The Alliance Commercial |
$2,421.64
|
| Rate for Payer: WEA Trust Commercial |
$2,663.80
|
| Rate for Payer: WPS Commercial |
$3,587.29
|
|
|
HIP ARTHROSCOPY/ARTHRODESIS
|
Facility
|
IP
|
$4,657.00
|
|
| Hospital Charge Code |
2959819
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,373.21 |
| Max. Negotiated Rate |
$4,455.82 |
| Rate for Payer: Aetna Commercial |
$4,358.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,165.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,566.94
|
| Rate for Payer: Cash Price |
$1,397.10
|
| Rate for Payer: Cigna Commercial |
$4,455.82
|
| Rate for Payer: Health EOS Commercial |
$4,310.52
|
| Rate for Payer: HFN Commercial |
$4,455.82
|
| Rate for Payer: Multiplan Commercial |
$3,874.62
|
| Rate for Payer: Preferred Network Access Commercial |
$4,455.82
|
| Rate for Payer: Quartz Beloit One Network |
$2,373.21
|
| Rate for Payer: Quartz Commercial |
$2,905.97
|
| Rate for Payer: WEA Trust Commercial |
$2,663.80
|
| Rate for Payer: WPS Commercial |
$3,587.29
|
|
|
HIP BALL FRACTURED HEAD 42MM MODULAR CATHCART 1363-42-000
|
Facility
|
IP
|
$4,373.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5767644
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,228.48 |
| Max. Negotiated Rate |
$4,184.09 |
| Rate for Payer: Aetna Commercial |
$4,093.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,911.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,410.40
|
| Rate for Payer: Cash Price |
$1,311.90
|
| Rate for Payer: Cigna Commercial |
$4,184.09
|
| Rate for Payer: Health EOS Commercial |
$4,047.65
|
| Rate for Payer: HFN Commercial |
$4,184.09
|
| Rate for Payer: Multiplan Commercial |
$3,638.34
|
| Rate for Payer: Preferred Network Access Commercial |
$4,184.09
|
| Rate for Payer: Quartz Beloit One Network |
$2,228.48
|
| Rate for Payer: Quartz Commercial |
$2,728.75
|
| Rate for Payer: WEA Trust Commercial |
$2,501.36
|
| Rate for Payer: WPS Commercial |
$3,368.52
|
|
|
HIP BALL FRACTURED HEAD 42MM MODULAR CATHCART 1363-42-000
|
Facility
|
OP
|
$4,373.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5767644
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,273.42 |
| Max. Negotiated Rate |
$4,184.09 |
| Rate for Payer: Aetna Commercial |
$4,093.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,911.21
|
| Rate for Payer: Aetna Managed Medicare |
$1,273.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,956.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,273.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,183.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,410.40
|
| Rate for Payer: Cash Price |
$1,311.90
|
| Rate for Payer: Cigna Commercial |
$4,184.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,545.09
|
| Rate for Payer: Health EOS Commercial |
$4,047.65
|
| Rate for Payer: HFN Commercial |
$4,184.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,410.94
|
| Rate for Payer: Multiplan Commercial |
$3,638.34
|
| Rate for Payer: NAPHCARE Commercial |
$2,728.75
|
| Rate for Payer: Preferred Network Access Commercial |
$4,184.09
|
| Rate for Payer: Quartz Beloit One Network |
$2,228.48
|
| Rate for Payer: Quartz Commercial |
$2,956.15
|
| Rate for Payer: Quartz Medicare Advantage |
$2,728.75
|
| Rate for Payer: The Alliance Commercial |
$2,273.96
|
| Rate for Payer: WEA Trust Commercial |
$2,501.36
|
| Rate for Payer: WPS Commercial |
$3,368.52
|
|
|
HIP BALL FRACTURED HEAD 43MM MODULAR CATHCART 1363-43-000
|
Facility
|
IP
|
$4,043.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6177982
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,060.31 |
| Max. Negotiated Rate |
$3,868.34 |
| Rate for Payer: Aetna Commercial |
$3,784.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,616.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,228.50
|
| Rate for Payer: Cash Price |
$1,212.90
|
| Rate for Payer: Cigna Commercial |
$3,868.34
|
| Rate for Payer: Health EOS Commercial |
$3,742.20
|
| Rate for Payer: HFN Commercial |
$3,868.34
|
| Rate for Payer: Multiplan Commercial |
$3,363.78
|
| Rate for Payer: Preferred Network Access Commercial |
$3,868.34
|
| Rate for Payer: Quartz Beloit One Network |
$2,060.31
|
| Rate for Payer: Quartz Commercial |
$2,522.83
|
| Rate for Payer: WEA Trust Commercial |
$2,312.60
|
| Rate for Payer: WPS Commercial |
$3,114.32
|
|
|
HIP BALL FRACTURED HEAD 43MM MODULAR CATHCART 1363-43-000
|
Facility
|
OP
|
$4,043.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6177982
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,177.32 |
| Max. Negotiated Rate |
$3,868.34 |
| Rate for Payer: Aetna Commercial |
$3,784.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,616.06
|
| Rate for Payer: Aetna Managed Medicare |
$1,177.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,733.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,102.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,018.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,228.50
|
| Rate for Payer: Cash Price |
$1,212.90
|
| Rate for Payer: Cigna Commercial |
$3,868.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,353.03
|
| Rate for Payer: Health EOS Commercial |
$3,742.20
|
| Rate for Payer: HFN Commercial |
$3,868.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,153.54
|
| Rate for Payer: Multiplan Commercial |
$3,363.78
|
| Rate for Payer: NAPHCARE Commercial |
$2,522.83
|
| Rate for Payer: Preferred Network Access Commercial |
$3,868.34
|
| Rate for Payer: Quartz Beloit One Network |
$2,060.31
|
| Rate for Payer: Quartz Commercial |
$2,733.07
|
| Rate for Payer: Quartz Medicare Advantage |
$2,522.83
|
| Rate for Payer: The Alliance Commercial |
$2,102.36
|
| Rate for Payer: WEA Trust Commercial |
$2,312.60
|
| Rate for Payer: WPS Commercial |
$3,114.32
|
|
