|
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 |
$769.53 |
| Max. Negotiated Rate |
$14,652.00 |
| Rate for Payer: Aetna Commercial |
$3,296.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,150.18
|
| Rate for Payer: Aetna Managed Medicare |
$1,025.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$769.53
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$769.53
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$769.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,941.39
|
| Rate for Payer: Cash Price |
$1,098.90
|
| Rate for Payer: Cash Price |
$1,098.90
|
| Rate for Payer: Cigna Commercial |
$3,369.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,049.81
|
| Rate for Payer: Health EOS Commercial |
$3,260.07
|
| Rate for Payer: HFN Commercial |
$3,369.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,747.25
|
| Rate for Payer: Multiplan Commercial |
$2,930.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,197.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,369.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,794.87
|
| Rate for Payer: Quartz Commercial |
$2,380.95
|
| Rate for Payer: Quartz Medicare Advantage |
$2,197.80
|
| Rate for Payer: The Alliance Commercial |
$14,652.00
|
| Rate for Payer: WEA Trust Commercial |
$2,014.65
|
| Rate for Payer: WPS Commercial |
$2,713.18
|
|
|
Hip Abduction Brace - PT Equipment Issued Rehab
|
Professional
|
Both
|
$3,663.00
|
|
|
Service Code
|
HCPCS L1686
|
| Hospital Charge Code |
2989874
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,611.72 |
| Max. Negotiated Rate |
$3,479.85 |
| Rate for Payer: Aetna Commercial |
$3,479.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,150.18
|
| Rate for Payer: Cash Price |
$1,098.90
|
| Rate for Payer: Cash Price |
$1,098.90
|
| Rate for Payer: Cigna Commercial |
$3,479.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,831.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,197.80
|
| Rate for Payer: Health EOS Commercial |
$3,333.33
|
| Rate for Payer: HFN Commercial |
$3,479.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,320.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,320.32
|
| Rate for Payer: Multiplan Commercial |
$2,930.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,479.85
|
| Rate for Payer: Quartz Beloit One Network |
$1,611.72
|
| Rate for Payer: Quartz Commercial |
$2,087.91
|
| Rate for Payer: The Alliance Commercial |
$1,831.50
|
| Rate for Payer: WEA Trust Commercial |
$2,014.65
|
| Rate for Payer: WPS Commercial |
$2,713.18
|
|
|
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC
|
Facility
|
IP
|
$55,484.00
|
|
|
Service Code
|
MSDRG 481
|
| Min. Negotiated Rate |
$19,958.14 |
| Max. Negotiated Rate |
$55,484.00 |
| Rate for Payer: Aetna Managed Medicare |
$19,958.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$43,428.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33,287.67
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31,625.46
|
| Rate for Payer: Anthem Medicare Advantage |
$19,958.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19,958.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19,958.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19,958.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35,107.16
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19,958.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40,460.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19,958.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19,958.14
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19,958.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19,958.14
|
| Rate for Payer: NAPHCARE Commercial |
$29,937.21
|
| Rate for Payer: Quartz Medicare Advantage |
$19,958.14
|
| Rate for Payer: The Alliance Commercial |
$55,484.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19,958.14
|
| Rate for Payer: United Healthcare PPO |
$31,499.06
|
| Rate for Payer: Wellcare Medicare |
$19,958.14
|
|
|
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC
|
Facility
|
IP
|
$78,720.00
|
|
|
Service Code
|
MSDRG 480
|
| Min. Negotiated Rate |
$28,316.46 |
| Max. Negotiated Rate |
$78,720.00 |
| Rate for Payer: Aetna Managed Medicare |
$28,316.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$61,891.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$47,438.95
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$45,070.10
|
| Rate for Payer: Anthem Medicare Advantage |
$28,316.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28,316.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28,316.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$28,316.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50,031.94
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$28,316.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$57,503.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$28,316.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28,316.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$28,316.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$28,316.46
|
| Rate for Payer: NAPHCARE Commercial |
$42,474.69
|
| Rate for Payer: Quartz Medicare Advantage |
$28,316.46
|
| Rate for Payer: The Alliance Commercial |
$78,720.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28,316.46
|
| Rate for Payer: United Healthcare PPO |
$44,767.25
|
| Rate for Payer: Wellcare Medicare |
$28,316.46
|
|
|
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC
|
Facility
|
IP
|
$42,550.00
|
|
|
Service Code
|
MSDRG 482
|
| Min. Negotiated Rate |
$15,305.60 |
| Max. Negotiated Rate |
$42,550.00 |
| Rate for Payer: Aetna Managed Medicare |
$15,305.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33,358.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25,568.79
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24,292.02
|
| Rate for Payer: Anthem Medicare Advantage |
$15,305.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15,305.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15,305.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15,305.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26,966.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15,305.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30,973.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15,305.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15,305.60
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15,305.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15,305.60
|
| Rate for Payer: NAPHCARE Commercial |
$22,958.40
|
| Rate for Payer: Quartz Medicare Advantage |
$15,305.60
|
| Rate for Payer: The Alliance Commercial |
$42,550.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15,305.60
|
| Rate for Payer: United Healthcare PPO |
$24,113.50
|
| Rate for Payer: Wellcare Medicare |
$15,305.60
|
|
|
HIP ARTHROPLASTY, BIPOLAR/HEMI ARTHROPLASTY
|
Facility
|
IP
|
$11,792.00
|
|
| Hospital Charge Code |
2959843
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$10,141.12
|
| 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
|
|
|
HIP ARTHROPLASTY, BIPOLAR/HEMI ARTHROPLASTY
|
Facility
|
OP
|
$11,792.00
|
|
| Hospital Charge Code |
2959843
|
|
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
|
|
|
HIP ARTHROPLASTY, TOTAL, ANTERIOR APROACH
|
Facility
|
OP
|
$13,037.00
|
|
| Hospital Charge Code |
5532668
|
|
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
|
|
|
HIP ARTHROPLASTY, TOTAL, ANTERIOR APROACH
|
Facility
|
IP
|
$13,037.00
|
|
| Hospital Charge Code |
5532668
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$11,211.82
|
| 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
|
|
|
HIP ARTHROPLASTY, TOTAL, BILATERAL
|
Facility
|
OP
|
$19,494.00
|
|
| Hospital Charge Code |
2950339
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,458.32 |
| Max. Negotiated Rate |
$77,976.00 |
| Rate for Payer: Aetna Commercial |
$17,544.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,764.84
|
| Rate for Payer: Aetna Managed Medicare |
$5,458.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,671.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,747.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,357.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,331.82
|
| Rate for Payer: Cash Price |
$5,848.20
|
| Rate for Payer: Cigna Commercial |
$17,934.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,908.84
|
| Rate for Payer: Health EOS Commercial |
$17,349.66
|
| Rate for Payer: HFN Commercial |
$17,934.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,620.50
|
| Rate for Payer: Multiplan Commercial |
$15,595.20
|
| Rate for Payer: NAPHCARE Commercial |
$11,696.40
|
| Rate for Payer: Preferred Network Access Commercial |
$17,934.48
|
| Rate for Payer: Quartz Beloit One Network |
$9,552.06
|
| Rate for Payer: Quartz Commercial |
$12,671.10
|
| Rate for Payer: Quartz Medicare Advantage |
$11,696.40
|
| Rate for Payer: The Alliance Commercial |
$77,976.00
|
| Rate for Payer: WEA Trust Commercial |
$10,721.70
|
| Rate for Payer: WPS Commercial |
$14,439.21
|
|
|
HIP ARTHROPLASTY, TOTAL, BILATERAL
|
Facility
|
IP
|
$19,494.00
|
|
| Hospital Charge Code |
2950339
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,552.06 |
| Max. Negotiated Rate |
$17,934.48 |
| Rate for Payer: Aetna Commercial |
$17,544.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,764.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,331.82
|
| Rate for Payer: Cash Price |
$5,848.20
|
| Rate for Payer: Cigna Commercial |
$17,934.48
|
| Rate for Payer: Health EOS Commercial |
$17,349.66
|
| Rate for Payer: HFN Commercial |
$17,934.48
|
| Rate for Payer: Multiplan Commercial |
$15,595.20
|
| Rate for Payer: NAPHCARE Commercial |
$11,696.40
|
| Rate for Payer: Preferred Network Access Commercial |
$17,934.48
|
| Rate for Payer: Quartz Beloit One Network |
$9,552.06
|
| Rate for Payer: Quartz Commercial |
$11,696.40
|
| Rate for Payer: WEA Trust Commercial |
$10,721.70
|
| Rate for Payer: WPS Commercial |
$14,439.21
|
|
|
HIP ARTHROPLASTY, TOTAL, CEMENTLESS
|
Facility
|
IP
|
$13,037.00
|
|
| Hospital Charge Code |
2960529
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$11,211.82
|
| 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
|
|
|
HIP ARTHROPLASTY, TOTAL, CEMENTLESS
|
Facility
|
OP
|
$13,037.00
|
|
| Hospital Charge Code |
2960529
|
|
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
|
|
|
HIP ARTHROPLASTY, TOTAL, REVISION
|
Facility
|
IP
|
$13,037.00
|
|
| Hospital Charge Code |
2960352
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$11,211.82
|
| 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
|
|
|
HIP ARTHROPLASTY, TOTAL, REVISION
|
Facility
|
OP
|
$13,037.00
|
|
| Hospital Charge Code |
2960352
|
|
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
|
|
|
HIP ARTHROSCOPY/ARTHRODESIS
|
Facility
|
IP
|
$4,657.00
|
|
| Hospital Charge Code |
2959819
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,281.93 |
| Max. Negotiated Rate |
$4,284.44 |
| Rate for Payer: Aetna Commercial |
$4,191.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,005.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,468.21
|
| Rate for Payer: Cash Price |
$1,397.10
|
| Rate for Payer: Cigna Commercial |
$4,284.44
|
| Rate for Payer: Health EOS Commercial |
$4,144.73
|
| Rate for Payer: HFN Commercial |
$4,284.44
|
| Rate for Payer: Multiplan Commercial |
$3,725.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,794.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,284.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,281.93
|
| Rate for Payer: Quartz Commercial |
$2,794.20
|
| Rate for Payer: WEA Trust Commercial |
$2,561.35
|
| Rate for Payer: WPS Commercial |
$3,449.44
|
|
|
HIP ARTHROSCOPY/ARTHRODESIS
|
Facility
|
OP
|
$4,657.00
|
|
| Hospital Charge Code |
2959819
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,303.96 |
| Max. Negotiated Rate |
$18,628.00 |
| Rate for Payer: Aetna Commercial |
$4,191.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,005.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,303.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,027.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,328.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,235.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,468.21
|
| Rate for Payer: Cash Price |
$1,397.10
|
| Rate for Payer: Cigna Commercial |
$4,284.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,606.06
|
| Rate for Payer: Health EOS Commercial |
$4,144.73
|
| Rate for Payer: HFN Commercial |
$4,284.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,492.75
|
| Rate for Payer: Multiplan Commercial |
$3,725.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,794.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,284.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,281.93
|
| Rate for Payer: Quartz Commercial |
$3,027.05
|
| Rate for Payer: Quartz Medicare Advantage |
$2,794.20
|
| Rate for Payer: The Alliance Commercial |
$18,628.00
|
| Rate for Payer: WEA Trust Commercial |
$2,561.35
|
| Rate for Payer: WPS Commercial |
$3,449.44
|
|
|
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 |
$1,224.44 |
| Max. Negotiated Rate |
$17,492.00 |
| Rate for Payer: Aetna Commercial |
$3,935.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,760.78
|
| Rate for Payer: Aetna Managed Medicare |
$1,224.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,842.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,186.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,099.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,317.69
|
| Rate for Payer: Cash Price |
$1,311.90
|
| Rate for Payer: Cigna Commercial |
$4,023.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,447.13
|
| Rate for Payer: Health EOS Commercial |
$3,891.97
|
| Rate for Payer: HFN Commercial |
$4,023.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,279.75
|
| Rate for Payer: Multiplan Commercial |
$3,498.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,623.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,023.16
|
| Rate for Payer: Quartz Beloit One Network |
$2,142.77
|
| Rate for Payer: Quartz Commercial |
$2,842.45
|
| Rate for Payer: Quartz Medicare Advantage |
$2,623.80
|
| Rate for Payer: The Alliance Commercial |
$17,492.00
|
| Rate for Payer: WEA Trust Commercial |
$2,405.15
|
| Rate for Payer: WPS Commercial |
$3,239.08
|
|
|
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 |
$2,142.77 |
| Max. Negotiated Rate |
$4,023.16 |
| Rate for Payer: Aetna Commercial |
$3,935.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,760.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,317.69
|
| Rate for Payer: Cash Price |
$1,311.90
|
| Rate for Payer: Cigna Commercial |
$4,023.16
|
| Rate for Payer: Health EOS Commercial |
$3,891.97
|
| Rate for Payer: HFN Commercial |
$4,023.16
|
| Rate for Payer: Multiplan Commercial |
$3,498.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,623.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,023.16
|
| Rate for Payer: Quartz Beloit One Network |
$2,142.77
|
| Rate for Payer: Quartz Commercial |
$2,623.80
|
| Rate for Payer: WEA Trust Commercial |
$2,405.15
|
| Rate for Payer: WPS Commercial |
$3,239.08
|
|
|
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 |
$1,132.04 |
| Max. Negotiated Rate |
$16,172.00 |
| Rate for Payer: Aetna Commercial |
$3,638.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,476.98
|
| Rate for Payer: Aetna Managed Medicare |
$1,132.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,627.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,021.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,940.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,142.79
|
| Rate for Payer: Cash Price |
$1,212.90
|
| Rate for Payer: Cigna Commercial |
$3,719.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,262.46
|
| Rate for Payer: Health EOS Commercial |
$3,598.27
|
| Rate for Payer: HFN Commercial |
$3,719.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,032.25
|
| Rate for Payer: Multiplan Commercial |
$3,234.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,425.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,719.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,981.07
|
| Rate for Payer: Quartz Commercial |
$2,627.95
|
| Rate for Payer: Quartz Medicare Advantage |
$2,425.80
|
| Rate for Payer: The Alliance Commercial |
$16,172.00
|
| Rate for Payer: WEA Trust Commercial |
$2,223.65
|
| Rate for Payer: WPS Commercial |
$2,994.65
|
|
|
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 |
$1,981.07 |
| Max. Negotiated Rate |
$3,719.56 |
| Rate for Payer: Aetna Commercial |
$3,638.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,476.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,142.79
|
| Rate for Payer: Cash Price |
$1,212.90
|
| Rate for Payer: Cigna Commercial |
$3,719.56
|
| Rate for Payer: Health EOS Commercial |
$3,598.27
|
| Rate for Payer: HFN Commercial |
$3,719.56
|
| Rate for Payer: Multiplan Commercial |
$3,234.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,425.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,719.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,981.07
|
| Rate for Payer: Quartz Commercial |
$2,425.80
|
| Rate for Payer: WEA Trust Commercial |
$2,223.65
|
| Rate for Payer: WPS Commercial |
$2,994.65
|
|
|
HIP BALL FRACTURED HEAD 44MM MODULAR CATHCART 1363-44-000
|
Facility
|
OP
|
$40,443.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6178088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,324.04 |
| Max. Negotiated Rate |
$161,772.00 |
| Rate for Payer: Aetna Commercial |
$36,398.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$34,780.98
|
| Rate for Payer: Aetna Managed Medicare |
$11,324.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$26,287.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20,221.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19,412.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$21,434.79
|
| Rate for Payer: Cash Price |
$12,132.90
|
| Rate for Payer: Cigna Commercial |
$37,207.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22,631.90
|
| Rate for Payer: Health EOS Commercial |
$35,994.27
|
| Rate for Payer: HFN Commercial |
$37,207.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30,332.25
|
| Rate for Payer: Multiplan Commercial |
$32,354.40
|
| Rate for Payer: NAPHCARE Commercial |
$24,265.80
|
| Rate for Payer: Preferred Network Access Commercial |
$37,207.56
|
| Rate for Payer: Quartz Beloit One Network |
$19,817.07
|
| Rate for Payer: Quartz Commercial |
$26,287.95
|
| Rate for Payer: Quartz Medicare Advantage |
$24,265.80
|
| Rate for Payer: The Alliance Commercial |
$161,772.00
|
| Rate for Payer: WEA Trust Commercial |
$22,243.65
|
| Rate for Payer: WPS Commercial |
$29,956.13
|
|
|
HIP BALL FRACTURED HEAD 44MM MODULAR CATHCART 1363-44-000
|
Facility
|
IP
|
$40,443.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6178088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$19,817.07 |
| Max. Negotiated Rate |
$37,207.56 |
| Rate for Payer: Aetna Commercial |
$36,398.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$34,780.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$21,434.79
|
| Rate for Payer: Cash Price |
$12,132.90
|
| Rate for Payer: Cigna Commercial |
$37,207.56
|
| Rate for Payer: Health EOS Commercial |
$35,994.27
|
| Rate for Payer: HFN Commercial |
$37,207.56
|
| Rate for Payer: Multiplan Commercial |
$32,354.40
|
| Rate for Payer: NAPHCARE Commercial |
$24,265.80
|
| Rate for Payer: Preferred Network Access Commercial |
$37,207.56
|
| Rate for Payer: Quartz Beloit One Network |
$19,817.07
|
| Rate for Payer: Quartz Commercial |
$24,265.80
|
| Rate for Payer: WEA Trust Commercial |
$22,243.65
|
| Rate for Payer: WPS Commercial |
$29,956.13
|
|
|
HIP BALL FRACTURED HEAD 45MM MODULAR CATHCART 1363-45-000
|
Facility
|
OP
|
$4,189.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563326
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,172.92 |
| Max. Negotiated Rate |
$16,756.00 |
| Rate for Payer: Aetna Commercial |
$3,770.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,602.54
|
| Rate for Payer: Aetna Managed Medicare |
$1,172.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,722.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,094.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,010.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,220.17
|
| Rate for Payer: Cash Price |
$1,256.70
|
| Rate for Payer: Cigna Commercial |
$3,853.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,344.16
|
| Rate for Payer: Health EOS Commercial |
$3,728.21
|
| Rate for Payer: HFN Commercial |
$3,853.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,141.75
|
| Rate for Payer: Multiplan Commercial |
$3,351.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,513.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,853.88
|
| Rate for Payer: Quartz Beloit One Network |
$2,052.61
|
| Rate for Payer: Quartz Commercial |
$2,722.85
|
| Rate for Payer: Quartz Medicare Advantage |
$2,513.40
|
| Rate for Payer: The Alliance Commercial |
$16,756.00
|
| Rate for Payer: WEA Trust Commercial |
$2,303.95
|
| Rate for Payer: WPS Commercial |
$3,102.79
|
|
|
HIP BALL FRACTURED HEAD 45MM MODULAR CATHCART 1363-45-000
|
Facility
|
IP
|
$4,189.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563326
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,052.61 |
| Max. Negotiated Rate |
$3,853.88 |
| Rate for Payer: Aetna Commercial |
$3,770.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,602.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,220.17
|
| Rate for Payer: Cash Price |
$1,256.70
|
| Rate for Payer: Cigna Commercial |
$3,853.88
|
| Rate for Payer: Health EOS Commercial |
$3,728.21
|
| Rate for Payer: HFN Commercial |
$3,853.88
|
| Rate for Payer: Multiplan Commercial |
$3,351.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,513.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,853.88
|
| Rate for Payer: Quartz Beloit One Network |
$2,052.61
|
| Rate for Payer: Quartz Commercial |
$2,513.40
|
| Rate for Payer: WEA Trust Commercial |
$2,303.95
|
| Rate for Payer: WPS Commercial |
$3,102.79
|
|
