|
HIP STEM ACCOLADE II SZ 2 6721-0230
|
Facility
|
IP
|
$17,074.00
|
|
| Hospital Charge Code |
4035317
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,700.91 |
| Max. Negotiated Rate |
$16,336.40 |
| Rate for Payer: Aetna Commercial |
$15,981.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,270.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,411.19
|
| Rate for Payer: Cash Price |
$5,122.20
|
| Rate for Payer: Cigna Commercial |
$16,336.40
|
| Rate for Payer: Health EOS Commercial |
$15,803.69
|
| Rate for Payer: HFN Commercial |
$16,336.40
|
| Rate for Payer: Multiplan Commercial |
$14,205.57
|
| Rate for Payer: Preferred Network Access Commercial |
$16,336.40
|
| Rate for Payer: Quartz Beloit One Network |
$8,700.91
|
| Rate for Payer: Quartz Commercial |
$10,654.18
|
| Rate for Payer: WEA Trust Commercial |
$9,766.33
|
| Rate for Payer: WPS Commercial |
$13,152.10
|
|
|
HIP STEM ACCOLADE II SZ 2 6721-0230
|
Facility
|
OP
|
$17,074.00
|
|
| Hospital Charge Code |
4035317
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,971.95 |
| Max. Negotiated Rate |
$16,336.40 |
| Rate for Payer: Aetna Commercial |
$15,981.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,270.99
|
| Rate for Payer: Aetna Managed Medicare |
$4,971.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,542.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,878.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,523.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,411.19
|
| Rate for Payer: Cash Price |
$5,122.20
|
| Rate for Payer: Cigna Commercial |
$16,336.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,937.07
|
| Rate for Payer: Health EOS Commercial |
$15,803.69
|
| Rate for Payer: HFN Commercial |
$16,336.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,317.72
|
| Rate for Payer: Multiplan Commercial |
$14,205.57
|
| Rate for Payer: NAPHCARE Commercial |
$10,654.18
|
| Rate for Payer: Preferred Network Access Commercial |
$16,336.40
|
| Rate for Payer: Quartz Beloit One Network |
$8,700.91
|
| Rate for Payer: Quartz Commercial |
$11,542.02
|
| Rate for Payer: Quartz Medicare Advantage |
$10,654.18
|
| Rate for Payer: The Alliance Commercial |
$8,878.48
|
| Rate for Payer: WEA Trust Commercial |
$9,766.33
|
| Rate for Payer: WPS Commercial |
$13,152.10
|
|
|
HIP STEM ACCOLADE II SZ 3 6721-0330
|
Facility
|
OP
|
$17,074.00
|
|
| Hospital Charge Code |
4493668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,971.95 |
| Max. Negotiated Rate |
$16,336.40 |
| Rate for Payer: Aetna Commercial |
$15,981.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,270.99
|
| Rate for Payer: Aetna Managed Medicare |
$4,971.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,542.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,878.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,523.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,411.19
|
| Rate for Payer: Cash Price |
$5,122.20
|
| Rate for Payer: Cigna Commercial |
$16,336.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,937.07
|
| Rate for Payer: Health EOS Commercial |
$15,803.69
|
| Rate for Payer: HFN Commercial |
$16,336.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,317.72
|
| Rate for Payer: Multiplan Commercial |
$14,205.57
|
| Rate for Payer: NAPHCARE Commercial |
$10,654.18
|
| Rate for Payer: Preferred Network Access Commercial |
$16,336.40
|
| Rate for Payer: Quartz Beloit One Network |
$8,700.91
|
| Rate for Payer: Quartz Commercial |
$11,542.02
|
| Rate for Payer: Quartz Medicare Advantage |
$10,654.18
|
| Rate for Payer: The Alliance Commercial |
$8,878.48
|
| Rate for Payer: WEA Trust Commercial |
$9,766.33
|
| Rate for Payer: WPS Commercial |
$13,152.10
|
|
|
HIP STEM ACCOLADE II SZ 3 6721-0330
|
Facility
|
IP
|
$17,074.00
|
|
| Hospital Charge Code |
4493668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,700.91 |
| Max. Negotiated Rate |
$16,336.40 |
| Rate for Payer: Aetna Commercial |
$15,981.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,270.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,411.19
|
| Rate for Payer: Cash Price |
$5,122.20
|
| Rate for Payer: Cigna Commercial |
$16,336.40
|
| Rate for Payer: Health EOS Commercial |
$15,803.69
|
| Rate for Payer: HFN Commercial |
$16,336.40
|
| Rate for Payer: Multiplan Commercial |
$14,205.57
|
| Rate for Payer: Preferred Network Access Commercial |
$16,336.40
|
| Rate for Payer: Quartz Beloit One Network |
$8,700.91
|
| Rate for Payer: Quartz Commercial |
$10,654.18
|
| Rate for Payer: WEA Trust Commercial |
$9,766.33
|
| Rate for Payer: WPS Commercial |
$13,152.10
|
|
|
HIP STEM ACCOLADE II SZ 4 6721-0435
|
Facility
|
IP
|
$17,732.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4220557
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,036.23 |
| Max. Negotiated Rate |
$16,965.98 |
| Rate for Payer: Aetna Commercial |
$16,597.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,859.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,773.88
|
| Rate for Payer: Cash Price |
$5,319.60
|
| Rate for Payer: Cigna Commercial |
$16,965.98
|
| Rate for Payer: Health EOS Commercial |
$16,412.74
|
| Rate for Payer: HFN Commercial |
$16,965.98
|
| Rate for Payer: Multiplan Commercial |
$14,753.02
|
| Rate for Payer: Preferred Network Access Commercial |
$16,965.98
|
| Rate for Payer: Quartz Beloit One Network |
$9,036.23
|
| Rate for Payer: Quartz Commercial |
$11,064.77
|
| Rate for Payer: WEA Trust Commercial |
$10,142.70
|
| Rate for Payer: WPS Commercial |
$13,658.96
|
|
|
HIP STEM ACCOLADE II SZ 4 6721-0435
|
Facility
|
OP
|
$17,732.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4220557
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,163.56 |
| Max. Negotiated Rate |
$16,965.98 |
| Rate for Payer: Aetna Commercial |
$16,597.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,859.50
|
| Rate for Payer: Aetna Managed Medicare |
$5,163.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,986.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,220.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,851.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,773.88
|
| Rate for Payer: Cash Price |
$5,319.60
|
| Rate for Payer: Cigna Commercial |
$16,965.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,320.02
|
| Rate for Payer: Health EOS Commercial |
$16,412.74
|
| Rate for Payer: HFN Commercial |
$16,965.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,830.96
|
| Rate for Payer: Multiplan Commercial |
$14,753.02
|
| Rate for Payer: NAPHCARE Commercial |
$11,064.77
|
| Rate for Payer: Preferred Network Access Commercial |
$16,965.98
|
| Rate for Payer: Quartz Beloit One Network |
$9,036.23
|
| Rate for Payer: Quartz Commercial |
$11,986.83
|
| Rate for Payer: Quartz Medicare Advantage |
$11,064.77
|
| Rate for Payer: The Alliance Commercial |
$9,220.64
|
| Rate for Payer: WEA Trust Commercial |
$10,142.70
|
| Rate for Payer: WPS Commercial |
$13,658.96
|
|
|
HIP STEM ACCOLADE II SZ 5 6721-0535
|
Facility
|
OP
|
$17,732.00
|
|
| Hospital Charge Code |
3949329
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,163.56 |
| Max. Negotiated Rate |
$16,965.98 |
| Rate for Payer: Aetna Commercial |
$16,597.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,859.50
|
| Rate for Payer: Aetna Managed Medicare |
$5,163.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,986.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,220.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,851.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,773.88
|
| Rate for Payer: Cash Price |
$5,319.60
|
| Rate for Payer: Cigna Commercial |
$16,965.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,320.02
|
| Rate for Payer: Health EOS Commercial |
$16,412.74
|
| Rate for Payer: HFN Commercial |
$16,965.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,830.96
|
| Rate for Payer: Multiplan Commercial |
$14,753.02
|
| Rate for Payer: NAPHCARE Commercial |
$11,064.77
|
| Rate for Payer: Preferred Network Access Commercial |
$16,965.98
|
| Rate for Payer: Quartz Beloit One Network |
$9,036.23
|
| Rate for Payer: Quartz Commercial |
$11,986.83
|
| Rate for Payer: Quartz Medicare Advantage |
$11,064.77
|
| Rate for Payer: The Alliance Commercial |
$9,220.64
|
| Rate for Payer: WEA Trust Commercial |
$10,142.70
|
| Rate for Payer: WPS Commercial |
$13,658.96
|
|
|
HIP STEM ACCOLADE II SZ 5 6721-0535
|
Facility
|
IP
|
$17,732.00
|
|
| Hospital Charge Code |
3949329
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,036.23 |
| Max. Negotiated Rate |
$16,965.98 |
| Rate for Payer: Aetna Commercial |
$16,597.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,859.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,773.88
|
| Rate for Payer: Cash Price |
$5,319.60
|
| Rate for Payer: Cigna Commercial |
$16,965.98
|
| Rate for Payer: Health EOS Commercial |
$16,412.74
|
| Rate for Payer: HFN Commercial |
$16,965.98
|
| Rate for Payer: Multiplan Commercial |
$14,753.02
|
| Rate for Payer: Preferred Network Access Commercial |
$16,965.98
|
| Rate for Payer: Quartz Beloit One Network |
$9,036.23
|
| Rate for Payer: Quartz Commercial |
$11,064.77
|
| Rate for Payer: WEA Trust Commercial |
$10,142.70
|
| Rate for Payer: WPS Commercial |
$13,658.96
|
|
|
HIP STEM ACCOLADE II SZ 6 6721-0635
|
Facility
|
OP
|
$17,074.00
|
|
| Hospital Charge Code |
4028637
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,971.95 |
| Max. Negotiated Rate |
$16,336.40 |
| Rate for Payer: Aetna Commercial |
$15,981.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,270.99
|
| Rate for Payer: Aetna Managed Medicare |
$4,971.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,542.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,878.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,523.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,411.19
|
| Rate for Payer: Cash Price |
$5,122.20
|
| Rate for Payer: Cigna Commercial |
$16,336.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,937.07
|
| Rate for Payer: Health EOS Commercial |
$15,803.69
|
| Rate for Payer: HFN Commercial |
$16,336.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,317.72
|
| Rate for Payer: Multiplan Commercial |
$14,205.57
|
| Rate for Payer: NAPHCARE Commercial |
$10,654.18
|
| Rate for Payer: Preferred Network Access Commercial |
$16,336.40
|
| Rate for Payer: Quartz Beloit One Network |
$8,700.91
|
| Rate for Payer: Quartz Commercial |
$11,542.02
|
| Rate for Payer: Quartz Medicare Advantage |
$10,654.18
|
| Rate for Payer: The Alliance Commercial |
$8,878.48
|
| Rate for Payer: WEA Trust Commercial |
$9,766.33
|
| Rate for Payer: WPS Commercial |
$13,152.10
|
|
|
HIP STEM ACCOLADE II SZ 6 6721-0635
|
Facility
|
IP
|
$17,074.00
|
|
| Hospital Charge Code |
4028637
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,700.91 |
| Max. Negotiated Rate |
$16,336.40 |
| Rate for Payer: Aetna Commercial |
$15,981.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,270.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,411.19
|
| Rate for Payer: Cash Price |
$5,122.20
|
| Rate for Payer: Cigna Commercial |
$16,336.40
|
| Rate for Payer: Health EOS Commercial |
$15,803.69
|
| Rate for Payer: HFN Commercial |
$16,336.40
|
| Rate for Payer: Multiplan Commercial |
$14,205.57
|
| Rate for Payer: Preferred Network Access Commercial |
$16,336.40
|
| Rate for Payer: Quartz Beloit One Network |
$8,700.91
|
| Rate for Payer: Quartz Commercial |
$10,654.18
|
| Rate for Payer: WEA Trust Commercial |
$9,766.33
|
| Rate for Payer: WPS Commercial |
$13,152.10
|
|
|
HIP STEM ACCOLADE II SZ 7 6721-0737
|
Facility
|
OP
|
$17,732.00
|
|
| Hospital Charge Code |
3693509
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,163.56 |
| Max. Negotiated Rate |
$16,965.98 |
| Rate for Payer: Aetna Commercial |
$16,597.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,859.50
|
| Rate for Payer: Aetna Managed Medicare |
$5,163.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,986.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,220.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,851.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,773.88
|
| Rate for Payer: Cash Price |
$5,319.60
|
| Rate for Payer: Cigna Commercial |
$16,965.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,320.02
|
| Rate for Payer: Health EOS Commercial |
$16,412.74
|
| Rate for Payer: HFN Commercial |
$16,965.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,830.96
|
| Rate for Payer: Multiplan Commercial |
$14,753.02
|
| Rate for Payer: NAPHCARE Commercial |
$11,064.77
|
| Rate for Payer: Preferred Network Access Commercial |
$16,965.98
|
| Rate for Payer: Quartz Beloit One Network |
$9,036.23
|
| Rate for Payer: Quartz Commercial |
$11,986.83
|
| Rate for Payer: Quartz Medicare Advantage |
$11,064.77
|
| Rate for Payer: The Alliance Commercial |
$9,220.64
|
| Rate for Payer: WEA Trust Commercial |
$10,142.70
|
| Rate for Payer: WPS Commercial |
$13,658.96
|
|
|
HIP STEM ACCOLADE II SZ 7 6721-0737
|
Facility
|
IP
|
$17,732.00
|
|
| Hospital Charge Code |
3693509
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,036.23 |
| Max. Negotiated Rate |
$16,965.98 |
| Rate for Payer: Aetna Commercial |
$16,597.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,859.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,773.88
|
| Rate for Payer: Cash Price |
$5,319.60
|
| Rate for Payer: Cigna Commercial |
$16,965.98
|
| Rate for Payer: Health EOS Commercial |
$16,412.74
|
| Rate for Payer: HFN Commercial |
$16,965.98
|
| Rate for Payer: Multiplan Commercial |
$14,753.02
|
| Rate for Payer: Preferred Network Access Commercial |
$16,965.98
|
| Rate for Payer: Quartz Beloit One Network |
$9,036.23
|
| Rate for Payer: Quartz Commercial |
$11,064.77
|
| Rate for Payer: WEA Trust Commercial |
$10,142.70
|
| Rate for Payer: WPS Commercial |
$13,658.96
|
|
|
HIP STEM ACCOLADE II SZ 8 6721-0837
|
Facility
|
IP
|
$17,732.00
|
|
| Hospital Charge Code |
3487505
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,036.23 |
| Max. Negotiated Rate |
$16,965.98 |
| Rate for Payer: Aetna Commercial |
$16,597.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,859.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,773.88
|
| Rate for Payer: Cash Price |
$5,319.60
|
| Rate for Payer: Cigna Commercial |
$16,965.98
|
| Rate for Payer: Health EOS Commercial |
$16,412.74
|
| Rate for Payer: HFN Commercial |
$16,965.98
|
| Rate for Payer: Multiplan Commercial |
$14,753.02
|
| Rate for Payer: Preferred Network Access Commercial |
$16,965.98
|
| Rate for Payer: Quartz Beloit One Network |
$9,036.23
|
| Rate for Payer: Quartz Commercial |
$11,064.77
|
| Rate for Payer: WEA Trust Commercial |
$10,142.70
|
| Rate for Payer: WPS Commercial |
$13,658.96
|
|
|
HIP STEM ACCOLADE II SZ 8 6721-0837
|
Facility
|
OP
|
$17,732.00
|
|
| Hospital Charge Code |
3487505
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,163.56 |
| Max. Negotiated Rate |
$16,965.98 |
| Rate for Payer: Aetna Commercial |
$16,597.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,859.50
|
| Rate for Payer: Aetna Managed Medicare |
$5,163.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,986.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,220.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,851.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,773.88
|
| Rate for Payer: Cash Price |
$5,319.60
|
| Rate for Payer: Cigna Commercial |
$16,965.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,320.02
|
| Rate for Payer: Health EOS Commercial |
$16,412.74
|
| Rate for Payer: HFN Commercial |
$16,965.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,830.96
|
| Rate for Payer: Multiplan Commercial |
$14,753.02
|
| Rate for Payer: NAPHCARE Commercial |
$11,064.77
|
| Rate for Payer: Preferred Network Access Commercial |
$16,965.98
|
| Rate for Payer: Quartz Beloit One Network |
$9,036.23
|
| Rate for Payer: Quartz Commercial |
$11,986.83
|
| Rate for Payer: Quartz Medicare Advantage |
$11,064.77
|
| Rate for Payer: The Alliance Commercial |
$9,220.64
|
| Rate for Payer: WEA Trust Commercial |
$10,142.70
|
| Rate for Payer: WPS Commercial |
$13,658.96
|
|
|
HIP STEM ACCOLADE II SZ 9 6721-0937
|
Facility
|
IP
|
$12,686.00
|
|
| Hospital Charge Code |
5179143
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,464.79 |
| Max. Negotiated Rate |
$12,137.96 |
| Rate for Payer: Aetna Commercial |
$11,874.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,346.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,992.52
|
| Rate for Payer: Cash Price |
$3,805.80
|
| Rate for Payer: Cigna Commercial |
$12,137.96
|
| Rate for Payer: Health EOS Commercial |
$11,742.16
|
| Rate for Payer: HFN Commercial |
$12,137.96
|
| Rate for Payer: Multiplan Commercial |
$10,554.75
|
| Rate for Payer: Preferred Network Access Commercial |
$12,137.96
|
| Rate for Payer: Quartz Beloit One Network |
$6,464.79
|
| Rate for Payer: Quartz Commercial |
$7,916.06
|
| Rate for Payer: WEA Trust Commercial |
$7,256.39
|
| Rate for Payer: WPS Commercial |
$9,772.03
|
|
|
HIP STEM ACCOLADE II SZ 9 6721-0937
|
Facility
|
OP
|
$12,686.00
|
|
| Hospital Charge Code |
5179143
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,694.16 |
| Max. Negotiated Rate |
$12,137.96 |
| Rate for Payer: Aetna Commercial |
$11,874.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,346.36
|
| Rate for Payer: Aetna Managed Medicare |
$3,694.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,575.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,596.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,332.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,992.52
|
| Rate for Payer: Cash Price |
$3,805.80
|
| Rate for Payer: Cigna Commercial |
$12,137.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,383.25
|
| Rate for Payer: Health EOS Commercial |
$11,742.16
|
| Rate for Payer: HFN Commercial |
$12,137.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,895.08
|
| Rate for Payer: Multiplan Commercial |
$10,554.75
|
| Rate for Payer: NAPHCARE Commercial |
$7,916.06
|
| Rate for Payer: Preferred Network Access Commercial |
$12,137.96
|
| Rate for Payer: Quartz Beloit One Network |
$6,464.79
|
| Rate for Payer: Quartz Commercial |
$8,575.74
|
| Rate for Payer: Quartz Medicare Advantage |
$7,916.06
|
| Rate for Payer: The Alliance Commercial |
$6,596.72
|
| Rate for Payer: WEA Trust Commercial |
$7,256.39
|
| Rate for Payer: WPS Commercial |
$9,772.03
|
|
|
HIP STEM ACCOLADE SZ 1 6077-0130
|
Facility
|
OP
|
$7,318.00
|
|
| Hospital Charge Code |
4241670
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,131.00 |
| Max. Negotiated Rate |
$7,001.86 |
| Rate for Payer: Aetna Commercial |
$6,849.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,545.22
|
| Rate for Payer: Aetna Managed Medicare |
$2,131.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,946.97
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,805.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,653.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,033.68
|
| Rate for Payer: Cash Price |
$2,195.40
|
| Rate for Payer: Cigna Commercial |
$7,001.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,259.08
|
| Rate for Payer: Health EOS Commercial |
$6,773.54
|
| Rate for Payer: HFN Commercial |
$7,001.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,708.04
|
| Rate for Payer: Multiplan Commercial |
$6,088.58
|
| Rate for Payer: NAPHCARE Commercial |
$4,566.43
|
| Rate for Payer: Preferred Network Access Commercial |
$7,001.86
|
| Rate for Payer: Quartz Beloit One Network |
$3,729.25
|
| Rate for Payer: Quartz Commercial |
$4,946.97
|
| Rate for Payer: Quartz Medicare Advantage |
$4,566.43
|
| Rate for Payer: The Alliance Commercial |
$3,805.36
|
| Rate for Payer: WEA Trust Commercial |
$4,185.90
|
| Rate for Payer: WPS Commercial |
$5,637.06
|
|
|
HIP STEM ACCOLADE SZ 1 6077-0130
|
Facility
|
IP
|
$7,318.00
|
|
| Hospital Charge Code |
4241670
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,729.25 |
| Max. Negotiated Rate |
$7,001.86 |
| Rate for Payer: Aetna Commercial |
$6,849.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,545.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,033.68
|
| Rate for Payer: Cash Price |
$2,195.40
|
| Rate for Payer: Cigna Commercial |
$7,001.86
|
| Rate for Payer: Health EOS Commercial |
$6,773.54
|
| Rate for Payer: HFN Commercial |
$7,001.86
|
| Rate for Payer: Multiplan Commercial |
$6,088.58
|
| Rate for Payer: Preferred Network Access Commercial |
$7,001.86
|
| Rate for Payer: Quartz Beloit One Network |
$3,729.25
|
| Rate for Payer: Quartz Commercial |
$4,566.43
|
| Rate for Payer: WEA Trust Commercial |
$4,185.90
|
| Rate for Payer: WPS Commercial |
$5,637.06
|
|
|
HIP STEM ACCOLADE SZ 2 6077-0230
|
Facility
|
OP
|
$7,318.00
|
|
| Hospital Charge Code |
4518630
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,131.00 |
| Max. Negotiated Rate |
$7,001.86 |
| Rate for Payer: Aetna Commercial |
$6,849.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,545.22
|
| Rate for Payer: Aetna Managed Medicare |
$2,131.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,946.97
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,805.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,653.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,033.68
|
| Rate for Payer: Cash Price |
$2,195.40
|
| Rate for Payer: Cigna Commercial |
$7,001.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,259.08
|
| Rate for Payer: Health EOS Commercial |
$6,773.54
|
| Rate for Payer: HFN Commercial |
$7,001.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,708.04
|
| Rate for Payer: Multiplan Commercial |
$6,088.58
|
| Rate for Payer: NAPHCARE Commercial |
$4,566.43
|
| Rate for Payer: Preferred Network Access Commercial |
$7,001.86
|
| Rate for Payer: Quartz Beloit One Network |
$3,729.25
|
| Rate for Payer: Quartz Commercial |
$4,946.97
|
| Rate for Payer: Quartz Medicare Advantage |
$4,566.43
|
| Rate for Payer: The Alliance Commercial |
$3,805.36
|
| Rate for Payer: WEA Trust Commercial |
$4,185.90
|
| Rate for Payer: WPS Commercial |
$5,637.06
|
|
|
HIP STEM ACCOLADE SZ 2 6077-0230
|
Facility
|
IP
|
$7,318.00
|
|
| Hospital Charge Code |
4518630
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,729.25 |
| Max. Negotiated Rate |
$7,001.86 |
| Rate for Payer: Aetna Commercial |
$6,849.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,545.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,033.68
|
| Rate for Payer: Cash Price |
$2,195.40
|
| Rate for Payer: Cigna Commercial |
$7,001.86
|
| Rate for Payer: Health EOS Commercial |
$6,773.54
|
| Rate for Payer: HFN Commercial |
$7,001.86
|
| Rate for Payer: Multiplan Commercial |
$6,088.58
|
| Rate for Payer: Preferred Network Access Commercial |
$7,001.86
|
| Rate for Payer: Quartz Beloit One Network |
$3,729.25
|
| Rate for Payer: Quartz Commercial |
$4,566.43
|
| Rate for Payer: WEA Trust Commercial |
$4,185.90
|
| Rate for Payer: WPS Commercial |
$5,637.06
|
|
|
HIP STEM ACCOLADE SZ 3 6077-0335
|
Facility
|
IP
|
$7,318.00
|
|
| Hospital Charge Code |
4518631
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,729.25 |
| Max. Negotiated Rate |
$7,001.86 |
| Rate for Payer: Aetna Commercial |
$6,849.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,545.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,033.68
|
| Rate for Payer: Cash Price |
$2,195.40
|
| Rate for Payer: Cigna Commercial |
$7,001.86
|
| Rate for Payer: Health EOS Commercial |
$6,773.54
|
| Rate for Payer: HFN Commercial |
$7,001.86
|
| Rate for Payer: Multiplan Commercial |
$6,088.58
|
| Rate for Payer: Preferred Network Access Commercial |
$7,001.86
|
| Rate for Payer: Quartz Beloit One Network |
$3,729.25
|
| Rate for Payer: Quartz Commercial |
$4,566.43
|
| Rate for Payer: WEA Trust Commercial |
$4,185.90
|
| Rate for Payer: WPS Commercial |
$5,637.06
|
|
|
HIP STEM ACCOLADE SZ 3 6077-0335
|
Facility
|
OP
|
$7,318.00
|
|
| Hospital Charge Code |
4518631
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,131.00 |
| Max. Negotiated Rate |
$7,001.86 |
| Rate for Payer: Aetna Commercial |
$6,849.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,545.22
|
| Rate for Payer: Aetna Managed Medicare |
$2,131.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,946.97
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,805.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,653.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,033.68
|
| Rate for Payer: Cash Price |
$2,195.40
|
| Rate for Payer: Cigna Commercial |
$7,001.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,259.08
|
| Rate for Payer: Health EOS Commercial |
$6,773.54
|
| Rate for Payer: HFN Commercial |
$7,001.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,708.04
|
| Rate for Payer: Multiplan Commercial |
$6,088.58
|
| Rate for Payer: NAPHCARE Commercial |
$4,566.43
|
| Rate for Payer: Preferred Network Access Commercial |
$7,001.86
|
| Rate for Payer: Quartz Beloit One Network |
$3,729.25
|
| Rate for Payer: Quartz Commercial |
$4,946.97
|
| Rate for Payer: Quartz Medicare Advantage |
$4,566.43
|
| Rate for Payer: The Alliance Commercial |
$3,805.36
|
| Rate for Payer: WEA Trust Commercial |
$4,185.90
|
| Rate for Payer: WPS Commercial |
$5,637.06
|
|
|
HIP STEM ACCOLADE SZ 4 6077-0435
|
Facility
|
IP
|
$7,318.00
|
|
| Hospital Charge Code |
4518632
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,729.25 |
| Max. Negotiated Rate |
$7,001.86 |
| Rate for Payer: Aetna Commercial |
$6,849.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,545.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,033.68
|
| Rate for Payer: Cash Price |
$2,195.40
|
| Rate for Payer: Cigna Commercial |
$7,001.86
|
| Rate for Payer: Health EOS Commercial |
$6,773.54
|
| Rate for Payer: HFN Commercial |
$7,001.86
|
| Rate for Payer: Multiplan Commercial |
$6,088.58
|
| Rate for Payer: Preferred Network Access Commercial |
$7,001.86
|
| Rate for Payer: Quartz Beloit One Network |
$3,729.25
|
| Rate for Payer: Quartz Commercial |
$4,566.43
|
| Rate for Payer: WEA Trust Commercial |
$4,185.90
|
| Rate for Payer: WPS Commercial |
$5,637.06
|
|
|
HIP STEM ACCOLADE SZ 4 6077-0435
|
Facility
|
OP
|
$7,318.00
|
|
| Hospital Charge Code |
4518632
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,131.00 |
| Max. Negotiated Rate |
$7,001.86 |
| Rate for Payer: Aetna Commercial |
$6,849.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,545.22
|
| Rate for Payer: Aetna Managed Medicare |
$2,131.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,946.97
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,805.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,653.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,033.68
|
| Rate for Payer: Cash Price |
$2,195.40
|
| Rate for Payer: Cigna Commercial |
$7,001.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,259.08
|
| Rate for Payer: Health EOS Commercial |
$6,773.54
|
| Rate for Payer: HFN Commercial |
$7,001.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,708.04
|
| Rate for Payer: Multiplan Commercial |
$6,088.58
|
| Rate for Payer: NAPHCARE Commercial |
$4,566.43
|
| Rate for Payer: Preferred Network Access Commercial |
$7,001.86
|
| Rate for Payer: Quartz Beloit One Network |
$3,729.25
|
| Rate for Payer: Quartz Commercial |
$4,946.97
|
| Rate for Payer: Quartz Medicare Advantage |
$4,566.43
|
| Rate for Payer: The Alliance Commercial |
$3,805.36
|
| Rate for Payer: WEA Trust Commercial |
$4,185.90
|
| Rate for Payer: WPS Commercial |
$5,637.06
|
|
|
HIP STEM ACCOLADE SZ 4 6077-0535
|
Facility
|
IP
|
$7,599.00
|
|
| Hospital Charge Code |
3922761
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,872.45 |
| Max. Negotiated Rate |
$7,270.72 |
| Rate for Payer: Aetna Commercial |
$7,112.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,796.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,188.57
|
| Rate for Payer: Cash Price |
$2,279.70
|
| Rate for Payer: Cigna Commercial |
$7,270.72
|
| Rate for Payer: Health EOS Commercial |
$7,033.63
|
| Rate for Payer: HFN Commercial |
$7,270.72
|
| Rate for Payer: Multiplan Commercial |
$6,322.37
|
| Rate for Payer: Preferred Network Access Commercial |
$7,270.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,872.45
|
| Rate for Payer: Quartz Commercial |
$4,741.78
|
| Rate for Payer: WEA Trust Commercial |
$4,346.63
|
| Rate for Payer: WPS Commercial |
$5,853.51
|
|
