|
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 |
$4,964.96 |
| Max. Negotiated Rate |
$70,928.00 |
| Rate for Payer: Aetna Commercial |
$15,958.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,249.52
|
| Rate for Payer: Aetna Managed Medicare |
$4,964.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,525.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,866.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,511.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,397.96
|
| Rate for Payer: Cash Price |
$5,319.60
|
| Rate for Payer: Cigna Commercial |
$16,313.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,922.83
|
| Rate for Payer: Health EOS Commercial |
$15,781.48
|
| Rate for Payer: HFN Commercial |
$16,313.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,299.00
|
| Rate for Payer: Multiplan Commercial |
$14,185.60
|
| Rate for Payer: NAPHCARE Commercial |
$10,639.20
|
| Rate for Payer: Preferred Network Access Commercial |
$16,313.44
|
| Rate for Payer: Quartz Beloit One Network |
$8,688.68
|
| Rate for Payer: Quartz Commercial |
$11,525.80
|
| Rate for Payer: Quartz Medicare Advantage |
$10,639.20
|
| Rate for Payer: The Alliance Commercial |
$70,928.00
|
| Rate for Payer: WEA Trust Commercial |
$9,752.60
|
| Rate for Payer: WPS Commercial |
$13,134.09
|
|
|
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 |
$8,688.68 |
| Max. Negotiated Rate |
$16,313.44 |
| Rate for Payer: Aetna Commercial |
$15,958.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,249.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,397.96
|
| Rate for Payer: Cash Price |
$5,319.60
|
| Rate for Payer: Cigna Commercial |
$16,313.44
|
| Rate for Payer: Health EOS Commercial |
$15,781.48
|
| Rate for Payer: HFN Commercial |
$16,313.44
|
| Rate for Payer: Multiplan Commercial |
$14,185.60
|
| Rate for Payer: NAPHCARE Commercial |
$10,639.20
|
| Rate for Payer: Preferred Network Access Commercial |
$16,313.44
|
| Rate for Payer: Quartz Beloit One Network |
$8,688.68
|
| Rate for Payer: Quartz Commercial |
$10,639.20
|
| Rate for Payer: WEA Trust Commercial |
$9,752.60
|
| Rate for Payer: WPS Commercial |
$13,134.09
|
|
|
HIP STEM ACCOLADE II SZ 5 6721-0535
|
Facility
|
IP
|
$17,732.00
|
|
| Hospital Charge Code |
3949329
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,688.68 |
| Max. Negotiated Rate |
$16,313.44 |
| Rate for Payer: Aetna Commercial |
$15,958.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,249.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,397.96
|
| Rate for Payer: Cash Price |
$5,319.60
|
| Rate for Payer: Cigna Commercial |
$16,313.44
|
| Rate for Payer: Health EOS Commercial |
$15,781.48
|
| Rate for Payer: HFN Commercial |
$16,313.44
|
| Rate for Payer: Multiplan Commercial |
$14,185.60
|
| Rate for Payer: NAPHCARE Commercial |
$10,639.20
|
| Rate for Payer: Preferred Network Access Commercial |
$16,313.44
|
| Rate for Payer: Quartz Beloit One Network |
$8,688.68
|
| Rate for Payer: Quartz Commercial |
$10,639.20
|
| Rate for Payer: WEA Trust Commercial |
$9,752.60
|
| Rate for Payer: WPS Commercial |
$13,134.09
|
|
|
HIP STEM ACCOLADE II SZ 5 6721-0535
|
Facility
|
OP
|
$17,732.00
|
|
| Hospital Charge Code |
3949329
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,964.96 |
| Max. Negotiated Rate |
$70,928.00 |
| Rate for Payer: Aetna Commercial |
$15,958.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,249.52
|
| Rate for Payer: Aetna Managed Medicare |
$4,964.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,525.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,866.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,511.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,397.96
|
| Rate for Payer: Cash Price |
$5,319.60
|
| Rate for Payer: Cigna Commercial |
$16,313.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,922.83
|
| Rate for Payer: Health EOS Commercial |
$15,781.48
|
| Rate for Payer: HFN Commercial |
$16,313.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,299.00
|
| Rate for Payer: Multiplan Commercial |
$14,185.60
|
| Rate for Payer: NAPHCARE Commercial |
$10,639.20
|
| Rate for Payer: Preferred Network Access Commercial |
$16,313.44
|
| Rate for Payer: Quartz Beloit One Network |
$8,688.68
|
| Rate for Payer: Quartz Commercial |
$11,525.80
|
| Rate for Payer: Quartz Medicare Advantage |
$10,639.20
|
| Rate for Payer: The Alliance Commercial |
$70,928.00
|
| Rate for Payer: WEA Trust Commercial |
$9,752.60
|
| Rate for Payer: WPS Commercial |
$13,134.09
|
|
|
HIP STEM ACCOLADE II SZ 6 6721-0635
|
Facility
|
OP
|
$17,074.00
|
|
| Hospital Charge Code |
4028637
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,780.72 |
| Max. Negotiated Rate |
$68,296.00 |
| Rate for Payer: Aetna Commercial |
$15,366.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,683.64
|
| Rate for Payer: Aetna Managed Medicare |
$4,780.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,098.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,537.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,195.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,049.22
|
| Rate for Payer: Cash Price |
$5,122.20
|
| Rate for Payer: Cigna Commercial |
$15,708.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,554.61
|
| Rate for Payer: Health EOS Commercial |
$15,195.86
|
| Rate for Payer: HFN Commercial |
$15,708.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,805.50
|
| Rate for Payer: Multiplan Commercial |
$13,659.20
|
| Rate for Payer: NAPHCARE Commercial |
$10,244.40
|
| Rate for Payer: Preferred Network Access Commercial |
$15,708.08
|
| Rate for Payer: Quartz Beloit One Network |
$8,366.26
|
| Rate for Payer: Quartz Commercial |
$11,098.10
|
| Rate for Payer: Quartz Medicare Advantage |
$10,244.40
|
| Rate for Payer: The Alliance Commercial |
$68,296.00
|
| Rate for Payer: WEA Trust Commercial |
$9,390.70
|
| Rate for Payer: WPS Commercial |
$12,646.71
|
|
|
HIP STEM ACCOLADE II SZ 6 6721-0635
|
Facility
|
IP
|
$17,074.00
|
|
| Hospital Charge Code |
4028637
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,366.26 |
| Max. Negotiated Rate |
$15,708.08 |
| Rate for Payer: Aetna Commercial |
$15,366.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,683.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,049.22
|
| Rate for Payer: Cash Price |
$5,122.20
|
| Rate for Payer: Cigna Commercial |
$15,708.08
|
| Rate for Payer: Health EOS Commercial |
$15,195.86
|
| Rate for Payer: HFN Commercial |
$15,708.08
|
| Rate for Payer: Multiplan Commercial |
$13,659.20
|
| Rate for Payer: NAPHCARE Commercial |
$10,244.40
|
| Rate for Payer: Preferred Network Access Commercial |
$15,708.08
|
| Rate for Payer: Quartz Beloit One Network |
$8,366.26
|
| Rate for Payer: Quartz Commercial |
$10,244.40
|
| Rate for Payer: WEA Trust Commercial |
$9,390.70
|
| Rate for Payer: WPS Commercial |
$12,646.71
|
|
|
HIP STEM ACCOLADE II SZ 7 6721-0737
|
Facility
|
OP
|
$17,732.00
|
|
| Hospital Charge Code |
3693509
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,964.96 |
| Max. Negotiated Rate |
$70,928.00 |
| Rate for Payer: Aetna Commercial |
$15,958.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,249.52
|
| Rate for Payer: Aetna Managed Medicare |
$4,964.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,525.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,866.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,511.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,397.96
|
| Rate for Payer: Cash Price |
$5,319.60
|
| Rate for Payer: Cigna Commercial |
$16,313.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,922.83
|
| Rate for Payer: Health EOS Commercial |
$15,781.48
|
| Rate for Payer: HFN Commercial |
$16,313.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,299.00
|
| Rate for Payer: Multiplan Commercial |
$14,185.60
|
| Rate for Payer: NAPHCARE Commercial |
$10,639.20
|
| Rate for Payer: Preferred Network Access Commercial |
$16,313.44
|
| Rate for Payer: Quartz Beloit One Network |
$8,688.68
|
| Rate for Payer: Quartz Commercial |
$11,525.80
|
| Rate for Payer: Quartz Medicare Advantage |
$10,639.20
|
| Rate for Payer: The Alliance Commercial |
$70,928.00
|
| Rate for Payer: WEA Trust Commercial |
$9,752.60
|
| Rate for Payer: WPS Commercial |
$13,134.09
|
|
|
HIP STEM ACCOLADE II SZ 7 6721-0737
|
Facility
|
IP
|
$17,732.00
|
|
| Hospital Charge Code |
3693509
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,688.68 |
| Max. Negotiated Rate |
$16,313.44 |
| Rate for Payer: Aetna Commercial |
$15,958.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,249.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,397.96
|
| Rate for Payer: Cash Price |
$5,319.60
|
| Rate for Payer: Cigna Commercial |
$16,313.44
|
| Rate for Payer: Health EOS Commercial |
$15,781.48
|
| Rate for Payer: HFN Commercial |
$16,313.44
|
| Rate for Payer: Multiplan Commercial |
$14,185.60
|
| Rate for Payer: NAPHCARE Commercial |
$10,639.20
|
| Rate for Payer: Preferred Network Access Commercial |
$16,313.44
|
| Rate for Payer: Quartz Beloit One Network |
$8,688.68
|
| Rate for Payer: Quartz Commercial |
$10,639.20
|
| Rate for Payer: WEA Trust Commercial |
$9,752.60
|
| Rate for Payer: WPS Commercial |
$13,134.09
|
|
|
HIP STEM ACCOLADE II SZ 8 6721-0837
|
Facility
|
OP
|
$17,732.00
|
|
| Hospital Charge Code |
3487505
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,964.96 |
| Max. Negotiated Rate |
$70,928.00 |
| Rate for Payer: Aetna Commercial |
$15,958.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,249.52
|
| Rate for Payer: Aetna Managed Medicare |
$4,964.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,525.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,866.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,511.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,397.96
|
| Rate for Payer: Cash Price |
$5,319.60
|
| Rate for Payer: Cigna Commercial |
$16,313.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,922.83
|
| Rate for Payer: Health EOS Commercial |
$15,781.48
|
| Rate for Payer: HFN Commercial |
$16,313.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,299.00
|
| Rate for Payer: Multiplan Commercial |
$14,185.60
|
| Rate for Payer: NAPHCARE Commercial |
$10,639.20
|
| Rate for Payer: Preferred Network Access Commercial |
$16,313.44
|
| Rate for Payer: Quartz Beloit One Network |
$8,688.68
|
| Rate for Payer: Quartz Commercial |
$11,525.80
|
| Rate for Payer: Quartz Medicare Advantage |
$10,639.20
|
| Rate for Payer: The Alliance Commercial |
$70,928.00
|
| Rate for Payer: WEA Trust Commercial |
$9,752.60
|
| Rate for Payer: WPS Commercial |
$13,134.09
|
|
|
HIP STEM ACCOLADE II SZ 8 6721-0837
|
Facility
|
IP
|
$17,732.00
|
|
| Hospital Charge Code |
3487505
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,688.68 |
| Max. Negotiated Rate |
$16,313.44 |
| Rate for Payer: Aetna Commercial |
$15,958.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,249.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,397.96
|
| Rate for Payer: Cash Price |
$5,319.60
|
| Rate for Payer: Cigna Commercial |
$16,313.44
|
| Rate for Payer: Health EOS Commercial |
$15,781.48
|
| Rate for Payer: HFN Commercial |
$16,313.44
|
| Rate for Payer: Multiplan Commercial |
$14,185.60
|
| Rate for Payer: NAPHCARE Commercial |
$10,639.20
|
| Rate for Payer: Preferred Network Access Commercial |
$16,313.44
|
| Rate for Payer: Quartz Beloit One Network |
$8,688.68
|
| Rate for Payer: Quartz Commercial |
$10,639.20
|
| Rate for Payer: WEA Trust Commercial |
$9,752.60
|
| Rate for Payer: WPS Commercial |
$13,134.09
|
|
|
HIP STEM ACCOLADE II SZ 9 6721-0937
|
Facility
|
OP
|
$12,686.00
|
|
| Hospital Charge Code |
5179143
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,552.08 |
| Max. Negotiated Rate |
$50,744.00 |
| Rate for Payer: Aetna Commercial |
$11,417.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,909.96
|
| Rate for Payer: Aetna Managed Medicare |
$3,552.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,245.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,343.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,089.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,723.58
|
| Rate for Payer: Cash Price |
$3,805.80
|
| Rate for Payer: Cigna Commercial |
$11,671.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,099.09
|
| Rate for Payer: Health EOS Commercial |
$11,290.54
|
| Rate for Payer: HFN Commercial |
$11,671.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,514.50
|
| Rate for Payer: Multiplan Commercial |
$10,148.80
|
| Rate for Payer: NAPHCARE Commercial |
$7,611.60
|
| Rate for Payer: Preferred Network Access Commercial |
$11,671.12
|
| Rate for Payer: Quartz Beloit One Network |
$6,216.14
|
| Rate for Payer: Quartz Commercial |
$8,245.90
|
| Rate for Payer: Quartz Medicare Advantage |
$7,611.60
|
| Rate for Payer: The Alliance Commercial |
$50,744.00
|
| Rate for Payer: WEA Trust Commercial |
$6,977.30
|
| Rate for Payer: WPS Commercial |
$9,396.52
|
|
|
HIP STEM ACCOLADE II SZ 9 6721-0937
|
Facility
|
IP
|
$12,686.00
|
|
| Hospital Charge Code |
5179143
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,216.14 |
| Max. Negotiated Rate |
$11,671.12 |
| Rate for Payer: Aetna Commercial |
$11,417.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,909.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,723.58
|
| Rate for Payer: Cash Price |
$3,805.80
|
| Rate for Payer: Cigna Commercial |
$11,671.12
|
| Rate for Payer: Health EOS Commercial |
$11,290.54
|
| Rate for Payer: HFN Commercial |
$11,671.12
|
| Rate for Payer: Multiplan Commercial |
$10,148.80
|
| Rate for Payer: NAPHCARE Commercial |
$7,611.60
|
| Rate for Payer: Preferred Network Access Commercial |
$11,671.12
|
| Rate for Payer: Quartz Beloit One Network |
$6,216.14
|
| Rate for Payer: Quartz Commercial |
$7,611.60
|
| Rate for Payer: WEA Trust Commercial |
$6,977.30
|
| Rate for Payer: WPS Commercial |
$9,396.52
|
|
|
HIP STEM ACCOLADE SZ 1 6077-0130
|
Facility
|
OP
|
$7,318.00
|
|
| Hospital Charge Code |
4241670
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,049.04 |
| Max. Negotiated Rate |
$29,272.00 |
| Rate for Payer: Aetna Commercial |
$6,586.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,293.48
|
| Rate for Payer: Aetna Managed Medicare |
$2,049.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,756.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,659.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,512.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,878.54
|
| Rate for Payer: Cash Price |
$2,195.40
|
| Rate for Payer: Cigna Commercial |
$6,732.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,095.15
|
| Rate for Payer: Health EOS Commercial |
$6,513.02
|
| Rate for Payer: HFN Commercial |
$6,732.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,488.50
|
| Rate for Payer: Multiplan Commercial |
$5,854.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,390.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,732.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,585.82
|
| Rate for Payer: Quartz Commercial |
$4,756.70
|
| Rate for Payer: Quartz Medicare Advantage |
$4,390.80
|
| Rate for Payer: The Alliance Commercial |
$29,272.00
|
| Rate for Payer: WEA Trust Commercial |
$4,024.90
|
| Rate for Payer: WPS Commercial |
$5,420.44
|
|
|
HIP STEM ACCOLADE SZ 1 6077-0130
|
Facility
|
IP
|
$7,318.00
|
|
| Hospital Charge Code |
4241670
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,585.82 |
| Max. Negotiated Rate |
$6,732.56 |
| Rate for Payer: Aetna Commercial |
$6,586.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,293.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,878.54
|
| Rate for Payer: Cash Price |
$2,195.40
|
| Rate for Payer: Cigna Commercial |
$6,732.56
|
| Rate for Payer: Health EOS Commercial |
$6,513.02
|
| Rate for Payer: HFN Commercial |
$6,732.56
|
| Rate for Payer: Multiplan Commercial |
$5,854.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,390.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,732.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,585.82
|
| Rate for Payer: Quartz Commercial |
$4,390.80
|
| Rate for Payer: WEA Trust Commercial |
$4,024.90
|
| Rate for Payer: WPS Commercial |
$5,420.44
|
|
|
HIP STEM ACCOLADE SZ 2 6077-0230
|
Facility
|
OP
|
$7,318.00
|
|
| Hospital Charge Code |
4518630
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,049.04 |
| Max. Negotiated Rate |
$29,272.00 |
| Rate for Payer: Aetna Commercial |
$6,586.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,293.48
|
| Rate for Payer: Aetna Managed Medicare |
$2,049.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,756.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,659.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,512.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,878.54
|
| Rate for Payer: Cash Price |
$2,195.40
|
| Rate for Payer: Cigna Commercial |
$6,732.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,095.15
|
| Rate for Payer: Health EOS Commercial |
$6,513.02
|
| Rate for Payer: HFN Commercial |
$6,732.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,488.50
|
| Rate for Payer: Multiplan Commercial |
$5,854.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,390.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,732.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,585.82
|
| Rate for Payer: Quartz Commercial |
$4,756.70
|
| Rate for Payer: Quartz Medicare Advantage |
$4,390.80
|
| Rate for Payer: The Alliance Commercial |
$29,272.00
|
| Rate for Payer: WEA Trust Commercial |
$4,024.90
|
| Rate for Payer: WPS Commercial |
$5,420.44
|
|
|
HIP STEM ACCOLADE SZ 2 6077-0230
|
Facility
|
IP
|
$7,318.00
|
|
| Hospital Charge Code |
4518630
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,585.82 |
| Max. Negotiated Rate |
$6,732.56 |
| Rate for Payer: Aetna Commercial |
$6,586.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,293.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,878.54
|
| Rate for Payer: Cash Price |
$2,195.40
|
| Rate for Payer: Cigna Commercial |
$6,732.56
|
| Rate for Payer: Health EOS Commercial |
$6,513.02
|
| Rate for Payer: HFN Commercial |
$6,732.56
|
| Rate for Payer: Multiplan Commercial |
$5,854.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,390.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,732.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,585.82
|
| Rate for Payer: Quartz Commercial |
$4,390.80
|
| Rate for Payer: WEA Trust Commercial |
$4,024.90
|
| Rate for Payer: WPS Commercial |
$5,420.44
|
|
|
HIP STEM ACCOLADE SZ 3 6077-0335
|
Facility
|
IP
|
$7,318.00
|
|
| Hospital Charge Code |
4518631
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,585.82 |
| Max. Negotiated Rate |
$6,732.56 |
| Rate for Payer: Aetna Commercial |
$6,586.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,293.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,878.54
|
| Rate for Payer: Cash Price |
$2,195.40
|
| Rate for Payer: Cigna Commercial |
$6,732.56
|
| Rate for Payer: Health EOS Commercial |
$6,513.02
|
| Rate for Payer: HFN Commercial |
$6,732.56
|
| Rate for Payer: Multiplan Commercial |
$5,854.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,390.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,732.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,585.82
|
| Rate for Payer: Quartz Commercial |
$4,390.80
|
| Rate for Payer: WEA Trust Commercial |
$4,024.90
|
| Rate for Payer: WPS Commercial |
$5,420.44
|
|
|
HIP STEM ACCOLADE SZ 3 6077-0335
|
Facility
|
OP
|
$7,318.00
|
|
| Hospital Charge Code |
4518631
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,049.04 |
| Max. Negotiated Rate |
$29,272.00 |
| Rate for Payer: Aetna Commercial |
$6,586.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,293.48
|
| Rate for Payer: Aetna Managed Medicare |
$2,049.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,756.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,659.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,512.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,878.54
|
| Rate for Payer: Cash Price |
$2,195.40
|
| Rate for Payer: Cigna Commercial |
$6,732.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,095.15
|
| Rate for Payer: Health EOS Commercial |
$6,513.02
|
| Rate for Payer: HFN Commercial |
$6,732.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,488.50
|
| Rate for Payer: Multiplan Commercial |
$5,854.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,390.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,732.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,585.82
|
| Rate for Payer: Quartz Commercial |
$4,756.70
|
| Rate for Payer: Quartz Medicare Advantage |
$4,390.80
|
| Rate for Payer: The Alliance Commercial |
$29,272.00
|
| Rate for Payer: WEA Trust Commercial |
$4,024.90
|
| Rate for Payer: WPS Commercial |
$5,420.44
|
|
|
HIP STEM ACCOLADE SZ 4 6077-0435
|
Facility
|
IP
|
$7,318.00
|
|
| Hospital Charge Code |
4518632
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,585.82 |
| Max. Negotiated Rate |
$6,732.56 |
| Rate for Payer: Aetna Commercial |
$6,586.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,293.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,878.54
|
| Rate for Payer: Cash Price |
$2,195.40
|
| Rate for Payer: Cigna Commercial |
$6,732.56
|
| Rate for Payer: Health EOS Commercial |
$6,513.02
|
| Rate for Payer: HFN Commercial |
$6,732.56
|
| Rate for Payer: Multiplan Commercial |
$5,854.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,390.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,732.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,585.82
|
| Rate for Payer: Quartz Commercial |
$4,390.80
|
| Rate for Payer: WEA Trust Commercial |
$4,024.90
|
| Rate for Payer: WPS Commercial |
$5,420.44
|
|
|
HIP STEM ACCOLADE SZ 4 6077-0435
|
Facility
|
OP
|
$7,318.00
|
|
| Hospital Charge Code |
4518632
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,049.04 |
| Max. Negotiated Rate |
$29,272.00 |
| Rate for Payer: Aetna Commercial |
$6,586.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,293.48
|
| Rate for Payer: Aetna Managed Medicare |
$2,049.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,756.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,659.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,512.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,878.54
|
| Rate for Payer: Cash Price |
$2,195.40
|
| Rate for Payer: Cigna Commercial |
$6,732.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,095.15
|
| Rate for Payer: Health EOS Commercial |
$6,513.02
|
| Rate for Payer: HFN Commercial |
$6,732.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,488.50
|
| Rate for Payer: Multiplan Commercial |
$5,854.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,390.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,732.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,585.82
|
| Rate for Payer: Quartz Commercial |
$4,756.70
|
| Rate for Payer: Quartz Medicare Advantage |
$4,390.80
|
| Rate for Payer: The Alliance Commercial |
$29,272.00
|
| Rate for Payer: WEA Trust Commercial |
$4,024.90
|
| Rate for Payer: WPS Commercial |
$5,420.44
|
|
|
HIP STEM ACCOLADE SZ 4 6077-0535
|
Facility
|
IP
|
$7,599.00
|
|
| Hospital Charge Code |
3922761
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,723.51 |
| Max. Negotiated Rate |
$6,991.08 |
| Rate for Payer: Aetna Commercial |
$6,839.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,535.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,027.47
|
| Rate for Payer: Cash Price |
$2,279.70
|
| Rate for Payer: Cigna Commercial |
$6,991.08
|
| Rate for Payer: Health EOS Commercial |
$6,763.11
|
| Rate for Payer: HFN Commercial |
$6,991.08
|
| Rate for Payer: Multiplan Commercial |
$6,079.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,559.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,991.08
|
| Rate for Payer: Quartz Beloit One Network |
$3,723.51
|
| Rate for Payer: Quartz Commercial |
$4,559.40
|
| Rate for Payer: WEA Trust Commercial |
$4,179.45
|
| Rate for Payer: WPS Commercial |
$5,628.58
|
|
|
HIP STEM ACCOLADE SZ 4 6077-0535
|
Facility
|
OP
|
$7,599.00
|
|
| Hospital Charge Code |
3922761
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,127.72 |
| Max. Negotiated Rate |
$30,396.00 |
| Rate for Payer: Aetna Commercial |
$6,839.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,535.14
|
| Rate for Payer: Aetna Managed Medicare |
$2,127.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,939.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,799.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,647.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,027.47
|
| Rate for Payer: Cash Price |
$2,279.70
|
| Rate for Payer: Cigna Commercial |
$6,991.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,252.40
|
| Rate for Payer: Health EOS Commercial |
$6,763.11
|
| Rate for Payer: HFN Commercial |
$6,991.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,699.25
|
| Rate for Payer: Multiplan Commercial |
$6,079.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,559.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,991.08
|
| Rate for Payer: Quartz Beloit One Network |
$3,723.51
|
| Rate for Payer: Quartz Commercial |
$4,939.35
|
| Rate for Payer: Quartz Medicare Advantage |
$4,559.40
|
| Rate for Payer: The Alliance Commercial |
$30,396.00
|
| Rate for Payer: WEA Trust Commercial |
$4,179.45
|
| Rate for Payer: WPS Commercial |
$5,628.58
|
|
|
HIP STEM ACCOLADE SZ 5 6077-0537
|
Facility
|
OP
|
$7,318.00
|
|
| Hospital Charge Code |
3995313
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,049.04 |
| Max. Negotiated Rate |
$29,272.00 |
| Rate for Payer: Aetna Commercial |
$6,586.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,293.48
|
| Rate for Payer: Aetna Managed Medicare |
$2,049.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,756.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,659.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,512.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,878.54
|
| Rate for Payer: Cash Price |
$2,195.40
|
| Rate for Payer: Cigna Commercial |
$6,732.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,095.15
|
| Rate for Payer: Health EOS Commercial |
$6,513.02
|
| Rate for Payer: HFN Commercial |
$6,732.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,488.50
|
| Rate for Payer: Multiplan Commercial |
$5,854.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,390.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,732.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,585.82
|
| Rate for Payer: Quartz Commercial |
$4,756.70
|
| Rate for Payer: Quartz Medicare Advantage |
$4,390.80
|
| Rate for Payer: The Alliance Commercial |
$29,272.00
|
| Rate for Payer: WEA Trust Commercial |
$4,024.90
|
| Rate for Payer: WPS Commercial |
$5,420.44
|
|
|
HIP STEM ACCOLADE SZ 5 6077-0537
|
Facility
|
IP
|
$7,318.00
|
|
| Hospital Charge Code |
3995313
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,585.82 |
| Max. Negotiated Rate |
$6,732.56 |
| Rate for Payer: Aetna Commercial |
$6,586.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,293.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,878.54
|
| Rate for Payer: Cash Price |
$2,195.40
|
| Rate for Payer: Cigna Commercial |
$6,732.56
|
| Rate for Payer: Health EOS Commercial |
$6,513.02
|
| Rate for Payer: HFN Commercial |
$6,732.56
|
| Rate for Payer: Multiplan Commercial |
$5,854.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,390.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,732.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,585.82
|
| Rate for Payer: Quartz Commercial |
$4,390.80
|
| Rate for Payer: WEA Trust Commercial |
$4,024.90
|
| Rate for Payer: WPS Commercial |
$5,420.44
|
|
|
HIP STEM ACCOLADE SZ 6 6077-0637
|
Facility
|
OP
|
$7,318.00
|
|
| Hospital Charge Code |
4079275
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,049.04 |
| Max. Negotiated Rate |
$29,272.00 |
| Rate for Payer: Aetna Commercial |
$6,586.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,293.48
|
| Rate for Payer: Aetna Managed Medicare |
$2,049.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,756.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,659.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,512.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,878.54
|
| Rate for Payer: Cash Price |
$2,195.40
|
| Rate for Payer: Cigna Commercial |
$6,732.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,095.15
|
| Rate for Payer: Health EOS Commercial |
$6,513.02
|
| Rate for Payer: HFN Commercial |
$6,732.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,488.50
|
| Rate for Payer: Multiplan Commercial |
$5,854.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,390.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,732.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,585.82
|
| Rate for Payer: Quartz Commercial |
$4,756.70
|
| Rate for Payer: Quartz Medicare Advantage |
$4,390.80
|
| Rate for Payer: The Alliance Commercial |
$29,272.00
|
| Rate for Payer: WEA Trust Commercial |
$4,024.90
|
| Rate for Payer: WPS Commercial |
$5,420.44
|
|
