|
KNEE ARTHROPLASTY, TOTAL, BILATERAL
|
Facility
|
IP
|
$19,936.00
|
|
| Hospital Charge Code |
2960532
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,159.39 |
| Max. Negotiated Rate |
$19,074.76 |
| Rate for Payer: Aetna Commercial |
$18,660.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,830.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,988.72
|
| Rate for Payer: Cash Price |
$5,980.80
|
| Rate for Payer: Cigna Commercial |
$19,074.76
|
| Rate for Payer: Health EOS Commercial |
$18,452.76
|
| Rate for Payer: HFN Commercial |
$19,074.76
|
| Rate for Payer: Multiplan Commercial |
$16,586.75
|
| Rate for Payer: Preferred Network Access Commercial |
$19,074.76
|
| Rate for Payer: Quartz Beloit One Network |
$10,159.39
|
| Rate for Payer: Quartz Commercial |
$12,440.06
|
| Rate for Payer: WEA Trust Commercial |
$11,403.39
|
| Rate for Payer: WPS Commercial |
$15,356.70
|
|
|
KNEE ARTHROPLASTY, TOTAL, BILATERAL
|
Facility
|
OP
|
$19,936.00
|
|
| Hospital Charge Code |
2960532
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,805.36 |
| Max. Negotiated Rate |
$19,074.76 |
| Rate for Payer: Aetna Commercial |
$18,660.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,830.76
|
| Rate for Payer: Aetna Managed Medicare |
$5,805.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,476.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,366.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,952.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,988.72
|
| Rate for Payer: Cash Price |
$5,980.80
|
| Rate for Payer: Cigna Commercial |
$19,074.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,602.75
|
| Rate for Payer: Health EOS Commercial |
$18,452.76
|
| Rate for Payer: HFN Commercial |
$19,074.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,550.08
|
| Rate for Payer: Multiplan Commercial |
$16,586.75
|
| Rate for Payer: NAPHCARE Commercial |
$12,440.06
|
| Rate for Payer: Preferred Network Access Commercial |
$19,074.76
|
| Rate for Payer: Quartz Beloit One Network |
$10,159.39
|
| Rate for Payer: Quartz Commercial |
$13,476.74
|
| Rate for Payer: Quartz Medicare Advantage |
$12,440.06
|
| Rate for Payer: The Alliance Commercial |
$10,366.72
|
| Rate for Payer: WEA Trust Commercial |
$11,403.39
|
| Rate for Payer: WPS Commercial |
$15,356.70
|
|
|
KNEE ARTHROPLASTY, TOTAL, REVISION
|
Facility
|
IP
|
$13,291.00
|
|
| Hospital Charge Code |
2960353
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,773.09 |
| Max. Negotiated Rate |
$12,716.83 |
| Rate for Payer: Aetna Commercial |
$12,440.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,887.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,326.00
|
| Rate for Payer: Cash Price |
$3,987.30
|
| Rate for Payer: Cigna Commercial |
$12,716.83
|
| Rate for Payer: Health EOS Commercial |
$12,302.15
|
| Rate for Payer: HFN Commercial |
$12,716.83
|
| Rate for Payer: Multiplan Commercial |
$11,058.11
|
| Rate for Payer: Preferred Network Access Commercial |
$12,716.83
|
| Rate for Payer: Quartz Beloit One Network |
$6,773.09
|
| Rate for Payer: Quartz Commercial |
$8,293.58
|
| Rate for Payer: WEA Trust Commercial |
$7,602.45
|
| Rate for Payer: WPS Commercial |
$10,238.06
|
|
|
KNEE ARTHROPLASTY, TOTAL, REVISION
|
Facility
|
OP
|
$13,291.00
|
|
| Hospital Charge Code |
2960353
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,870.34 |
| Max. Negotiated Rate |
$12,716.83 |
| Rate for Payer: Aetna Commercial |
$12,440.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,887.47
|
| Rate for Payer: Aetna Managed Medicare |
$3,870.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,984.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,911.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,634.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,326.00
|
| Rate for Payer: Cash Price |
$3,987.30
|
| Rate for Payer: Cigna Commercial |
$12,716.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,735.36
|
| Rate for Payer: Health EOS Commercial |
$12,302.15
|
| Rate for Payer: HFN Commercial |
$12,716.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,366.98
|
| Rate for Payer: Multiplan Commercial |
$11,058.11
|
| Rate for Payer: NAPHCARE Commercial |
$8,293.58
|
| Rate for Payer: Preferred Network Access Commercial |
$12,716.83
|
| Rate for Payer: Quartz Beloit One Network |
$6,773.09
|
| Rate for Payer: Quartz Commercial |
$8,984.72
|
| Rate for Payer: Quartz Medicare Advantage |
$8,293.58
|
| Rate for Payer: The Alliance Commercial |
$6,911.32
|
| Rate for Payer: WEA Trust Commercial |
$7,602.45
|
| Rate for Payer: WPS Commercial |
$10,238.06
|
|
|
KNEE ARTHROSCOPY
|
Facility
|
OP
|
$8,560.00
|
|
| Hospital Charge Code |
2959829
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,492.67 |
| Max. Negotiated Rate |
$8,190.21 |
| Rate for Payer: Aetna Commercial |
$8,012.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,656.06
|
| Rate for Payer: Aetna Managed Medicare |
$2,492.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,786.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,451.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,273.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,718.27
|
| Rate for Payer: Cash Price |
$2,568.00
|
| Rate for Payer: Cigna Commercial |
$8,190.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,981.92
|
| Rate for Payer: Health EOS Commercial |
$7,923.14
|
| Rate for Payer: HFN Commercial |
$8,190.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,676.80
|
| Rate for Payer: Multiplan Commercial |
$7,121.92
|
| Rate for Payer: NAPHCARE Commercial |
$5,341.44
|
| Rate for Payer: Preferred Network Access Commercial |
$8,190.21
|
| Rate for Payer: Quartz Beloit One Network |
$4,362.18
|
| Rate for Payer: Quartz Commercial |
$5,786.56
|
| Rate for Payer: Quartz Medicare Advantage |
$5,341.44
|
| Rate for Payer: The Alliance Commercial |
$4,451.20
|
| Rate for Payer: WEA Trust Commercial |
$4,896.32
|
| Rate for Payer: WPS Commercial |
$6,593.77
|
|
|
KNEE ARTHROSCOPY
|
Facility
|
IP
|
$8,560.00
|
|
| Hospital Charge Code |
2959829
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,362.18 |
| Max. Negotiated Rate |
$8,190.21 |
| Rate for Payer: Aetna Commercial |
$8,012.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,656.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,718.27
|
| Rate for Payer: Cash Price |
$2,568.00
|
| Rate for Payer: Cigna Commercial |
$8,190.21
|
| Rate for Payer: Health EOS Commercial |
$7,923.14
|
| Rate for Payer: HFN Commercial |
$8,190.21
|
| Rate for Payer: Multiplan Commercial |
$7,121.92
|
| Rate for Payer: Preferred Network Access Commercial |
$8,190.21
|
| Rate for Payer: Quartz Beloit One Network |
$4,362.18
|
| Rate for Payer: Quartz Commercial |
$5,341.44
|
| Rate for Payer: WEA Trust Commercial |
$4,896.32
|
| Rate for Payer: WPS Commercial |
$6,593.77
|
|
|
KNEE ARTHROSCOPY, DX 29870
|
Professional
|
Both
|
$1,970.00
|
|
|
Service Code
|
CPT 29870
|
| Hospital Charge Code |
3014328
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$382.46 |
| Max. Negotiated Rate |
$1,946.36 |
| Rate for Payer: Aetna Commercial |
$1,946.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,761.97
|
| Rate for Payer: Aetna Managed Medicare |
$382.46
|
| Rate for Payer: Anthem Medicare Advantage |
$382.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$382.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$382.46
|
| Rate for Payer: Cash Price |
$591.00
|
| Rate for Payer: Cash Price |
$591.00
|
| Rate for Payer: Cash Price |
$591.00
|
| Rate for Payer: Cigna Commercial |
$1,946.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$469.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$382.46
|
| Rate for Payer: Health EOS Commercial |
$1,864.41
|
| Rate for Payer: HFN Commercial |
$1,946.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,407.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,407.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$382.46
|
| Rate for Payer: Multiplan Commercial |
$1,639.04
|
| Rate for Payer: NAPHCARE Commercial |
$573.69
|
| Rate for Payer: Preferred Network Access Commercial |
$1,946.36
|
| Rate for Payer: Quartz Beloit One Network |
$901.47
|
| Rate for Payer: Quartz Commercial |
$1,167.82
|
| Rate for Payer: Quartz Medicare Advantage |
$382.46
|
| Rate for Payer: The Alliance Commercial |
$1,625.45
|
| Rate for Payer: United Healthcare Medicaid |
$469.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$382.46
|
| Rate for Payer: WEA Trust Commercial |
$1,126.84
|
| Rate for Payer: WPS Commercial |
$1,721.07
|
|
|
KNEE ARTHROTOMY/ARTHRODESIS/BURSECTOMY/OSTEOTOMY
|
Facility
|
IP
|
$4,912.00
|
|
| Hospital Charge Code |
2959825
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,503.16 |
| Max. Negotiated Rate |
$4,699.80 |
| Rate for Payer: Aetna Commercial |
$4,597.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,393.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,707.49
|
| Rate for Payer: Cash Price |
$1,473.60
|
| Rate for Payer: Cigna Commercial |
$4,699.80
|
| Rate for Payer: Health EOS Commercial |
$4,546.55
|
| Rate for Payer: HFN Commercial |
$4,699.80
|
| Rate for Payer: Multiplan Commercial |
$4,086.78
|
| Rate for Payer: Preferred Network Access Commercial |
$4,699.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,503.16
|
| Rate for Payer: Quartz Commercial |
$3,065.09
|
| Rate for Payer: WEA Trust Commercial |
$2,809.66
|
| Rate for Payer: WPS Commercial |
$3,783.71
|
|
|
KNEE ARTHROTOMY/ARTHRODESIS/BURSECTOMY/OSTEOTOMY
|
Facility
|
OP
|
$4,912.00
|
|
| Hospital Charge Code |
2959825
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,430.37 |
| Max. Negotiated Rate |
$4,699.80 |
| Rate for Payer: Aetna Commercial |
$4,597.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,393.29
|
| Rate for Payer: Aetna Managed Medicare |
$1,430.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,320.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,554.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,452.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,707.49
|
| Rate for Payer: Cash Price |
$1,473.60
|
| Rate for Payer: Cigna Commercial |
$4,699.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,858.78
|
| Rate for Payer: Health EOS Commercial |
$4,546.55
|
| Rate for Payer: HFN Commercial |
$4,699.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,831.36
|
| Rate for Payer: Multiplan Commercial |
$4,086.78
|
| Rate for Payer: NAPHCARE Commercial |
$3,065.09
|
| Rate for Payer: Preferred Network Access Commercial |
$4,699.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,503.16
|
| Rate for Payer: Quartz Commercial |
$3,320.51
|
| Rate for Payer: Quartz Medicare Advantage |
$3,065.09
|
| Rate for Payer: The Alliance Commercial |
$2,554.24
|
| Rate for Payer: WEA Trust Commercial |
$2,809.66
|
| Rate for Payer: WPS Commercial |
$3,783.71
|
|
|
KNEE BONE GRAFTING
|
Facility
|
IP
|
$4,170.00
|
|
| Hospital Charge Code |
2959864
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,125.03 |
| Max. Negotiated Rate |
$3,989.86 |
| Rate for Payer: Aetna Commercial |
$3,903.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,729.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,298.50
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cigna Commercial |
$3,989.86
|
| Rate for Payer: Health EOS Commercial |
$3,859.75
|
| Rate for Payer: HFN Commercial |
$3,989.86
|
| Rate for Payer: Multiplan Commercial |
$3,469.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,989.86
|
| Rate for Payer: Quartz Beloit One Network |
$2,125.03
|
| Rate for Payer: Quartz Commercial |
$2,602.08
|
| Rate for Payer: WEA Trust Commercial |
$2,385.24
|
| Rate for Payer: WPS Commercial |
$3,212.15
|
|
|
KNEE BONE GRAFTING
|
Facility
|
OP
|
$4,170.00
|
|
| Hospital Charge Code |
2959864
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,214.30 |
| Max. Negotiated Rate |
$3,989.86 |
| Rate for Payer: Aetna Commercial |
$3,903.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,729.65
|
| Rate for Payer: Aetna Managed Medicare |
$1,214.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,818.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,168.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,081.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,298.50
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cigna Commercial |
$3,989.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,426.94
|
| Rate for Payer: Health EOS Commercial |
$3,859.75
|
| Rate for Payer: HFN Commercial |
$3,989.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,252.60
|
| Rate for Payer: Multiplan Commercial |
$3,469.44
|
| Rate for Payer: NAPHCARE Commercial |
$2,602.08
|
| Rate for Payer: Preferred Network Access Commercial |
$3,989.86
|
| Rate for Payer: Quartz Beloit One Network |
$2,125.03
|
| Rate for Payer: Quartz Commercial |
$2,818.92
|
| Rate for Payer: Quartz Medicare Advantage |
$2,602.08
|
| Rate for Payer: The Alliance Commercial |
$2,168.40
|
| Rate for Payer: WEA Trust Commercial |
$2,385.24
|
| Rate for Payer: WPS Commercial |
$3,212.15
|
|
|
KNEE BRACE HINGED L1831
|
Facility
|
OP
|
$3,049.00
|
|
| Hospital Charge Code |
2974047
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$887.87 |
| Max. Negotiated Rate |
$2,917.28 |
| Rate for Payer: Aetna Commercial |
$2,853.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,727.03
|
| Rate for Payer: Aetna Managed Medicare |
$887.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,061.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,585.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,522.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,680.61
|
| Rate for Payer: Cash Price |
$914.70
|
| Rate for Payer: Cigna Commercial |
$2,917.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,774.52
|
| Rate for Payer: Health EOS Commercial |
$2,822.15
|
| Rate for Payer: HFN Commercial |
$2,917.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,378.22
|
| Rate for Payer: Multiplan Commercial |
$2,536.77
|
| Rate for Payer: NAPHCARE Commercial |
$1,902.58
|
| Rate for Payer: Preferred Network Access Commercial |
$2,917.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,553.77
|
| Rate for Payer: Quartz Commercial |
$2,061.12
|
| Rate for Payer: Quartz Medicare Advantage |
$1,902.58
|
| Rate for Payer: The Alliance Commercial |
$1,585.48
|
| Rate for Payer: WEA Trust Commercial |
$1,744.03
|
| Rate for Payer: WPS Commercial |
$2,348.64
|
|
|
KNEE BRACE HINGED L1831
|
Facility
|
IP
|
$3,049.00
|
|
| Hospital Charge Code |
2974047
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1,553.77 |
| Max. Negotiated Rate |
$2,917.28 |
| Rate for Payer: Aetna Commercial |
$2,853.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,727.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,680.61
|
| Rate for Payer: Cash Price |
$914.70
|
| Rate for Payer: Cigna Commercial |
$2,917.28
|
| Rate for Payer: Health EOS Commercial |
$2,822.15
|
| Rate for Payer: HFN Commercial |
$2,917.28
|
| Rate for Payer: Multiplan Commercial |
$2,536.77
|
| Rate for Payer: Preferred Network Access Commercial |
$2,917.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,553.77
|
| Rate for Payer: Quartz Commercial |
$1,902.58
|
| Rate for Payer: WEA Trust Commercial |
$1,744.03
|
| Rate for Payer: WPS Commercial |
$2,348.64
|
|
|
KNEE BRACE XL 5674-BLK-XL
|
Facility
|
OP
|
$1,025.00
|
|
| Hospital Charge Code |
3072382
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$298.48 |
| Max. Negotiated Rate |
$980.72 |
| Rate for Payer: Aetna Commercial |
$959.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$916.76
|
| Rate for Payer: Aetna Managed Medicare |
$298.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$692.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$533.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$511.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$564.98
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cigna Commercial |
$980.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$596.55
|
| Rate for Payer: Health EOS Commercial |
$948.74
|
| Rate for Payer: HFN Commercial |
$980.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$799.50
|
| Rate for Payer: Multiplan Commercial |
$852.80
|
| Rate for Payer: NAPHCARE Commercial |
$639.60
|
| Rate for Payer: Preferred Network Access Commercial |
$980.72
|
| Rate for Payer: Quartz Beloit One Network |
$522.34
|
| Rate for Payer: Quartz Commercial |
$692.90
|
| Rate for Payer: Quartz Medicare Advantage |
$639.60
|
| Rate for Payer: The Alliance Commercial |
$533.00
|
| Rate for Payer: WEA Trust Commercial |
$586.30
|
| Rate for Payer: WPS Commercial |
$789.56
|
|
|
KNEE BRACE XL 5674-BLK-XL
|
Facility
|
IP
|
$1,025.00
|
|
| Hospital Charge Code |
3072382
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$522.34 |
| Max. Negotiated Rate |
$980.72 |
| Rate for Payer: Aetna Commercial |
$959.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$916.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$564.98
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cigna Commercial |
$980.72
|
| Rate for Payer: Health EOS Commercial |
$948.74
|
| Rate for Payer: HFN Commercial |
$980.72
|
| Rate for Payer: Multiplan Commercial |
$852.80
|
| Rate for Payer: Preferred Network Access Commercial |
$980.72
|
| Rate for Payer: Quartz Beloit One Network |
$522.34
|
| Rate for Payer: Quartz Commercial |
$639.60
|
| Rate for Payer: WEA Trust Commercial |
$586.30
|
| Rate for Payer: WPS Commercial |
$789.56
|
|
|
KNEE PATELLECTOMY
|
Facility
|
IP
|
$4,492.00
|
|
| Hospital Charge Code |
2960308
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,289.12 |
| Max. Negotiated Rate |
$4,297.95 |
| Rate for Payer: Aetna Commercial |
$4,204.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,017.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,475.99
|
| Rate for Payer: Cash Price |
$1,347.60
|
| Rate for Payer: Cigna Commercial |
$4,297.95
|
| Rate for Payer: Health EOS Commercial |
$4,157.80
|
| Rate for Payer: HFN Commercial |
$4,297.95
|
| Rate for Payer: Multiplan Commercial |
$3,737.34
|
| Rate for Payer: Preferred Network Access Commercial |
$4,297.95
|
| Rate for Payer: Quartz Beloit One Network |
$2,289.12
|
| Rate for Payer: Quartz Commercial |
$2,803.01
|
| Rate for Payer: WEA Trust Commercial |
$2,569.42
|
| Rate for Payer: WPS Commercial |
$3,460.19
|
|
|
KNEE PATELLECTOMY
|
Facility
|
OP
|
$4,492.00
|
|
| Hospital Charge Code |
2960308
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,308.07 |
| Max. Negotiated Rate |
$4,297.95 |
| Rate for Payer: Aetna Commercial |
$4,204.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,017.64
|
| Rate for Payer: Aetna Managed Medicare |
$1,308.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,036.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,335.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,242.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,475.99
|
| Rate for Payer: Cash Price |
$1,347.60
|
| Rate for Payer: Cigna Commercial |
$4,297.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,614.34
|
| Rate for Payer: Health EOS Commercial |
$4,157.80
|
| Rate for Payer: HFN Commercial |
$4,297.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,503.76
|
| Rate for Payer: Multiplan Commercial |
$3,737.34
|
| Rate for Payer: NAPHCARE Commercial |
$2,803.01
|
| Rate for Payer: Preferred Network Access Commercial |
$4,297.95
|
| Rate for Payer: Quartz Beloit One Network |
$2,289.12
|
| Rate for Payer: Quartz Commercial |
$3,036.59
|
| Rate for Payer: Quartz Medicare Advantage |
$2,803.01
|
| Rate for Payer: The Alliance Commercial |
$2,335.84
|
| Rate for Payer: WEA Trust Commercial |
$2,569.42
|
| Rate for Payer: WPS Commercial |
$3,460.19
|
|
|
KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC
|
Facility
|
IP
|
$58,579.04
|
|
|
Service Code
|
MSDRG 488
|
| Min. Negotiated Rate |
$14,053.36 |
| Max. Negotiated Rate |
$58,579.04 |
| Rate for Payer: Aetna Managed Medicare |
$14,053.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33,243.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25,481.05
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24,208.66
|
| Rate for Payer: Anthem Medicare Advantage |
$14,053.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14,053.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14,053.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14,053.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26,873.84
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14,053.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42,721.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14,053.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14,053.36
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14,053.36
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14,053.36
|
| Rate for Payer: NAPHCARE Commercial |
$21,080.05
|
| Rate for Payer: Quartz Medicare Advantage |
$14,053.36
|
| Rate for Payer: The Alliance Commercial |
$58,579.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14,053.36
|
| Rate for Payer: United Healthcare PPO |
$33,259.50
|
| Rate for Payer: Wellcare Medicare |
$14,053.36
|
|
|
KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC
|
Facility
|
IP
|
$34,555.04
|
|
|
Service Code
|
MSDRG 489
|
| Min. Negotiated Rate |
$9,059.45 |
| Max. Negotiated Rate |
$34,555.04 |
| Rate for Payer: Aetna Managed Medicare |
$9,059.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$24,367.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,677.63
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,744.97
|
| Rate for Payer: Anthem Medicare Advantage |
$9,059.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,059.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,059.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,059.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19,698.54
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,059.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25,100.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,059.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9,059.45
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9,059.45
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,059.45
|
| Rate for Payer: NAPHCARE Commercial |
$13,589.18
|
| Rate for Payer: Quartz Medicare Advantage |
$9,059.45
|
| Rate for Payer: The Alliance Commercial |
$34,555.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,059.45
|
| Rate for Payer: United Healthcare PPO |
$19,541.10
|
| Rate for Payer: Wellcare Medicare |
$9,059.45
|
|
|
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC
|
Facility
|
IP
|
$55,861.52
|
|
|
Service Code
|
MSDRG 486
|
| Min. Negotiated Rate |
$16,520.83 |
| Max. Negotiated Rate |
$55,861.52 |
| Rate for Payer: Aetna Managed Medicare |
$16,520.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45,626.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$34,972.06
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$33,225.74
|
| Rate for Payer: Anthem Medicare Advantage |
$16,520.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16,520.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16,520.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16,520.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36,883.62
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16,520.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40,728.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16,520.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16,520.83
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16,520.83
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16,520.83
|
| Rate for Payer: NAPHCARE Commercial |
$24,781.24
|
| Rate for Payer: Quartz Medicare Advantage |
$16,520.83
|
| Rate for Payer: The Alliance Commercial |
$55,861.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16,520.83
|
| Rate for Payer: United Healthcare PPO |
$31,707.52
|
| Rate for Payer: Wellcare Medicare |
$16,520.83
|
|
|
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC
|
Facility
|
IP
|
$91,410.80
|
|
|
Service Code
|
MSDRG 485
|
| Min. Negotiated Rate |
$25,220.55 |
| Max. Negotiated Rate |
$91,410.80 |
| Rate for Payer: Aetna Managed Medicare |
$25,220.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$70,412.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$53,970.79
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$51,275.78
|
| Rate for Payer: Anthem Medicare Advantage |
$25,220.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25,220.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25,220.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$25,220.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$56,920.82
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$25,220.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66,802.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$25,220.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25,220.55
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$25,220.55
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$25,220.55
|
| Rate for Payer: NAPHCARE Commercial |
$37,830.83
|
| Rate for Payer: Quartz Medicare Advantage |
$25,220.55
|
| Rate for Payer: The Alliance Commercial |
$91,410.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25,220.55
|
| Rate for Payer: United Healthcare PPO |
$52,006.46
|
| Rate for Payer: Wellcare Medicare |
$25,220.55
|
|
|
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC
|
Facility
|
IP
|
$43,048.72
|
|
|
Service Code
|
MSDRG 487
|
| Min. Negotiated Rate |
$12,501.05 |
| Max. Negotiated Rate |
$43,048.72 |
| Rate for Payer: Aetna Managed Medicare |
$12,501.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$34,173.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26,193.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24,885.54
|
| Rate for Payer: Anthem Medicare Advantage |
$12,501.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12,501.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12,501.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12,501.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27,625.23
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12,501.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31,330.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12,501.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12,501.05
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12,501.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12,501.05
|
| Rate for Payer: NAPHCARE Commercial |
$18,751.57
|
| Rate for Payer: Quartz Medicare Advantage |
$12,501.05
|
| Rate for Payer: The Alliance Commercial |
$43,048.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,501.05
|
| Rate for Payer: United Healthcare PPO |
$24,391.26
|
| Rate for Payer: Wellcare Medicare |
$12,501.05
|
|
|
KNEE SUPPORT MED WITH OPEN PATELLA NE7702-73
|
Facility
|
IP
|
$133.00
|
|
| Hospital Charge Code |
2974247
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$67.78 |
| Max. Negotiated Rate |
$127.25 |
| Rate for Payer: Aetna Commercial |
$124.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.31
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna Commercial |
$127.25
|
| Rate for Payer: Health EOS Commercial |
$123.10
|
| Rate for Payer: HFN Commercial |
$127.25
|
| Rate for Payer: Multiplan Commercial |
$110.66
|
| Rate for Payer: Preferred Network Access Commercial |
$127.25
|
| Rate for Payer: Quartz Beloit One Network |
$67.78
|
| Rate for Payer: Quartz Commercial |
$82.99
|
| Rate for Payer: WEA Trust Commercial |
$76.08
|
| Rate for Payer: WPS Commercial |
$102.45
|
|
|
KNEE SUPPORT MED WITH OPEN PATELLA NE7702-73
|
Facility
|
OP
|
$133.00
|
|
| Hospital Charge Code |
2974247
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$38.73 |
| Max. Negotiated Rate |
$127.25 |
| Rate for Payer: Aetna Commercial |
$124.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.96
|
| Rate for Payer: Aetna Managed Medicare |
$38.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$89.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$69.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$66.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.31
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna Commercial |
$127.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$77.41
|
| Rate for Payer: Health EOS Commercial |
$123.10
|
| Rate for Payer: HFN Commercial |
$127.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$103.74
|
| Rate for Payer: Multiplan Commercial |
$110.66
|
| Rate for Payer: NAPHCARE Commercial |
$82.99
|
| Rate for Payer: Preferred Network Access Commercial |
$127.25
|
| Rate for Payer: Quartz Beloit One Network |
$67.78
|
| Rate for Payer: Quartz Commercial |
$89.91
|
| Rate for Payer: Quartz Medicare Advantage |
$82.99
|
| Rate for Payer: The Alliance Commercial |
$69.16
|
| Rate for Payer: WEA Trust Commercial |
$76.08
|
| Rate for Payer: WPS Commercial |
$102.45
|
|
|
KNEE, TENDON & NERVE REPAIR
|
Facility
|
IP
|
$4,170.00
|
|
| Hospital Charge Code |
2960424
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,125.03 |
| Max. Negotiated Rate |
$3,989.86 |
| Rate for Payer: Aetna Commercial |
$3,903.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,729.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,298.50
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cigna Commercial |
$3,989.86
|
| Rate for Payer: Health EOS Commercial |
$3,859.75
|
| Rate for Payer: HFN Commercial |
$3,989.86
|
| Rate for Payer: Multiplan Commercial |
$3,469.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,989.86
|
| Rate for Payer: Quartz Beloit One Network |
$2,125.03
|
| Rate for Payer: Quartz Commercial |
$2,602.08
|
| Rate for Payer: WEA Trust Commercial |
$2,385.24
|
| Rate for Payer: WPS Commercial |
$3,212.15
|
|
