|
ARTICULAR SURFACE YELLOW EF 14MM LCCK 5994-32-14
|
Facility
IP
|
$10,348.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2973996
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,070.52 |
| Max. Negotiated Rate |
$9,520.16 |
| Rate for Payer: Aetna Commercial |
$9,313.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,484.44
|
| Rate for Payer: Cash Price |
$3,104.40
|
| Rate for Payer: Cigna Commercial |
$9,520.16
|
| Rate for Payer: Health EOS Commercial |
$9,209.72
|
| Rate for Payer: HFN Commercial |
$9,520.16
|
| Rate for Payer: Multiplan Commercial |
$8,278.40
|
| Rate for Payer: NAPHCARE Commercial |
$6,208.80
|
| Rate for Payer: Preferred Network Access Commercial |
$9,520.16
|
| Rate for Payer: Quartz Beloit One Network |
$5,070.52
|
| Rate for Payer: Quartz Commercial |
$6,208.80
|
| Rate for Payer: WEA Trust Commercial |
$5,691.40
|
| Rate for Payer: WPS Commercial |
$7,664.76
|
|
|
ARTICULAR SURFACE YELLOW EF 17MM LCCK 5994-32-17
|
Facility
IP
|
$10,348.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2974007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,070.52 |
| Max. Negotiated Rate |
$9,520.16 |
| Rate for Payer: Aetna Commercial |
$9,313.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,484.44
|
| Rate for Payer: Cash Price |
$3,104.40
|
| Rate for Payer: Cigna Commercial |
$9,520.16
|
| Rate for Payer: Health EOS Commercial |
$9,209.72
|
| Rate for Payer: HFN Commercial |
$9,520.16
|
| Rate for Payer: Multiplan Commercial |
$8,278.40
|
| Rate for Payer: NAPHCARE Commercial |
$6,208.80
|
| Rate for Payer: Preferred Network Access Commercial |
$9,520.16
|
| Rate for Payer: Quartz Beloit One Network |
$5,070.52
|
| Rate for Payer: Quartz Commercial |
$6,208.80
|
| Rate for Payer: WEA Trust Commercial |
$5,691.40
|
| Rate for Payer: WPS Commercial |
$7,664.76
|
|
|
ARTICULAR SURFACE YELLOW EF 17MM LCCK 5994-32-17
|
Facility
OP
|
$10,348.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2974007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,897.44 |
| Max. Negotiated Rate |
$9,520.16 |
| Rate for Payer: Aetna Commercial |
$9,313.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,899.28
|
| Rate for Payer: Aetna Managed Medicare |
$2,897.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,726.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,174.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,967.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,484.44
|
| Rate for Payer: Cash Price |
$3,104.40
|
| Rate for Payer: Cigna Commercial |
$9,520.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,790.74
|
| Rate for Payer: Health EOS Commercial |
$9,209.72
|
| Rate for Payer: HFN Commercial |
$9,520.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,761.00
|
| Rate for Payer: Multiplan Commercial |
$8,278.40
|
| Rate for Payer: NAPHCARE Commercial |
$6,208.80
|
| Rate for Payer: Preferred Network Access Commercial |
$9,520.16
|
| Rate for Payer: Quartz Beloit One Network |
$5,070.52
|
| Rate for Payer: Quartz Commercial |
$6,726.20
|
| Rate for Payer: Quartz Medicare Advantage |
$6,208.80
|
| Rate for Payer: WEA Trust Commercial |
$5,691.40
|
| Rate for Payer: WPS Commercial |
$7,664.76
|
|
|
ARTICULATE SURFACE 5-6/13MM PS 71453223
|
Facility
OP
|
$13,706.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3072569
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,837.68 |
| Max. Negotiated Rate |
$12,609.52 |
| Rate for Payer: Aetna Commercial |
$12,335.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,787.16
|
| Rate for Payer: Aetna Managed Medicare |
$3,837.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,908.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,853.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,578.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,264.18
|
| Rate for Payer: Cash Price |
$4,111.80
|
| Rate for Payer: Cigna Commercial |
$12,609.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,669.88
|
| Rate for Payer: Health EOS Commercial |
$12,198.34
|
| Rate for Payer: HFN Commercial |
$12,609.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,279.50
|
| Rate for Payer: Multiplan Commercial |
$10,964.80
|
| Rate for Payer: NAPHCARE Commercial |
$8,223.60
|
| Rate for Payer: Preferred Network Access Commercial |
$12,609.52
|
| Rate for Payer: Quartz Beloit One Network |
$6,715.94
|
| Rate for Payer: Quartz Commercial |
$8,908.90
|
| Rate for Payer: Quartz Medicare Advantage |
$8,223.60
|
| Rate for Payer: WEA Trust Commercial |
$7,538.30
|
| Rate for Payer: WPS Commercial |
$10,152.03
|
|
|
ARTICULATE SURFACE 5-6/13MM PS 71453223
|
Facility
IP
|
$13,706.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3072569
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,715.94 |
| Max. Negotiated Rate |
$12,609.52 |
| Rate for Payer: Aetna Commercial |
$12,335.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,264.18
|
| Rate for Payer: Cash Price |
$4,111.80
|
| Rate for Payer: Cigna Commercial |
$12,609.52
|
| Rate for Payer: Health EOS Commercial |
$12,198.34
|
| Rate for Payer: HFN Commercial |
$12,609.52
|
| Rate for Payer: Multiplan Commercial |
$10,964.80
|
| Rate for Payer: NAPHCARE Commercial |
$8,223.60
|
| Rate for Payer: Preferred Network Access Commercial |
$12,609.52
|
| Rate for Payer: Quartz Beloit One Network |
$6,715.94
|
| Rate for Payer: Quartz Commercial |
$8,223.60
|
| Rate for Payer: WEA Trust Commercial |
$7,538.30
|
| Rate for Payer: WPS Commercial |
$10,152.03
|
|
|
ARTICULATE SURFACE PROLONG GH 5-6 14MM 5962-42-14
|
Facility
OP
|
$9,011.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967622
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,523.08 |
| Max. Negotiated Rate |
$8,290.12 |
| Rate for Payer: Aetna Commercial |
$8,109.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,749.46
|
| Rate for Payer: Aetna Managed Medicare |
$2,523.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,857.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,505.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,325.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,775.83
|
| Rate for Payer: Cash Price |
$2,703.30
|
| Rate for Payer: Cigna Commercial |
$8,290.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,042.56
|
| Rate for Payer: Health EOS Commercial |
$8,019.79
|
| Rate for Payer: HFN Commercial |
$8,290.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,758.25
|
| Rate for Payer: Multiplan Commercial |
$7,208.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,406.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,290.12
|
| Rate for Payer: Quartz Beloit One Network |
$4,415.39
|
| Rate for Payer: Quartz Commercial |
$5,857.15
|
| Rate for Payer: Quartz Medicare Advantage |
$5,406.60
|
| Rate for Payer: WEA Trust Commercial |
$4,956.05
|
| Rate for Payer: WPS Commercial |
$6,674.45
|
|
|
ARTICULATE SURFACE PROLONG GH 5-6 14MM 5962-42-14
|
Facility
IP
|
$9,011.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967622
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,415.39 |
| Max. Negotiated Rate |
$8,290.12 |
| Rate for Payer: Aetna Commercial |
$8,109.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,775.83
|
| Rate for Payer: Cash Price |
$2,703.30
|
| Rate for Payer: Cigna Commercial |
$8,290.12
|
| Rate for Payer: Health EOS Commercial |
$8,019.79
|
| Rate for Payer: HFN Commercial |
$8,290.12
|
| Rate for Payer: Multiplan Commercial |
$7,208.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,406.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,290.12
|
| Rate for Payer: Quartz Beloit One Network |
$4,415.39
|
| Rate for Payer: Quartz Commercial |
$5,406.60
|
| Rate for Payer: WEA Trust Commercial |
$4,956.05
|
| Rate for Payer: WPS Commercial |
$6,674.45
|
|
|
ARTICULATE SURFACE PSN CR VE 11MM 3-11 EF LT 42-5120-005-11
|
Facility
OP
|
$8,771.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4106951
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,455.88 |
| Max. Negotiated Rate |
$8,069.32 |
| Rate for Payer: Aetna Commercial |
$7,893.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,543.06
|
| Rate for Payer: Aetna Managed Medicare |
$2,455.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,701.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,385.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,210.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,648.63
|
| Rate for Payer: Cash Price |
$2,631.30
|
| Rate for Payer: Cigna Commercial |
$8,069.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,908.25
|
| Rate for Payer: Health EOS Commercial |
$7,806.19
|
| Rate for Payer: HFN Commercial |
$8,069.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,578.25
|
| Rate for Payer: Multiplan Commercial |
$7,016.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,262.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,069.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,297.79
|
| Rate for Payer: Quartz Commercial |
$5,701.15
|
| Rate for Payer: Quartz Medicare Advantage |
$5,262.60
|
| Rate for Payer: WEA Trust Commercial |
$4,824.05
|
| Rate for Payer: WPS Commercial |
$6,496.68
|
|
|
ARTICULATE SURFACE PSN CR VE 11MM 3-11 EF LT 42-5120-005-11
|
Facility
IP
|
$8,771.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4106951
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,297.79 |
| Max. Negotiated Rate |
$8,069.32 |
| Rate for Payer: Aetna Commercial |
$7,893.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,648.63
|
| Rate for Payer: Cash Price |
$2,631.30
|
| Rate for Payer: Cigna Commercial |
$8,069.32
|
| Rate for Payer: Health EOS Commercial |
$7,806.19
|
| Rate for Payer: HFN Commercial |
$8,069.32
|
| Rate for Payer: Multiplan Commercial |
$7,016.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,262.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,069.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,297.79
|
| Rate for Payer: Quartz Commercial |
$5,262.60
|
| Rate for Payer: WEA Trust Commercial |
$4,824.05
|
| Rate for Payer: WPS Commercial |
$6,496.68
|
|
|
ARTICULATE SURFACE ROTATING HINGE NEXGEN SZ D 17MM 00-5880-040-17
|
Facility
OP
|
$9,179.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6192972
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,570.12 |
| Max. Negotiated Rate |
$8,444.68 |
| Rate for Payer: Aetna Commercial |
$8,261.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,893.94
|
| Rate for Payer: Aetna Managed Medicare |
$2,570.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,966.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,589.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,405.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,864.87
|
| Rate for Payer: Cash Price |
$2,753.70
|
| Rate for Payer: Cigna Commercial |
$8,444.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,136.57
|
| Rate for Payer: Health EOS Commercial |
$8,169.31
|
| Rate for Payer: HFN Commercial |
$8,444.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,884.25
|
| Rate for Payer: Multiplan Commercial |
$7,343.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,507.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,444.68
|
| Rate for Payer: Quartz Beloit One Network |
$4,497.71
|
| Rate for Payer: Quartz Commercial |
$5,966.35
|
| Rate for Payer: Quartz Medicare Advantage |
$5,507.40
|
| Rate for Payer: WEA Trust Commercial |
$5,048.45
|
| Rate for Payer: WPS Commercial |
$6,798.89
|
|
|
ARTICULATE SURFACE ROTATING HINGE NEXGEN SZ D 17MM 00-5880-040-17
|
Facility
IP
|
$9,179.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6192972
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,497.71 |
| Max. Negotiated Rate |
$8,444.68 |
| Rate for Payer: Aetna Commercial |
$8,261.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,864.87
|
| Rate for Payer: Cash Price |
$2,753.70
|
| Rate for Payer: Cigna Commercial |
$8,444.68
|
| Rate for Payer: Health EOS Commercial |
$8,169.31
|
| Rate for Payer: HFN Commercial |
$8,444.68
|
| Rate for Payer: Multiplan Commercial |
$7,343.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,507.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,444.68
|
| Rate for Payer: Quartz Beloit One Network |
$4,497.71
|
| Rate for Payer: Quartz Commercial |
$5,507.40
|
| Rate for Payer: WEA Trust Commercial |
$5,048.45
|
| Rate for Payer: WPS Commercial |
$6,798.89
|
|
|
ART LINE INSERT SAMPLING/MONITORING/TRANSFUSION
|
Facility
OP
|
$648.00
|
|
|
Service Code
|
CPT 36620
|
| Hospital Charge Code |
5464767
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$181.44 |
| Max. Negotiated Rate |
$12,148.04 |
| Rate for Payer: Aetna Commercial |
$583.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$557.28
|
| Rate for Payer: Aetna Managed Medicare |
$181.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$421.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$324.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$311.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$343.44
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cigna Commercial |
$596.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Health EOS Commercial |
$576.72
|
| Rate for Payer: HFN Commercial |
$596.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$486.00
|
| Rate for Payer: Multiplan Commercial |
$518.40
|
| Rate for Payer: NAPHCARE Commercial |
$388.80
|
| Rate for Payer: Preferred Network Access Commercial |
$596.16
|
| Rate for Payer: Quartz Beloit One Network |
$317.52
|
| Rate for Payer: Quartz Commercial |
$421.20
|
| Rate for Payer: Quartz Medicare Advantage |
$388.80
|
| Rate for Payer: The Alliance Commercial |
$12,148.04
|
| Rate for Payer: WEA Trust Commercial |
$356.40
|
| Rate for Payer: WPS Commercial |
$479.97
|
|
|
ART LINE INSERT SAMPLING/MONITORING/TRANSFUSION
|
Facility
IP
|
$648.00
|
|
|
Service Code
|
CPT 36620
|
| Hospital Charge Code |
5464767
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$317.52 |
| Max. Negotiated Rate |
$596.16 |
| Rate for Payer: Aetna Commercial |
$583.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$343.44
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cigna Commercial |
$596.16
|
| Rate for Payer: Health EOS Commercial |
$576.72
|
| Rate for Payer: HFN Commercial |
$596.16
|
| Rate for Payer: Multiplan Commercial |
$518.40
|
| Rate for Payer: NAPHCARE Commercial |
$388.80
|
| Rate for Payer: Preferred Network Access Commercial |
$596.16
|
| Rate for Payer: Quartz Beloit One Network |
$317.52
|
| Rate for Payer: Quartz Commercial |
$388.80
|
| Rate for Payer: WEA Trust Commercial |
$356.40
|
| Rate for Payer: WPS Commercial |
$479.97
|
|
|
ART SURFACE CD/3-4 10MM 5994-30-10
|
Facility
OP
|
$10,062.00
|
|
| Hospital Charge Code |
2969427
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,817.36 |
| Max. Negotiated Rate |
$40,248.00 |
| Rate for Payer: Aetna Commercial |
$9,055.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,653.32
|
| Rate for Payer: Aetna Managed Medicare |
$2,817.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,540.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,031.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,829.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,332.86
|
| Rate for Payer: Cash Price |
$3,018.60
|
| Rate for Payer: Cigna Commercial |
$9,257.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,630.70
|
| Rate for Payer: Health EOS Commercial |
$8,955.18
|
| Rate for Payer: HFN Commercial |
$9,257.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,546.50
|
| Rate for Payer: Multiplan Commercial |
$8,049.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,037.20
|
| Rate for Payer: Preferred Network Access Commercial |
$9,257.04
|
| Rate for Payer: Quartz Beloit One Network |
$4,930.38
|
| Rate for Payer: Quartz Commercial |
$6,540.30
|
| Rate for Payer: Quartz Medicare Advantage |
$6,037.20
|
| Rate for Payer: The Alliance Commercial |
$40,248.00
|
| Rate for Payer: WEA Trust Commercial |
$5,534.10
|
| Rate for Payer: WPS Commercial |
$7,452.92
|
|
|
ART SURFACE CD/3-4 10MM 5994-30-10
|
Facility
IP
|
$10,062.00
|
|
| Hospital Charge Code |
2969427
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,930.38 |
| Max. Negotiated Rate |
$9,257.04 |
| Rate for Payer: Aetna Commercial |
$9,055.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,332.86
|
| Rate for Payer: Cash Price |
$3,018.60
|
| Rate for Payer: Cigna Commercial |
$9,257.04
|
| Rate for Payer: Health EOS Commercial |
$8,955.18
|
| Rate for Payer: HFN Commercial |
$9,257.04
|
| Rate for Payer: Multiplan Commercial |
$8,049.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,037.20
|
| Rate for Payer: Preferred Network Access Commercial |
$9,257.04
|
| Rate for Payer: Quartz Beloit One Network |
$4,930.38
|
| Rate for Payer: Quartz Commercial |
$6,037.20
|
| Rate for Payer: WEA Trust Commercial |
$5,534.10
|
| Rate for Payer: WPS Commercial |
$7,452.92
|
|
|
ART SURFACE PSN CR VE 3-11 EF 14MM RT 42-5220-005-14
|
Facility
OP
|
$8,446.00
|
|
| Hospital Charge Code |
4641025
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,364.88 |
| Max. Negotiated Rate |
$33,784.00 |
| Rate for Payer: Aetna Commercial |
$7,601.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,263.56
|
| Rate for Payer: Aetna Managed Medicare |
$2,364.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,489.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,223.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,054.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,476.38
|
| Rate for Payer: Cash Price |
$2,533.80
|
| Rate for Payer: Cigna Commercial |
$7,770.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,726.38
|
| Rate for Payer: Health EOS Commercial |
$7,516.94
|
| Rate for Payer: HFN Commercial |
$7,770.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,334.50
|
| Rate for Payer: Multiplan Commercial |
$6,756.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,067.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,770.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,138.54
|
| Rate for Payer: Quartz Commercial |
$5,489.90
|
| Rate for Payer: Quartz Medicare Advantage |
$5,067.60
|
| Rate for Payer: The Alliance Commercial |
$33,784.00
|
| Rate for Payer: WEA Trust Commercial |
$4,645.30
|
| Rate for Payer: WPS Commercial |
$6,255.95
|
|
|
ART SURFACE PSN CR VE 3-11 EF 14MM RT 42-5220-005-14
|
Facility
IP
|
$8,446.00
|
|
| Hospital Charge Code |
4641025
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,138.54 |
| Max. Negotiated Rate |
$7,770.32 |
| Rate for Payer: Aetna Commercial |
$7,601.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,476.38
|
| Rate for Payer: Cash Price |
$2,533.80
|
| Rate for Payer: Cigna Commercial |
$7,770.32
|
| Rate for Payer: Health EOS Commercial |
$7,516.94
|
| Rate for Payer: HFN Commercial |
$7,770.32
|
| Rate for Payer: Multiplan Commercial |
$6,756.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,067.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,770.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,138.54
|
| Rate for Payer: Quartz Commercial |
$5,067.60
|
| Rate for Payer: WEA Trust Commercial |
$4,645.30
|
| Rate for Payer: WPS Commercial |
$6,255.95
|
|
|
ART SURFACE PSN CR VE 3-11 EF 16MM RT 42-5220-005-16
|
Facility
OP
|
$8,446.00
|
|
| Hospital Charge Code |
4641026
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,364.88 |
| Max. Negotiated Rate |
$33,784.00 |
| Rate for Payer: Aetna Commercial |
$7,601.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,263.56
|
| Rate for Payer: Aetna Managed Medicare |
$2,364.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,489.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,223.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,054.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,476.38
|
| Rate for Payer: Cash Price |
$2,533.80
|
| Rate for Payer: Cigna Commercial |
$7,770.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,726.38
|
| Rate for Payer: Health EOS Commercial |
$7,516.94
|
| Rate for Payer: HFN Commercial |
$7,770.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,334.50
|
| Rate for Payer: Multiplan Commercial |
$6,756.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,067.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,770.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,138.54
|
| Rate for Payer: Quartz Commercial |
$5,489.90
|
| Rate for Payer: Quartz Medicare Advantage |
$5,067.60
|
| Rate for Payer: The Alliance Commercial |
$33,784.00
|
| Rate for Payer: WEA Trust Commercial |
$4,645.30
|
| Rate for Payer: WPS Commercial |
$6,255.95
|
|
|
ART SURFACE PSN CR VE 3-11 EF 16MM RT 42-5220-005-16
|
Facility
IP
|
$8,446.00
|
|
| Hospital Charge Code |
4641026
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,138.54 |
| Max. Negotiated Rate |
$7,770.32 |
| Rate for Payer: Aetna Commercial |
$7,601.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,476.38
|
| Rate for Payer: Cash Price |
$2,533.80
|
| Rate for Payer: Cigna Commercial |
$7,770.32
|
| Rate for Payer: Health EOS Commercial |
$7,516.94
|
| Rate for Payer: HFN Commercial |
$7,770.32
|
| Rate for Payer: Multiplan Commercial |
$6,756.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,067.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,770.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,138.54
|
| Rate for Payer: Quartz Commercial |
$5,067.60
|
| Rate for Payer: WEA Trust Commercial |
$4,645.30
|
| Rate for Payer: WPS Commercial |
$6,255.95
|
|
|
ART SURFACE PSN CR VE 3-11 EF 18MM RT 42-5220-005-18
|
Facility
OP
|
$8,446.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
4641027
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,364.88 |
| Max. Negotiated Rate |
$7,770.32 |
| Rate for Payer: Aetna Commercial |
$7,601.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,263.56
|
| Rate for Payer: Aetna Managed Medicare |
$2,364.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,489.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,223.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,054.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,476.38
|
| Rate for Payer: Cash Price |
$2,533.80
|
| Rate for Payer: Cigna Commercial |
$7,770.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,726.38
|
| Rate for Payer: Health EOS Commercial |
$7,516.94
|
| Rate for Payer: HFN Commercial |
$7,770.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,334.50
|
| Rate for Payer: Multiplan Commercial |
$6,756.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,067.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,770.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,138.54
|
| Rate for Payer: Quartz Commercial |
$5,489.90
|
| Rate for Payer: Quartz Medicare Advantage |
$5,067.60
|
| Rate for Payer: WEA Trust Commercial |
$4,645.30
|
| Rate for Payer: WPS Commercial |
$6,255.95
|
|
|
ART SURFACE PSN CR VE 3-11 EF 18MM RT 42-5220-005-18
|
Facility
IP
|
$8,446.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
4641027
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,138.54 |
| Max. Negotiated Rate |
$7,770.32 |
| Rate for Payer: Aetna Commercial |
$7,601.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,476.38
|
| Rate for Payer: Cash Price |
$2,533.80
|
| Rate for Payer: Cigna Commercial |
$7,770.32
|
| Rate for Payer: Health EOS Commercial |
$7,516.94
|
| Rate for Payer: HFN Commercial |
$7,770.32
|
| Rate for Payer: Multiplan Commercial |
$6,756.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,067.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,770.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,138.54
|
| Rate for Payer: Quartz Commercial |
$5,067.60
|
| Rate for Payer: WEA Trust Commercial |
$4,645.30
|
| Rate for Payer: WPS Commercial |
$6,255.95
|
|
|
ART SURFACE PSN CR VE 7-12 GH 13MM RT 42-5220-006-13
|
Facility
IP
|
$8,446.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
4641028
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,138.54 |
| Max. Negotiated Rate |
$7,770.32 |
| Rate for Payer: Aetna Commercial |
$7,601.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,476.38
|
| Rate for Payer: Cash Price |
$2,533.80
|
| Rate for Payer: Cigna Commercial |
$7,770.32
|
| Rate for Payer: Health EOS Commercial |
$7,516.94
|
| Rate for Payer: HFN Commercial |
$7,770.32
|
| Rate for Payer: Multiplan Commercial |
$6,756.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,067.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,770.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,138.54
|
| Rate for Payer: Quartz Commercial |
$5,067.60
|
| Rate for Payer: WEA Trust Commercial |
$4,645.30
|
| Rate for Payer: WPS Commercial |
$6,255.95
|
|
|
ART SURFACE PSN CR VE 7-12 GH 13MM RT 42-5220-006-13
|
Facility
OP
|
$8,446.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
4641028
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,364.88 |
| Max. Negotiated Rate |
$7,770.32 |
| Rate for Payer: Aetna Commercial |
$7,601.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,263.56
|
| Rate for Payer: Aetna Managed Medicare |
$2,364.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,489.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,223.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,054.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,476.38
|
| Rate for Payer: Cash Price |
$2,533.80
|
| Rate for Payer: Cigna Commercial |
$7,770.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,726.38
|
| Rate for Payer: Health EOS Commercial |
$7,516.94
|
| Rate for Payer: HFN Commercial |
$7,770.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,334.50
|
| Rate for Payer: Multiplan Commercial |
$6,756.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,067.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,770.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,138.54
|
| Rate for Payer: Quartz Commercial |
$5,489.90
|
| Rate for Payer: Quartz Medicare Advantage |
$5,067.60
|
| Rate for Payer: WEA Trust Commercial |
$4,645.30
|
| Rate for Payer: WPS Commercial |
$6,255.95
|
|
|
ART SURFACE PSN CR VE 7-12 GH 16MM RT 42-5220-006-16
|
Facility
IP
|
$8,446.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
4641029
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,138.54 |
| Max. Negotiated Rate |
$7,770.32 |
| Rate for Payer: Aetna Commercial |
$7,601.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,476.38
|
| Rate for Payer: Cash Price |
$2,533.80
|
| Rate for Payer: Cigna Commercial |
$7,770.32
|
| Rate for Payer: Health EOS Commercial |
$7,516.94
|
| Rate for Payer: HFN Commercial |
$7,770.32
|
| Rate for Payer: Multiplan Commercial |
$6,756.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,067.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,770.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,138.54
|
| Rate for Payer: Quartz Commercial |
$5,067.60
|
| Rate for Payer: WEA Trust Commercial |
$4,645.30
|
| Rate for Payer: WPS Commercial |
$6,255.95
|
|
|
ART SURFACE PSN CR VE 7-12 GH 16MM RT 42-5220-006-16
|
Facility
OP
|
$8,446.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
4641029
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,364.88 |
| Max. Negotiated Rate |
$7,770.32 |
| Rate for Payer: Aetna Commercial |
$7,601.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,263.56
|
| Rate for Payer: Aetna Managed Medicare |
$2,364.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,489.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,223.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,054.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,476.38
|
| Rate for Payer: Cash Price |
$2,533.80
|
| Rate for Payer: Cigna Commercial |
$7,770.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,726.38
|
| Rate for Payer: Health EOS Commercial |
$7,516.94
|
| Rate for Payer: HFN Commercial |
$7,770.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,334.50
|
| Rate for Payer: Multiplan Commercial |
$6,756.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,067.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,770.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,138.54
|
| Rate for Payer: Quartz Commercial |
$5,489.90
|
| Rate for Payer: Quartz Medicare Advantage |
$5,067.60
|
| Rate for Payer: WEA Trust Commercial |
$4,645.30
|
| Rate for Payer: WPS Commercial |
$6,255.95
|
|
