|
COMPONENT FEM D-MINUS RT FLEX CR 5950-14-06
|
Facility
OP
|
$18,600.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967652
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,208.00 |
| Max. Negotiated Rate |
$17,112.00 |
| Rate for Payer: Aetna Commercial |
$16,740.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,996.00
|
| Rate for Payer: Aetna Managed Medicare |
$5,208.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,090.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,300.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,928.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,858.00
|
| Rate for Payer: Cash Price |
$5,580.00
|
| Rate for Payer: Cigna Commercial |
$17,112.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,408.56
|
| Rate for Payer: Health EOS Commercial |
$16,554.00
|
| Rate for Payer: HFN Commercial |
$17,112.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,950.00
|
| Rate for Payer: Multiplan Commercial |
$14,880.00
|
| Rate for Payer: NAPHCARE Commercial |
$11,160.00
|
| Rate for Payer: Preferred Network Access Commercial |
$17,112.00
|
| Rate for Payer: Quartz Beloit One Network |
$9,114.00
|
| Rate for Payer: Quartz Commercial |
$12,090.00
|
| Rate for Payer: Quartz Medicare Advantage |
$11,160.00
|
| Rate for Payer: WEA Trust Commercial |
$10,230.00
|
| Rate for Payer: WPS Commercial |
$13,777.02
|
|
|
COMPONENT FEM D-MINUS RT GSF FLEX CR 00-5750-014-06
|
Facility
OP
|
$17,969.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967653
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,031.32 |
| Max. Negotiated Rate |
$16,531.48 |
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,055.45
|
| Rate for Payer: Aetna Commercial |
$16,172.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,453.34
|
| Rate for Payer: Aetna Managed Medicare |
$5,031.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,679.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,984.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,625.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,523.57
|
| Rate for Payer: Cash Price |
$5,390.70
|
| Rate for Payer: Cigna Commercial |
$16,531.48
|
| Rate for Payer: Health EOS Commercial |
$15,992.41
|
| Rate for Payer: HFN Commercial |
$16,531.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,476.75
|
| Rate for Payer: Multiplan Commercial |
$14,375.20
|
| Rate for Payer: NAPHCARE Commercial |
$10,781.40
|
| Rate for Payer: Preferred Network Access Commercial |
$16,531.48
|
| Rate for Payer: Quartz Beloit One Network |
$8,804.81
|
| Rate for Payer: Quartz Commercial |
$11,679.85
|
| Rate for Payer: Quartz Medicare Advantage |
$10,781.40
|
| Rate for Payer: WEA Trust Commercial |
$9,882.95
|
| Rate for Payer: WPS Commercial |
$13,309.64
|
|
|
COMPONENT FEM D-MINUS RT GSF FLEX CR 00-5750-014-06
|
Facility
IP
|
$17,969.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967653
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,804.81 |
| Max. Negotiated Rate |
$16,531.48 |
| Rate for Payer: Aetna Commercial |
$16,172.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,523.57
|
| Rate for Payer: Cash Price |
$5,390.70
|
| Rate for Payer: Cigna Commercial |
$16,531.48
|
| Rate for Payer: Health EOS Commercial |
$15,992.41
|
| Rate for Payer: HFN Commercial |
$16,531.48
|
| Rate for Payer: Multiplan Commercial |
$14,375.20
|
| Rate for Payer: NAPHCARE Commercial |
$10,781.40
|
| Rate for Payer: Preferred Network Access Commercial |
$16,531.48
|
| Rate for Payer: Quartz Beloit One Network |
$8,804.81
|
| Rate for Payer: Quartz Commercial |
$10,781.40
|
| Rate for Payer: WEA Trust Commercial |
$9,882.95
|
| Rate for Payer: WPS Commercial |
$13,309.64
|
|
|
COMPONENT FEM D-RT 5950-14-02 FLEX CR PRECOAT
|
Facility
OP
|
$18,600.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967654
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,208.00 |
| Max. Negotiated Rate |
$17,112.00 |
| Rate for Payer: Aetna Commercial |
$16,740.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,996.00
|
| Rate for Payer: Aetna Managed Medicare |
$5,208.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,090.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,300.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,928.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,858.00
|
| Rate for Payer: Cash Price |
$5,580.00
|
| Rate for Payer: Cigna Commercial |
$17,112.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,408.56
|
| Rate for Payer: Health EOS Commercial |
$16,554.00
|
| Rate for Payer: HFN Commercial |
$17,112.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,950.00
|
| Rate for Payer: Multiplan Commercial |
$14,880.00
|
| Rate for Payer: NAPHCARE Commercial |
$11,160.00
|
| Rate for Payer: Preferred Network Access Commercial |
$17,112.00
|
| Rate for Payer: Quartz Beloit One Network |
$9,114.00
|
| Rate for Payer: Quartz Commercial |
$12,090.00
|
| Rate for Payer: Quartz Medicare Advantage |
$11,160.00
|
| Rate for Payer: WEA Trust Commercial |
$10,230.00
|
| Rate for Payer: WPS Commercial |
$13,777.02
|
|
|
COMPONENT FEM D-RT 5950-14-02 FLEX CR PRECOAT
|
Facility
IP
|
$18,600.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967654
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,114.00 |
| Max. Negotiated Rate |
$17,112.00 |
| Rate for Payer: Aetna Commercial |
$16,740.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,858.00
|
| Rate for Payer: Cash Price |
$5,580.00
|
| Rate for Payer: Cigna Commercial |
$17,112.00
|
| Rate for Payer: Health EOS Commercial |
$16,554.00
|
| Rate for Payer: HFN Commercial |
$17,112.00
|
| Rate for Payer: Multiplan Commercial |
$14,880.00
|
| Rate for Payer: NAPHCARE Commercial |
$11,160.00
|
| Rate for Payer: Preferred Network Access Commercial |
$17,112.00
|
| Rate for Payer: Quartz Beloit One Network |
$9,114.00
|
| Rate for Payer: Quartz Commercial |
$11,160.00
|
| Rate for Payer: WEA Trust Commercial |
$10,230.00
|
| Rate for Payer: WPS Commercial |
$13,777.02
|
|
|
COMPONENT FEM D-RT GSF FLEX CR 00-5750-014-02
|
Facility
IP
|
$17,969.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967655
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,804.81 |
| Max. Negotiated Rate |
$16,531.48 |
| Rate for Payer: Aetna Commercial |
$16,172.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,523.57
|
| Rate for Payer: Cash Price |
$5,390.70
|
| Rate for Payer: Cigna Commercial |
$16,531.48
|
| Rate for Payer: Health EOS Commercial |
$15,992.41
|
| Rate for Payer: HFN Commercial |
$16,531.48
|
| Rate for Payer: Multiplan Commercial |
$14,375.20
|
| Rate for Payer: NAPHCARE Commercial |
$10,781.40
|
| Rate for Payer: Preferred Network Access Commercial |
$16,531.48
|
| Rate for Payer: Quartz Beloit One Network |
$8,804.81
|
| Rate for Payer: Quartz Commercial |
$10,781.40
|
| Rate for Payer: WEA Trust Commercial |
$9,882.95
|
| Rate for Payer: WPS Commercial |
$13,309.64
|
|
|
COMPONENT FEM D-RT GSF FLEX CR 00-5750-014-02
|
Facility
OP
|
$17,969.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967655
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,031.32 |
| Max. Negotiated Rate |
$16,531.48 |
| Rate for Payer: Aetna Commercial |
$16,172.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,453.34
|
| Rate for Payer: Aetna Managed Medicare |
$5,031.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,679.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,984.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,625.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,523.57
|
| Rate for Payer: Cash Price |
$5,390.70
|
| Rate for Payer: Cigna Commercial |
$16,531.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,055.45
|
| Rate for Payer: Health EOS Commercial |
$15,992.41
|
| Rate for Payer: HFN Commercial |
$16,531.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,476.75
|
| Rate for Payer: Multiplan Commercial |
$14,375.20
|
| Rate for Payer: NAPHCARE Commercial |
$10,781.40
|
| Rate for Payer: Preferred Network Access Commercial |
$16,531.48
|
| Rate for Payer: Quartz Beloit One Network |
$8,804.81
|
| Rate for Payer: Quartz Commercial |
$11,679.85
|
| Rate for Payer: Quartz Medicare Advantage |
$10,781.40
|
| Rate for Payer: WEA Trust Commercial |
$9,882.95
|
| Rate for Payer: WPS Commercial |
$13,309.64
|
|
|
COMPONENT FEM E-LT FLEX CR PRECOAT 5950-15-01
|
Facility
IP
|
$18,600.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967656
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,114.00 |
| Max. Negotiated Rate |
$17,112.00 |
| Rate for Payer: Aetna Commercial |
$16,740.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,858.00
|
| Rate for Payer: Cash Price |
$5,580.00
|
| Rate for Payer: Cigna Commercial |
$17,112.00
|
| Rate for Payer: Health EOS Commercial |
$16,554.00
|
| Rate for Payer: HFN Commercial |
$17,112.00
|
| Rate for Payer: Multiplan Commercial |
$14,880.00
|
| Rate for Payer: NAPHCARE Commercial |
$11,160.00
|
| Rate for Payer: Preferred Network Access Commercial |
$17,112.00
|
| Rate for Payer: Quartz Beloit One Network |
$9,114.00
|
| Rate for Payer: Quartz Commercial |
$11,160.00
|
| Rate for Payer: WEA Trust Commercial |
$10,230.00
|
| Rate for Payer: WPS Commercial |
$13,777.02
|
|
|
COMPONENT FEM E-LT FLEX CR PRECOAT 5950-15-01
|
Facility
OP
|
$18,600.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967656
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,208.00 |
| Max. Negotiated Rate |
$17,112.00 |
| Rate for Payer: Aetna Commercial |
$16,740.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,996.00
|
| Rate for Payer: Aetna Managed Medicare |
$5,208.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,090.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,300.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,928.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,858.00
|
| Rate for Payer: Cash Price |
$5,580.00
|
| Rate for Payer: Cigna Commercial |
$17,112.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,408.56
|
| Rate for Payer: Health EOS Commercial |
$16,554.00
|
| Rate for Payer: HFN Commercial |
$17,112.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,950.00
|
| Rate for Payer: Multiplan Commercial |
$14,880.00
|
| Rate for Payer: NAPHCARE Commercial |
$11,160.00
|
| Rate for Payer: Preferred Network Access Commercial |
$17,112.00
|
| Rate for Payer: Quartz Beloit One Network |
$9,114.00
|
| Rate for Payer: Quartz Commercial |
$12,090.00
|
| Rate for Payer: Quartz Medicare Advantage |
$11,160.00
|
| Rate for Payer: WEA Trust Commercial |
$10,230.00
|
| Rate for Payer: WPS Commercial |
$13,777.02
|
|
|
COMPONENT FEM E-LT GSF FLEX CR 00-5750-015-01
|
Facility
OP
|
$17,969.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967657
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,031.32 |
| Max. Negotiated Rate |
$16,531.48 |
| Rate for Payer: Aetna Commercial |
$16,172.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,453.34
|
| Rate for Payer: Aetna Managed Medicare |
$5,031.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,679.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,984.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,625.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,523.57
|
| Rate for Payer: Cash Price |
$5,390.70
|
| Rate for Payer: Cigna Commercial |
$16,531.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,055.45
|
| Rate for Payer: Health EOS Commercial |
$15,992.41
|
| Rate for Payer: HFN Commercial |
$16,531.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,476.75
|
| Rate for Payer: Multiplan Commercial |
$14,375.20
|
| Rate for Payer: NAPHCARE Commercial |
$10,781.40
|
| Rate for Payer: Preferred Network Access Commercial |
$16,531.48
|
| Rate for Payer: Quartz Beloit One Network |
$8,804.81
|
| Rate for Payer: Quartz Commercial |
$11,679.85
|
| Rate for Payer: Quartz Medicare Advantage |
$10,781.40
|
| Rate for Payer: WEA Trust Commercial |
$9,882.95
|
| Rate for Payer: WPS Commercial |
$13,309.64
|
|
|
COMPONENT FEM E-LT GSF FLEX CR 00-5750-015-01
|
Facility
IP
|
$17,969.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967657
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,804.81 |
| Max. Negotiated Rate |
$16,531.48 |
| Rate for Payer: Aetna Commercial |
$16,172.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,523.57
|
| Rate for Payer: Cash Price |
$5,390.70
|
| Rate for Payer: Cigna Commercial |
$16,531.48
|
| Rate for Payer: Health EOS Commercial |
$15,992.41
|
| Rate for Payer: HFN Commercial |
$16,531.48
|
| Rate for Payer: Multiplan Commercial |
$14,375.20
|
| Rate for Payer: NAPHCARE Commercial |
$10,781.40
|
| Rate for Payer: Preferred Network Access Commercial |
$16,531.48
|
| Rate for Payer: Quartz Beloit One Network |
$8,804.81
|
| Rate for Payer: Quartz Commercial |
$10,781.40
|
| Rate for Payer: WEA Trust Commercial |
$9,882.95
|
| Rate for Payer: WPS Commercial |
$13,309.64
|
|
|
COMPONENT FEM E-LT TI-NIDIUM 00-5968-015-51COMPONENT FEM E-LT TI-NIDIUM 00-5968-015-51
|
Facility
OP
|
$24,212.00
|
|
| Hospital Charge Code |
2967455
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,779.36 |
| Max. Negotiated Rate |
$96,848.00 |
| Rate for Payer: Aetna Commercial |
$21,790.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20,822.32
|
| Rate for Payer: Aetna Managed Medicare |
$6,779.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,737.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,106.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,621.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12,832.36
|
| Rate for Payer: Cash Price |
$7,263.60
|
| Rate for Payer: Cigna Commercial |
$22,275.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13,549.04
|
| Rate for Payer: Health EOS Commercial |
$21,548.68
|
| Rate for Payer: HFN Commercial |
$22,275.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18,159.00
|
| Rate for Payer: Multiplan Commercial |
$19,369.60
|
| Rate for Payer: NAPHCARE Commercial |
$14,527.20
|
| Rate for Payer: Preferred Network Access Commercial |
$22,275.04
|
| Rate for Payer: Quartz Beloit One Network |
$11,863.88
|
| Rate for Payer: Quartz Commercial |
$15,737.80
|
| Rate for Payer: Quartz Medicare Advantage |
$14,527.20
|
| Rate for Payer: The Alliance Commercial |
$96,848.00
|
| Rate for Payer: WEA Trust Commercial |
$13,316.60
|
| Rate for Payer: WPS Commercial |
$17,933.83
|
|
|
COMPONENT FEM E-LT TI-NIDIUM 00-5968-015-51COMPONENT FEM E-LT TI-NIDIUM 00-5968-015-51
|
Facility
IP
|
$24,212.00
|
|
| Hospital Charge Code |
2967455
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,863.88 |
| Max. Negotiated Rate |
$22,275.04 |
| Rate for Payer: Aetna Commercial |
$21,790.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12,832.36
|
| Rate for Payer: Cash Price |
$7,263.60
|
| Rate for Payer: Cigna Commercial |
$22,275.04
|
| Rate for Payer: Health EOS Commercial |
$21,548.68
|
| Rate for Payer: HFN Commercial |
$22,275.04
|
| Rate for Payer: Multiplan Commercial |
$19,369.60
|
| Rate for Payer: NAPHCARE Commercial |
$14,527.20
|
| Rate for Payer: Preferred Network Access Commercial |
$22,275.04
|
| Rate for Payer: Quartz Beloit One Network |
$11,863.88
|
| Rate for Payer: Quartz Commercial |
$14,527.20
|
| Rate for Payer: WEA Trust Commercial |
$13,316.60
|
| Rate for Payer: WPS Commercial |
$17,933.83
|
|
|
COMPONENT FEM E-MINUS LT FLEX CR 5950-15-05
|
Facility
OP
|
$18,600.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967658
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,208.00 |
| Max. Negotiated Rate |
$17,112.00 |
| Rate for Payer: Aetna Commercial |
$16,740.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,996.00
|
| Rate for Payer: Aetna Managed Medicare |
$5,208.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,090.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,300.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,928.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,858.00
|
| Rate for Payer: Cash Price |
$5,580.00
|
| Rate for Payer: Cigna Commercial |
$17,112.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,408.56
|
| Rate for Payer: Health EOS Commercial |
$16,554.00
|
| Rate for Payer: HFN Commercial |
$17,112.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,950.00
|
| Rate for Payer: Multiplan Commercial |
$14,880.00
|
| Rate for Payer: NAPHCARE Commercial |
$11,160.00
|
| Rate for Payer: Preferred Network Access Commercial |
$17,112.00
|
| Rate for Payer: Quartz Beloit One Network |
$9,114.00
|
| Rate for Payer: Quartz Commercial |
$12,090.00
|
| Rate for Payer: Quartz Medicare Advantage |
$11,160.00
|
| Rate for Payer: WEA Trust Commercial |
$10,230.00
|
| Rate for Payer: WPS Commercial |
$13,777.02
|
|
|
COMPONENT FEM E-MINUS LT FLEX CR 5950-15-05
|
Facility
IP
|
$18,600.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967658
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,114.00 |
| Max. Negotiated Rate |
$17,112.00 |
| Rate for Payer: Aetna Commercial |
$16,740.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,858.00
|
| Rate for Payer: Cash Price |
$5,580.00
|
| Rate for Payer: Cigna Commercial |
$17,112.00
|
| Rate for Payer: Health EOS Commercial |
$16,554.00
|
| Rate for Payer: HFN Commercial |
$17,112.00
|
| Rate for Payer: Multiplan Commercial |
$14,880.00
|
| Rate for Payer: NAPHCARE Commercial |
$11,160.00
|
| Rate for Payer: Preferred Network Access Commercial |
$17,112.00
|
| Rate for Payer: Quartz Beloit One Network |
$9,114.00
|
| Rate for Payer: Quartz Commercial |
$11,160.00
|
| Rate for Payer: WEA Trust Commercial |
$10,230.00
|
| Rate for Payer: WPS Commercial |
$13,777.02
|
|
|
COMPONENT FEM E-MINUS LT GSF FLEX CR 00-5750-015-05
|
Facility
OP
|
$17,969.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967659
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,031.32 |
| Max. Negotiated Rate |
$16,531.48 |
| Rate for Payer: Aetna Commercial |
$16,172.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,453.34
|
| Rate for Payer: Aetna Managed Medicare |
$5,031.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,679.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,984.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,625.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,523.57
|
| Rate for Payer: Cash Price |
$5,390.70
|
| Rate for Payer: Cigna Commercial |
$16,531.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,055.45
|
| Rate for Payer: Health EOS Commercial |
$15,992.41
|
| Rate for Payer: HFN Commercial |
$16,531.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,476.75
|
| Rate for Payer: Multiplan Commercial |
$14,375.20
|
| Rate for Payer: NAPHCARE Commercial |
$10,781.40
|
| Rate for Payer: Preferred Network Access Commercial |
$16,531.48
|
| Rate for Payer: Quartz Beloit One Network |
$8,804.81
|
| Rate for Payer: Quartz Commercial |
$11,679.85
|
| Rate for Payer: Quartz Medicare Advantage |
$10,781.40
|
| Rate for Payer: WEA Trust Commercial |
$9,882.95
|
| Rate for Payer: WPS Commercial |
$13,309.64
|
|
|
COMPONENT FEM E-MINUS LT GSF FLEX CR 00-5750-015-05
|
Facility
IP
|
$17,969.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967659
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,804.81 |
| Max. Negotiated Rate |
$16,531.48 |
| Rate for Payer: Aetna Commercial |
$16,172.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,523.57
|
| Rate for Payer: Cash Price |
$5,390.70
|
| Rate for Payer: Cigna Commercial |
$16,531.48
|
| Rate for Payer: Health EOS Commercial |
$15,992.41
|
| Rate for Payer: HFN Commercial |
$16,531.48
|
| Rate for Payer: Multiplan Commercial |
$14,375.20
|
| Rate for Payer: NAPHCARE Commercial |
$10,781.40
|
| Rate for Payer: Preferred Network Access Commercial |
$16,531.48
|
| Rate for Payer: Quartz Beloit One Network |
$8,804.81
|
| Rate for Payer: Quartz Commercial |
$10,781.40
|
| Rate for Payer: WEA Trust Commercial |
$9,882.95
|
| Rate for Payer: WPS Commercial |
$13,309.64
|
|
|
COMPONENT FEM E-MINUS RT FLEX CR 5950-15-06
|
Facility
IP
|
$18,600.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967660
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,114.00 |
| Max. Negotiated Rate |
$17,112.00 |
| Rate for Payer: Aetna Commercial |
$16,740.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,858.00
|
| Rate for Payer: Cash Price |
$5,580.00
|
| Rate for Payer: Cigna Commercial |
$17,112.00
|
| Rate for Payer: Health EOS Commercial |
$16,554.00
|
| Rate for Payer: HFN Commercial |
$17,112.00
|
| Rate for Payer: Multiplan Commercial |
$14,880.00
|
| Rate for Payer: NAPHCARE Commercial |
$11,160.00
|
| Rate for Payer: Preferred Network Access Commercial |
$17,112.00
|
| Rate for Payer: Quartz Beloit One Network |
$9,114.00
|
| Rate for Payer: Quartz Commercial |
$11,160.00
|
| Rate for Payer: WEA Trust Commercial |
$10,230.00
|
| Rate for Payer: WPS Commercial |
$13,777.02
|
|
|
COMPONENT FEM E-MINUS RT FLEX CR 5950-15-06
|
Facility
OP
|
$18,600.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967660
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,208.00 |
| Max. Negotiated Rate |
$17,112.00 |
| Rate for Payer: Aetna Commercial |
$16,740.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,996.00
|
| Rate for Payer: Aetna Managed Medicare |
$5,208.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,090.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,300.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,928.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,858.00
|
| Rate for Payer: Cash Price |
$5,580.00
|
| Rate for Payer: Cigna Commercial |
$17,112.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,408.56
|
| Rate for Payer: Health EOS Commercial |
$16,554.00
|
| Rate for Payer: HFN Commercial |
$17,112.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,950.00
|
| Rate for Payer: Multiplan Commercial |
$14,880.00
|
| Rate for Payer: NAPHCARE Commercial |
$11,160.00
|
| Rate for Payer: Preferred Network Access Commercial |
$17,112.00
|
| Rate for Payer: Quartz Beloit One Network |
$9,114.00
|
| Rate for Payer: Quartz Commercial |
$12,090.00
|
| Rate for Payer: Quartz Medicare Advantage |
$11,160.00
|
| Rate for Payer: WEA Trust Commercial |
$10,230.00
|
| Rate for Payer: WPS Commercial |
$13,777.02
|
|
|
COMPONENT FEM E-MINUS RT GSF FLEX CR 00-5750-015-06
|
Facility
IP
|
$17,969.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967661
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,804.81 |
| Max. Negotiated Rate |
$16,531.48 |
| Rate for Payer: Aetna Commercial |
$16,172.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,523.57
|
| Rate for Payer: Cash Price |
$5,390.70
|
| Rate for Payer: Cigna Commercial |
$16,531.48
|
| Rate for Payer: Health EOS Commercial |
$15,992.41
|
| Rate for Payer: HFN Commercial |
$16,531.48
|
| Rate for Payer: Multiplan Commercial |
$14,375.20
|
| Rate for Payer: NAPHCARE Commercial |
$10,781.40
|
| Rate for Payer: Preferred Network Access Commercial |
$16,531.48
|
| Rate for Payer: Quartz Beloit One Network |
$8,804.81
|
| Rate for Payer: Quartz Commercial |
$10,781.40
|
| Rate for Payer: WEA Trust Commercial |
$9,882.95
|
| Rate for Payer: WPS Commercial |
$13,309.64
|
|
|
COMPONENT FEM E-MINUS RT GSF FLEX CR 00-5750-015-06
|
Facility
OP
|
$17,969.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967661
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,031.32 |
| Max. Negotiated Rate |
$16,531.48 |
| Rate for Payer: Aetna Commercial |
$16,172.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,453.34
|
| Rate for Payer: Aetna Managed Medicare |
$5,031.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,679.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,984.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,625.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,523.57
|
| Rate for Payer: Cash Price |
$5,390.70
|
| Rate for Payer: Cigna Commercial |
$16,531.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,055.45
|
| Rate for Payer: Health EOS Commercial |
$15,992.41
|
| Rate for Payer: HFN Commercial |
$16,531.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,476.75
|
| Rate for Payer: Multiplan Commercial |
$14,375.20
|
| Rate for Payer: NAPHCARE Commercial |
$10,781.40
|
| Rate for Payer: Preferred Network Access Commercial |
$16,531.48
|
| Rate for Payer: Quartz Beloit One Network |
$8,804.81
|
| Rate for Payer: Quartz Commercial |
$11,679.85
|
| Rate for Payer: Quartz Medicare Advantage |
$10,781.40
|
| Rate for Payer: WEA Trust Commercial |
$9,882.95
|
| Rate for Payer: WPS Commercial |
$13,309.64
|
|
|
COMPONENT FEM E-RT FLEX CR PRECOAT 5950-15-02
|
Facility
OP
|
$18,600.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967662
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,208.00 |
| Max. Negotiated Rate |
$17,112.00 |
| Rate for Payer: Aetna Commercial |
$16,740.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,996.00
|
| Rate for Payer: Aetna Managed Medicare |
$5,208.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,090.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,300.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,928.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,858.00
|
| Rate for Payer: Cash Price |
$5,580.00
|
| Rate for Payer: Cigna Commercial |
$17,112.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,408.56
|
| Rate for Payer: Health EOS Commercial |
$16,554.00
|
| Rate for Payer: HFN Commercial |
$17,112.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,950.00
|
| Rate for Payer: Multiplan Commercial |
$14,880.00
|
| Rate for Payer: NAPHCARE Commercial |
$11,160.00
|
| Rate for Payer: Preferred Network Access Commercial |
$17,112.00
|
| Rate for Payer: Quartz Beloit One Network |
$9,114.00
|
| Rate for Payer: Quartz Commercial |
$12,090.00
|
| Rate for Payer: Quartz Medicare Advantage |
$11,160.00
|
| Rate for Payer: WEA Trust Commercial |
$10,230.00
|
| Rate for Payer: WPS Commercial |
$13,777.02
|
|
|
COMPONENT FEM E-RT FLEX CR PRECOAT 5950-15-02
|
Facility
IP
|
$18,600.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967662
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,114.00 |
| Max. Negotiated Rate |
$17,112.00 |
| Rate for Payer: Aetna Commercial |
$16,740.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,858.00
|
| Rate for Payer: Cash Price |
$5,580.00
|
| Rate for Payer: Cigna Commercial |
$17,112.00
|
| Rate for Payer: Health EOS Commercial |
$16,554.00
|
| Rate for Payer: HFN Commercial |
$17,112.00
|
| Rate for Payer: Multiplan Commercial |
$14,880.00
|
| Rate for Payer: NAPHCARE Commercial |
$11,160.00
|
| Rate for Payer: Preferred Network Access Commercial |
$17,112.00
|
| Rate for Payer: Quartz Beloit One Network |
$9,114.00
|
| Rate for Payer: Quartz Commercial |
$11,160.00
|
| Rate for Payer: WEA Trust Commercial |
$10,230.00
|
| Rate for Payer: WPS Commercial |
$13,777.02
|
|
|
COMPONENT FEM E-RT GSF FLEX CR 00-5750-015-02
|
Facility
IP
|
$17,969.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967663
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,804.81 |
| Max. Negotiated Rate |
$16,531.48 |
| Rate for Payer: Aetna Commercial |
$16,172.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,523.57
|
| Rate for Payer: Cash Price |
$5,390.70
|
| Rate for Payer: Cigna Commercial |
$16,531.48
|
| Rate for Payer: Health EOS Commercial |
$15,992.41
|
| Rate for Payer: HFN Commercial |
$16,531.48
|
| Rate for Payer: Multiplan Commercial |
$14,375.20
|
| Rate for Payer: NAPHCARE Commercial |
$10,781.40
|
| Rate for Payer: Preferred Network Access Commercial |
$16,531.48
|
| Rate for Payer: Quartz Beloit One Network |
$8,804.81
|
| Rate for Payer: Quartz Commercial |
$10,781.40
|
| Rate for Payer: WEA Trust Commercial |
$9,882.95
|
| Rate for Payer: WPS Commercial |
$13,309.64
|
|
|
COMPONENT FEM E-RT GSF FLEX CR 00-5750-015-02
|
Facility
OP
|
$17,969.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967663
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,031.32 |
| Max. Negotiated Rate |
$16,531.48 |
| Rate for Payer: Aetna Commercial |
$16,172.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,453.34
|
| Rate for Payer: Aetna Managed Medicare |
$5,031.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,679.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,984.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,625.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,523.57
|
| Rate for Payer: Cash Price |
$5,390.70
|
| Rate for Payer: Cigna Commercial |
$16,531.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,055.45
|
| Rate for Payer: Health EOS Commercial |
$15,992.41
|
| Rate for Payer: HFN Commercial |
$16,531.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,476.75
|
| Rate for Payer: Multiplan Commercial |
$14,375.20
|
| Rate for Payer: NAPHCARE Commercial |
$10,781.40
|
| Rate for Payer: Preferred Network Access Commercial |
$16,531.48
|
| Rate for Payer: Quartz Beloit One Network |
$8,804.81
|
| Rate for Payer: Quartz Commercial |
$11,679.85
|
| Rate for Payer: Quartz Medicare Advantage |
$10,781.40
|
| Rate for Payer: WEA Trust Commercial |
$9,882.95
|
| Rate for Payer: WPS Commercial |
$13,309.64
|
|
