|
COMPONENT FEM F-LT FLEX CR PRECOAT 5950-16-01
|
Facility
OP
|
$18,600.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967664
|
|
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 F-LT FLEX CR PRECOAT 5950-16-01
|
Facility
IP
|
$18,600.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967664
|
|
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 F-LT GSF CR FLEX PORUS 00-5752-016-01
|
Facility
IP
|
$14,935.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5458863
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,318.15 |
| Max. Negotiated Rate |
$13,740.20 |
| Rate for Payer: Aetna Commercial |
$13,441.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,915.55
|
| Rate for Payer: Cash Price |
$4,480.50
|
| Rate for Payer: Cigna Commercial |
$13,740.20
|
| Rate for Payer: Health EOS Commercial |
$13,292.15
|
| Rate for Payer: HFN Commercial |
$13,740.20
|
| Rate for Payer: Multiplan Commercial |
$11,948.00
|
| Rate for Payer: NAPHCARE Commercial |
$8,961.00
|
| Rate for Payer: Preferred Network Access Commercial |
$13,740.20
|
| Rate for Payer: Quartz Beloit One Network |
$7,318.15
|
| Rate for Payer: Quartz Commercial |
$8,961.00
|
| Rate for Payer: WEA Trust Commercial |
$8,214.25
|
| Rate for Payer: WPS Commercial |
$11,062.35
|
|
|
COMPONENT FEM F-LT GSF CR FLEX PORUS 00-5752-016-01
|
Facility
OP
|
$14,935.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5458863
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,181.80 |
| Max. Negotiated Rate |
$13,740.20 |
| Rate for Payer: Aetna Commercial |
$13,441.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,844.10
|
| Rate for Payer: Aetna Managed Medicare |
$4,181.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,707.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,467.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,168.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,915.55
|
| Rate for Payer: Cash Price |
$4,480.50
|
| Rate for Payer: Cigna Commercial |
$13,740.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,357.63
|
| Rate for Payer: Health EOS Commercial |
$13,292.15
|
| Rate for Payer: HFN Commercial |
$13,740.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,201.25
|
| Rate for Payer: Multiplan Commercial |
$11,948.00
|
| Rate for Payer: NAPHCARE Commercial |
$8,961.00
|
| Rate for Payer: Preferred Network Access Commercial |
$13,740.20
|
| Rate for Payer: Quartz Beloit One Network |
$7,318.15
|
| Rate for Payer: Quartz Commercial |
$9,707.75
|
| Rate for Payer: Quartz Medicare Advantage |
$8,961.00
|
| Rate for Payer: WEA Trust Commercial |
$8,214.25
|
| Rate for Payer: WPS Commercial |
$11,062.35
|
|
|
COMPONENT FEM F-MINUS LT FLEX CR 5950-16-05
|
Facility
IP
|
$18,600.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967666
|
|
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 F-MINUS LT FLEX CR 5950-16-05
|
Facility
OP
|
$18,600.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967666
|
|
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 F-MINUS LT GSF FLEX CR 00-5750-016-05
|
Facility
OP
|
$17,969.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967667
|
|
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 F-MINUS LT GSF FLEX CR 00-5750-016-05
|
Facility
IP
|
$17,969.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967667
|
|
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 F-MINUS RT FLEX CR 5950-16-06
|
Facility
IP
|
$18,600.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967668
|
|
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 F-MINUS RT FLEX CR 5950-16-06
|
Facility
OP
|
$18,600.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967668
|
|
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 F-MINUS RT GSF FLEX CR 00-5750-016-06
|
Facility
IP
|
$17,969.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967669
|
|
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 F-MINUS RT GSF FLEX CR 00-5750-016-06
|
Facility
OP
|
$17,969.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967669
|
|
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 F-RT FLEX CR PRECOAT 5950-16-02
|
Facility
IP
|
$18,600.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967670
|
|
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 F-RT FLEX CR PRECOAT 5950-16-02
|
Facility
OP
|
$18,600.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967670
|
|
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 G-LT FLEX CR PRECOAT 5950-17-01
|
Facility
OP
|
$18,600.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967672
|
|
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 G-LT FLEX CR PRECOAT 5950-17-01
|
Facility
IP
|
$18,600.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967672
|
|
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 G-LT GSF FLEX CR 00-5750-017-01
|
Facility
OP
|
$17,969.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967673
|
|
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 G-LT GSF FLEX CR 00-5750-017-01
|
Facility
IP
|
$17,969.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967673
|
|
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 G-MINUS LT FLEX CR 5950-17-05
|
Facility
IP
|
$18,600.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967674
|
|
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 G-MINUS LT FLEX CR 5950-17-05
|
Facility
OP
|
$18,600.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967674
|
|
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 G-MINUS LT GSF FLEX CR 00-5750-017-05
|
Facility
OP
|
$17,969.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967675
|
|
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 G-MINUS LT GSF FLEX CR 00-5750-017-05
|
Facility
IP
|
$17,969.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967675
|
|
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 G-MINUS RT FLEX CR 5950-17-06
|
Facility
IP
|
$18,600.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967676
|
|
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 G-MINUS RT FLEX CR 5950-17-06
|
Facility
OP
|
$18,600.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967676
|
|
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 G-MINUS RT GSF FLEX CR 00-5750-017-06
|
Facility
IP
|
$17,969.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967677
|
|
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
|
|
