|
COMPONENT FEM C-MINUS RT GSF FLEX CR 00-5750-013-06
|
Facility
|
OP
|
$17,969.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,232.57 |
| Max. Negotiated Rate |
$17,192.74 |
| Rate for Payer: Aetna Commercial |
$16,818.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,071.47
|
| Rate for Payer: Aetna Managed Medicare |
$5,232.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,147.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,343.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,970.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,904.51
|
| Rate for Payer: Cash Price |
$5,390.70
|
| Rate for Payer: Cigna Commercial |
$17,192.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,457.96
|
| Rate for Payer: Health EOS Commercial |
$16,632.11
|
| Rate for Payer: HFN Commercial |
$17,192.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,015.82
|
| Rate for Payer: Multiplan Commercial |
$14,950.21
|
| Rate for Payer: NAPHCARE Commercial |
$11,212.66
|
| Rate for Payer: Preferred Network Access Commercial |
$17,192.74
|
| Rate for Payer: Quartz Beloit One Network |
$9,157.00
|
| Rate for Payer: Quartz Commercial |
$12,147.04
|
| Rate for Payer: Quartz Medicare Advantage |
$11,212.66
|
| Rate for Payer: The Alliance Commercial |
$9,343.88
|
| Rate for Payer: WEA Trust Commercial |
$10,278.27
|
| Rate for Payer: WPS Commercial |
$13,841.52
|
|
|
COMPONENT FEM C-RT FLEX CR PRECOAT 5960-13-02
|
Facility
|
OP
|
$18,600.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967646
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,416.32 |
| Max. Negotiated Rate |
$17,796.48 |
| Rate for Payer: Aetna Commercial |
$17,409.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,635.84
|
| Rate for Payer: Aetna Managed Medicare |
$5,416.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,573.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,672.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,285.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,252.32
|
| Rate for Payer: Cash Price |
$5,580.00
|
| Rate for Payer: Cigna Commercial |
$17,796.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,825.20
|
| Rate for Payer: Health EOS Commercial |
$17,216.16
|
| Rate for Payer: HFN Commercial |
$17,796.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,508.00
|
| Rate for Payer: Multiplan Commercial |
$15,475.20
|
| Rate for Payer: NAPHCARE Commercial |
$11,606.40
|
| Rate for Payer: Preferred Network Access Commercial |
$17,796.48
|
| Rate for Payer: Quartz Beloit One Network |
$9,478.56
|
| Rate for Payer: Quartz Commercial |
$12,573.60
|
| Rate for Payer: Quartz Medicare Advantage |
$11,606.40
|
| Rate for Payer: The Alliance Commercial |
$9,672.00
|
| Rate for Payer: WEA Trust Commercial |
$10,639.20
|
| Rate for Payer: WPS Commercial |
$14,327.58
|
|
|
COMPONENT FEM C-RT FLEX CR PRECOAT 5960-13-02
|
Facility
|
IP
|
$18,600.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967646
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,478.56 |
| Max. Negotiated Rate |
$17,796.48 |
| Rate for Payer: Aetna Commercial |
$17,409.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,635.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,252.32
|
| Rate for Payer: Cash Price |
$5,580.00
|
| Rate for Payer: Cigna Commercial |
$17,796.48
|
| Rate for Payer: Health EOS Commercial |
$17,216.16
|
| Rate for Payer: HFN Commercial |
$17,796.48
|
| Rate for Payer: Multiplan Commercial |
$15,475.20
|
| Rate for Payer: Preferred Network Access Commercial |
$17,796.48
|
| Rate for Payer: Quartz Beloit One Network |
$9,478.56
|
| Rate for Payer: Quartz Commercial |
$11,606.40
|
| Rate for Payer: WEA Trust Commercial |
$10,639.20
|
| Rate for Payer: WPS Commercial |
$14,327.58
|
|
|
COMPONENT FEM C-RT GSF FLEX CR 00-5750-013-02
|
Facility
|
OP
|
$17,969.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967647
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,232.57 |
| Max. Negotiated Rate |
$17,192.74 |
| Rate for Payer: Aetna Commercial |
$16,818.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,071.47
|
| Rate for Payer: Aetna Managed Medicare |
$5,232.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,147.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,343.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,970.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,904.51
|
| Rate for Payer: Cash Price |
$5,390.70
|
| Rate for Payer: Cigna Commercial |
$17,192.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,457.96
|
| Rate for Payer: Health EOS Commercial |
$16,632.11
|
| Rate for Payer: HFN Commercial |
$17,192.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,015.82
|
| Rate for Payer: Multiplan Commercial |
$14,950.21
|
| Rate for Payer: NAPHCARE Commercial |
$11,212.66
|
| Rate for Payer: Preferred Network Access Commercial |
$17,192.74
|
| Rate for Payer: Quartz Beloit One Network |
$9,157.00
|
| Rate for Payer: Quartz Commercial |
$12,147.04
|
| Rate for Payer: Quartz Medicare Advantage |
$11,212.66
|
| Rate for Payer: The Alliance Commercial |
$9,343.88
|
| Rate for Payer: WEA Trust Commercial |
$10,278.27
|
| Rate for Payer: WPS Commercial |
$13,841.52
|
|
|
COMPONENT FEM C-RT GSF FLEX CR 00-5750-013-02
|
Facility
|
IP
|
$17,969.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967647
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,157.00 |
| Max. Negotiated Rate |
$17,192.74 |
| Rate for Payer: Aetna Commercial |
$16,818.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,071.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,904.51
|
| Rate for Payer: Cash Price |
$5,390.70
|
| Rate for Payer: Cigna Commercial |
$17,192.74
|
| Rate for Payer: Health EOS Commercial |
$16,632.11
|
| Rate for Payer: HFN Commercial |
$17,192.74
|
| Rate for Payer: Multiplan Commercial |
$14,950.21
|
| Rate for Payer: Preferred Network Access Commercial |
$17,192.74
|
| Rate for Payer: Quartz Beloit One Network |
$9,157.00
|
| Rate for Payer: Quartz Commercial |
$11,212.66
|
| Rate for Payer: WEA Trust Commercial |
$10,278.27
|
| Rate for Payer: WPS Commercial |
$13,841.52
|
|
|
COMPONENT FEM D-LT FLEX CR PRECOAT 5950-14-01
|
Facility
|
IP
|
$18,600.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967648
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,478.56 |
| Max. Negotiated Rate |
$17,796.48 |
| Rate for Payer: Aetna Commercial |
$17,409.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,635.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,252.32
|
| Rate for Payer: Cash Price |
$5,580.00
|
| Rate for Payer: Cigna Commercial |
$17,796.48
|
| Rate for Payer: Health EOS Commercial |
$17,216.16
|
| Rate for Payer: HFN Commercial |
$17,796.48
|
| Rate for Payer: Multiplan Commercial |
$15,475.20
|
| Rate for Payer: Preferred Network Access Commercial |
$17,796.48
|
| Rate for Payer: Quartz Beloit One Network |
$9,478.56
|
| Rate for Payer: Quartz Commercial |
$11,606.40
|
| Rate for Payer: WEA Trust Commercial |
$10,639.20
|
| Rate for Payer: WPS Commercial |
$14,327.58
|
|
|
COMPONENT FEM D-LT FLEX CR PRECOAT 5950-14-01
|
Facility
|
OP
|
$18,600.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967648
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,416.32 |
| Max. Negotiated Rate |
$17,796.48 |
| Rate for Payer: Aetna Commercial |
$17,409.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,635.84
|
| Rate for Payer: Aetna Managed Medicare |
$5,416.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,573.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,672.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,285.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,252.32
|
| Rate for Payer: Cash Price |
$5,580.00
|
| Rate for Payer: Cigna Commercial |
$17,796.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,825.20
|
| Rate for Payer: Health EOS Commercial |
$17,216.16
|
| Rate for Payer: HFN Commercial |
$17,796.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,508.00
|
| Rate for Payer: Multiplan Commercial |
$15,475.20
|
| Rate for Payer: NAPHCARE Commercial |
$11,606.40
|
| Rate for Payer: Preferred Network Access Commercial |
$17,796.48
|
| Rate for Payer: Quartz Beloit One Network |
$9,478.56
|
| Rate for Payer: Quartz Commercial |
$12,573.60
|
| Rate for Payer: Quartz Medicare Advantage |
$11,606.40
|
| Rate for Payer: The Alliance Commercial |
$9,672.00
|
| Rate for Payer: WEA Trust Commercial |
$10,639.20
|
| Rate for Payer: WPS Commercial |
$14,327.58
|
|
|
COMPONENT FEM D-LT GSF FLEX CR 00-5750-014-01
|
Facility
|
OP
|
$17,969.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967649
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,232.57 |
| Max. Negotiated Rate |
$17,192.74 |
| Rate for Payer: Aetna Commercial |
$16,818.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,071.47
|
| Rate for Payer: Aetna Managed Medicare |
$5,232.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,147.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,343.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,970.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,904.51
|
| Rate for Payer: Cash Price |
$5,390.70
|
| Rate for Payer: Cigna Commercial |
$17,192.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,457.96
|
| Rate for Payer: Health EOS Commercial |
$16,632.11
|
| Rate for Payer: HFN Commercial |
$17,192.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,015.82
|
| Rate for Payer: Multiplan Commercial |
$14,950.21
|
| Rate for Payer: NAPHCARE Commercial |
$11,212.66
|
| Rate for Payer: Preferred Network Access Commercial |
$17,192.74
|
| Rate for Payer: Quartz Beloit One Network |
$9,157.00
|
| Rate for Payer: Quartz Commercial |
$12,147.04
|
| Rate for Payer: Quartz Medicare Advantage |
$11,212.66
|
| Rate for Payer: The Alliance Commercial |
$9,343.88
|
| Rate for Payer: WEA Trust Commercial |
$10,278.27
|
| Rate for Payer: WPS Commercial |
$13,841.52
|
|
|
COMPONENT FEM D-LT GSF FLEX CR 00-5750-014-01
|
Facility
|
IP
|
$17,969.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967649
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,157.00 |
| Max. Negotiated Rate |
$17,192.74 |
| Rate for Payer: Aetna Commercial |
$16,818.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,071.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,904.51
|
| Rate for Payer: Cash Price |
$5,390.70
|
| Rate for Payer: Cigna Commercial |
$17,192.74
|
| Rate for Payer: Health EOS Commercial |
$16,632.11
|
| Rate for Payer: HFN Commercial |
$17,192.74
|
| Rate for Payer: Multiplan Commercial |
$14,950.21
|
| Rate for Payer: Preferred Network Access Commercial |
$17,192.74
|
| Rate for Payer: Quartz Beloit One Network |
$9,157.00
|
| Rate for Payer: Quartz Commercial |
$11,212.66
|
| Rate for Payer: WEA Trust Commercial |
$10,278.27
|
| Rate for Payer: WPS Commercial |
$13,841.52
|
|
|
COMPONENT FEM D-MINUS LT FLEX CR 5950-14-05
|
Facility
|
OP
|
$18,600.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967650
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,416.32 |
| Max. Negotiated Rate |
$17,796.48 |
| Rate for Payer: Aetna Commercial |
$17,409.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,635.84
|
| Rate for Payer: Aetna Managed Medicare |
$5,416.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,573.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,672.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,285.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,252.32
|
| Rate for Payer: Cash Price |
$5,580.00
|
| Rate for Payer: Cigna Commercial |
$17,796.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,825.20
|
| Rate for Payer: Health EOS Commercial |
$17,216.16
|
| Rate for Payer: HFN Commercial |
$17,796.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,508.00
|
| Rate for Payer: Multiplan Commercial |
$15,475.20
|
| Rate for Payer: NAPHCARE Commercial |
$11,606.40
|
| Rate for Payer: Preferred Network Access Commercial |
$17,796.48
|
| Rate for Payer: Quartz Beloit One Network |
$9,478.56
|
| Rate for Payer: Quartz Commercial |
$12,573.60
|
| Rate for Payer: Quartz Medicare Advantage |
$11,606.40
|
| Rate for Payer: The Alliance Commercial |
$9,672.00
|
| Rate for Payer: WEA Trust Commercial |
$10,639.20
|
| Rate for Payer: WPS Commercial |
$14,327.58
|
|
|
COMPONENT FEM D-MINUS LT FLEX CR 5950-14-05
|
Facility
|
IP
|
$18,600.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967650
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,478.56 |
| Max. Negotiated Rate |
$17,796.48 |
| Rate for Payer: Aetna Commercial |
$17,409.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,635.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,252.32
|
| Rate for Payer: Cash Price |
$5,580.00
|
| Rate for Payer: Cigna Commercial |
$17,796.48
|
| Rate for Payer: Health EOS Commercial |
$17,216.16
|
| Rate for Payer: HFN Commercial |
$17,796.48
|
| Rate for Payer: Multiplan Commercial |
$15,475.20
|
| Rate for Payer: Preferred Network Access Commercial |
$17,796.48
|
| Rate for Payer: Quartz Beloit One Network |
$9,478.56
|
| Rate for Payer: Quartz Commercial |
$11,606.40
|
| Rate for Payer: WEA Trust Commercial |
$10,639.20
|
| Rate for Payer: WPS Commercial |
$14,327.58
|
|
|
COMPONENT FEM D-MINUS LT GSF FLEX CR 00-5750-014-05
|
Facility
|
IP
|
$17,969.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967651
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,157.00 |
| Max. Negotiated Rate |
$17,192.74 |
| Rate for Payer: Aetna Commercial |
$16,818.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,071.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,904.51
|
| Rate for Payer: Cash Price |
$5,390.70
|
| Rate for Payer: Cigna Commercial |
$17,192.74
|
| Rate for Payer: Health EOS Commercial |
$16,632.11
|
| Rate for Payer: HFN Commercial |
$17,192.74
|
| Rate for Payer: Multiplan Commercial |
$14,950.21
|
| Rate for Payer: Preferred Network Access Commercial |
$17,192.74
|
| Rate for Payer: Quartz Beloit One Network |
$9,157.00
|
| Rate for Payer: Quartz Commercial |
$11,212.66
|
| Rate for Payer: WEA Trust Commercial |
$10,278.27
|
| Rate for Payer: WPS Commercial |
$13,841.52
|
|
|
COMPONENT FEM D-MINUS LT GSF FLEX CR 00-5750-014-05
|
Facility
|
OP
|
$17,969.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967651
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,232.57 |
| Max. Negotiated Rate |
$17,192.74 |
| Rate for Payer: Aetna Commercial |
$16,818.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,071.47
|
| Rate for Payer: Aetna Managed Medicare |
$5,232.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,147.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,343.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,970.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,904.51
|
| Rate for Payer: Cash Price |
$5,390.70
|
| Rate for Payer: Cigna Commercial |
$17,192.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,457.96
|
| Rate for Payer: Health EOS Commercial |
$16,632.11
|
| Rate for Payer: HFN Commercial |
$17,192.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,015.82
|
| Rate for Payer: Multiplan Commercial |
$14,950.21
|
| Rate for Payer: NAPHCARE Commercial |
$11,212.66
|
| Rate for Payer: Preferred Network Access Commercial |
$17,192.74
|
| Rate for Payer: Quartz Beloit One Network |
$9,157.00
|
| Rate for Payer: Quartz Commercial |
$12,147.04
|
| Rate for Payer: Quartz Medicare Advantage |
$11,212.66
|
| Rate for Payer: The Alliance Commercial |
$9,343.88
|
| Rate for Payer: WEA Trust Commercial |
$10,278.27
|
| Rate for Payer: WPS Commercial |
$13,841.52
|
|
|
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 |
$5,416.32 |
| Max. Negotiated Rate |
$17,796.48 |
| Rate for Payer: Aetna Commercial |
$17,409.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,635.84
|
| Rate for Payer: Aetna Managed Medicare |
$5,416.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,573.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,672.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,285.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,252.32
|
| Rate for Payer: Cash Price |
$5,580.00
|
| Rate for Payer: Cigna Commercial |
$17,796.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,825.20
|
| Rate for Payer: Health EOS Commercial |
$17,216.16
|
| Rate for Payer: HFN Commercial |
$17,796.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,508.00
|
| Rate for Payer: Multiplan Commercial |
$15,475.20
|
| Rate for Payer: NAPHCARE Commercial |
$11,606.40
|
| Rate for Payer: Preferred Network Access Commercial |
$17,796.48
|
| Rate for Payer: Quartz Beloit One Network |
$9,478.56
|
| Rate for Payer: Quartz Commercial |
$12,573.60
|
| Rate for Payer: Quartz Medicare Advantage |
$11,606.40
|
| Rate for Payer: The Alliance Commercial |
$9,672.00
|
| Rate for Payer: WEA Trust Commercial |
$10,639.20
|
| Rate for Payer: WPS Commercial |
$14,327.58
|
|
|
COMPONENT FEM D-MINUS RT FLEX CR 5950-14-06
|
Facility
|
IP
|
$18,600.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967652
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,478.56 |
| Max. Negotiated Rate |
$17,796.48 |
| Rate for Payer: Aetna Commercial |
$17,409.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,635.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,252.32
|
| Rate for Payer: Cash Price |
$5,580.00
|
| Rate for Payer: Cigna Commercial |
$17,796.48
|
| Rate for Payer: Health EOS Commercial |
$17,216.16
|
| Rate for Payer: HFN Commercial |
$17,796.48
|
| Rate for Payer: Multiplan Commercial |
$15,475.20
|
| Rate for Payer: Preferred Network Access Commercial |
$17,796.48
|
| Rate for Payer: Quartz Beloit One Network |
$9,478.56
|
| Rate for Payer: Quartz Commercial |
$11,606.40
|
| Rate for Payer: WEA Trust Commercial |
$10,639.20
|
| Rate for Payer: WPS Commercial |
$14,327.58
|
|
|
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 |
$9,157.00 |
| Max. Negotiated Rate |
$17,192.74 |
| Rate for Payer: Aetna Commercial |
$16,818.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,071.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,904.51
|
| Rate for Payer: Cash Price |
$5,390.70
|
| Rate for Payer: Cigna Commercial |
$17,192.74
|
| Rate for Payer: Health EOS Commercial |
$16,632.11
|
| Rate for Payer: HFN Commercial |
$17,192.74
|
| Rate for Payer: Multiplan Commercial |
$14,950.21
|
| Rate for Payer: Preferred Network Access Commercial |
$17,192.74
|
| Rate for Payer: Quartz Beloit One Network |
$9,157.00
|
| Rate for Payer: Quartz Commercial |
$11,212.66
|
| Rate for Payer: WEA Trust Commercial |
$10,278.27
|
| Rate for Payer: WPS Commercial |
$13,841.52
|
|
|
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 |
$5,232.57 |
| Max. Negotiated Rate |
$17,192.74 |
| Rate for Payer: Aetna Commercial |
$16,818.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,071.47
|
| Rate for Payer: Aetna Managed Medicare |
$5,232.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,147.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,343.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,970.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,904.51
|
| Rate for Payer: Cash Price |
$5,390.70
|
| Rate for Payer: Cigna Commercial |
$17,192.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,457.96
|
| Rate for Payer: Health EOS Commercial |
$16,632.11
|
| Rate for Payer: HFN Commercial |
$17,192.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,015.82
|
| Rate for Payer: Multiplan Commercial |
$14,950.21
|
| Rate for Payer: NAPHCARE Commercial |
$11,212.66
|
| Rate for Payer: Preferred Network Access Commercial |
$17,192.74
|
| Rate for Payer: Quartz Beloit One Network |
$9,157.00
|
| Rate for Payer: Quartz Commercial |
$12,147.04
|
| Rate for Payer: Quartz Medicare Advantage |
$11,212.66
|
| Rate for Payer: The Alliance Commercial |
$9,343.88
|
| Rate for Payer: WEA Trust Commercial |
$10,278.27
|
| Rate for Payer: WPS Commercial |
$13,841.52
|
|
|
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 |
$5,416.32 |
| Max. Negotiated Rate |
$17,796.48 |
| Rate for Payer: Aetna Commercial |
$17,409.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,635.84
|
| Rate for Payer: Aetna Managed Medicare |
$5,416.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,573.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,672.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,285.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,252.32
|
| Rate for Payer: Cash Price |
$5,580.00
|
| Rate for Payer: Cigna Commercial |
$17,796.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,825.20
|
| Rate for Payer: Health EOS Commercial |
$17,216.16
|
| Rate for Payer: HFN Commercial |
$17,796.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,508.00
|
| Rate for Payer: Multiplan Commercial |
$15,475.20
|
| Rate for Payer: NAPHCARE Commercial |
$11,606.40
|
| Rate for Payer: Preferred Network Access Commercial |
$17,796.48
|
| Rate for Payer: Quartz Beloit One Network |
$9,478.56
|
| Rate for Payer: Quartz Commercial |
$12,573.60
|
| Rate for Payer: Quartz Medicare Advantage |
$11,606.40
|
| Rate for Payer: The Alliance Commercial |
$9,672.00
|
| Rate for Payer: WEA Trust Commercial |
$10,639.20
|
| Rate for Payer: WPS Commercial |
$14,327.58
|
|
|
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 |
$9,478.56 |
| Max. Negotiated Rate |
$17,796.48 |
| Rate for Payer: Aetna Commercial |
$17,409.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,635.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,252.32
|
| Rate for Payer: Cash Price |
$5,580.00
|
| Rate for Payer: Cigna Commercial |
$17,796.48
|
| Rate for Payer: Health EOS Commercial |
$17,216.16
|
| Rate for Payer: HFN Commercial |
$17,796.48
|
| Rate for Payer: Multiplan Commercial |
$15,475.20
|
| Rate for Payer: Preferred Network Access Commercial |
$17,796.48
|
| Rate for Payer: Quartz Beloit One Network |
$9,478.56
|
| Rate for Payer: Quartz Commercial |
$11,606.40
|
| Rate for Payer: WEA Trust Commercial |
$10,639.20
|
| Rate for Payer: WPS Commercial |
$14,327.58
|
|
|
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 |
$5,232.57 |
| Max. Negotiated Rate |
$17,192.74 |
| Rate for Payer: Aetna Commercial |
$16,818.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,071.47
|
| Rate for Payer: Aetna Managed Medicare |
$5,232.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,147.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,343.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,970.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,904.51
|
| Rate for Payer: Cash Price |
$5,390.70
|
| Rate for Payer: Cigna Commercial |
$17,192.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,457.96
|
| Rate for Payer: Health EOS Commercial |
$16,632.11
|
| Rate for Payer: HFN Commercial |
$17,192.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,015.82
|
| Rate for Payer: Multiplan Commercial |
$14,950.21
|
| Rate for Payer: NAPHCARE Commercial |
$11,212.66
|
| Rate for Payer: Preferred Network Access Commercial |
$17,192.74
|
| Rate for Payer: Quartz Beloit One Network |
$9,157.00
|
| Rate for Payer: Quartz Commercial |
$12,147.04
|
| Rate for Payer: Quartz Medicare Advantage |
$11,212.66
|
| Rate for Payer: The Alliance Commercial |
$9,343.88
|
| Rate for Payer: WEA Trust Commercial |
$10,278.27
|
| Rate for Payer: WPS Commercial |
$13,841.52
|
|
|
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 |
$9,157.00 |
| Max. Negotiated Rate |
$17,192.74 |
| Rate for Payer: Aetna Commercial |
$16,818.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,071.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,904.51
|
| Rate for Payer: Cash Price |
$5,390.70
|
| Rate for Payer: Cigna Commercial |
$17,192.74
|
| Rate for Payer: Health EOS Commercial |
$16,632.11
|
| Rate for Payer: HFN Commercial |
$17,192.74
|
| Rate for Payer: Multiplan Commercial |
$14,950.21
|
| Rate for Payer: Preferred Network Access Commercial |
$17,192.74
|
| Rate for Payer: Quartz Beloit One Network |
$9,157.00
|
| Rate for Payer: Quartz Commercial |
$11,212.66
|
| Rate for Payer: WEA Trust Commercial |
$10,278.27
|
| Rate for Payer: WPS Commercial |
$13,841.52
|
|
|
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 |
$9,478.56 |
| Max. Negotiated Rate |
$17,796.48 |
| Rate for Payer: Aetna Commercial |
$17,409.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,635.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,252.32
|
| Rate for Payer: Cash Price |
$5,580.00
|
| Rate for Payer: Cigna Commercial |
$17,796.48
|
| Rate for Payer: Health EOS Commercial |
$17,216.16
|
| Rate for Payer: HFN Commercial |
$17,796.48
|
| Rate for Payer: Multiplan Commercial |
$15,475.20
|
| Rate for Payer: Preferred Network Access Commercial |
$17,796.48
|
| Rate for Payer: Quartz Beloit One Network |
$9,478.56
|
| Rate for Payer: Quartz Commercial |
$11,606.40
|
| Rate for Payer: WEA Trust Commercial |
$10,639.20
|
| Rate for Payer: WPS Commercial |
$14,327.58
|
|
|
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 |
$5,416.32 |
| Max. Negotiated Rate |
$17,796.48 |
| Rate for Payer: Aetna Commercial |
$17,409.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,635.84
|
| Rate for Payer: Aetna Managed Medicare |
$5,416.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,573.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,672.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,285.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,252.32
|
| Rate for Payer: Cash Price |
$5,580.00
|
| Rate for Payer: Cigna Commercial |
$17,796.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,825.20
|
| Rate for Payer: Health EOS Commercial |
$17,216.16
|
| Rate for Payer: HFN Commercial |
$17,796.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,508.00
|
| Rate for Payer: Multiplan Commercial |
$15,475.20
|
| Rate for Payer: NAPHCARE Commercial |
$11,606.40
|
| Rate for Payer: Preferred Network Access Commercial |
$17,796.48
|
| Rate for Payer: Quartz Beloit One Network |
$9,478.56
|
| Rate for Payer: Quartz Commercial |
$12,573.60
|
| Rate for Payer: Quartz Medicare Advantage |
$11,606.40
|
| Rate for Payer: The Alliance Commercial |
$9,672.00
|
| Rate for Payer: WEA Trust Commercial |
$10,639.20
|
| Rate for Payer: WPS Commercial |
$14,327.58
|
|
|
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 |
$9,157.00 |
| Max. Negotiated Rate |
$17,192.74 |
| Rate for Payer: Aetna Commercial |
$16,818.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,071.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,904.51
|
| Rate for Payer: Cash Price |
$5,390.70
|
| Rate for Payer: Cigna Commercial |
$17,192.74
|
| Rate for Payer: Health EOS Commercial |
$16,632.11
|
| Rate for Payer: HFN Commercial |
$17,192.74
|
| Rate for Payer: Multiplan Commercial |
$14,950.21
|
| Rate for Payer: Preferred Network Access Commercial |
$17,192.74
|
| Rate for Payer: Quartz Beloit One Network |
$9,157.00
|
| Rate for Payer: Quartz Commercial |
$11,212.66
|
| Rate for Payer: WEA Trust Commercial |
$10,278.27
|
| Rate for Payer: WPS Commercial |
$13,841.52
|
|
|
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 |
$5,232.57 |
| Max. Negotiated Rate |
$17,192.74 |
| Rate for Payer: Aetna Commercial |
$16,818.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,071.47
|
| Rate for Payer: Aetna Managed Medicare |
$5,232.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,147.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,343.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,970.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,904.51
|
| Rate for Payer: Cash Price |
$5,390.70
|
| Rate for Payer: Cigna Commercial |
$17,192.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,457.96
|
| Rate for Payer: Health EOS Commercial |
$16,632.11
|
| Rate for Payer: HFN Commercial |
$17,192.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,015.82
|
| Rate for Payer: Multiplan Commercial |
$14,950.21
|
| Rate for Payer: NAPHCARE Commercial |
$11,212.66
|
| Rate for Payer: Preferred Network Access Commercial |
$17,192.74
|
| Rate for Payer: Quartz Beloit One Network |
$9,157.00
|
| Rate for Payer: Quartz Commercial |
$12,147.04
|
| Rate for Payer: Quartz Medicare Advantage |
$11,212.66
|
| Rate for Payer: The Alliance Commercial |
$9,343.88
|
| Rate for Payer: WEA Trust Commercial |
$10,278.27
|
| Rate for Payer: WPS Commercial |
$13,841.52
|
|
