|
FEMORAL COMP E-RT LCCK 5994-15-92
|
Facility
|
IP
|
$31,995.00
|
|
| Hospital Charge Code |
2969424
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15,677.55 |
| Max. Negotiated Rate |
$29,435.40 |
| Rate for Payer: Aetna Commercial |
$28,795.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$27,515.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16,957.35
|
| Rate for Payer: Cash Price |
$9,598.50
|
| Rate for Payer: Cigna Commercial |
$29,435.40
|
| Rate for Payer: Health EOS Commercial |
$28,475.55
|
| Rate for Payer: HFN Commercial |
$29,435.40
|
| Rate for Payer: Multiplan Commercial |
$25,596.00
|
| Rate for Payer: NAPHCARE Commercial |
$19,197.00
|
| Rate for Payer: Preferred Network Access Commercial |
$29,435.40
|
| Rate for Payer: Quartz Beloit One Network |
$15,677.55
|
| Rate for Payer: Quartz Commercial |
$19,197.00
|
| Rate for Payer: WEA Trust Commercial |
$17,597.25
|
| Rate for Payer: WPS Commercial |
$23,698.70
|
|
|
FEMORAL COMP E-RT LCCK 5994-15-92
|
Facility
|
OP
|
$31,995.00
|
|
| Hospital Charge Code |
2969424
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,958.60 |
| Max. Negotiated Rate |
$127,980.00 |
| Rate for Payer: Aetna Commercial |
$28,795.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$27,515.70
|
| Rate for Payer: Aetna Managed Medicare |
$8,958.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20,796.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15,997.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,357.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16,957.35
|
| Rate for Payer: Cash Price |
$9,598.50
|
| Rate for Payer: Cigna Commercial |
$29,435.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17,904.40
|
| Rate for Payer: Health EOS Commercial |
$28,475.55
|
| Rate for Payer: HFN Commercial |
$29,435.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23,996.25
|
| Rate for Payer: Multiplan Commercial |
$25,596.00
|
| Rate for Payer: NAPHCARE Commercial |
$19,197.00
|
| Rate for Payer: Preferred Network Access Commercial |
$29,435.40
|
| Rate for Payer: Quartz Beloit One Network |
$15,677.55
|
| Rate for Payer: Quartz Commercial |
$20,796.75
|
| Rate for Payer: Quartz Medicare Advantage |
$19,197.00
|
| Rate for Payer: The Alliance Commercial |
$127,980.00
|
| Rate for Payer: WEA Trust Commercial |
$17,597.25
|
| Rate for Payer: WPS Commercial |
$23,698.70
|
|
|
FEMORAL COMP E-RT LPS FLEX 5960-15-52
|
Facility
|
OP
|
$18,598.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967689
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,207.44 |
| Max. Negotiated Rate |
$74,392.00 |
| Rate for Payer: Aetna Commercial |
$16,738.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,994.28
|
| Rate for Payer: Aetna Managed Medicare |
$5,207.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,088.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,299.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,927.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,856.94
|
| Rate for Payer: Cash Price |
$5,579.40
|
| Rate for Payer: Cigna Commercial |
$17,110.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,407.44
|
| Rate for Payer: Health EOS Commercial |
$16,552.22
|
| Rate for Payer: HFN Commercial |
$17,110.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,948.50
|
| Rate for Payer: Multiplan Commercial |
$14,878.40
|
| Rate for Payer: NAPHCARE Commercial |
$11,158.80
|
| Rate for Payer: Preferred Network Access Commercial |
$17,110.16
|
| Rate for Payer: Quartz Beloit One Network |
$9,113.02
|
| Rate for Payer: Quartz Commercial |
$12,088.70
|
| Rate for Payer: Quartz Medicare Advantage |
$11,158.80
|
| Rate for Payer: The Alliance Commercial |
$74,392.00
|
| Rate for Payer: WEA Trust Commercial |
$10,228.90
|
| Rate for Payer: WPS Commercial |
$13,775.54
|
|
|
FEMORAL COMP E-RT LPS FLEX 5960-15-52
|
Facility
|
IP
|
$18,598.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967689
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,113.02 |
| Max. Negotiated Rate |
$17,110.16 |
| Rate for Payer: Aetna Commercial |
$16,738.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,994.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,856.94
|
| Rate for Payer: Cash Price |
$5,579.40
|
| Rate for Payer: Cigna Commercial |
$17,110.16
|
| Rate for Payer: Health EOS Commercial |
$16,552.22
|
| Rate for Payer: HFN Commercial |
$17,110.16
|
| Rate for Payer: Multiplan Commercial |
$14,878.40
|
| Rate for Payer: NAPHCARE Commercial |
$11,158.80
|
| Rate for Payer: Preferred Network Access Commercial |
$17,110.16
|
| Rate for Payer: Quartz Beloit One Network |
$9,113.02
|
| Rate for Payer: Quartz Commercial |
$11,158.80
|
| Rate for Payer: WEA Trust Commercial |
$10,228.90
|
| Rate for Payer: WPS Commercial |
$13,775.54
|
|
|
FEMORAL COMP E-RT LPS FLEX GSF 00-5764-015-52
|
Facility
|
IP
|
$17,969.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967702
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$15,453.34
|
| 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
|
|
|
FEMORAL COMP E-RT LPS FLEX GSF 00-5764-015-52
|
Facility
|
OP
|
$17,969.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967702
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,031.32 |
| Max. Negotiated Rate |
$71,876.00 |
| 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: The Alliance Commercial |
$71,876.00
|
| Rate for Payer: WEA Trust Commercial |
$9,882.95
|
| Rate for Payer: WPS Commercial |
$13,309.64
|
|
|
FEMORAL COMP F-LT LPS FLEX 5960-16-51
|
Facility
|
OP
|
$18,598.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967690
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,207.44 |
| Max. Negotiated Rate |
$74,392.00 |
| Rate for Payer: Aetna Commercial |
$16,738.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,994.28
|
| Rate for Payer: Aetna Managed Medicare |
$5,207.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,088.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,299.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,927.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,856.94
|
| Rate for Payer: Cash Price |
$5,579.40
|
| Rate for Payer: Cigna Commercial |
$17,110.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,407.44
|
| Rate for Payer: Health EOS Commercial |
$16,552.22
|
| Rate for Payer: HFN Commercial |
$17,110.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,948.50
|
| Rate for Payer: Multiplan Commercial |
$14,878.40
|
| Rate for Payer: NAPHCARE Commercial |
$11,158.80
|
| Rate for Payer: Preferred Network Access Commercial |
$17,110.16
|
| Rate for Payer: Quartz Beloit One Network |
$9,113.02
|
| Rate for Payer: Quartz Commercial |
$12,088.70
|
| Rate for Payer: Quartz Medicare Advantage |
$11,158.80
|
| Rate for Payer: The Alliance Commercial |
$74,392.00
|
| Rate for Payer: WEA Trust Commercial |
$10,228.90
|
| Rate for Payer: WPS Commercial |
$13,775.54
|
|
|
FEMORAL COMP F-LT LPS FLEX 5960-16-51
|
Facility
|
IP
|
$18,598.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967690
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,113.02 |
| Max. Negotiated Rate |
$17,110.16 |
| Rate for Payer: Aetna Commercial |
$16,738.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,994.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,856.94
|
| Rate for Payer: Cash Price |
$5,579.40
|
| Rate for Payer: Cigna Commercial |
$17,110.16
|
| Rate for Payer: Health EOS Commercial |
$16,552.22
|
| Rate for Payer: HFN Commercial |
$17,110.16
|
| Rate for Payer: Multiplan Commercial |
$14,878.40
|
| Rate for Payer: NAPHCARE Commercial |
$11,158.80
|
| Rate for Payer: Preferred Network Access Commercial |
$17,110.16
|
| Rate for Payer: Quartz Beloit One Network |
$9,113.02
|
| Rate for Payer: Quartz Commercial |
$11,158.80
|
| Rate for Payer: WEA Trust Commercial |
$10,228.90
|
| Rate for Payer: WPS Commercial |
$13,775.54
|
|
|
FEMORAL COMP F-LT LPS FLEX GSF 00-5764-016-51
|
Facility
|
OP
|
$17,969.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967699
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,031.32 |
| Max. Negotiated Rate |
$71,876.00 |
| 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: The Alliance Commercial |
$71,876.00
|
| Rate for Payer: WEA Trust Commercial |
$9,882.95
|
| Rate for Payer: WPS Commercial |
$13,309.64
|
|
|
FEMORAL COMP F-LT LPS FLEX GSF 00-5764-016-51
|
Facility
|
IP
|
$17,969.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967699
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$15,453.34
|
| 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
|
|
|
FEMORAL COMP F-RT LPS FLEX 5960-16-52
|
Facility
|
IP
|
$18,598.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967691
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,113.02 |
| Max. Negotiated Rate |
$17,110.16 |
| Rate for Payer: Aetna Commercial |
$16,738.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,994.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,856.94
|
| Rate for Payer: Cash Price |
$5,579.40
|
| Rate for Payer: Cigna Commercial |
$17,110.16
|
| Rate for Payer: Health EOS Commercial |
$16,552.22
|
| Rate for Payer: HFN Commercial |
$17,110.16
|
| Rate for Payer: Multiplan Commercial |
$14,878.40
|
| Rate for Payer: NAPHCARE Commercial |
$11,158.80
|
| Rate for Payer: Preferred Network Access Commercial |
$17,110.16
|
| Rate for Payer: Quartz Beloit One Network |
$9,113.02
|
| Rate for Payer: Quartz Commercial |
$11,158.80
|
| Rate for Payer: WEA Trust Commercial |
$10,228.90
|
| Rate for Payer: WPS Commercial |
$13,775.54
|
|
|
FEMORAL COMP F-RT LPS FLEX 5960-16-52
|
Facility
|
OP
|
$18,598.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967691
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,207.44 |
| Max. Negotiated Rate |
$74,392.00 |
| Rate for Payer: Aetna Commercial |
$16,738.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,994.28
|
| Rate for Payer: Aetna Managed Medicare |
$5,207.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,088.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,299.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,927.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,856.94
|
| Rate for Payer: Cash Price |
$5,579.40
|
| Rate for Payer: Cigna Commercial |
$17,110.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,407.44
|
| Rate for Payer: Health EOS Commercial |
$16,552.22
|
| Rate for Payer: HFN Commercial |
$17,110.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,948.50
|
| Rate for Payer: Multiplan Commercial |
$14,878.40
|
| Rate for Payer: NAPHCARE Commercial |
$11,158.80
|
| Rate for Payer: Preferred Network Access Commercial |
$17,110.16
|
| Rate for Payer: Quartz Beloit One Network |
$9,113.02
|
| Rate for Payer: Quartz Commercial |
$12,088.70
|
| Rate for Payer: Quartz Medicare Advantage |
$11,158.80
|
| Rate for Payer: The Alliance Commercial |
$74,392.00
|
| Rate for Payer: WEA Trust Commercial |
$10,228.90
|
| Rate for Payer: WPS Commercial |
$13,775.54
|
|
|
FEMORAL COMP F RT LPS FLEX GSF 00-5764-016-52
|
Facility
|
IP
|
$17,969.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967703
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$15,453.34
|
| 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
|
|
|
FEMORAL COMP F RT LPS FLEX GSF 00-5764-016-52
|
Facility
|
OP
|
$17,969.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967703
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,031.32 |
| Max. Negotiated Rate |
$71,876.00 |
| 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: The Alliance Commercial |
$71,876.00
|
| Rate for Payer: WEA Trust Commercial |
$9,882.95
|
| Rate for Payer: WPS Commercial |
$13,309.64
|
|
|
FEMORAL COMP G-LT LPS FLEX 5960-17-51
|
Facility
|
IP
|
$18,598.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967692
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,113.02 |
| Max. Negotiated Rate |
$17,110.16 |
| Rate for Payer: Aetna Commercial |
$16,738.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,994.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,856.94
|
| Rate for Payer: Cash Price |
$5,579.40
|
| Rate for Payer: Cigna Commercial |
$17,110.16
|
| Rate for Payer: Health EOS Commercial |
$16,552.22
|
| Rate for Payer: HFN Commercial |
$17,110.16
|
| Rate for Payer: Multiplan Commercial |
$14,878.40
|
| Rate for Payer: NAPHCARE Commercial |
$11,158.80
|
| Rate for Payer: Preferred Network Access Commercial |
$17,110.16
|
| Rate for Payer: Quartz Beloit One Network |
$9,113.02
|
| Rate for Payer: Quartz Commercial |
$11,158.80
|
| Rate for Payer: WEA Trust Commercial |
$10,228.90
|
| Rate for Payer: WPS Commercial |
$13,775.54
|
|
|
FEMORAL COMP G-LT LPS FLEX 5960-17-51
|
Facility
|
OP
|
$18,598.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967692
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,207.44 |
| Max. Negotiated Rate |
$74,392.00 |
| Rate for Payer: Aetna Commercial |
$16,738.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,994.28
|
| Rate for Payer: Aetna Managed Medicare |
$5,207.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,088.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,299.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,927.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,856.94
|
| Rate for Payer: Cash Price |
$5,579.40
|
| Rate for Payer: Cigna Commercial |
$17,110.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,407.44
|
| Rate for Payer: Health EOS Commercial |
$16,552.22
|
| Rate for Payer: HFN Commercial |
$17,110.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,948.50
|
| Rate for Payer: Multiplan Commercial |
$14,878.40
|
| Rate for Payer: NAPHCARE Commercial |
$11,158.80
|
| Rate for Payer: Preferred Network Access Commercial |
$17,110.16
|
| Rate for Payer: Quartz Beloit One Network |
$9,113.02
|
| Rate for Payer: Quartz Commercial |
$12,088.70
|
| Rate for Payer: Quartz Medicare Advantage |
$11,158.80
|
| Rate for Payer: The Alliance Commercial |
$74,392.00
|
| Rate for Payer: WEA Trust Commercial |
$10,228.90
|
| Rate for Payer: WPS Commercial |
$13,775.54
|
|
|
FEMORAL COMP G LT LPS FLEX GSF 00-5764-017-51
|
Facility
|
IP
|
$17,969.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967693
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$15,453.34
|
| 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
|
|
|
FEMORAL COMP G LT LPS FLEX GSF 00-5764-017-51
|
Facility
|
OP
|
$17,969.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967693
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,031.32 |
| Max. Negotiated Rate |
$71,876.00 |
| 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: The Alliance Commercial |
$71,876.00
|
| Rate for Payer: WEA Trust Commercial |
$9,882.95
|
| Rate for Payer: WPS Commercial |
$13,309.64
|
|
|
FEMORAL COMP G-RT LPS FLEX 5960-17-52
|
Facility
|
OP
|
$18,598.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967694
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,207.44 |
| Max. Negotiated Rate |
$74,392.00 |
| Rate for Payer: Aetna Commercial |
$16,738.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,994.28
|
| Rate for Payer: Aetna Managed Medicare |
$5,207.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,088.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,299.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,927.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,856.94
|
| Rate for Payer: Cash Price |
$5,579.40
|
| Rate for Payer: Cigna Commercial |
$17,110.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,407.44
|
| Rate for Payer: Health EOS Commercial |
$16,552.22
|
| Rate for Payer: HFN Commercial |
$17,110.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,948.50
|
| Rate for Payer: Multiplan Commercial |
$14,878.40
|
| Rate for Payer: NAPHCARE Commercial |
$11,158.80
|
| Rate for Payer: Preferred Network Access Commercial |
$17,110.16
|
| Rate for Payer: Quartz Beloit One Network |
$9,113.02
|
| Rate for Payer: Quartz Commercial |
$12,088.70
|
| Rate for Payer: Quartz Medicare Advantage |
$11,158.80
|
| Rate for Payer: The Alliance Commercial |
$74,392.00
|
| Rate for Payer: WEA Trust Commercial |
$10,228.90
|
| Rate for Payer: WPS Commercial |
$13,775.54
|
|
|
FEMORAL COMP G-RT LPS FLEX 5960-17-52
|
Facility
|
IP
|
$18,598.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967694
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,113.02 |
| Max. Negotiated Rate |
$17,110.16 |
| Rate for Payer: Aetna Commercial |
$16,738.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,994.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,856.94
|
| Rate for Payer: Cash Price |
$5,579.40
|
| Rate for Payer: Cigna Commercial |
$17,110.16
|
| Rate for Payer: Health EOS Commercial |
$16,552.22
|
| Rate for Payer: HFN Commercial |
$17,110.16
|
| Rate for Payer: Multiplan Commercial |
$14,878.40
|
| Rate for Payer: NAPHCARE Commercial |
$11,158.80
|
| Rate for Payer: Preferred Network Access Commercial |
$17,110.16
|
| Rate for Payer: Quartz Beloit One Network |
$9,113.02
|
| Rate for Payer: Quartz Commercial |
$11,158.80
|
| Rate for Payer: WEA Trust Commercial |
$10,228.90
|
| Rate for Payer: WPS Commercial |
$13,775.54
|
|
|
FEMORAL COMP G RT LPS FLEX GSF 00-5764-017-52
|
Facility
|
IP
|
$17,969.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967704
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$15,453.34
|
| 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
|
|
|
FEMORAL COMP G RT LPS FLEX GSF 00-5764-017-52
|
Facility
|
OP
|
$17,969.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967704
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,031.32 |
| Max. Negotiated Rate |
$71,876.00 |
| 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: The Alliance Commercial |
$71,876.00
|
| Rate for Payer: WEA Trust Commercial |
$9,882.95
|
| Rate for Payer: WPS Commercial |
$13,309.64
|
|
|
FEMORAL COMP H LEFT LPS MACRO 5596-18-51
|
Facility
|
IP
|
$11,398.00
|
|
| Hospital Charge Code |
2967468
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,585.02 |
| Max. Negotiated Rate |
$10,486.16 |
| Rate for Payer: Aetna Commercial |
$10,258.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,802.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,040.94
|
| Rate for Payer: Cash Price |
$3,419.40
|
| Rate for Payer: Cigna Commercial |
$10,486.16
|
| Rate for Payer: Health EOS Commercial |
$10,144.22
|
| Rate for Payer: HFN Commercial |
$10,486.16
|
| Rate for Payer: Multiplan Commercial |
$9,118.40
|
| Rate for Payer: NAPHCARE Commercial |
$6,838.80
|
| Rate for Payer: Preferred Network Access Commercial |
$10,486.16
|
| Rate for Payer: Quartz Beloit One Network |
$5,585.02
|
| Rate for Payer: Quartz Commercial |
$6,838.80
|
| Rate for Payer: WEA Trust Commercial |
$6,268.90
|
| Rate for Payer: WPS Commercial |
$8,442.50
|
|
|
FEMORAL COMP H LEFT LPS MACRO 5596-18-51
|
Facility
|
OP
|
$11,398.00
|
|
| Hospital Charge Code |
2967468
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,191.44 |
| Max. Negotiated Rate |
$45,592.00 |
| Rate for Payer: Aetna Commercial |
$10,258.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,802.28
|
| Rate for Payer: Aetna Managed Medicare |
$3,191.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,408.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,699.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,471.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,040.94
|
| Rate for Payer: Cash Price |
$3,419.40
|
| Rate for Payer: Cigna Commercial |
$10,486.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,378.32
|
| Rate for Payer: Health EOS Commercial |
$10,144.22
|
| Rate for Payer: HFN Commercial |
$10,486.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,548.50
|
| Rate for Payer: Multiplan Commercial |
$9,118.40
|
| Rate for Payer: NAPHCARE Commercial |
$6,838.80
|
| Rate for Payer: Preferred Network Access Commercial |
$10,486.16
|
| Rate for Payer: Quartz Beloit One Network |
$5,585.02
|
| Rate for Payer: Quartz Commercial |
$7,408.70
|
| Rate for Payer: Quartz Medicare Advantage |
$6,838.80
|
| Rate for Payer: The Alliance Commercial |
$45,592.00
|
| Rate for Payer: WEA Trust Commercial |
$6,268.90
|
| Rate for Payer: WPS Commercial |
$8,442.50
|
|
|
FEMORAL COMP H RIGHT LPS MACRO 5596-18-52
|
Facility
|
OP
|
$11,398.00
|
|
| Hospital Charge Code |
2967469
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,191.44 |
| Max. Negotiated Rate |
$45,592.00 |
| Rate for Payer: Aetna Commercial |
$10,258.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,802.28
|
| Rate for Payer: Aetna Managed Medicare |
$3,191.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,408.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,699.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,471.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,040.94
|
| Rate for Payer: Cash Price |
$3,419.40
|
| Rate for Payer: Cigna Commercial |
$10,486.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,378.32
|
| Rate for Payer: Health EOS Commercial |
$10,144.22
|
| Rate for Payer: HFN Commercial |
$10,486.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,548.50
|
| Rate for Payer: Multiplan Commercial |
$9,118.40
|
| Rate for Payer: NAPHCARE Commercial |
$6,838.80
|
| Rate for Payer: Preferred Network Access Commercial |
$10,486.16
|
| Rate for Payer: Quartz Beloit One Network |
$5,585.02
|
| Rate for Payer: Quartz Commercial |
$7,408.70
|
| Rate for Payer: Quartz Medicare Advantage |
$6,838.80
|
| Rate for Payer: The Alliance Commercial |
$45,592.00
|
| Rate for Payer: WEA Trust Commercial |
$6,268.90
|
| Rate for Payer: WPS Commercial |
$8,442.50
|
|
