|
FEMORAL HEAD VERSYS 28MM +3.5 8018-28-03
|
Facility
|
IP
|
$4,653.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967874
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.97 |
| Max. Negotiated Rate |
$4,280.76 |
| Rate for Payer: Aetna Commercial |
$4,187.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,001.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,466.09
|
| Rate for Payer: Cash Price |
$1,395.90
|
| Rate for Payer: Cigna Commercial |
$4,280.76
|
| Rate for Payer: Health EOS Commercial |
$4,141.17
|
| Rate for Payer: HFN Commercial |
$4,280.76
|
| Rate for Payer: Multiplan Commercial |
$3,722.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,791.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,280.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,279.97
|
| Rate for Payer: Quartz Commercial |
$2,791.80
|
| Rate for Payer: WEA Trust Commercial |
$2,559.15
|
| Rate for Payer: WPS Commercial |
$3,446.48
|
|
|
FEMORAL HEAD VERSYS 28MM +3.5 8018-28-03
|
Facility
|
OP
|
$4,653.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967874
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,302.84 |
| Max. Negotiated Rate |
$18,612.00 |
| Rate for Payer: Aetna Commercial |
$4,187.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,001.58
|
| Rate for Payer: Aetna Managed Medicare |
$1,302.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,024.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,326.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,233.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,466.09
|
| Rate for Payer: Cash Price |
$1,395.90
|
| Rate for Payer: Cigna Commercial |
$4,280.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,603.82
|
| Rate for Payer: Health EOS Commercial |
$4,141.17
|
| Rate for Payer: HFN Commercial |
$4,280.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,489.75
|
| Rate for Payer: Multiplan Commercial |
$3,722.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,791.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,280.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,279.97
|
| Rate for Payer: Quartz Commercial |
$3,024.45
|
| Rate for Payer: Quartz Medicare Advantage |
$2,791.80
|
| Rate for Payer: The Alliance Commercial |
$18,612.00
|
| Rate for Payer: WEA Trust Commercial |
$2,559.15
|
| Rate for Payer: WPS Commercial |
$3,446.48
|
|
|
FEMORAL HEAD VERSYS 28MM +7.0 8018-28-04
|
Facility
|
IP
|
$4,653.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967875
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.97 |
| Max. Negotiated Rate |
$4,280.76 |
| Rate for Payer: Aetna Commercial |
$4,187.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,001.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,466.09
|
| Rate for Payer: Cash Price |
$1,395.90
|
| Rate for Payer: Cigna Commercial |
$4,280.76
|
| Rate for Payer: Health EOS Commercial |
$4,141.17
|
| Rate for Payer: HFN Commercial |
$4,280.76
|
| Rate for Payer: Multiplan Commercial |
$3,722.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,791.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,280.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,279.97
|
| Rate for Payer: Quartz Commercial |
$2,791.80
|
| Rate for Payer: WEA Trust Commercial |
$2,559.15
|
| Rate for Payer: WPS Commercial |
$3,446.48
|
|
|
FEMORAL HEAD VERSYS 28MM +7.0 8018-28-04
|
Facility
|
OP
|
$4,653.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967875
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,302.84 |
| Max. Negotiated Rate |
$18,612.00 |
| Rate for Payer: Aetna Commercial |
$4,187.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,001.58
|
| Rate for Payer: Aetna Managed Medicare |
$1,302.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,024.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,326.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,233.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,466.09
|
| Rate for Payer: Cash Price |
$1,395.90
|
| Rate for Payer: Cigna Commercial |
$4,280.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,603.82
|
| Rate for Payer: Health EOS Commercial |
$4,141.17
|
| Rate for Payer: HFN Commercial |
$4,280.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,489.75
|
| Rate for Payer: Multiplan Commercial |
$3,722.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,791.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,280.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,279.97
|
| Rate for Payer: Quartz Commercial |
$3,024.45
|
| Rate for Payer: Quartz Medicare Advantage |
$2,791.80
|
| Rate for Payer: The Alliance Commercial |
$18,612.00
|
| Rate for Payer: WEA Trust Commercial |
$2,559.15
|
| Rate for Payer: WPS Commercial |
$3,446.48
|
|
|
FEMORAL HEAD VERSYS 36MM +0 8018-36-02
|
Facility
|
IP
|
$9,076.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967695
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,447.24 |
| Max. Negotiated Rate |
$8,349.92 |
| Rate for Payer: Aetna Commercial |
$8,168.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,805.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,810.28
|
| Rate for Payer: Cash Price |
$2,722.80
|
| Rate for Payer: Cigna Commercial |
$8,349.92
|
| Rate for Payer: Health EOS Commercial |
$8,077.64
|
| Rate for Payer: HFN Commercial |
$8,349.92
|
| Rate for Payer: Multiplan Commercial |
$7,260.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,445.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,349.92
|
| Rate for Payer: Quartz Beloit One Network |
$4,447.24
|
| Rate for Payer: Quartz Commercial |
$5,445.60
|
| Rate for Payer: WEA Trust Commercial |
$4,991.80
|
| Rate for Payer: WPS Commercial |
$6,722.59
|
|
|
FEMORAL HEAD VERSYS 36MM +0 8018-36-02
|
Facility
|
OP
|
$9,076.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967695
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,541.28 |
| Max. Negotiated Rate |
$36,304.00 |
| Rate for Payer: Aetna Commercial |
$8,168.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,805.36
|
| Rate for Payer: Aetna Managed Medicare |
$2,541.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,899.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,538.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,356.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,810.28
|
| Rate for Payer: Cash Price |
$2,722.80
|
| Rate for Payer: Cigna Commercial |
$8,349.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,078.93
|
| Rate for Payer: Health EOS Commercial |
$8,077.64
|
| Rate for Payer: HFN Commercial |
$8,349.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,807.00
|
| Rate for Payer: Multiplan Commercial |
$7,260.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,445.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,349.92
|
| Rate for Payer: Quartz Beloit One Network |
$4,447.24
|
| Rate for Payer: Quartz Commercial |
$5,899.40
|
| Rate for Payer: Quartz Medicare Advantage |
$5,445.60
|
| Rate for Payer: The Alliance Commercial |
$36,304.00
|
| Rate for Payer: WEA Trust Commercial |
$4,991.80
|
| Rate for Payer: WPS Commercial |
$6,722.59
|
|
|
FEMORAL HEAD VERSYS 36mm +10.5 8018-36-05
|
Facility
|
IP
|
$8,739.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967696
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,282.11 |
| Max. Negotiated Rate |
$8,039.88 |
| Rate for Payer: Aetna Commercial |
$7,865.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,515.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,631.67
|
| Rate for Payer: Cash Price |
$2,621.70
|
| Rate for Payer: Cigna Commercial |
$8,039.88
|
| Rate for Payer: Health EOS Commercial |
$7,777.71
|
| Rate for Payer: HFN Commercial |
$8,039.88
|
| Rate for Payer: Multiplan Commercial |
$6,991.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,243.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,039.88
|
| Rate for Payer: Quartz Beloit One Network |
$4,282.11
|
| Rate for Payer: Quartz Commercial |
$5,243.40
|
| Rate for Payer: WEA Trust Commercial |
$4,806.45
|
| Rate for Payer: WPS Commercial |
$6,472.98
|
|
|
FEMORAL HEAD VERSYS 36mm +10.5 8018-36-05
|
Facility
|
OP
|
$8,739.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967696
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,446.92 |
| Max. Negotiated Rate |
$34,956.00 |
| Rate for Payer: Aetna Commercial |
$7,865.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,515.54
|
| Rate for Payer: Aetna Managed Medicare |
$2,446.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,680.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,369.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,194.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,631.67
|
| Rate for Payer: Cash Price |
$2,621.70
|
| Rate for Payer: Cigna Commercial |
$8,039.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,890.34
|
| Rate for Payer: Health EOS Commercial |
$7,777.71
|
| Rate for Payer: HFN Commercial |
$8,039.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,554.25
|
| Rate for Payer: Multiplan Commercial |
$6,991.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,243.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,039.88
|
| Rate for Payer: Quartz Beloit One Network |
$4,282.11
|
| Rate for Payer: Quartz Commercial |
$5,680.35
|
| Rate for Payer: Quartz Medicare Advantage |
$5,243.40
|
| Rate for Payer: The Alliance Commercial |
$34,956.00
|
| Rate for Payer: WEA Trust Commercial |
$4,806.45
|
| Rate for Payer: WPS Commercial |
$6,472.98
|
|
|
FEMORAL HEAD VERSYS 36mm +3.5 8018-36-03
|
Facility
|
IP
|
$9,076.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967697
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,447.24 |
| Max. Negotiated Rate |
$8,349.92 |
| Rate for Payer: Aetna Commercial |
$8,168.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,805.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,810.28
|
| Rate for Payer: Cash Price |
$2,722.80
|
| Rate for Payer: Cigna Commercial |
$8,349.92
|
| Rate for Payer: Health EOS Commercial |
$8,077.64
|
| Rate for Payer: HFN Commercial |
$8,349.92
|
| Rate for Payer: Multiplan Commercial |
$7,260.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,445.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,349.92
|
| Rate for Payer: Quartz Beloit One Network |
$4,447.24
|
| Rate for Payer: Quartz Commercial |
$5,445.60
|
| Rate for Payer: WEA Trust Commercial |
$4,991.80
|
| Rate for Payer: WPS Commercial |
$6,722.59
|
|
|
FEMORAL HEAD VERSYS 36mm +3.5 8018-36-03
|
Facility
|
OP
|
$9,076.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967697
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,541.28 |
| Max. Negotiated Rate |
$36,304.00 |
| Rate for Payer: Aetna Commercial |
$8,168.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,805.36
|
| Rate for Payer: Aetna Managed Medicare |
$2,541.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,899.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,538.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,356.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,810.28
|
| Rate for Payer: Cash Price |
$2,722.80
|
| Rate for Payer: Cigna Commercial |
$8,349.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,078.93
|
| Rate for Payer: Health EOS Commercial |
$8,077.64
|
| Rate for Payer: HFN Commercial |
$8,349.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,807.00
|
| Rate for Payer: Multiplan Commercial |
$7,260.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,445.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,349.92
|
| Rate for Payer: Quartz Beloit One Network |
$4,447.24
|
| Rate for Payer: Quartz Commercial |
$5,899.40
|
| Rate for Payer: Quartz Medicare Advantage |
$5,445.60
|
| Rate for Payer: The Alliance Commercial |
$36,304.00
|
| Rate for Payer: WEA Trust Commercial |
$4,991.80
|
| Rate for Payer: WPS Commercial |
$6,722.59
|
|
|
FEMORAL HEAD VERSYS 36MM +7 8018-36-04
|
Facility
|
IP
|
$8,739.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967698
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,282.11 |
| Max. Negotiated Rate |
$8,039.88 |
| Rate for Payer: Aetna Commercial |
$7,865.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,515.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,631.67
|
| Rate for Payer: Cash Price |
$2,621.70
|
| Rate for Payer: Cigna Commercial |
$8,039.88
|
| Rate for Payer: Health EOS Commercial |
$7,777.71
|
| Rate for Payer: HFN Commercial |
$8,039.88
|
| Rate for Payer: Multiplan Commercial |
$6,991.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,243.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,039.88
|
| Rate for Payer: Quartz Beloit One Network |
$4,282.11
|
| Rate for Payer: Quartz Commercial |
$5,243.40
|
| Rate for Payer: WEA Trust Commercial |
$4,806.45
|
| Rate for Payer: WPS Commercial |
$6,472.98
|
|
|
FEMORAL HEAD VERSYS 36MM +7 8018-36-04
|
Facility
|
OP
|
$8,739.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967698
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,446.92 |
| Max. Negotiated Rate |
$34,956.00 |
| Rate for Payer: Aetna Commercial |
$7,865.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,515.54
|
| Rate for Payer: Aetna Managed Medicare |
$2,446.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,680.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,369.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,194.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,631.67
|
| Rate for Payer: Cash Price |
$2,621.70
|
| Rate for Payer: Cigna Commercial |
$8,039.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,890.34
|
| Rate for Payer: Health EOS Commercial |
$7,777.71
|
| Rate for Payer: HFN Commercial |
$8,039.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,554.25
|
| Rate for Payer: Multiplan Commercial |
$6,991.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,243.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,039.88
|
| Rate for Payer: Quartz Beloit One Network |
$4,282.11
|
| Rate for Payer: Quartz Commercial |
$5,680.35
|
| Rate for Payer: Quartz Medicare Advantage |
$5,243.40
|
| Rate for Payer: The Alliance Commercial |
$34,956.00
|
| Rate for Payer: WEA Trust Commercial |
$4,806.45
|
| Rate for Payer: WPS Commercial |
$6,472.98
|
|
|
FEMORAL HEAD VERSYS 40MM +7.0 8018-40-04
|
Facility
|
OP
|
$4,642.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5184691
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,299.76 |
| Max. Negotiated Rate |
$18,568.00 |
| Rate for Payer: Aetna Commercial |
$4,177.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,992.12
|
| Rate for Payer: Aetna Managed Medicare |
$1,299.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,017.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,321.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,228.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,460.26
|
| Rate for Payer: Cash Price |
$1,392.60
|
| Rate for Payer: Cigna Commercial |
$4,270.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,597.66
|
| Rate for Payer: Health EOS Commercial |
$4,131.38
|
| Rate for Payer: HFN Commercial |
$4,270.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,481.50
|
| Rate for Payer: Multiplan Commercial |
$3,713.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,785.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,270.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,274.58
|
| Rate for Payer: Quartz Commercial |
$3,017.30
|
| Rate for Payer: Quartz Medicare Advantage |
$2,785.20
|
| Rate for Payer: The Alliance Commercial |
$18,568.00
|
| Rate for Payer: WEA Trust Commercial |
$2,553.10
|
| Rate for Payer: WPS Commercial |
$3,438.33
|
|
|
FEMORAL HEAD VERSYS 40MM +7.0 8018-40-04
|
Facility
|
IP
|
$4,642.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5184691
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,274.58 |
| Max. Negotiated Rate |
$4,270.64 |
| Rate for Payer: Aetna Commercial |
$4,177.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,992.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,460.26
|
| Rate for Payer: Cash Price |
$1,392.60
|
| Rate for Payer: Cigna Commercial |
$4,270.64
|
| Rate for Payer: Health EOS Commercial |
$4,131.38
|
| Rate for Payer: HFN Commercial |
$4,270.64
|
| Rate for Payer: Multiplan Commercial |
$3,713.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,785.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,270.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,274.58
|
| Rate for Payer: Quartz Commercial |
$2,785.20
|
| Rate for Payer: WEA Trust Commercial |
$2,553.10
|
| Rate for Payer: WPS Commercial |
$3,438.33
|
|
|
FEMORAL INTRAMEDULLARY RODDING
|
Facility
|
IP
|
$5,312.00
|
|
| Hospital Charge Code |
2960150
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,602.88 |
| Max. Negotiated Rate |
$4,887.04 |
| Rate for Payer: Aetna Commercial |
$4,780.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,568.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,815.36
|
| Rate for Payer: Cash Price |
$1,593.60
|
| Rate for Payer: Cigna Commercial |
$4,887.04
|
| Rate for Payer: Health EOS Commercial |
$4,727.68
|
| Rate for Payer: HFN Commercial |
$4,887.04
|
| Rate for Payer: Multiplan Commercial |
$4,249.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,187.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,887.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,602.88
|
| Rate for Payer: Quartz Commercial |
$3,187.20
|
| Rate for Payer: WEA Trust Commercial |
$2,921.60
|
| Rate for Payer: WPS Commercial |
$3,934.60
|
|
|
FEMORAL INTRAMEDULLARY RODDING
|
Facility
|
OP
|
$5,312.00
|
|
| Hospital Charge Code |
2960150
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,487.36 |
| Max. Negotiated Rate |
$21,248.00 |
| Rate for Payer: Aetna Commercial |
$4,780.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,568.32
|
| Rate for Payer: Aetna Managed Medicare |
$1,487.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,452.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,656.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,549.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,815.36
|
| Rate for Payer: Cash Price |
$1,593.60
|
| Rate for Payer: Cigna Commercial |
$4,887.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,972.60
|
| Rate for Payer: Health EOS Commercial |
$4,727.68
|
| Rate for Payer: HFN Commercial |
$4,887.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,984.00
|
| Rate for Payer: Multiplan Commercial |
$4,249.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,187.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,887.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,602.88
|
| Rate for Payer: Quartz Commercial |
$3,452.80
|
| Rate for Payer: Quartz Medicare Advantage |
$3,187.20
|
| Rate for Payer: The Alliance Commercial |
$21,248.00
|
| Rate for Payer: WEA Trust Commercial |
$2,921.60
|
| Rate for Payer: WPS Commercial |
$3,934.60
|
|
|
FEMORAL NAIL 9MM FRN GT 400 LT 04.033.971S
|
Facility
|
IP
|
$9,845.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6182641
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,824.05 |
| Max. Negotiated Rate |
$9,057.40 |
| Rate for Payer: Aetna Commercial |
$8,860.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,466.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,217.85
|
| Rate for Payer: Cash Price |
$2,953.50
|
| Rate for Payer: Cigna Commercial |
$9,057.40
|
| Rate for Payer: Health EOS Commercial |
$8,762.05
|
| Rate for Payer: HFN Commercial |
$9,057.40
|
| Rate for Payer: Multiplan Commercial |
$7,876.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,907.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9,057.40
|
| Rate for Payer: Quartz Beloit One Network |
$4,824.05
|
| Rate for Payer: Quartz Commercial |
$5,907.00
|
| Rate for Payer: WEA Trust Commercial |
$5,414.75
|
| Rate for Payer: WPS Commercial |
$7,292.19
|
|
|
FEMORAL NAIL 9MM FRN GT 400 LT 04.033.971S
|
Facility
|
OP
|
$9,845.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6182641
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,756.60 |
| Max. Negotiated Rate |
$39,380.00 |
| Rate for Payer: Aetna Commercial |
$8,860.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,466.70
|
| Rate for Payer: Aetna Managed Medicare |
$2,756.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,399.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,922.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,725.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,217.85
|
| Rate for Payer: Cash Price |
$2,953.50
|
| Rate for Payer: Cigna Commercial |
$9,057.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,509.26
|
| Rate for Payer: Health EOS Commercial |
$8,762.05
|
| Rate for Payer: HFN Commercial |
$9,057.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,383.75
|
| Rate for Payer: Multiplan Commercial |
$7,876.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,907.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9,057.40
|
| Rate for Payer: Quartz Beloit One Network |
$4,824.05
|
| Rate for Payer: Quartz Commercial |
$6,399.25
|
| Rate for Payer: Quartz Medicare Advantage |
$5,907.00
|
| Rate for Payer: The Alliance Commercial |
$39,380.00
|
| Rate for Payer: WEA Trust Commercial |
$5,414.75
|
| Rate for Payer: WPS Commercial |
$7,292.19
|
|
|
FEMORAL NAIL RFNA RETROGRADE 10MM X 340MM 10 DEG BEND 04.233.035S
|
Facility
|
IP
|
$11,872.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6202972
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,817.28 |
| Max. Negotiated Rate |
$10,922.24 |
| Rate for Payer: Aetna Commercial |
$10,684.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,209.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,292.16
|
| Rate for Payer: Cash Price |
$3,561.60
|
| Rate for Payer: Cigna Commercial |
$10,922.24
|
| Rate for Payer: Health EOS Commercial |
$10,566.08
|
| Rate for Payer: HFN Commercial |
$10,922.24
|
| Rate for Payer: Multiplan Commercial |
$9,497.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,123.20
|
| Rate for Payer: Preferred Network Access Commercial |
$10,922.24
|
| Rate for Payer: Quartz Beloit One Network |
$5,817.28
|
| Rate for Payer: Quartz Commercial |
$7,123.20
|
| Rate for Payer: WEA Trust Commercial |
$6,529.60
|
| Rate for Payer: WPS Commercial |
$8,793.59
|
|
|
FEMORAL NAIL RFNA RETROGRADE 10MM X 340MM 10 DEG BEND 04.233.035S
|
Facility
|
OP
|
$11,872.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6202972
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,324.16 |
| Max. Negotiated Rate |
$47,488.00 |
| Rate for Payer: Aetna Commercial |
$10,684.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,209.92
|
| Rate for Payer: Aetna Managed Medicare |
$3,324.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,716.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,936.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,698.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,292.16
|
| Rate for Payer: Cash Price |
$3,561.60
|
| Rate for Payer: Cigna Commercial |
$10,922.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,643.57
|
| Rate for Payer: Health EOS Commercial |
$10,566.08
|
| Rate for Payer: HFN Commercial |
$10,922.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,904.00
|
| Rate for Payer: Multiplan Commercial |
$9,497.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,123.20
|
| Rate for Payer: Preferred Network Access Commercial |
$10,922.24
|
| Rate for Payer: Quartz Beloit One Network |
$5,817.28
|
| Rate for Payer: Quartz Commercial |
$7,716.80
|
| Rate for Payer: Quartz Medicare Advantage |
$7,123.20
|
| Rate for Payer: The Alliance Commercial |
$47,488.00
|
| Rate for Payer: WEA Trust Commercial |
$6,529.60
|
| Rate for Payer: WPS Commercial |
$8,793.59
|
|
|
FEMORAL NAIL RFNA RETROGRADE 12MM X 240MM STD BEND 04.233.224S
|
Facility
|
OP
|
$10,725.14
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6246184
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,003.04 |
| Max. Negotiated Rate |
$42,900.56 |
| Rate for Payer: Aetna Commercial |
$9,652.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,223.62
|
| Rate for Payer: Aetna Managed Medicare |
$3,003.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,971.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,362.57
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,148.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,684.32
|
| Rate for Payer: Cash Price |
$3,217.54
|
| Rate for Payer: Cigna Commercial |
$9,867.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,001.79
|
| Rate for Payer: Health EOS Commercial |
$9,545.37
|
| Rate for Payer: HFN Commercial |
$9,867.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,043.86
|
| Rate for Payer: Multiplan Commercial |
$8,580.11
|
| Rate for Payer: NAPHCARE Commercial |
$6,435.08
|
| Rate for Payer: Preferred Network Access Commercial |
$9,867.13
|
| Rate for Payer: Quartz Beloit One Network |
$5,255.32
|
| Rate for Payer: Quartz Commercial |
$6,971.34
|
| Rate for Payer: Quartz Medicare Advantage |
$6,435.08
|
| Rate for Payer: The Alliance Commercial |
$42,900.56
|
| Rate for Payer: WEA Trust Commercial |
$5,898.83
|
| Rate for Payer: WPS Commercial |
$7,944.11
|
|
|
FEMORAL NAIL RFNA RETROGRADE 12MM X 240MM STD BEND 04.233.224S
|
Facility
|
IP
|
$10,725.14
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6246184
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,255.32 |
| Max. Negotiated Rate |
$9,867.13 |
| Rate for Payer: Aetna Commercial |
$9,652.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,223.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,684.32
|
| Rate for Payer: Cash Price |
$3,217.54
|
| Rate for Payer: Cigna Commercial |
$9,867.13
|
| Rate for Payer: Health EOS Commercial |
$9,545.37
|
| Rate for Payer: HFN Commercial |
$9,867.13
|
| Rate for Payer: Multiplan Commercial |
$8,580.11
|
| Rate for Payer: NAPHCARE Commercial |
$6,435.08
|
| Rate for Payer: Preferred Network Access Commercial |
$9,867.13
|
| Rate for Payer: Quartz Beloit One Network |
$5,255.32
|
| Rate for Payer: Quartz Commercial |
$6,435.08
|
| Rate for Payer: WEA Trust Commercial |
$5,898.83
|
| Rate for Payer: WPS Commercial |
$7,944.11
|
|
|
FEMORAL NAIL RFNA RETROGRADE 12MM X 380MM STD BEND 5DEG RT 04.233.238S
|
Facility
|
OP
|
$11,122.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6175472
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,114.16 |
| Max. Negotiated Rate |
$44,488.00 |
| Rate for Payer: Aetna Commercial |
$10,009.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,564.92
|
| Rate for Payer: Aetna Managed Medicare |
$3,114.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,229.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,561.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,338.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,894.66
|
| Rate for Payer: Cash Price |
$3,336.60
|
| Rate for Payer: Cigna Commercial |
$10,232.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,223.87
|
| Rate for Payer: Health EOS Commercial |
$9,898.58
|
| Rate for Payer: HFN Commercial |
$10,232.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,341.50
|
| Rate for Payer: Multiplan Commercial |
$8,897.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,673.20
|
| Rate for Payer: Preferred Network Access Commercial |
$10,232.24
|
| Rate for Payer: Quartz Beloit One Network |
$5,449.78
|
| Rate for Payer: Quartz Commercial |
$7,229.30
|
| Rate for Payer: Quartz Medicare Advantage |
$6,673.20
|
| Rate for Payer: The Alliance Commercial |
$44,488.00
|
| Rate for Payer: WEA Trust Commercial |
$6,117.10
|
| Rate for Payer: WPS Commercial |
$8,238.07
|
|
|
FEMORAL NAIL RFNA RETROGRADE 12MM X 380MM STD BEND 5DEG RT 04.233.238S
|
Facility
|
IP
|
$11,122.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6175472
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,449.78 |
| Max. Negotiated Rate |
$10,232.24 |
| Rate for Payer: Aetna Commercial |
$10,009.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,564.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,894.66
|
| Rate for Payer: Cash Price |
$3,336.60
|
| Rate for Payer: Cigna Commercial |
$10,232.24
|
| Rate for Payer: Health EOS Commercial |
$9,898.58
|
| Rate for Payer: HFN Commercial |
$10,232.24
|
| Rate for Payer: Multiplan Commercial |
$8,897.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,673.20
|
| Rate for Payer: Preferred Network Access Commercial |
$10,232.24
|
| Rate for Payer: Quartz Beloit One Network |
$5,449.78
|
| Rate for Payer: Quartz Commercial |
$6,673.20
|
| Rate for Payer: WEA Trust Commercial |
$6,117.10
|
| Rate for Payer: WPS Commercial |
$8,238.07
|
|
|
FEMORAL POPLITEAL/TIBIAL/DISTAL BYPASS GRAFT
|
Facility
|
OP
|
$16,743.00
|
|
| Hospital Charge Code |
2960067
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,688.04 |
| Max. Negotiated Rate |
$66,972.00 |
| Rate for Payer: Aetna Commercial |
$15,068.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,398.98
|
| Rate for Payer: Aetna Managed Medicare |
$4,688.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,882.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,371.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,036.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,873.79
|
| Rate for Payer: Cash Price |
$5,022.90
|
| Rate for Payer: Cigna Commercial |
$15,403.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,369.38
|
| Rate for Payer: Health EOS Commercial |
$14,901.27
|
| Rate for Payer: HFN Commercial |
$15,403.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,557.25
|
| Rate for Payer: Multiplan Commercial |
$13,394.40
|
| Rate for Payer: NAPHCARE Commercial |
$10,045.80
|
| Rate for Payer: Preferred Network Access Commercial |
$15,403.56
|
| Rate for Payer: Quartz Beloit One Network |
$8,204.07
|
| Rate for Payer: Quartz Commercial |
$10,882.95
|
| Rate for Payer: Quartz Medicare Advantage |
$10,045.80
|
| Rate for Payer: The Alliance Commercial |
$66,972.00
|
| Rate for Payer: WEA Trust Commercial |
$9,208.65
|
| Rate for Payer: WPS Commercial |
$12,401.54
|
|
