|
HIP BALL FRACTURED HEAD 44MM MODULAR CATHCART 1363-44-000
|
Facility
|
OP
|
$40,443.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6178088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,777.00 |
| Max. Negotiated Rate |
$38,695.86 |
| Rate for Payer: Aetna Commercial |
$37,854.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$36,172.22
|
| Rate for Payer: Aetna Managed Medicare |
$11,777.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$27,339.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21,030.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20,189.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$22,292.18
|
| Rate for Payer: Cash Price |
$12,132.90
|
| Rate for Payer: Cigna Commercial |
$38,695.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23,537.83
|
| Rate for Payer: Health EOS Commercial |
$37,434.04
|
| Rate for Payer: HFN Commercial |
$38,695.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31,545.54
|
| Rate for Payer: Multiplan Commercial |
$33,648.58
|
| Rate for Payer: NAPHCARE Commercial |
$25,236.43
|
| Rate for Payer: Preferred Network Access Commercial |
$38,695.86
|
| Rate for Payer: Quartz Beloit One Network |
$20,609.75
|
| Rate for Payer: Quartz Commercial |
$27,339.47
|
| Rate for Payer: Quartz Medicare Advantage |
$25,236.43
|
| Rate for Payer: The Alliance Commercial |
$21,030.36
|
| Rate for Payer: WEA Trust Commercial |
$23,133.40
|
| Rate for Payer: WPS Commercial |
$31,153.24
|
|
|
HIP BALL FRACTURED HEAD 44MM MODULAR CATHCART 1363-44-000
|
Facility
|
IP
|
$40,443.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6178088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20,609.75 |
| Max. Negotiated Rate |
$38,695.86 |
| Rate for Payer: Aetna Commercial |
$37,854.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$36,172.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$22,292.18
|
| Rate for Payer: Cash Price |
$12,132.90
|
| Rate for Payer: Cigna Commercial |
$38,695.86
|
| Rate for Payer: Health EOS Commercial |
$37,434.04
|
| Rate for Payer: HFN Commercial |
$38,695.86
|
| Rate for Payer: Multiplan Commercial |
$33,648.58
|
| Rate for Payer: Preferred Network Access Commercial |
$38,695.86
|
| Rate for Payer: Quartz Beloit One Network |
$20,609.75
|
| Rate for Payer: Quartz Commercial |
$25,236.43
|
| Rate for Payer: WEA Trust Commercial |
$23,133.40
|
| Rate for Payer: WPS Commercial |
$31,153.24
|
|
|
HIP BALL FRACTURED HEAD 45MM MODULAR CATHCART 1363-45-000
|
Facility
|
IP
|
$4,189.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563326
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,134.71 |
| Max. Negotiated Rate |
$4,008.04 |
| Rate for Payer: Aetna Commercial |
$3,920.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,746.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,308.98
|
| Rate for Payer: Cash Price |
$1,256.70
|
| Rate for Payer: Cigna Commercial |
$4,008.04
|
| Rate for Payer: Health EOS Commercial |
$3,877.34
|
| Rate for Payer: HFN Commercial |
$4,008.04
|
| Rate for Payer: Multiplan Commercial |
$3,485.25
|
| Rate for Payer: Preferred Network Access Commercial |
$4,008.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,134.71
|
| Rate for Payer: Quartz Commercial |
$2,613.94
|
| Rate for Payer: WEA Trust Commercial |
$2,396.11
|
| Rate for Payer: WPS Commercial |
$3,226.79
|
|
|
HIP BALL FRACTURED HEAD 45MM MODULAR CATHCART 1363-45-000
|
Facility
|
OP
|
$4,189.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563326
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,219.84 |
| Max. Negotiated Rate |
$4,008.04 |
| Rate for Payer: Aetna Commercial |
$3,920.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,746.64
|
| Rate for Payer: Aetna Managed Medicare |
$1,219.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,831.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,178.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,091.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,308.98
|
| Rate for Payer: Cash Price |
$1,256.70
|
| Rate for Payer: Cigna Commercial |
$4,008.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,438.00
|
| Rate for Payer: Health EOS Commercial |
$3,877.34
|
| Rate for Payer: HFN Commercial |
$4,008.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,267.42
|
| Rate for Payer: Multiplan Commercial |
$3,485.25
|
| Rate for Payer: NAPHCARE Commercial |
$2,613.94
|
| Rate for Payer: Preferred Network Access Commercial |
$4,008.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,134.71
|
| Rate for Payer: Quartz Commercial |
$2,831.76
|
| Rate for Payer: Quartz Medicare Advantage |
$2,613.94
|
| Rate for Payer: The Alliance Commercial |
$2,178.28
|
| Rate for Payer: WEA Trust Commercial |
$2,396.11
|
| Rate for Payer: WPS Commercial |
$3,226.79
|
|
|
HIP BALL FRACTURED HEAD 46MM MODULAR CATHCART 1363-46-000
|
Facility
|
OP
|
$4,373.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5685793
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,273.42 |
| Max. Negotiated Rate |
$4,184.09 |
| Rate for Payer: Aetna Commercial |
$4,093.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,911.21
|
| Rate for Payer: Aetna Managed Medicare |
$1,273.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,956.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,273.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,183.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,410.40
|
| Rate for Payer: Cash Price |
$1,311.90
|
| Rate for Payer: Cigna Commercial |
$4,184.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,545.09
|
| Rate for Payer: Health EOS Commercial |
$4,047.65
|
| Rate for Payer: HFN Commercial |
$4,184.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,410.94
|
| Rate for Payer: Multiplan Commercial |
$3,638.34
|
| Rate for Payer: NAPHCARE Commercial |
$2,728.75
|
| Rate for Payer: Preferred Network Access Commercial |
$4,184.09
|
| Rate for Payer: Quartz Beloit One Network |
$2,228.48
|
| Rate for Payer: Quartz Commercial |
$2,956.15
|
| Rate for Payer: Quartz Medicare Advantage |
$2,728.75
|
| Rate for Payer: The Alliance Commercial |
$2,273.96
|
| Rate for Payer: WEA Trust Commercial |
$2,501.36
|
| Rate for Payer: WPS Commercial |
$3,368.52
|
|
|
HIP BALL FRACTURED HEAD 46MM MODULAR CATHCART 1363-46-000
|
Facility
|
IP
|
$4,373.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5685793
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,228.48 |
| Max. Negotiated Rate |
$4,184.09 |
| Rate for Payer: Aetna Commercial |
$4,093.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,911.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,410.40
|
| Rate for Payer: Cash Price |
$1,311.90
|
| Rate for Payer: Cigna Commercial |
$4,184.09
|
| Rate for Payer: Health EOS Commercial |
$4,047.65
|
| Rate for Payer: HFN Commercial |
$4,184.09
|
| Rate for Payer: Multiplan Commercial |
$3,638.34
|
| Rate for Payer: Preferred Network Access Commercial |
$4,184.09
|
| Rate for Payer: Quartz Beloit One Network |
$2,228.48
|
| Rate for Payer: Quartz Commercial |
$2,728.75
|
| Rate for Payer: WEA Trust Commercial |
$2,501.36
|
| Rate for Payer: WPS Commercial |
$3,368.52
|
|
|
HIP BALL FRACTURED HEAD 47MM MODULAR CATHCART 1363-47-000
|
Facility
|
OP
|
$4,373.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5895695
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,273.42 |
| Max. Negotiated Rate |
$4,184.09 |
| Rate for Payer: Aetna Commercial |
$4,093.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,911.21
|
| Rate for Payer: Aetna Managed Medicare |
$1,273.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,956.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,273.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,183.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,410.40
|
| Rate for Payer: Cash Price |
$1,311.90
|
| Rate for Payer: Cigna Commercial |
$4,184.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,545.09
|
| Rate for Payer: Health EOS Commercial |
$4,047.65
|
| Rate for Payer: HFN Commercial |
$4,184.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,410.94
|
| Rate for Payer: Multiplan Commercial |
$3,638.34
|
| Rate for Payer: NAPHCARE Commercial |
$2,728.75
|
| Rate for Payer: Preferred Network Access Commercial |
$4,184.09
|
| Rate for Payer: Quartz Beloit One Network |
$2,228.48
|
| Rate for Payer: Quartz Commercial |
$2,956.15
|
| Rate for Payer: Quartz Medicare Advantage |
$2,728.75
|
| Rate for Payer: The Alliance Commercial |
$2,273.96
|
| Rate for Payer: WEA Trust Commercial |
$2,501.36
|
| Rate for Payer: WPS Commercial |
$3,368.52
|
|
|
HIP BALL FRACTURED HEAD 47MM MODULAR CATHCART 1363-47-000
|
Facility
|
IP
|
$4,373.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5895695
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,228.48 |
| Max. Negotiated Rate |
$4,184.09 |
| Rate for Payer: Aetna Commercial |
$4,093.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,911.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,410.40
|
| Rate for Payer: Cash Price |
$1,311.90
|
| Rate for Payer: Cigna Commercial |
$4,184.09
|
| Rate for Payer: Health EOS Commercial |
$4,047.65
|
| Rate for Payer: HFN Commercial |
$4,184.09
|
| Rate for Payer: Multiplan Commercial |
$3,638.34
|
| Rate for Payer: Preferred Network Access Commercial |
$4,184.09
|
| Rate for Payer: Quartz Beloit One Network |
$2,228.48
|
| Rate for Payer: Quartz Commercial |
$2,728.75
|
| Rate for Payer: WEA Trust Commercial |
$2,501.36
|
| Rate for Payer: WPS Commercial |
$3,368.52
|
|
|
HIP BALL FRACTURED HEAD 49MM MODULAR CATHCART 1363-49-000
|
Facility
|
OP
|
$4,043.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6178271
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,177.32 |
| Max. Negotiated Rate |
$3,868.34 |
| Rate for Payer: Aetna Commercial |
$3,784.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,616.06
|
| Rate for Payer: Aetna Managed Medicare |
$1,177.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,733.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,102.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,018.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,228.50
|
| Rate for Payer: Cash Price |
$1,212.90
|
| Rate for Payer: Cigna Commercial |
$3,868.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,353.03
|
| Rate for Payer: Health EOS Commercial |
$3,742.20
|
| Rate for Payer: HFN Commercial |
$3,868.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,153.54
|
| Rate for Payer: Multiplan Commercial |
$3,363.78
|
| Rate for Payer: NAPHCARE Commercial |
$2,522.83
|
| Rate for Payer: Preferred Network Access Commercial |
$3,868.34
|
| Rate for Payer: Quartz Beloit One Network |
$2,060.31
|
| Rate for Payer: Quartz Commercial |
$2,733.07
|
| Rate for Payer: Quartz Medicare Advantage |
$2,522.83
|
| Rate for Payer: The Alliance Commercial |
$2,102.36
|
| Rate for Payer: WEA Trust Commercial |
$2,312.60
|
| Rate for Payer: WPS Commercial |
$3,114.32
|
|
|
HIP BALL FRACTURED HEAD 49MM MODULAR CATHCART 1363-49-000
|
Facility
|
IP
|
$4,043.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6178271
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,060.31 |
| Max. Negotiated Rate |
$3,868.34 |
| Rate for Payer: Aetna Commercial |
$3,784.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,616.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,228.50
|
| Rate for Payer: Cash Price |
$1,212.90
|
| Rate for Payer: Cigna Commercial |
$3,868.34
|
| Rate for Payer: Health EOS Commercial |
$3,742.20
|
| Rate for Payer: HFN Commercial |
$3,868.34
|
| Rate for Payer: Multiplan Commercial |
$3,363.78
|
| Rate for Payer: Preferred Network Access Commercial |
$3,868.34
|
| Rate for Payer: Quartz Beloit One Network |
$2,060.31
|
| Rate for Payer: Quartz Commercial |
$2,522.83
|
| Rate for Payer: WEA Trust Commercial |
$2,312.60
|
| Rate for Payer: WPS Commercial |
$3,114.32
|
|
|
HIP BALL FRACTURED HEAD 50MM MODULAR CATHCART 1363-50-000
|
Facility
|
OP
|
$2,603.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5520975
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$757.99 |
| Max. Negotiated Rate |
$2,490.55 |
| Rate for Payer: Aetna Commercial |
$2,436.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,328.12
|
| Rate for Payer: Aetna Managed Medicare |
$757.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,759.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,353.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,299.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,434.77
|
| Rate for Payer: Cash Price |
$780.90
|
| Rate for Payer: Cigna Commercial |
$2,490.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,514.95
|
| Rate for Payer: Health EOS Commercial |
$2,409.34
|
| Rate for Payer: HFN Commercial |
$2,490.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,030.34
|
| Rate for Payer: Multiplan Commercial |
$2,165.70
|
| Rate for Payer: NAPHCARE Commercial |
$1,624.27
|
| Rate for Payer: Preferred Network Access Commercial |
$2,490.55
|
| Rate for Payer: Quartz Beloit One Network |
$1,326.49
|
| Rate for Payer: Quartz Commercial |
$1,759.63
|
| Rate for Payer: Quartz Medicare Advantage |
$1,624.27
|
| Rate for Payer: The Alliance Commercial |
$1,353.56
|
| Rate for Payer: WEA Trust Commercial |
$1,488.92
|
| Rate for Payer: WPS Commercial |
$2,005.09
|
|
|
HIP BALL FRACTURED HEAD 50MM MODULAR CATHCART 1363-50-000
|
Facility
|
IP
|
$2,603.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5520975
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,326.49 |
| Max. Negotiated Rate |
$2,490.55 |
| Rate for Payer: Aetna Commercial |
$2,436.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,328.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,434.77
|
| Rate for Payer: Cash Price |
$780.90
|
| Rate for Payer: Cigna Commercial |
$2,490.55
|
| Rate for Payer: Health EOS Commercial |
$2,409.34
|
| Rate for Payer: HFN Commercial |
$2,490.55
|
| Rate for Payer: Multiplan Commercial |
$2,165.70
|
| Rate for Payer: Preferred Network Access Commercial |
$2,490.55
|
| Rate for Payer: Quartz Beloit One Network |
$1,326.49
|
| Rate for Payer: Quartz Commercial |
$1,624.27
|
| Rate for Payer: WEA Trust Commercial |
$1,488.92
|
| Rate for Payer: WPS Commercial |
$2,005.09
|
|
|
HIP BALL FRACTURED HEAD 51MM MODULAR CATHCART 1363-51-000
|
Facility
|
IP
|
$4,205.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6049628
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,142.87 |
| Max. Negotiated Rate |
$4,023.34 |
| Rate for Payer: Aetna Commercial |
$3,935.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,760.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,317.80
|
| Rate for Payer: Cash Price |
$1,261.50
|
| Rate for Payer: Cigna Commercial |
$4,023.34
|
| Rate for Payer: Health EOS Commercial |
$3,892.15
|
| Rate for Payer: HFN Commercial |
$4,023.34
|
| Rate for Payer: Multiplan Commercial |
$3,498.56
|
| Rate for Payer: Preferred Network Access Commercial |
$4,023.34
|
| Rate for Payer: Quartz Beloit One Network |
$2,142.87
|
| Rate for Payer: Quartz Commercial |
$2,623.92
|
| Rate for Payer: WEA Trust Commercial |
$2,405.26
|
| Rate for Payer: WPS Commercial |
$3,239.11
|
|
|
HIP BALL FRACTURED HEAD 51MM MODULAR CATHCART 1363-51-000
|
Facility
|
OP
|
$4,205.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6049628
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,224.50 |
| Max. Negotiated Rate |
$4,023.34 |
| Rate for Payer: Aetna Commercial |
$3,935.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,760.95
|
| Rate for Payer: Aetna Managed Medicare |
$1,224.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,842.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,186.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,099.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,317.80
|
| Rate for Payer: Cash Price |
$1,261.50
|
| Rate for Payer: Cigna Commercial |
$4,023.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,447.31
|
| Rate for Payer: Health EOS Commercial |
$3,892.15
|
| Rate for Payer: HFN Commercial |
$4,023.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,279.90
|
| Rate for Payer: Multiplan Commercial |
$3,498.56
|
| Rate for Payer: NAPHCARE Commercial |
$2,623.92
|
| Rate for Payer: Preferred Network Access Commercial |
$4,023.34
|
| Rate for Payer: Quartz Beloit One Network |
$2,142.87
|
| Rate for Payer: Quartz Commercial |
$2,842.58
|
| Rate for Payer: Quartz Medicare Advantage |
$2,623.92
|
| Rate for Payer: The Alliance Commercial |
$2,186.60
|
| Rate for Payer: WEA Trust Commercial |
$2,405.26
|
| Rate for Payer: WPS Commercial |
$3,239.11
|
|
|
HIP BALL FRACTURED HEAD 52MM MODULAR CATHCART 1363-52-000
|
Facility
|
IP
|
$2,820.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5520923
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,437.07 |
| Max. Negotiated Rate |
$2,698.18 |
| Rate for Payer: Aetna Commercial |
$2,639.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,522.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,554.38
|
| Rate for Payer: Cash Price |
$846.00
|
| Rate for Payer: Cigna Commercial |
$2,698.18
|
| Rate for Payer: Health EOS Commercial |
$2,610.19
|
| Rate for Payer: HFN Commercial |
$2,698.18
|
| Rate for Payer: Multiplan Commercial |
$2,346.24
|
| Rate for Payer: Preferred Network Access Commercial |
$2,698.18
|
| Rate for Payer: Quartz Beloit One Network |
$1,437.07
|
| Rate for Payer: Quartz Commercial |
$1,759.68
|
| Rate for Payer: WEA Trust Commercial |
$1,613.04
|
| Rate for Payer: WPS Commercial |
$2,172.25
|
|
|
HIP BALL FRACTURED HEAD 52MM MODULAR CATHCART 1363-52-000
|
Facility
|
OP
|
$2,820.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5520923
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$821.18 |
| Max. Negotiated Rate |
$2,698.18 |
| Rate for Payer: Aetna Commercial |
$2,639.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,522.21
|
| Rate for Payer: Aetna Managed Medicare |
$821.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,906.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,466.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,407.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,554.38
|
| Rate for Payer: Cash Price |
$846.00
|
| Rate for Payer: Cigna Commercial |
$2,698.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,641.24
|
| Rate for Payer: Health EOS Commercial |
$2,610.19
|
| Rate for Payer: HFN Commercial |
$2,698.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,199.60
|
| Rate for Payer: Multiplan Commercial |
$2,346.24
|
| Rate for Payer: NAPHCARE Commercial |
$1,759.68
|
| Rate for Payer: Preferred Network Access Commercial |
$2,698.18
|
| Rate for Payer: Quartz Beloit One Network |
$1,437.07
|
| Rate for Payer: Quartz Commercial |
$1,906.32
|
| Rate for Payer: Quartz Medicare Advantage |
$1,759.68
|
| Rate for Payer: The Alliance Commercial |
$1,466.40
|
| Rate for Payer: WEA Trust Commercial |
$1,613.04
|
| Rate for Payer: WPS Commercial |
$2,172.25
|
|
|
HIP BALL FRACTURED HEAD 53MM MODULAR CATHCART 1363-53-000
|
Facility
|
OP
|
$4,548.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5597609
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,324.38 |
| Max. Negotiated Rate |
$4,351.53 |
| Rate for Payer: Aetna Commercial |
$4,256.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,067.73
|
| Rate for Payer: Aetna Managed Medicare |
$1,324.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,074.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,364.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,270.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,506.86
|
| Rate for Payer: Cash Price |
$1,364.40
|
| Rate for Payer: Cigna Commercial |
$4,351.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,646.94
|
| Rate for Payer: Health EOS Commercial |
$4,209.63
|
| Rate for Payer: HFN Commercial |
$4,351.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,547.44
|
| Rate for Payer: Multiplan Commercial |
$3,783.94
|
| Rate for Payer: NAPHCARE Commercial |
$2,837.95
|
| Rate for Payer: Preferred Network Access Commercial |
$4,351.53
|
| Rate for Payer: Quartz Beloit One Network |
$2,317.66
|
| Rate for Payer: Quartz Commercial |
$3,074.45
|
| Rate for Payer: Quartz Medicare Advantage |
$2,837.95
|
| Rate for Payer: The Alliance Commercial |
$2,364.96
|
| Rate for Payer: WEA Trust Commercial |
$2,601.46
|
| Rate for Payer: WPS Commercial |
$3,503.32
|
|
|
HIP BALL FRACTURED HEAD 53MM MODULAR CATHCART 1363-53-000
|
Facility
|
IP
|
$4,548.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5597609
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,317.66 |
| Max. Negotiated Rate |
$4,351.53 |
| Rate for Payer: Aetna Commercial |
$4,256.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,067.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,506.86
|
| Rate for Payer: Cash Price |
$1,364.40
|
| Rate for Payer: Cigna Commercial |
$4,351.53
|
| Rate for Payer: Health EOS Commercial |
$4,209.63
|
| Rate for Payer: HFN Commercial |
$4,351.53
|
| Rate for Payer: Multiplan Commercial |
$3,783.94
|
| Rate for Payer: Preferred Network Access Commercial |
$4,351.53
|
| Rate for Payer: Quartz Beloit One Network |
$2,317.66
|
| Rate for Payer: Quartz Commercial |
$2,837.95
|
| Rate for Payer: WEA Trust Commercial |
$2,601.46
|
| Rate for Payer: WPS Commercial |
$3,503.32
|
|
|
HIP BALL FRACTURED HEAD 54MM MODULAR CATHCART 1363-54-000
|
Facility
|
OP
|
$4,205.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5799692
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,224.50 |
| Max. Negotiated Rate |
$4,023.34 |
| Rate for Payer: Aetna Commercial |
$3,935.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,760.95
|
| Rate for Payer: Aetna Managed Medicare |
$1,224.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,842.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,186.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,099.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,317.80
|
| Rate for Payer: Cash Price |
$1,261.50
|
| Rate for Payer: Cigna Commercial |
$4,023.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,447.31
|
| Rate for Payer: Health EOS Commercial |
$3,892.15
|
| Rate for Payer: HFN Commercial |
$4,023.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,279.90
|
| Rate for Payer: Multiplan Commercial |
$3,498.56
|
| Rate for Payer: NAPHCARE Commercial |
$2,623.92
|
| Rate for Payer: Preferred Network Access Commercial |
$4,023.34
|
| Rate for Payer: Quartz Beloit One Network |
$2,142.87
|
| Rate for Payer: Quartz Commercial |
$2,842.58
|
| Rate for Payer: Quartz Medicare Advantage |
$2,623.92
|
| Rate for Payer: The Alliance Commercial |
$2,186.60
|
| Rate for Payer: WEA Trust Commercial |
$2,405.26
|
| Rate for Payer: WPS Commercial |
$3,239.11
|
|
|
HIP BALL FRACTURED HEAD 54MM MODULAR CATHCART 1363-54-000
|
Facility
|
IP
|
$4,205.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5799692
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,142.87 |
| Max. Negotiated Rate |
$4,023.34 |
| Rate for Payer: Aetna Commercial |
$3,935.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,760.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,317.80
|
| Rate for Payer: Cash Price |
$1,261.50
|
| Rate for Payer: Cigna Commercial |
$4,023.34
|
| Rate for Payer: Health EOS Commercial |
$3,892.15
|
| Rate for Payer: HFN Commercial |
$4,023.34
|
| Rate for Payer: Multiplan Commercial |
$3,498.56
|
| Rate for Payer: Preferred Network Access Commercial |
$4,023.34
|
| Rate for Payer: Quartz Beloit One Network |
$2,142.87
|
| Rate for Payer: Quartz Commercial |
$2,623.92
|
| Rate for Payer: WEA Trust Commercial |
$2,405.26
|
| Rate for Payer: WPS Commercial |
$3,239.11
|
|
|
HIP BALL FRACTURED HEAD 58MM MODULAR CATHCART 1363-58-000
|
Facility
|
OP
|
$4,205.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6172813
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,224.50 |
| Max. Negotiated Rate |
$4,023.34 |
| Rate for Payer: Aetna Commercial |
$3,935.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,760.95
|
| Rate for Payer: Aetna Managed Medicare |
$1,224.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,842.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,186.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,099.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,317.80
|
| Rate for Payer: Cash Price |
$1,261.50
|
| Rate for Payer: Cigna Commercial |
$4,023.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,447.31
|
| Rate for Payer: Health EOS Commercial |
$3,892.15
|
| Rate for Payer: HFN Commercial |
$4,023.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,279.90
|
| Rate for Payer: Multiplan Commercial |
$3,498.56
|
| Rate for Payer: NAPHCARE Commercial |
$2,623.92
|
| Rate for Payer: Preferred Network Access Commercial |
$4,023.34
|
| Rate for Payer: Quartz Beloit One Network |
$2,142.87
|
| Rate for Payer: Quartz Commercial |
$2,842.58
|
| Rate for Payer: Quartz Medicare Advantage |
$2,623.92
|
| Rate for Payer: The Alliance Commercial |
$2,186.60
|
| Rate for Payer: WEA Trust Commercial |
$2,405.26
|
| Rate for Payer: WPS Commercial |
$3,239.11
|
|
|
HIP BALL FRACTURED HEAD 58MM MODULAR CATHCART 1363-58-000
|
Facility
|
IP
|
$4,205.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6172813
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,142.87 |
| Max. Negotiated Rate |
$4,023.34 |
| Rate for Payer: Aetna Commercial |
$3,935.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,760.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,317.80
|
| Rate for Payer: Cash Price |
$1,261.50
|
| Rate for Payer: Cigna Commercial |
$4,023.34
|
| Rate for Payer: Health EOS Commercial |
$3,892.15
|
| Rate for Payer: HFN Commercial |
$4,023.34
|
| Rate for Payer: Multiplan Commercial |
$3,498.56
|
| Rate for Payer: Preferred Network Access Commercial |
$4,023.34
|
| Rate for Payer: Quartz Beloit One Network |
$2,142.87
|
| Rate for Payer: Quartz Commercial |
$2,623.92
|
| Rate for Payer: WEA Trust Commercial |
$2,405.26
|
| Rate for Payer: WPS Commercial |
$3,239.11
|
|
|
HIP BONE GRAFTING
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2959863
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,145.87 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,145.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,660.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,046.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,964.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,290.17
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,069.30
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,455.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,660.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,455.44
|
| Rate for Payer: The Alliance Commercial |
$2,046.20
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
HIP BONE GRAFTING
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2959863
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,005.28 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,455.44
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
HIP CANNULATED SCREW
|
Facility
|
IP
|
$5,721.00
|
|
| Hospital Charge Code |
2960122
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,915.42 |
| Max. Negotiated Rate |
$5,473.85 |
| Rate for Payer: Aetna Commercial |
$5,354.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,116.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,153.42
|
| Rate for Payer: Cash Price |
$1,716.30
|
| Rate for Payer: Cigna Commercial |
$5,473.85
|
| Rate for Payer: Health EOS Commercial |
$5,295.36
|
| Rate for Payer: HFN Commercial |
$5,473.85
|
| Rate for Payer: Multiplan Commercial |
$4,759.87
|
| Rate for Payer: Preferred Network Access Commercial |
$5,473.85
|
| Rate for Payer: Quartz Beloit One Network |
$2,915.42
|
| Rate for Payer: Quartz Commercial |
$3,569.90
|
| Rate for Payer: WEA Trust Commercial |
$3,272.41
|
| Rate for Payer: WPS Commercial |
$4,406.89
|
|
