|
HIP CANNULATED SCREW
|
Facility
|
OP
|
$5,721.00
|
|
| Hospital Charge Code |
2960122
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,665.96 |
| 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: Aetna Managed Medicare |
$1,665.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,867.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,974.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,855.92
|
| 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: Dean Health DHI/DHP/ASO |
$3,329.62
|
| Rate for Payer: Health EOS Commercial |
$5,295.36
|
| Rate for Payer: HFN Commercial |
$5,473.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,462.38
|
| Rate for Payer: Multiplan Commercial |
$4,759.87
|
| Rate for Payer: NAPHCARE Commercial |
$3,569.90
|
| 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 |
$3,867.40
|
| Rate for Payer: Quartz Medicare Advantage |
$3,569.90
|
| Rate for Payer: The Alliance Commercial |
$2,974.92
|
| Rate for Payer: WEA Trust Commercial |
$3,272.41
|
| Rate for Payer: WPS Commercial |
$4,406.89
|
|
|
HIP CORE DECOMPRESSION
|
Facility
|
IP
|
$5,314.00
|
|
| Hospital Charge Code |
2960119
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,708.01 |
| Max. Negotiated Rate |
$5,084.44 |
| Rate for Payer: Aetna Commercial |
$4,973.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,752.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,929.08
|
| Rate for Payer: Cash Price |
$1,594.20
|
| Rate for Payer: Cigna Commercial |
$5,084.44
|
| Rate for Payer: Health EOS Commercial |
$4,918.64
|
| Rate for Payer: HFN Commercial |
$5,084.44
|
| Rate for Payer: Multiplan Commercial |
$4,421.25
|
| Rate for Payer: Preferred Network Access Commercial |
$5,084.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,708.01
|
| Rate for Payer: Quartz Commercial |
$3,315.94
|
| Rate for Payer: WEA Trust Commercial |
$3,039.61
|
| Rate for Payer: WPS Commercial |
$4,093.37
|
|
|
HIP CORE DECOMPRESSION
|
Facility
|
OP
|
$5,314.00
|
|
| Hospital Charge Code |
2960119
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,547.44 |
| Max. Negotiated Rate |
$5,084.44 |
| Rate for Payer: Aetna Commercial |
$4,973.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,752.84
|
| Rate for Payer: Aetna Managed Medicare |
$1,547.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,592.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,763.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,652.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,929.08
|
| Rate for Payer: Cash Price |
$1,594.20
|
| Rate for Payer: Cigna Commercial |
$5,084.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,092.75
|
| Rate for Payer: Health EOS Commercial |
$4,918.64
|
| Rate for Payer: HFN Commercial |
$5,084.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,144.92
|
| Rate for Payer: Multiplan Commercial |
$4,421.25
|
| Rate for Payer: NAPHCARE Commercial |
$3,315.94
|
| Rate for Payer: Preferred Network Access Commercial |
$5,084.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,708.01
|
| Rate for Payer: Quartz Commercial |
$3,592.26
|
| Rate for Payer: Quartz Medicare Advantage |
$3,315.94
|
| Rate for Payer: The Alliance Commercial |
$2,763.28
|
| Rate for Payer: WEA Trust Commercial |
$3,039.61
|
| Rate for Payer: WPS Commercial |
$4,093.37
|
|
|
HIP OSTEOTOMY
|
Facility
|
OP
|
$4,324.00
|
|
| Hospital Charge Code |
2960291
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,259.15 |
| Max. Negotiated Rate |
$4,137.20 |
| Rate for Payer: Aetna Commercial |
$4,047.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,867.39
|
| Rate for Payer: Aetna Managed Medicare |
$1,259.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,923.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,248.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,158.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,383.39
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$4,137.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,516.57
|
| Rate for Payer: Health EOS Commercial |
$4,002.29
|
| Rate for Payer: HFN Commercial |
$4,137.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,372.72
|
| Rate for Payer: Multiplan Commercial |
$3,597.57
|
| Rate for Payer: NAPHCARE Commercial |
$2,698.18
|
| Rate for Payer: Preferred Network Access Commercial |
$4,137.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,203.51
|
| Rate for Payer: Quartz Commercial |
$2,923.02
|
| Rate for Payer: Quartz Medicare Advantage |
$2,698.18
|
| Rate for Payer: The Alliance Commercial |
$2,248.48
|
| Rate for Payer: WEA Trust Commercial |
$2,473.33
|
| Rate for Payer: WPS Commercial |
$3,330.78
|
|
|
HIP OSTEOTOMY
|
Facility
|
IP
|
$4,324.00
|
|
| Hospital Charge Code |
2960291
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,203.51 |
| Max. Negotiated Rate |
$4,137.20 |
| Rate for Payer: Aetna Commercial |
$4,047.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,867.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,383.39
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$4,137.20
|
| Rate for Payer: Health EOS Commercial |
$4,002.29
|
| Rate for Payer: HFN Commercial |
$4,137.20
|
| Rate for Payer: Multiplan Commercial |
$3,597.57
|
| Rate for Payer: Preferred Network Access Commercial |
$4,137.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,203.51
|
| Rate for Payer: Quartz Commercial |
$2,698.18
|
| Rate for Payer: WEA Trust Commercial |
$2,473.33
|
| Rate for Payer: WPS Commercial |
$3,330.78
|
|
|
HIP PINNING/SIDE PLATE
|
Facility
|
OP
|
$5,721.00
|
|
| Hospital Charge Code |
2960120
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,665.96 |
| 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: Aetna Managed Medicare |
$1,665.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,867.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,974.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,855.92
|
| 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: Dean Health DHI/DHP/ASO |
$3,329.62
|
| Rate for Payer: Health EOS Commercial |
$5,295.36
|
| Rate for Payer: HFN Commercial |
$5,473.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,462.38
|
| Rate for Payer: Multiplan Commercial |
$4,759.87
|
| Rate for Payer: NAPHCARE Commercial |
$3,569.90
|
| 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 |
$3,867.40
|
| Rate for Payer: Quartz Medicare Advantage |
$3,569.90
|
| Rate for Payer: The Alliance Commercial |
$2,974.92
|
| Rate for Payer: WEA Trust Commercial |
$3,272.41
|
| Rate for Payer: WPS Commercial |
$4,406.89
|
|
|
HIP PINNING/SIDE PLATE
|
Facility
|
IP
|
$5,721.00
|
|
| Hospital Charge Code |
2960120
|
|
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
|
|
|
HIP PLATE 130 DEG 2HL STD BARREL KEYLESS OMEGA 3 597102S
|
Facility
|
OP
|
$4,653.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6184981
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,354.95 |
| Max. Negotiated Rate |
$4,451.99 |
| Rate for Payer: Aetna Commercial |
$4,355.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,161.64
|
| Rate for Payer: Aetna Managed Medicare |
$1,354.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,145.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,419.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,322.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,564.73
|
| Rate for Payer: Cash Price |
$1,395.90
|
| Rate for Payer: Cigna Commercial |
$4,451.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,708.05
|
| Rate for Payer: Health EOS Commercial |
$4,306.82
|
| Rate for Payer: HFN Commercial |
$4,451.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,629.34
|
| Rate for Payer: Multiplan Commercial |
$3,871.30
|
| Rate for Payer: NAPHCARE Commercial |
$2,903.47
|
| Rate for Payer: Preferred Network Access Commercial |
$4,451.99
|
| Rate for Payer: Quartz Beloit One Network |
$2,371.17
|
| Rate for Payer: Quartz Commercial |
$3,145.43
|
| Rate for Payer: Quartz Medicare Advantage |
$2,903.47
|
| Rate for Payer: The Alliance Commercial |
$2,419.56
|
| Rate for Payer: WEA Trust Commercial |
$2,661.52
|
| Rate for Payer: WPS Commercial |
$3,584.21
|
|
|
HIP PLATE 130 DEG 2HL STD BARREL KEYLESS OMEGA 3 597102S
|
Facility
|
IP
|
$4,653.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6184981
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,371.17 |
| Max. Negotiated Rate |
$4,451.99 |
| Rate for Payer: Aetna Commercial |
$4,355.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,161.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,564.73
|
| Rate for Payer: Cash Price |
$1,395.90
|
| Rate for Payer: Cigna Commercial |
$4,451.99
|
| Rate for Payer: Health EOS Commercial |
$4,306.82
|
| Rate for Payer: HFN Commercial |
$4,451.99
|
| Rate for Payer: Multiplan Commercial |
$3,871.30
|
| Rate for Payer: Preferred Network Access Commercial |
$4,451.99
|
| Rate for Payer: Quartz Beloit One Network |
$2,371.17
|
| Rate for Payer: Quartz Commercial |
$2,903.47
|
| Rate for Payer: WEA Trust Commercial |
$2,661.52
|
| Rate for Payer: WPS Commercial |
$3,584.21
|
|
|
HIP PLATE 130 DEG 6HL STD BARREL KEYLESS OMEGA 3 597106S
|
Facility
|
IP
|
$3,736.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5459546
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,903.87 |
| Max. Negotiated Rate |
$3,574.60 |
| Rate for Payer: Aetna Commercial |
$3,496.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,341.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,059.28
|
| Rate for Payer: Cash Price |
$1,120.80
|
| Rate for Payer: Cigna Commercial |
$3,574.60
|
| Rate for Payer: Health EOS Commercial |
$3,458.04
|
| Rate for Payer: HFN Commercial |
$3,574.60
|
| Rate for Payer: Multiplan Commercial |
$3,108.35
|
| Rate for Payer: Preferred Network Access Commercial |
$3,574.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,903.87
|
| Rate for Payer: Quartz Commercial |
$2,331.26
|
| Rate for Payer: WEA Trust Commercial |
$2,136.99
|
| Rate for Payer: WPS Commercial |
$2,877.84
|
|
|
HIP PLATE 130 DEG 6HL STD BARREL KEYLESS OMEGA 3 597106S
|
Facility
|
OP
|
$3,736.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5459546
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,087.92 |
| Max. Negotiated Rate |
$3,574.60 |
| Rate for Payer: Aetna Commercial |
$3,496.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,341.48
|
| Rate for Payer: Aetna Managed Medicare |
$1,087.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,525.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,942.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,865.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,059.28
|
| Rate for Payer: Cash Price |
$1,120.80
|
| Rate for Payer: Cigna Commercial |
$3,574.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,174.35
|
| Rate for Payer: Health EOS Commercial |
$3,458.04
|
| Rate for Payer: HFN Commercial |
$3,574.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,914.08
|
| Rate for Payer: Multiplan Commercial |
$3,108.35
|
| Rate for Payer: NAPHCARE Commercial |
$2,331.26
|
| Rate for Payer: Preferred Network Access Commercial |
$3,574.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,903.87
|
| Rate for Payer: Quartz Commercial |
$2,525.54
|
| Rate for Payer: Quartz Medicare Advantage |
$2,331.26
|
| Rate for Payer: The Alliance Commercial |
$1,942.72
|
| Rate for Payer: WEA Trust Commercial |
$2,136.99
|
| Rate for Payer: WPS Commercial |
$2,877.84
|
|
|
HIP PLATE 135 DEG 2HL STD BARREL KEYLESS OMEGA 3 597122S
|
Facility
|
OP
|
$3,736.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5729873
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,087.92 |
| Max. Negotiated Rate |
$3,574.60 |
| Rate for Payer: Aetna Commercial |
$3,496.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,341.48
|
| Rate for Payer: Aetna Managed Medicare |
$1,087.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,525.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,942.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,865.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,059.28
|
| Rate for Payer: Cash Price |
$1,120.80
|
| Rate for Payer: Cigna Commercial |
$3,574.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,174.35
|
| Rate for Payer: Health EOS Commercial |
$3,458.04
|
| Rate for Payer: HFN Commercial |
$3,574.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,914.08
|
| Rate for Payer: Multiplan Commercial |
$3,108.35
|
| Rate for Payer: NAPHCARE Commercial |
$2,331.26
|
| Rate for Payer: Preferred Network Access Commercial |
$3,574.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,903.87
|
| Rate for Payer: Quartz Commercial |
$2,525.54
|
| Rate for Payer: Quartz Medicare Advantage |
$2,331.26
|
| Rate for Payer: The Alliance Commercial |
$1,942.72
|
| Rate for Payer: WEA Trust Commercial |
$2,136.99
|
| Rate for Payer: WPS Commercial |
$2,877.84
|
|
|
HIP PLATE 135 DEG 2HL STD BARREL KEYLESS OMEGA 3 597122S
|
Facility
|
IP
|
$3,736.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5729873
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,903.87 |
| Max. Negotiated Rate |
$3,574.60 |
| Rate for Payer: Aetna Commercial |
$3,496.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,341.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,059.28
|
| Rate for Payer: Cash Price |
$1,120.80
|
| Rate for Payer: Cigna Commercial |
$3,574.60
|
| Rate for Payer: Health EOS Commercial |
$3,458.04
|
| Rate for Payer: HFN Commercial |
$3,574.60
|
| Rate for Payer: Multiplan Commercial |
$3,108.35
|
| Rate for Payer: Preferred Network Access Commercial |
$3,574.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,903.87
|
| Rate for Payer: Quartz Commercial |
$2,331.26
|
| Rate for Payer: WEA Trust Commercial |
$2,136.99
|
| Rate for Payer: WPS Commercial |
$2,877.84
|
|
|
HIP PROSTHESIS AUSTIN-MOORE 41MM 4021-08-41
|
Facility
|
IP
|
$5,848.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967710
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,980.14 |
| Max. Negotiated Rate |
$5,595.37 |
| Rate for Payer: Aetna Commercial |
$5,473.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,230.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,223.42
|
| Rate for Payer: Cash Price |
$1,754.40
|
| Rate for Payer: Cigna Commercial |
$5,595.37
|
| Rate for Payer: Health EOS Commercial |
$5,412.91
|
| Rate for Payer: HFN Commercial |
$5,595.37
|
| Rate for Payer: Multiplan Commercial |
$4,865.54
|
| Rate for Payer: Preferred Network Access Commercial |
$5,595.37
|
| Rate for Payer: Quartz Beloit One Network |
$2,980.14
|
| Rate for Payer: Quartz Commercial |
$3,649.15
|
| Rate for Payer: WEA Trust Commercial |
$3,345.06
|
| Rate for Payer: WPS Commercial |
$4,504.71
|
|
|
HIP PROSTHESIS AUSTIN-MOORE 41MM 4021-08-41
|
Facility
|
OP
|
$5,848.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967710
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,702.94 |
| Max. Negotiated Rate |
$5,595.37 |
| Rate for Payer: Aetna Commercial |
$5,473.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,230.45
|
| Rate for Payer: Aetna Managed Medicare |
$1,702.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,953.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,040.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,919.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,223.42
|
| Rate for Payer: Cash Price |
$1,754.40
|
| Rate for Payer: Cigna Commercial |
$5,595.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,403.54
|
| Rate for Payer: Health EOS Commercial |
$5,412.91
|
| Rate for Payer: HFN Commercial |
$5,595.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,561.44
|
| Rate for Payer: Multiplan Commercial |
$4,865.54
|
| Rate for Payer: NAPHCARE Commercial |
$3,649.15
|
| Rate for Payer: Preferred Network Access Commercial |
$5,595.37
|
| Rate for Payer: Quartz Beloit One Network |
$2,980.14
|
| Rate for Payer: Quartz Commercial |
$3,953.25
|
| Rate for Payer: Quartz Medicare Advantage |
$3,649.15
|
| Rate for Payer: The Alliance Commercial |
$3,040.96
|
| Rate for Payer: WEA Trust Commercial |
$3,345.06
|
| Rate for Payer: WPS Commercial |
$4,504.71
|
|
|
HIP PROSTHESIS AUSTIN-MOORE 43MM 4021-08-43
|
Facility
|
OP
|
$8,221.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967711
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,393.96 |
| Max. Negotiated Rate |
$7,865.85 |
| Rate for Payer: Aetna Commercial |
$7,694.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,352.86
|
| Rate for Payer: Aetna Managed Medicare |
$2,393.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,557.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,274.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,103.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,531.42
|
| Rate for Payer: Cash Price |
$2,466.30
|
| Rate for Payer: Cigna Commercial |
$7,865.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,784.62
|
| Rate for Payer: Health EOS Commercial |
$7,609.36
|
| Rate for Payer: HFN Commercial |
$7,865.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,412.38
|
| Rate for Payer: Multiplan Commercial |
$6,839.87
|
| Rate for Payer: NAPHCARE Commercial |
$5,129.90
|
| Rate for Payer: Preferred Network Access Commercial |
$7,865.85
|
| Rate for Payer: Quartz Beloit One Network |
$4,189.42
|
| Rate for Payer: Quartz Commercial |
$5,557.40
|
| Rate for Payer: Quartz Medicare Advantage |
$5,129.90
|
| Rate for Payer: The Alliance Commercial |
$4,274.92
|
| Rate for Payer: WEA Trust Commercial |
$4,702.41
|
| Rate for Payer: WPS Commercial |
$6,332.64
|
|
|
HIP PROSTHESIS AUSTIN-MOORE 43MM 4021-08-43
|
Facility
|
IP
|
$8,221.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967711
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,189.42 |
| Max. Negotiated Rate |
$7,865.85 |
| Rate for Payer: Aetna Commercial |
$7,694.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,352.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,531.42
|
| Rate for Payer: Cash Price |
$2,466.30
|
| Rate for Payer: Cigna Commercial |
$7,865.85
|
| Rate for Payer: Health EOS Commercial |
$7,609.36
|
| Rate for Payer: HFN Commercial |
$7,865.85
|
| Rate for Payer: Multiplan Commercial |
$6,839.87
|
| Rate for Payer: Preferred Network Access Commercial |
$7,865.85
|
| Rate for Payer: Quartz Beloit One Network |
$4,189.42
|
| Rate for Payer: Quartz Commercial |
$5,129.90
|
| Rate for Payer: WEA Trust Commercial |
$4,702.41
|
| Rate for Payer: WPS Commercial |
$6,332.64
|
|
|
HIP PROSTHESIS AUSTIN-MOORE 44MM 4021-08-44
|
Facility
|
OP
|
$8,221.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967712
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,393.96 |
| Max. Negotiated Rate |
$7,865.85 |
| Rate for Payer: Aetna Commercial |
$7,694.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,352.86
|
| Rate for Payer: Aetna Managed Medicare |
$2,393.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,557.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,274.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,103.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,531.42
|
| Rate for Payer: Cash Price |
$2,466.30
|
| Rate for Payer: Cigna Commercial |
$7,865.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,784.62
|
| Rate for Payer: Health EOS Commercial |
$7,609.36
|
| Rate for Payer: HFN Commercial |
$7,865.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,412.38
|
| Rate for Payer: Multiplan Commercial |
$6,839.87
|
| Rate for Payer: NAPHCARE Commercial |
$5,129.90
|
| Rate for Payer: Preferred Network Access Commercial |
$7,865.85
|
| Rate for Payer: Quartz Beloit One Network |
$4,189.42
|
| Rate for Payer: Quartz Commercial |
$5,557.40
|
| Rate for Payer: Quartz Medicare Advantage |
$5,129.90
|
| Rate for Payer: The Alliance Commercial |
$4,274.92
|
| Rate for Payer: WEA Trust Commercial |
$4,702.41
|
| Rate for Payer: WPS Commercial |
$6,332.64
|
|
|
HIP PROSTHESIS AUSTIN-MOORE 44MM 4021-08-44
|
Facility
|
IP
|
$8,221.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967712
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,189.42 |
| Max. Negotiated Rate |
$7,865.85 |
| Rate for Payer: Aetna Commercial |
$7,694.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,352.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,531.42
|
| Rate for Payer: Cash Price |
$2,466.30
|
| Rate for Payer: Cigna Commercial |
$7,865.85
|
| Rate for Payer: Health EOS Commercial |
$7,609.36
|
| Rate for Payer: HFN Commercial |
$7,865.85
|
| Rate for Payer: Multiplan Commercial |
$6,839.87
|
| Rate for Payer: Preferred Network Access Commercial |
$7,865.85
|
| Rate for Payer: Quartz Beloit One Network |
$4,189.42
|
| Rate for Payer: Quartz Commercial |
$5,129.90
|
| Rate for Payer: WEA Trust Commercial |
$4,702.41
|
| Rate for Payer: WPS Commercial |
$6,332.64
|
|
|
HIP PROSTHESIS AUSTIN-MOORE 46MM 4021-08-46
|
Facility
|
OP
|
$7,008.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,040.73 |
| Max. Negotiated Rate |
$6,705.25 |
| Rate for Payer: Aetna Commercial |
$6,559.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,267.96
|
| Rate for Payer: Aetna Managed Medicare |
$2,040.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,737.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,644.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,498.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,862.81
|
| Rate for Payer: Cash Price |
$2,102.40
|
| Rate for Payer: Cigna Commercial |
$6,705.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,078.66
|
| Rate for Payer: Health EOS Commercial |
$6,486.60
|
| Rate for Payer: HFN Commercial |
$6,705.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,466.24
|
| Rate for Payer: Multiplan Commercial |
$5,830.66
|
| Rate for Payer: NAPHCARE Commercial |
$4,372.99
|
| Rate for Payer: Preferred Network Access Commercial |
$6,705.25
|
| Rate for Payer: Quartz Beloit One Network |
$3,571.28
|
| Rate for Payer: Quartz Commercial |
$4,737.41
|
| Rate for Payer: Quartz Medicare Advantage |
$4,372.99
|
| Rate for Payer: The Alliance Commercial |
$3,644.16
|
| Rate for Payer: WEA Trust Commercial |
$4,008.58
|
| Rate for Payer: WPS Commercial |
$5,398.26
|
|
|
HIP PROSTHESIS AUSTIN-MOORE 46MM 4021-08-46
|
Facility
|
IP
|
$7,008.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,571.28 |
| Max. Negotiated Rate |
$6,705.25 |
| Rate for Payer: Aetna Commercial |
$6,559.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,267.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,862.81
|
| Rate for Payer: Cash Price |
$2,102.40
|
| Rate for Payer: Cigna Commercial |
$6,705.25
|
| Rate for Payer: Health EOS Commercial |
$6,486.60
|
| Rate for Payer: HFN Commercial |
$6,705.25
|
| Rate for Payer: Multiplan Commercial |
$5,830.66
|
| Rate for Payer: Preferred Network Access Commercial |
$6,705.25
|
| Rate for Payer: Quartz Beloit One Network |
$3,571.28
|
| Rate for Payer: Quartz Commercial |
$4,372.99
|
| Rate for Payer: WEA Trust Commercial |
$4,008.58
|
| Rate for Payer: WPS Commercial |
$5,398.26
|
|
|
HIP PROSTHESIS AUSTIN-MOORE 48MM 4021-08-48
|
Facility
|
OP
|
$8,221.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967714
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,393.96 |
| Max. Negotiated Rate |
$7,865.85 |
| Rate for Payer: Aetna Commercial |
$7,694.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,352.86
|
| Rate for Payer: Aetna Managed Medicare |
$2,393.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,557.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,274.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,103.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,531.42
|
| Rate for Payer: Cash Price |
$2,466.30
|
| Rate for Payer: Cigna Commercial |
$7,865.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,784.62
|
| Rate for Payer: Health EOS Commercial |
$7,609.36
|
| Rate for Payer: HFN Commercial |
$7,865.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,412.38
|
| Rate for Payer: Multiplan Commercial |
$6,839.87
|
| Rate for Payer: NAPHCARE Commercial |
$5,129.90
|
| Rate for Payer: Preferred Network Access Commercial |
$7,865.85
|
| Rate for Payer: Quartz Beloit One Network |
$4,189.42
|
| Rate for Payer: Quartz Commercial |
$5,557.40
|
| Rate for Payer: Quartz Medicare Advantage |
$5,129.90
|
| Rate for Payer: The Alliance Commercial |
$4,274.92
|
| Rate for Payer: WEA Trust Commercial |
$4,702.41
|
| Rate for Payer: WPS Commercial |
$6,332.64
|
|
|
HIP PROSTHESIS AUSTIN-MOORE 48MM 4021-08-48
|
Facility
|
IP
|
$8,221.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967714
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,189.42 |
| Max. Negotiated Rate |
$7,865.85 |
| Rate for Payer: Aetna Commercial |
$7,694.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,352.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,531.42
|
| Rate for Payer: Cash Price |
$2,466.30
|
| Rate for Payer: Cigna Commercial |
$7,865.85
|
| Rate for Payer: Health EOS Commercial |
$7,609.36
|
| Rate for Payer: HFN Commercial |
$7,865.85
|
| Rate for Payer: Multiplan Commercial |
$6,839.87
|
| Rate for Payer: Preferred Network Access Commercial |
$7,865.85
|
| Rate for Payer: Quartz Beloit One Network |
$4,189.42
|
| Rate for Payer: Quartz Commercial |
$5,129.90
|
| Rate for Payer: WEA Trust Commercial |
$4,702.41
|
| Rate for Payer: WPS Commercial |
$6,332.64
|
|
|
HIP PROSTHESIS AUSTIN-MOORE 49MM 4021-08-49
|
Facility
|
OP
|
$5,848.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967715
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,702.94 |
| Max. Negotiated Rate |
$5,595.37 |
| Rate for Payer: Aetna Commercial |
$5,473.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,230.45
|
| Rate for Payer: Aetna Managed Medicare |
$1,702.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,953.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,040.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,919.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,223.42
|
| Rate for Payer: Cash Price |
$1,754.40
|
| Rate for Payer: Cigna Commercial |
$5,595.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,403.54
|
| Rate for Payer: Health EOS Commercial |
$5,412.91
|
| Rate for Payer: HFN Commercial |
$5,595.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,561.44
|
| Rate for Payer: Multiplan Commercial |
$4,865.54
|
| Rate for Payer: NAPHCARE Commercial |
$3,649.15
|
| Rate for Payer: Preferred Network Access Commercial |
$5,595.37
|
| Rate for Payer: Quartz Beloit One Network |
$2,980.14
|
| Rate for Payer: Quartz Commercial |
$3,953.25
|
| Rate for Payer: Quartz Medicare Advantage |
$3,649.15
|
| Rate for Payer: The Alliance Commercial |
$3,040.96
|
| Rate for Payer: WEA Trust Commercial |
$3,345.06
|
| Rate for Payer: WPS Commercial |
$4,504.71
|
|
|
HIP PROSTHESIS AUSTIN-MOORE 49MM 4021-08-49
|
Facility
|
IP
|
$5,848.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967715
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,980.14 |
| Max. Negotiated Rate |
$5,595.37 |
| Rate for Payer: Aetna Commercial |
$5,473.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,230.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,223.42
|
| Rate for Payer: Cash Price |
$1,754.40
|
| Rate for Payer: Cigna Commercial |
$5,595.37
|
| Rate for Payer: Health EOS Commercial |
$5,412.91
|
| Rate for Payer: HFN Commercial |
$5,595.37
|
| Rate for Payer: Multiplan Commercial |
$4,865.54
|
| Rate for Payer: Preferred Network Access Commercial |
$5,595.37
|
| Rate for Payer: Quartz Beloit One Network |
$2,980.14
|
| Rate for Payer: Quartz Commercial |
$3,649.15
|
| Rate for Payer: WEA Trust Commercial |
$3,345.06
|
| Rate for Payer: WPS Commercial |
$4,504.71
|
|
