|
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 |
$1,224.44 |
| Max. Negotiated Rate |
$17,492.00 |
| Rate for Payer: Aetna Commercial |
$3,935.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,760.78
|
| Rate for Payer: Aetna Managed Medicare |
$1,224.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,842.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,186.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,099.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,317.69
|
| Rate for Payer: Cash Price |
$1,311.90
|
| Rate for Payer: Cigna Commercial |
$4,023.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,447.13
|
| Rate for Payer: Health EOS Commercial |
$3,891.97
|
| Rate for Payer: HFN Commercial |
$4,023.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,279.75
|
| Rate for Payer: Multiplan Commercial |
$3,498.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,623.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,023.16
|
| Rate for Payer: Quartz Beloit One Network |
$2,142.77
|
| Rate for Payer: Quartz Commercial |
$2,842.45
|
| Rate for Payer: Quartz Medicare Advantage |
$2,623.80
|
| Rate for Payer: The Alliance Commercial |
$17,492.00
|
| Rate for Payer: WEA Trust Commercial |
$2,405.15
|
| Rate for Payer: WPS Commercial |
$3,239.08
|
|
|
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 |
$2,142.77 |
| Max. Negotiated Rate |
$4,023.16 |
| Rate for Payer: Aetna Commercial |
$3,935.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,760.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,317.69
|
| Rate for Payer: Cash Price |
$1,311.90
|
| Rate for Payer: Cigna Commercial |
$4,023.16
|
| Rate for Payer: Health EOS Commercial |
$3,891.97
|
| Rate for Payer: HFN Commercial |
$4,023.16
|
| Rate for Payer: Multiplan Commercial |
$3,498.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,623.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,023.16
|
| Rate for Payer: Quartz Beloit One Network |
$2,142.77
|
| Rate for Payer: Quartz Commercial |
$2,623.80
|
| Rate for Payer: WEA Trust Commercial |
$2,405.15
|
| Rate for Payer: WPS Commercial |
$3,239.08
|
|
|
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 |
$2,142.77 |
| Max. Negotiated Rate |
$4,023.16 |
| Rate for Payer: Aetna Commercial |
$3,935.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,760.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,317.69
|
| Rate for Payer: Cash Price |
$1,311.90
|
| Rate for Payer: Cigna Commercial |
$4,023.16
|
| Rate for Payer: Health EOS Commercial |
$3,891.97
|
| Rate for Payer: HFN Commercial |
$4,023.16
|
| Rate for Payer: Multiplan Commercial |
$3,498.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,623.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,023.16
|
| Rate for Payer: Quartz Beloit One Network |
$2,142.77
|
| Rate for Payer: Quartz Commercial |
$2,623.80
|
| Rate for Payer: WEA Trust Commercial |
$2,405.15
|
| Rate for Payer: WPS Commercial |
$3,239.08
|
|
|
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 |
$1,224.44 |
| Max. Negotiated Rate |
$17,492.00 |
| Rate for Payer: Aetna Commercial |
$3,935.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,760.78
|
| Rate for Payer: Aetna Managed Medicare |
$1,224.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,842.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,186.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,099.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,317.69
|
| Rate for Payer: Cash Price |
$1,311.90
|
| Rate for Payer: Cigna Commercial |
$4,023.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,447.13
|
| Rate for Payer: Health EOS Commercial |
$3,891.97
|
| Rate for Payer: HFN Commercial |
$4,023.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,279.75
|
| Rate for Payer: Multiplan Commercial |
$3,498.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,623.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,023.16
|
| Rate for Payer: Quartz Beloit One Network |
$2,142.77
|
| Rate for Payer: Quartz Commercial |
$2,842.45
|
| Rate for Payer: Quartz Medicare Advantage |
$2,623.80
|
| Rate for Payer: The Alliance Commercial |
$17,492.00
|
| Rate for Payer: WEA Trust Commercial |
$2,405.15
|
| Rate for Payer: WPS Commercial |
$3,239.08
|
|
|
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 |
$1,132.04 |
| Max. Negotiated Rate |
$16,172.00 |
| Rate for Payer: Aetna Commercial |
$3,638.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,476.98
|
| Rate for Payer: Aetna Managed Medicare |
$1,132.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,627.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,021.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,940.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,142.79
|
| Rate for Payer: Cash Price |
$1,212.90
|
| Rate for Payer: Cigna Commercial |
$3,719.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,262.46
|
| Rate for Payer: Health EOS Commercial |
$3,598.27
|
| Rate for Payer: HFN Commercial |
$3,719.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,032.25
|
| Rate for Payer: Multiplan Commercial |
$3,234.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,425.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,719.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,981.07
|
| Rate for Payer: Quartz Commercial |
$2,627.95
|
| Rate for Payer: Quartz Medicare Advantage |
$2,425.80
|
| Rate for Payer: The Alliance Commercial |
$16,172.00
|
| Rate for Payer: WEA Trust Commercial |
$2,223.65
|
| Rate for Payer: WPS Commercial |
$2,994.65
|
|
|
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 |
$1,981.07 |
| Max. Negotiated Rate |
$3,719.56 |
| Rate for Payer: Aetna Commercial |
$3,638.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,476.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,142.79
|
| Rate for Payer: Cash Price |
$1,212.90
|
| Rate for Payer: Cigna Commercial |
$3,719.56
|
| Rate for Payer: Health EOS Commercial |
$3,598.27
|
| Rate for Payer: HFN Commercial |
$3,719.56
|
| Rate for Payer: Multiplan Commercial |
$3,234.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,425.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,719.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,981.07
|
| Rate for Payer: Quartz Commercial |
$2,425.80
|
| Rate for Payer: WEA Trust Commercial |
$2,223.65
|
| Rate for Payer: WPS Commercial |
$2,994.65
|
|
|
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 |
$1,275.47 |
| Max. Negotiated Rate |
$2,394.76 |
| Rate for Payer: Aetna Commercial |
$2,342.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,238.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,379.59
|
| Rate for Payer: Cash Price |
$780.90
|
| Rate for Payer: Cigna Commercial |
$2,394.76
|
| Rate for Payer: Health EOS Commercial |
$2,316.67
|
| Rate for Payer: HFN Commercial |
$2,394.76
|
| Rate for Payer: Multiplan Commercial |
$2,082.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,561.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,394.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,275.47
|
| Rate for Payer: Quartz Commercial |
$1,561.80
|
| Rate for Payer: WEA Trust Commercial |
$1,431.65
|
| Rate for Payer: WPS Commercial |
$1,928.04
|
|
|
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 |
$728.84 |
| Max. Negotiated Rate |
$10,412.00 |
| Rate for Payer: Aetna Commercial |
$2,342.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,238.58
|
| Rate for Payer: Aetna Managed Medicare |
$728.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,691.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,301.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,249.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,379.59
|
| Rate for Payer: Cash Price |
$780.90
|
| Rate for Payer: Cigna Commercial |
$2,394.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,456.64
|
| Rate for Payer: Health EOS Commercial |
$2,316.67
|
| Rate for Payer: HFN Commercial |
$2,394.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,952.25
|
| Rate for Payer: Multiplan Commercial |
$2,082.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,561.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,394.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,275.47
|
| Rate for Payer: Quartz Commercial |
$1,691.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,561.80
|
| Rate for Payer: The Alliance Commercial |
$10,412.00
|
| Rate for Payer: WEA Trust Commercial |
$1,431.65
|
| Rate for Payer: WPS Commercial |
$1,928.04
|
|
|
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 |
$1,177.40 |
| Max. Negotiated Rate |
$16,820.00 |
| Rate for Payer: Aetna Commercial |
$3,784.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,616.30
|
| Rate for Payer: Aetna Managed Medicare |
$1,177.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,733.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,102.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,018.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,228.65
|
| Rate for Payer: Cash Price |
$1,261.50
|
| Rate for Payer: Cigna Commercial |
$3,868.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,353.12
|
| Rate for Payer: Health EOS Commercial |
$3,742.45
|
| Rate for Payer: HFN Commercial |
$3,868.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,153.75
|
| Rate for Payer: Multiplan Commercial |
$3,364.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,523.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,868.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,060.45
|
| Rate for Payer: Quartz Commercial |
$2,733.25
|
| Rate for Payer: Quartz Medicare Advantage |
$2,523.00
|
| Rate for Payer: The Alliance Commercial |
$16,820.00
|
| Rate for Payer: WEA Trust Commercial |
$2,312.75
|
| Rate for Payer: WPS Commercial |
$3,114.64
|
|
|
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 |
$2,060.45 |
| Max. Negotiated Rate |
$3,868.60 |
| Rate for Payer: Aetna Commercial |
$3,784.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,616.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,228.65
|
| Rate for Payer: Cash Price |
$1,261.50
|
| Rate for Payer: Cigna Commercial |
$3,868.60
|
| Rate for Payer: Health EOS Commercial |
$3,742.45
|
| Rate for Payer: HFN Commercial |
$3,868.60
|
| Rate for Payer: Multiplan Commercial |
$3,364.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,523.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,868.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,060.45
|
| Rate for Payer: Quartz Commercial |
$2,523.00
|
| Rate for Payer: WEA Trust Commercial |
$2,312.75
|
| Rate for Payer: WPS Commercial |
$3,114.64
|
|
|
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 |
$789.60 |
| Max. Negotiated Rate |
$11,280.00 |
| Rate for Payer: Aetna Commercial |
$2,538.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,425.20
|
| Rate for Payer: Aetna Managed Medicare |
$789.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,833.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,410.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,353.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,494.60
|
| Rate for Payer: Cash Price |
$846.00
|
| Rate for Payer: Cigna Commercial |
$2,594.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,578.07
|
| Rate for Payer: Health EOS Commercial |
$2,509.80
|
| Rate for Payer: HFN Commercial |
$2,594.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,115.00
|
| Rate for Payer: Multiplan Commercial |
$2,256.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,692.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,594.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,381.80
|
| Rate for Payer: Quartz Commercial |
$1,833.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,692.00
|
| Rate for Payer: The Alliance Commercial |
$11,280.00
|
| Rate for Payer: WEA Trust Commercial |
$1,551.00
|
| Rate for Payer: WPS Commercial |
$2,088.77
|
|
|
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 |
$1,381.80 |
| Max. Negotiated Rate |
$2,594.40 |
| Rate for Payer: Aetna Commercial |
$2,538.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,425.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,494.60
|
| Rate for Payer: Cash Price |
$846.00
|
| Rate for Payer: Cigna Commercial |
$2,594.40
|
| Rate for Payer: Health EOS Commercial |
$2,509.80
|
| Rate for Payer: HFN Commercial |
$2,594.40
|
| Rate for Payer: Multiplan Commercial |
$2,256.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,692.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,594.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,381.80
|
| Rate for Payer: Quartz Commercial |
$1,692.00
|
| Rate for Payer: WEA Trust Commercial |
$1,551.00
|
| Rate for Payer: WPS Commercial |
$2,088.77
|
|
|
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 |
$1,273.44 |
| Max. Negotiated Rate |
$18,192.00 |
| Rate for Payer: Aetna Commercial |
$4,093.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,911.28
|
| Rate for Payer: Aetna Managed Medicare |
$1,273.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,956.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,274.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,183.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,410.44
|
| Rate for Payer: Cash Price |
$1,364.40
|
| Rate for Payer: Cigna Commercial |
$4,184.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,545.06
|
| Rate for Payer: Health EOS Commercial |
$4,047.72
|
| Rate for Payer: HFN Commercial |
$4,184.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,411.00
|
| Rate for Payer: Multiplan Commercial |
$3,638.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,728.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,184.16
|
| Rate for Payer: Quartz Beloit One Network |
$2,228.52
|
| Rate for Payer: Quartz Commercial |
$2,956.20
|
| Rate for Payer: Quartz Medicare Advantage |
$2,728.80
|
| Rate for Payer: The Alliance Commercial |
$18,192.00
|
| Rate for Payer: WEA Trust Commercial |
$2,501.40
|
| Rate for Payer: WPS Commercial |
$3,368.70
|
|
|
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 |
$2,228.52 |
| Max. Negotiated Rate |
$4,184.16 |
| Rate for Payer: Aetna Commercial |
$4,093.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,911.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,410.44
|
| Rate for Payer: Cash Price |
$1,364.40
|
| Rate for Payer: Cigna Commercial |
$4,184.16
|
| Rate for Payer: Health EOS Commercial |
$4,047.72
|
| Rate for Payer: HFN Commercial |
$4,184.16
|
| Rate for Payer: Multiplan Commercial |
$3,638.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,728.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,184.16
|
| Rate for Payer: Quartz Beloit One Network |
$2,228.52
|
| Rate for Payer: Quartz Commercial |
$2,728.80
|
| Rate for Payer: WEA Trust Commercial |
$2,501.40
|
| Rate for Payer: WPS Commercial |
$3,368.70
|
|
|
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 |
$1,177.40 |
| Max. Negotiated Rate |
$16,820.00 |
| Rate for Payer: Aetna Commercial |
$3,784.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,616.30
|
| Rate for Payer: Aetna Managed Medicare |
$1,177.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,733.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,102.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,018.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,228.65
|
| Rate for Payer: Cash Price |
$1,261.50
|
| Rate for Payer: Cigna Commercial |
$3,868.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,353.12
|
| Rate for Payer: Health EOS Commercial |
$3,742.45
|
| Rate for Payer: HFN Commercial |
$3,868.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,153.75
|
| Rate for Payer: Multiplan Commercial |
$3,364.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,523.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,868.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,060.45
|
| Rate for Payer: Quartz Commercial |
$2,733.25
|
| Rate for Payer: Quartz Medicare Advantage |
$2,523.00
|
| Rate for Payer: The Alliance Commercial |
$16,820.00
|
| Rate for Payer: WEA Trust Commercial |
$2,312.75
|
| Rate for Payer: WPS Commercial |
$3,114.64
|
|
|
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 |
$2,060.45 |
| Max. Negotiated Rate |
$3,868.60 |
| Rate for Payer: Aetna Commercial |
$3,784.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,616.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,228.65
|
| Rate for Payer: Cash Price |
$1,261.50
|
| Rate for Payer: Cigna Commercial |
$3,868.60
|
| Rate for Payer: Health EOS Commercial |
$3,742.45
|
| Rate for Payer: HFN Commercial |
$3,868.60
|
| Rate for Payer: Multiplan Commercial |
$3,364.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,523.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,868.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,060.45
|
| Rate for Payer: Quartz Commercial |
$2,523.00
|
| Rate for Payer: WEA Trust Commercial |
$2,312.75
|
| Rate for Payer: WPS Commercial |
$3,114.64
|
|
|
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 |
$1,177.40 |
| Max. Negotiated Rate |
$16,820.00 |
| Rate for Payer: Aetna Commercial |
$3,784.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,616.30
|
| Rate for Payer: Aetna Managed Medicare |
$1,177.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,733.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,102.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,018.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,228.65
|
| Rate for Payer: Cash Price |
$1,261.50
|
| Rate for Payer: Cigna Commercial |
$3,868.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,353.12
|
| Rate for Payer: Health EOS Commercial |
$3,742.45
|
| Rate for Payer: HFN Commercial |
$3,868.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,153.75
|
| Rate for Payer: Multiplan Commercial |
$3,364.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,523.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,868.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,060.45
|
| Rate for Payer: Quartz Commercial |
$2,733.25
|
| Rate for Payer: Quartz Medicare Advantage |
$2,523.00
|
| Rate for Payer: The Alliance Commercial |
$16,820.00
|
| Rate for Payer: WEA Trust Commercial |
$2,312.75
|
| Rate for Payer: WPS Commercial |
$3,114.64
|
|
|
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 |
$2,060.45 |
| Max. Negotiated Rate |
$3,868.60 |
| Rate for Payer: Aetna Commercial |
$3,784.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,616.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,228.65
|
| Rate for Payer: Cash Price |
$1,261.50
|
| Rate for Payer: Cigna Commercial |
$3,868.60
|
| Rate for Payer: Health EOS Commercial |
$3,742.45
|
| Rate for Payer: HFN Commercial |
$3,868.60
|
| Rate for Payer: Multiplan Commercial |
$3,364.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,523.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,868.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,060.45
|
| Rate for Payer: Quartz Commercial |
$2,523.00
|
| Rate for Payer: WEA Trust Commercial |
$2,312.75
|
| Rate for Payer: WPS Commercial |
$3,114.64
|
|
|
HIP BONE GRAFTING
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2959863
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,101.80 |
| Max. Negotiated Rate |
$15,740.00 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,101.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,557.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,967.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,888.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,202.03
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,951.25
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,557.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,361.00
|
| Rate for Payer: The Alliance Commercial |
$15,740.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
HIP BONE GRAFTING
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2959863
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,928.15 |
| Max. Negotiated Rate |
$3,620.20 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,361.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
HIP CANNULATED SCREW
|
Facility
|
IP
|
$5,721.00
|
|
| Hospital Charge Code |
2960122
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,803.29 |
| Max. Negotiated Rate |
$5,263.32 |
| Rate for Payer: Aetna Commercial |
$5,148.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,920.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,032.13
|
| Rate for Payer: Cash Price |
$1,716.30
|
| Rate for Payer: Cigna Commercial |
$5,263.32
|
| Rate for Payer: Health EOS Commercial |
$5,091.69
|
| Rate for Payer: HFN Commercial |
$5,263.32
|
| Rate for Payer: Multiplan Commercial |
$4,576.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,432.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,263.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,803.29
|
| Rate for Payer: Quartz Commercial |
$3,432.60
|
| Rate for Payer: WEA Trust Commercial |
$3,146.55
|
| Rate for Payer: WPS Commercial |
$4,237.54
|
|
|
HIP CANNULATED SCREW
|
Facility
|
OP
|
$5,721.00
|
|
| Hospital Charge Code |
2960122
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,601.88 |
| Max. Negotiated Rate |
$22,884.00 |
| Rate for Payer: Aetna Commercial |
$5,148.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,920.06
|
| Rate for Payer: Aetna Managed Medicare |
$1,601.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,718.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,860.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,746.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,032.13
|
| Rate for Payer: Cash Price |
$1,716.30
|
| Rate for Payer: Cigna Commercial |
$5,263.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,201.47
|
| Rate for Payer: Health EOS Commercial |
$5,091.69
|
| Rate for Payer: HFN Commercial |
$5,263.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,290.75
|
| Rate for Payer: Multiplan Commercial |
$4,576.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,432.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,263.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,803.29
|
| Rate for Payer: Quartz Commercial |
$3,718.65
|
| Rate for Payer: Quartz Medicare Advantage |
$3,432.60
|
| Rate for Payer: The Alliance Commercial |
$22,884.00
|
| Rate for Payer: WEA Trust Commercial |
$3,146.55
|
| Rate for Payer: WPS Commercial |
$4,237.54
|
|
|
HIP CORE DECOMPRESSION
|
Facility
|
IP
|
$5,314.00
|
|
| Hospital Charge Code |
2960119
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,603.86 |
| Max. Negotiated Rate |
$4,888.88 |
| Rate for Payer: Aetna Commercial |
$4,782.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,570.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,816.42
|
| Rate for Payer: Cash Price |
$1,594.20
|
| Rate for Payer: Cigna Commercial |
$4,888.88
|
| Rate for Payer: Health EOS Commercial |
$4,729.46
|
| Rate for Payer: HFN Commercial |
$4,888.88
|
| Rate for Payer: Multiplan Commercial |
$4,251.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,188.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,888.88
|
| Rate for Payer: Quartz Beloit One Network |
$2,603.86
|
| Rate for Payer: Quartz Commercial |
$3,188.40
|
| Rate for Payer: WEA Trust Commercial |
$2,922.70
|
| Rate for Payer: WPS Commercial |
$3,936.08
|
|
|
HIP CORE DECOMPRESSION
|
Facility
|
OP
|
$5,314.00
|
|
| Hospital Charge Code |
2960119
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,487.92 |
| Max. Negotiated Rate |
$21,256.00 |
| Rate for Payer: Aetna Commercial |
$4,782.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,570.04
|
| Rate for Payer: Aetna Managed Medicare |
$1,487.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,454.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,657.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,550.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,816.42
|
| Rate for Payer: Cash Price |
$1,594.20
|
| Rate for Payer: Cigna Commercial |
$4,888.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,973.71
|
| Rate for Payer: Health EOS Commercial |
$4,729.46
|
| Rate for Payer: HFN Commercial |
$4,888.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,985.50
|
| Rate for Payer: Multiplan Commercial |
$4,251.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,188.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,888.88
|
| Rate for Payer: Quartz Beloit One Network |
$2,603.86
|
| Rate for Payer: Quartz Commercial |
$3,454.10
|
| Rate for Payer: Quartz Medicare Advantage |
$3,188.40
|
| Rate for Payer: The Alliance Commercial |
$21,256.00
|
| Rate for Payer: WEA Trust Commercial |
$2,922.70
|
| Rate for Payer: WPS Commercial |
$3,936.08
|
|
|
HIP OSTEOTOMY
|
Facility
|
IP
|
$4,324.00
|
|
| Hospital Charge Code |
2960291
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,118.76 |
| Max. Negotiated Rate |
$3,978.08 |
| Rate for Payer: Aetna Commercial |
$3,891.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,718.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,291.72
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$3,978.08
|
| Rate for Payer: Health EOS Commercial |
$3,848.36
|
| Rate for Payer: HFN Commercial |
$3,978.08
|
| Rate for Payer: Multiplan Commercial |
$3,459.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,594.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,978.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,118.76
|
| Rate for Payer: Quartz Commercial |
$2,594.40
|
| Rate for Payer: WEA Trust Commercial |
$2,378.20
|
| Rate for Payer: WPS Commercial |
$3,202.79
|
|
