|
HIP OSTEOTOMY
|
Facility
|
OP
|
$4,324.00
|
|
| Hospital Charge Code |
2960291
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,210.72 |
| Max. Negotiated Rate |
$17,296.00 |
| Rate for Payer: Aetna Commercial |
$3,891.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,718.64
|
| Rate for Payer: Aetna Managed Medicare |
$1,210.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,810.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,162.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,075.52
|
| 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: Dean Health DHI/DHP/ASO |
$2,419.71
|
| Rate for Payer: Health EOS Commercial |
$3,848.36
|
| Rate for Payer: HFN Commercial |
$3,978.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,243.00
|
| 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 |
$2,810.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2,594.40
|
| Rate for Payer: The Alliance Commercial |
$17,296.00
|
| Rate for Payer: WEA Trust Commercial |
$2,378.20
|
| Rate for Payer: WPS Commercial |
$3,202.79
|
|
|
HIP PINNING/SIDE PLATE
|
Facility
|
OP
|
$5,721.00
|
|
| Hospital Charge Code |
2960120
|
|
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 PINNING/SIDE PLATE
|
Facility
|
IP
|
$5,721.00
|
|
| Hospital Charge Code |
2960120
|
|
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 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 |
$2,279.97 |
| Max. Negotiated Rate |
$4,280.76 |
| Rate for Payer: Aetna Commercial |
$4,187.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,001.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,466.09
|
| Rate for Payer: Cash Price |
$1,395.90
|
| Rate for Payer: Cigna Commercial |
$4,280.76
|
| Rate for Payer: Health EOS Commercial |
$4,141.17
|
| Rate for Payer: HFN Commercial |
$4,280.76
|
| Rate for Payer: Multiplan Commercial |
$3,722.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,791.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,280.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,279.97
|
| Rate for Payer: Quartz Commercial |
$2,791.80
|
| Rate for Payer: WEA Trust Commercial |
$2,559.15
|
| Rate for Payer: WPS Commercial |
$3,446.48
|
|
|
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 |
$1,302.84 |
| Max. Negotiated Rate |
$18,612.00 |
| Rate for Payer: Aetna Commercial |
$4,187.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,001.58
|
| Rate for Payer: Aetna Managed Medicare |
$1,302.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,024.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,326.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,233.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,466.09
|
| Rate for Payer: Cash Price |
$1,395.90
|
| Rate for Payer: Cigna Commercial |
$4,280.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,603.82
|
| Rate for Payer: Health EOS Commercial |
$4,141.17
|
| Rate for Payer: HFN Commercial |
$4,280.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,489.75
|
| Rate for Payer: Multiplan Commercial |
$3,722.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,791.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,280.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,279.97
|
| Rate for Payer: Quartz Commercial |
$3,024.45
|
| Rate for Payer: Quartz Medicare Advantage |
$2,791.80
|
| Rate for Payer: The Alliance Commercial |
$18,612.00
|
| Rate for Payer: WEA Trust Commercial |
$2,559.15
|
| Rate for Payer: WPS Commercial |
$3,446.48
|
|
|
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 |
$1,046.08 |
| Max. Negotiated Rate |
$14,944.00 |
| Rate for Payer: Aetna Commercial |
$3,362.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,212.96
|
| Rate for Payer: Aetna Managed Medicare |
$1,046.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,428.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,868.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,793.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,980.08
|
| Rate for Payer: Cash Price |
$1,120.80
|
| Rate for Payer: Cigna Commercial |
$3,437.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,090.67
|
| Rate for Payer: Health EOS Commercial |
$3,325.04
|
| Rate for Payer: HFN Commercial |
$3,437.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,802.00
|
| Rate for Payer: Multiplan Commercial |
$2,988.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,241.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,437.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,830.64
|
| Rate for Payer: Quartz Commercial |
$2,428.40
|
| Rate for Payer: Quartz Medicare Advantage |
$2,241.60
|
| Rate for Payer: The Alliance Commercial |
$14,944.00
|
| Rate for Payer: WEA Trust Commercial |
$2,054.80
|
| Rate for Payer: WPS Commercial |
$2,767.26
|
|
|
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 |
$1,830.64 |
| Max. Negotiated Rate |
$3,437.12 |
| Rate for Payer: Aetna Commercial |
$3,362.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,212.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,980.08
|
| Rate for Payer: Cash Price |
$1,120.80
|
| Rate for Payer: Cigna Commercial |
$3,437.12
|
| Rate for Payer: Health EOS Commercial |
$3,325.04
|
| Rate for Payer: HFN Commercial |
$3,437.12
|
| Rate for Payer: Multiplan Commercial |
$2,988.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,241.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,437.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,830.64
|
| Rate for Payer: Quartz Commercial |
$2,241.60
|
| Rate for Payer: WEA Trust Commercial |
$2,054.80
|
| Rate for Payer: WPS Commercial |
$2,767.26
|
|
|
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 |
$1,830.64 |
| Max. Negotiated Rate |
$3,437.12 |
| Rate for Payer: Aetna Commercial |
$3,362.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,212.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,980.08
|
| Rate for Payer: Cash Price |
$1,120.80
|
| Rate for Payer: Cigna Commercial |
$3,437.12
|
| Rate for Payer: Health EOS Commercial |
$3,325.04
|
| Rate for Payer: HFN Commercial |
$3,437.12
|
| Rate for Payer: Multiplan Commercial |
$2,988.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,241.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,437.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,830.64
|
| Rate for Payer: Quartz Commercial |
$2,241.60
|
| Rate for Payer: WEA Trust Commercial |
$2,054.80
|
| Rate for Payer: WPS Commercial |
$2,767.26
|
|
|
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 |
$1,046.08 |
| Max. Negotiated Rate |
$14,944.00 |
| Rate for Payer: Aetna Commercial |
$3,362.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,212.96
|
| Rate for Payer: Aetna Managed Medicare |
$1,046.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,428.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,868.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,793.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,980.08
|
| Rate for Payer: Cash Price |
$1,120.80
|
| Rate for Payer: Cigna Commercial |
$3,437.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,090.67
|
| Rate for Payer: Health EOS Commercial |
$3,325.04
|
| Rate for Payer: HFN Commercial |
$3,437.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,802.00
|
| Rate for Payer: Multiplan Commercial |
$2,988.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,241.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,437.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,830.64
|
| Rate for Payer: Quartz Commercial |
$2,428.40
|
| Rate for Payer: Quartz Medicare Advantage |
$2,241.60
|
| Rate for Payer: The Alliance Commercial |
$14,944.00
|
| Rate for Payer: WEA Trust Commercial |
$2,054.80
|
| Rate for Payer: WPS Commercial |
$2,767.26
|
|
|
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 |
$2,865.52 |
| Max. Negotiated Rate |
$5,380.16 |
| Rate for Payer: Aetna Commercial |
$5,263.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,029.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,099.44
|
| Rate for Payer: Cash Price |
$1,754.40
|
| Rate for Payer: Cigna Commercial |
$5,380.16
|
| Rate for Payer: Health EOS Commercial |
$5,204.72
|
| Rate for Payer: HFN Commercial |
$5,380.16
|
| Rate for Payer: Multiplan Commercial |
$4,678.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,508.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,380.16
|
| Rate for Payer: Quartz Beloit One Network |
$2,865.52
|
| Rate for Payer: Quartz Commercial |
$3,508.80
|
| Rate for Payer: WEA Trust Commercial |
$3,216.40
|
| Rate for Payer: WPS Commercial |
$4,331.61
|
|
|
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 |
$1,637.44 |
| Max. Negotiated Rate |
$23,392.00 |
| Rate for Payer: Aetna Commercial |
$5,263.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,029.28
|
| Rate for Payer: Aetna Managed Medicare |
$1,637.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,801.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,924.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,807.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,099.44
|
| Rate for Payer: Cash Price |
$1,754.40
|
| Rate for Payer: Cigna Commercial |
$5,380.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,272.54
|
| Rate for Payer: Health EOS Commercial |
$5,204.72
|
| Rate for Payer: HFN Commercial |
$5,380.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,386.00
|
| Rate for Payer: Multiplan Commercial |
$4,678.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,508.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,380.16
|
| Rate for Payer: Quartz Beloit One Network |
$2,865.52
|
| Rate for Payer: Quartz Commercial |
$3,801.20
|
| Rate for Payer: Quartz Medicare Advantage |
$3,508.80
|
| Rate for Payer: The Alliance Commercial |
$23,392.00
|
| Rate for Payer: WEA Trust Commercial |
$3,216.40
|
| Rate for Payer: WPS Commercial |
$4,331.61
|
|
|
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 |
$2,301.88 |
| Max. Negotiated Rate |
$32,884.00 |
| Rate for Payer: Aetna Commercial |
$7,398.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,070.06
|
| Rate for Payer: Aetna Managed Medicare |
$2,301.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,343.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,110.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,946.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,357.13
|
| Rate for Payer: Cash Price |
$2,466.30
|
| Rate for Payer: Cigna Commercial |
$7,563.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,600.47
|
| Rate for Payer: Health EOS Commercial |
$7,316.69
|
| Rate for Payer: HFN Commercial |
$7,563.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,165.75
|
| Rate for Payer: Multiplan Commercial |
$6,576.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,932.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,563.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,028.29
|
| Rate for Payer: Quartz Commercial |
$5,343.65
|
| Rate for Payer: Quartz Medicare Advantage |
$4,932.60
|
| Rate for Payer: The Alliance Commercial |
$32,884.00
|
| Rate for Payer: WEA Trust Commercial |
$4,521.55
|
| Rate for Payer: WPS Commercial |
$6,089.29
|
|
|
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 |
$4,028.29 |
| Max. Negotiated Rate |
$7,563.32 |
| Rate for Payer: Aetna Commercial |
$7,398.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,070.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,357.13
|
| Rate for Payer: Cash Price |
$2,466.30
|
| Rate for Payer: Cigna Commercial |
$7,563.32
|
| Rate for Payer: Health EOS Commercial |
$7,316.69
|
| Rate for Payer: HFN Commercial |
$7,563.32
|
| Rate for Payer: Multiplan Commercial |
$6,576.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,932.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,563.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,028.29
|
| Rate for Payer: Quartz Commercial |
$4,932.60
|
| Rate for Payer: WEA Trust Commercial |
$4,521.55
|
| Rate for Payer: WPS Commercial |
$6,089.29
|
|
|
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 |
$4,028.29 |
| Max. Negotiated Rate |
$7,563.32 |
| Rate for Payer: Aetna Commercial |
$7,398.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,070.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,357.13
|
| Rate for Payer: Cash Price |
$2,466.30
|
| Rate for Payer: Cigna Commercial |
$7,563.32
|
| Rate for Payer: Health EOS Commercial |
$7,316.69
|
| Rate for Payer: HFN Commercial |
$7,563.32
|
| Rate for Payer: Multiplan Commercial |
$6,576.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,932.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,563.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,028.29
|
| Rate for Payer: Quartz Commercial |
$4,932.60
|
| Rate for Payer: WEA Trust Commercial |
$4,521.55
|
| Rate for Payer: WPS Commercial |
$6,089.29
|
|
|
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 |
$2,301.88 |
| Max. Negotiated Rate |
$32,884.00 |
| Rate for Payer: Aetna Commercial |
$7,398.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,070.06
|
| Rate for Payer: Aetna Managed Medicare |
$2,301.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,343.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,110.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,946.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,357.13
|
| Rate for Payer: Cash Price |
$2,466.30
|
| Rate for Payer: Cigna Commercial |
$7,563.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,600.47
|
| Rate for Payer: Health EOS Commercial |
$7,316.69
|
| Rate for Payer: HFN Commercial |
$7,563.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,165.75
|
| Rate for Payer: Multiplan Commercial |
$6,576.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,932.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,563.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,028.29
|
| Rate for Payer: Quartz Commercial |
$5,343.65
|
| Rate for Payer: Quartz Medicare Advantage |
$4,932.60
|
| Rate for Payer: The Alliance Commercial |
$32,884.00
|
| Rate for Payer: WEA Trust Commercial |
$4,521.55
|
| Rate for Payer: WPS Commercial |
$6,089.29
|
|
|
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 |
$3,433.92 |
| Max. Negotiated Rate |
$6,447.36 |
| Rate for Payer: Aetna Commercial |
$6,307.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,026.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,714.24
|
| Rate for Payer: Cash Price |
$2,102.40
|
| Rate for Payer: Cigna Commercial |
$6,447.36
|
| Rate for Payer: Health EOS Commercial |
$6,237.12
|
| Rate for Payer: HFN Commercial |
$6,447.36
|
| Rate for Payer: Multiplan Commercial |
$5,606.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,204.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,447.36
|
| Rate for Payer: Quartz Beloit One Network |
$3,433.92
|
| Rate for Payer: Quartz Commercial |
$4,204.80
|
| Rate for Payer: WEA Trust Commercial |
$3,854.40
|
| Rate for Payer: WPS Commercial |
$5,190.83
|
|
|
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 |
$1,962.24 |
| Max. Negotiated Rate |
$28,032.00 |
| Rate for Payer: Aetna Commercial |
$6,307.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,026.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,962.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,555.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,504.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,363.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,714.24
|
| Rate for Payer: Cash Price |
$2,102.40
|
| Rate for Payer: Cigna Commercial |
$6,447.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,921.68
|
| Rate for Payer: Health EOS Commercial |
$6,237.12
|
| Rate for Payer: HFN Commercial |
$6,447.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,256.00
|
| Rate for Payer: Multiplan Commercial |
$5,606.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,204.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,447.36
|
| Rate for Payer: Quartz Beloit One Network |
$3,433.92
|
| Rate for Payer: Quartz Commercial |
$4,555.20
|
| Rate for Payer: Quartz Medicare Advantage |
$4,204.80
|
| Rate for Payer: The Alliance Commercial |
$28,032.00
|
| Rate for Payer: WEA Trust Commercial |
$3,854.40
|
| Rate for Payer: WPS Commercial |
$5,190.83
|
|
|
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 |
$4,028.29 |
| Max. Negotiated Rate |
$7,563.32 |
| Rate for Payer: Aetna Commercial |
$7,398.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,070.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,357.13
|
| Rate for Payer: Cash Price |
$2,466.30
|
| Rate for Payer: Cigna Commercial |
$7,563.32
|
| Rate for Payer: Health EOS Commercial |
$7,316.69
|
| Rate for Payer: HFN Commercial |
$7,563.32
|
| Rate for Payer: Multiplan Commercial |
$6,576.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,932.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,563.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,028.29
|
| Rate for Payer: Quartz Commercial |
$4,932.60
|
| Rate for Payer: WEA Trust Commercial |
$4,521.55
|
| Rate for Payer: WPS Commercial |
$6,089.29
|
|
|
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 |
$2,301.88 |
| Max. Negotiated Rate |
$32,884.00 |
| Rate for Payer: Aetna Commercial |
$7,398.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,070.06
|
| Rate for Payer: Aetna Managed Medicare |
$2,301.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,343.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,110.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,946.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,357.13
|
| Rate for Payer: Cash Price |
$2,466.30
|
| Rate for Payer: Cigna Commercial |
$7,563.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,600.47
|
| Rate for Payer: Health EOS Commercial |
$7,316.69
|
| Rate for Payer: HFN Commercial |
$7,563.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,165.75
|
| Rate for Payer: Multiplan Commercial |
$6,576.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,932.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,563.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,028.29
|
| Rate for Payer: Quartz Commercial |
$5,343.65
|
| Rate for Payer: Quartz Medicare Advantage |
$4,932.60
|
| Rate for Payer: The Alliance Commercial |
$32,884.00
|
| Rate for Payer: WEA Trust Commercial |
$4,521.55
|
| Rate for Payer: WPS Commercial |
$6,089.29
|
|
|
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 |
$2,865.52 |
| Max. Negotiated Rate |
$5,380.16 |
| Rate for Payer: Aetna Commercial |
$5,263.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,029.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,099.44
|
| Rate for Payer: Cash Price |
$1,754.40
|
| Rate for Payer: Cigna Commercial |
$5,380.16
|
| Rate for Payer: Health EOS Commercial |
$5,204.72
|
| Rate for Payer: HFN Commercial |
$5,380.16
|
| Rate for Payer: Multiplan Commercial |
$4,678.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,508.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,380.16
|
| Rate for Payer: Quartz Beloit One Network |
$2,865.52
|
| Rate for Payer: Quartz Commercial |
$3,508.80
|
| Rate for Payer: WEA Trust Commercial |
$3,216.40
|
| Rate for Payer: WPS Commercial |
$4,331.61
|
|
|
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 |
$1,637.44 |
| Max. Negotiated Rate |
$23,392.00 |
| Rate for Payer: Aetna Commercial |
$5,263.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,029.28
|
| Rate for Payer: Aetna Managed Medicare |
$1,637.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,801.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,924.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,807.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,099.44
|
| Rate for Payer: Cash Price |
$1,754.40
|
| Rate for Payer: Cigna Commercial |
$5,380.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,272.54
|
| Rate for Payer: Health EOS Commercial |
$5,204.72
|
| Rate for Payer: HFN Commercial |
$5,380.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,386.00
|
| Rate for Payer: Multiplan Commercial |
$4,678.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,508.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,380.16
|
| Rate for Payer: Quartz Beloit One Network |
$2,865.52
|
| Rate for Payer: Quartz Commercial |
$3,801.20
|
| Rate for Payer: Quartz Medicare Advantage |
$3,508.80
|
| Rate for Payer: The Alliance Commercial |
$23,392.00
|
| Rate for Payer: WEA Trust Commercial |
$3,216.40
|
| Rate for Payer: WPS Commercial |
$4,331.61
|
|
|
HIP PROSTHESIS AUSTIN-MOORE 51MM 4021-08-51
|
Facility
|
IP
|
$6,107.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967716
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,992.43 |
| Max. Negotiated Rate |
$5,618.44 |
| Rate for Payer: Aetna Commercial |
$5,496.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,252.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,236.71
|
| Rate for Payer: Cash Price |
$1,832.10
|
| Rate for Payer: Cigna Commercial |
$5,618.44
|
| Rate for Payer: Health EOS Commercial |
$5,435.23
|
| Rate for Payer: HFN Commercial |
$5,618.44
|
| Rate for Payer: Multiplan Commercial |
$4,885.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,664.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,618.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,992.43
|
| Rate for Payer: Quartz Commercial |
$3,664.20
|
| Rate for Payer: WEA Trust Commercial |
$3,358.85
|
| Rate for Payer: WPS Commercial |
$4,523.45
|
|
|
HIP PROSTHESIS AUSTIN-MOORE 51MM 4021-08-51
|
Facility
|
OP
|
$6,107.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967716
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,709.96 |
| Max. Negotiated Rate |
$24,428.00 |
| Rate for Payer: Aetna Commercial |
$5,496.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,252.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,709.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,969.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,053.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,931.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,236.71
|
| Rate for Payer: Cash Price |
$1,832.10
|
| Rate for Payer: Cigna Commercial |
$5,618.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,417.48
|
| Rate for Payer: Health EOS Commercial |
$5,435.23
|
| Rate for Payer: HFN Commercial |
$5,618.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,580.25
|
| Rate for Payer: Multiplan Commercial |
$4,885.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,664.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,618.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,992.43
|
| Rate for Payer: Quartz Commercial |
$3,969.55
|
| Rate for Payer: Quartz Medicare Advantage |
$3,664.20
|
| Rate for Payer: The Alliance Commercial |
$24,428.00
|
| Rate for Payer: WEA Trust Commercial |
$3,358.85
|
| Rate for Payer: WPS Commercial |
$4,523.45
|
|
|
HIP PROSTHESIS AUSTIN-MOORE 52MM 4021-08-52
|
Facility
|
IP
|
$7,008.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967717
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,433.92 |
| Max. Negotiated Rate |
$6,447.36 |
| Rate for Payer: Aetna Commercial |
$6,307.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,026.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,714.24
|
| Rate for Payer: Cash Price |
$2,102.40
|
| Rate for Payer: Cigna Commercial |
$6,447.36
|
| Rate for Payer: Health EOS Commercial |
$6,237.12
|
| Rate for Payer: HFN Commercial |
$6,447.36
|
| Rate for Payer: Multiplan Commercial |
$5,606.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,204.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,447.36
|
| Rate for Payer: Quartz Beloit One Network |
$3,433.92
|
| Rate for Payer: Quartz Commercial |
$4,204.80
|
| Rate for Payer: WEA Trust Commercial |
$3,854.40
|
| Rate for Payer: WPS Commercial |
$5,190.83
|
|
|
HIP PROSTHESIS AUSTIN-MOORE 52MM 4021-08-52
|
Facility
|
OP
|
$7,008.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967717
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,962.24 |
| Max. Negotiated Rate |
$28,032.00 |
| Rate for Payer: Aetna Commercial |
$6,307.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,026.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,962.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,555.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,504.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,363.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,714.24
|
| Rate for Payer: Cash Price |
$2,102.40
|
| Rate for Payer: Cigna Commercial |
$6,447.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,921.68
|
| Rate for Payer: Health EOS Commercial |
$6,237.12
|
| Rate for Payer: HFN Commercial |
$6,447.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,256.00
|
| Rate for Payer: Multiplan Commercial |
$5,606.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,204.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,447.36
|
| Rate for Payer: Quartz Beloit One Network |
$3,433.92
|
| Rate for Payer: Quartz Commercial |
$4,555.20
|
| Rate for Payer: Quartz Medicare Advantage |
$4,204.80
|
| Rate for Payer: The Alliance Commercial |
$28,032.00
|
| Rate for Payer: WEA Trust Commercial |
$3,854.40
|
| Rate for Payer: WPS Commercial |
$5,190.83
|
|
