|
HIP PROSTHESIS AUSTIN-MOORE 54MM 4021-08-54
|
Facility
|
OP
|
$7,008.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967718
|
|
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 54MM 4021-08-54
|
Facility
|
IP
|
$7,008.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967718
|
|
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 REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC
|
Facility
|
IP
|
$79,924.00
|
|
|
Service Code
|
MSDRG 521
|
| Min. Negotiated Rate |
$28,749.69 |
| Max. Negotiated Rate |
$79,924.00 |
| Rate for Payer: Aetna Managed Medicare |
$28,749.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$62,730.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$48,082.19
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$45,681.22
|
| Rate for Payer: Anthem Medicare Advantage |
$28,749.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28,749.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28,749.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$28,749.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50,710.34
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$28,749.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58,386.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$28,749.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28,749.69
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$28,749.69
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$28,749.69
|
| Rate for Payer: NAPHCARE Commercial |
$43,124.54
|
| Rate for Payer: Quartz Medicare Advantage |
$28,749.69
|
| Rate for Payer: The Alliance Commercial |
$79,924.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28,749.69
|
| Rate for Payer: United Healthcare PPO |
$45,454.95
|
| Rate for Payer: Wellcare Medicare |
$28,749.69
|
|
|
HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC
|
Facility
|
IP
|
$56,475.00
|
|
|
Service Code
|
MSDRG 522
|
| Min. Negotiated Rate |
$20,314.85 |
| Max. Negotiated Rate |
$56,475.00 |
| Rate for Payer: Aetna Managed Medicare |
$20,314.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44,267.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33,930.91
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32,236.58
|
| Rate for Payer: Anthem Medicare Advantage |
$20,314.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20,314.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20,314.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$20,314.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35,785.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$20,314.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$41,187.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20,314.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20,314.85
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$20,314.85
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$20,314.85
|
| Rate for Payer: NAPHCARE Commercial |
$30,472.28
|
| Rate for Payer: Quartz Medicare Advantage |
$20,314.85
|
| Rate for Payer: The Alliance Commercial |
$56,475.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20,314.85
|
| Rate for Payer: United Healthcare PPO |
$32,065.31
|
| Rate for Payer: Wellcare Medicare |
$20,314.85
|
|
|
HIP SPICA ADULT
|
Facility
|
IP
|
$3,602.00
|
|
| Hospital Charge Code |
3075862
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1,764.98 |
| Max. Negotiated Rate |
$3,313.84 |
| Rate for Payer: Aetna Commercial |
$3,241.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,097.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,909.06
|
| Rate for Payer: Cash Price |
$1,080.60
|
| Rate for Payer: Cigna Commercial |
$3,313.84
|
| Rate for Payer: Health EOS Commercial |
$3,205.78
|
| Rate for Payer: HFN Commercial |
$3,313.84
|
| Rate for Payer: Multiplan Commercial |
$2,881.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,161.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,313.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,764.98
|
| Rate for Payer: Quartz Commercial |
$2,161.20
|
| Rate for Payer: WEA Trust Commercial |
$1,981.10
|
| Rate for Payer: WPS Commercial |
$2,668.00
|
|
|
HIP SPICA ADULT
|
Facility
|
OP
|
$3,602.00
|
|
| Hospital Charge Code |
3075862
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1,008.56 |
| Max. Negotiated Rate |
$14,408.00 |
| Rate for Payer: Aetna Commercial |
$3,241.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,097.72
|
| Rate for Payer: Aetna Managed Medicare |
$1,008.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,341.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,801.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,728.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,909.06
|
| Rate for Payer: Cash Price |
$1,080.60
|
| Rate for Payer: Cigna Commercial |
$3,313.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,015.68
|
| Rate for Payer: Health EOS Commercial |
$3,205.78
|
| Rate for Payer: HFN Commercial |
$3,313.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,701.50
|
| Rate for Payer: Multiplan Commercial |
$2,881.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,161.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,313.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,764.98
|
| Rate for Payer: Quartz Commercial |
$2,341.30
|
| Rate for Payer: Quartz Medicare Advantage |
$2,161.20
|
| Rate for Payer: The Alliance Commercial |
$14,408.00
|
| Rate for Payer: WEA Trust Commercial |
$1,981.10
|
| Rate for Payer: WPS Commercial |
$2,668.00
|
|
|
HIP SPICA CAST
|
Facility
|
IP
|
$270.00
|
|
| Hospital Charge Code |
2960121
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$132.30 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna Commercial |
$243.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$232.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.10
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$248.40
|
| Rate for Payer: Health EOS Commercial |
$240.30
|
| Rate for Payer: HFN Commercial |
$248.40
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: NAPHCARE Commercial |
$162.00
|
| Rate for Payer: Preferred Network Access Commercial |
$248.40
|
| Rate for Payer: Quartz Beloit One Network |
$132.30
|
| Rate for Payer: Quartz Commercial |
$162.00
|
| Rate for Payer: WEA Trust Commercial |
$148.50
|
| Rate for Payer: WPS Commercial |
$199.99
|
|
|
HIP SPICA CAST
|
Facility
|
OP
|
$270.00
|
|
| Hospital Charge Code |
2960121
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$1,080.00 |
| Rate for Payer: Aetna Commercial |
$243.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$232.20
|
| Rate for Payer: Aetna Managed Medicare |
$75.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$175.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$135.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$129.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.10
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$248.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$151.09
|
| Rate for Payer: Health EOS Commercial |
$240.30
|
| Rate for Payer: HFN Commercial |
$248.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.50
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: NAPHCARE Commercial |
$162.00
|
| Rate for Payer: Preferred Network Access Commercial |
$248.40
|
| Rate for Payer: Quartz Beloit One Network |
$132.30
|
| Rate for Payer: Quartz Commercial |
$175.50
|
| Rate for Payer: Quartz Medicare Advantage |
$162.00
|
| Rate for Payer: The Alliance Commercial |
$1,080.00
|
| Rate for Payer: WEA Trust Commercial |
$148.50
|
| Rate for Payer: WPS Commercial |
$199.99
|
|
|
HIP SPICA CHILD
|
Facility
|
IP
|
$2,913.00
|
|
| Hospital Charge Code |
3075861
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1,427.37 |
| Max. Negotiated Rate |
$2,679.96 |
| Rate for Payer: Aetna Commercial |
$2,621.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,505.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,543.89
|
| Rate for Payer: Cash Price |
$873.90
|
| Rate for Payer: Cigna Commercial |
$2,679.96
|
| Rate for Payer: Health EOS Commercial |
$2,592.57
|
| Rate for Payer: HFN Commercial |
$2,679.96
|
| Rate for Payer: Multiplan Commercial |
$2,330.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,747.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,679.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,427.37
|
| Rate for Payer: Quartz Commercial |
$1,747.80
|
| Rate for Payer: WEA Trust Commercial |
$1,602.15
|
| Rate for Payer: WPS Commercial |
$2,157.66
|
|
|
HIP SPICA CHILD
|
Facility
|
OP
|
$2,913.00
|
|
| Hospital Charge Code |
3075861
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$815.64 |
| Max. Negotiated Rate |
$11,652.00 |
| Rate for Payer: Aetna Commercial |
$2,621.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,505.18
|
| Rate for Payer: Aetna Managed Medicare |
$815.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,893.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,456.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,398.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,543.89
|
| Rate for Payer: Cash Price |
$873.90
|
| Rate for Payer: Cigna Commercial |
$2,679.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,630.11
|
| Rate for Payer: Health EOS Commercial |
$2,592.57
|
| Rate for Payer: HFN Commercial |
$2,679.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,184.75
|
| Rate for Payer: Multiplan Commercial |
$2,330.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,747.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,679.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,427.37
|
| Rate for Payer: Quartz Commercial |
$1,893.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,747.80
|
| Rate for Payer: The Alliance Commercial |
$11,652.00
|
| Rate for Payer: WEA Trust Commercial |
$1,602.15
|
| Rate for Payer: WPS Commercial |
$2,157.66
|
|
|
HIP SPICA INFANT
|
Facility
|
OP
|
$1,975.00
|
|
| Hospital Charge Code |
3075860
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$553.00 |
| Max. Negotiated Rate |
$7,900.00 |
| Rate for Payer: Aetna Commercial |
$1,777.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,698.50
|
| Rate for Payer: Aetna Managed Medicare |
$553.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,283.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$987.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$948.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,046.75
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cigna Commercial |
$1,817.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,105.21
|
| Rate for Payer: Health EOS Commercial |
$1,757.75
|
| Rate for Payer: HFN Commercial |
$1,817.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,481.25
|
| Rate for Payer: Multiplan Commercial |
$1,580.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,185.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,817.00
|
| Rate for Payer: Quartz Beloit One Network |
$967.75
|
| Rate for Payer: Quartz Commercial |
$1,283.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,185.00
|
| Rate for Payer: The Alliance Commercial |
$7,900.00
|
| Rate for Payer: WEA Trust Commercial |
$1,086.25
|
| Rate for Payer: WPS Commercial |
$1,462.88
|
|
|
HIP SPICA INFANT
|
Facility
|
IP
|
$1,975.00
|
|
| Hospital Charge Code |
3075860
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$967.75 |
| Max. Negotiated Rate |
$1,817.00 |
| Rate for Payer: Aetna Commercial |
$1,777.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,698.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,046.75
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cigna Commercial |
$1,817.00
|
| Rate for Payer: Health EOS Commercial |
$1,757.75
|
| Rate for Payer: HFN Commercial |
$1,817.00
|
| Rate for Payer: Multiplan Commercial |
$1,580.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,185.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,817.00
|
| Rate for Payer: Quartz Beloit One Network |
$967.75
|
| Rate for Payer: Quartz Commercial |
$1,185.00
|
| Rate for Payer: WEA Trust Commercial |
$1,086.25
|
| Rate for Payer: WPS Commercial |
$1,462.88
|
|
|
HIP STEM ACCOLADE C CEMENTED SZ 4 6058-0435D
|
Facility
|
IP
|
$8,851.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6153690
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,336.99 |
| Max. Negotiated Rate |
$8,142.92 |
| Rate for Payer: Aetna Commercial |
$7,965.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,611.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,691.03
|
| Rate for Payer: Cash Price |
$2,655.30
|
| Rate for Payer: Cigna Commercial |
$8,142.92
|
| Rate for Payer: Health EOS Commercial |
$7,877.39
|
| Rate for Payer: HFN Commercial |
$8,142.92
|
| Rate for Payer: Multiplan Commercial |
$7,080.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,310.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,142.92
|
| Rate for Payer: Quartz Beloit One Network |
$4,336.99
|
| Rate for Payer: Quartz Commercial |
$5,310.60
|
| Rate for Payer: WEA Trust Commercial |
$4,868.05
|
| Rate for Payer: WPS Commercial |
$6,555.94
|
|
|
HIP STEM ACCOLADE C CEMENTED SZ 4 6058-0435D
|
Facility
|
OP
|
$8,851.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6153690
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,478.28 |
| Max. Negotiated Rate |
$35,404.00 |
| Rate for Payer: Aetna Commercial |
$7,965.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,611.86
|
| Rate for Payer: Aetna Managed Medicare |
$2,478.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,753.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,425.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,248.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,691.03
|
| Rate for Payer: Cash Price |
$2,655.30
|
| Rate for Payer: Cigna Commercial |
$8,142.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,953.02
|
| Rate for Payer: Health EOS Commercial |
$7,877.39
|
| Rate for Payer: HFN Commercial |
$8,142.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,638.25
|
| Rate for Payer: Multiplan Commercial |
$7,080.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,310.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,142.92
|
| Rate for Payer: Quartz Beloit One Network |
$4,336.99
|
| Rate for Payer: Quartz Commercial |
$5,753.15
|
| Rate for Payer: Quartz Medicare Advantage |
$5,310.60
|
| Rate for Payer: The Alliance Commercial |
$35,404.00
|
| Rate for Payer: WEA Trust Commercial |
$4,868.05
|
| Rate for Payer: WPS Commercial |
$6,555.94
|
|
|
HIP STEM ACCOLADE C CEMENTED SZ 5 6058-0537D
|
Facility
|
IP
|
$9,209.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5729751
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,512.41 |
| Max. Negotiated Rate |
$8,472.28 |
| Rate for Payer: Aetna Commercial |
$8,288.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,919.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,880.77
|
| Rate for Payer: Cash Price |
$2,762.70
|
| Rate for Payer: Cigna Commercial |
$8,472.28
|
| Rate for Payer: Health EOS Commercial |
$8,196.01
|
| Rate for Payer: HFN Commercial |
$8,472.28
|
| Rate for Payer: Multiplan Commercial |
$7,367.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,525.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,472.28
|
| Rate for Payer: Quartz Beloit One Network |
$4,512.41
|
| Rate for Payer: Quartz Commercial |
$5,525.40
|
| Rate for Payer: WEA Trust Commercial |
$5,064.95
|
| Rate for Payer: WPS Commercial |
$6,821.11
|
|
|
HIP STEM ACCOLADE C CEMENTED SZ 5 6058-0537D
|
Facility
|
OP
|
$9,209.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5729751
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,578.52 |
| Max. Negotiated Rate |
$36,836.00 |
| Rate for Payer: Aetna Commercial |
$8,288.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,919.74
|
| Rate for Payer: Aetna Managed Medicare |
$2,578.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,985.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,604.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,420.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,880.77
|
| Rate for Payer: Cash Price |
$2,762.70
|
| Rate for Payer: Cigna Commercial |
$8,472.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,153.36
|
| Rate for Payer: Health EOS Commercial |
$8,196.01
|
| Rate for Payer: HFN Commercial |
$8,472.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,906.75
|
| Rate for Payer: Multiplan Commercial |
$7,367.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,525.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,472.28
|
| Rate for Payer: Quartz Beloit One Network |
$4,512.41
|
| Rate for Payer: Quartz Commercial |
$5,985.85
|
| Rate for Payer: Quartz Medicare Advantage |
$5,525.40
|
| Rate for Payer: The Alliance Commercial |
$36,836.00
|
| Rate for Payer: WEA Trust Commercial |
$5,064.95
|
| Rate for Payer: WPS Commercial |
$6,821.11
|
|
|
HIP STEM ACCOLADE CEMENTED SZ 2 127 DEG 6057-0230D
|
Facility
|
OP
|
$10,976.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4519064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,073.28 |
| Max. Negotiated Rate |
$43,904.00 |
| Rate for Payer: Aetna Commercial |
$9,878.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,439.36
|
| Rate for Payer: Aetna Managed Medicare |
$3,073.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,134.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,488.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,268.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,817.28
|
| Rate for Payer: Cash Price |
$3,292.80
|
| Rate for Payer: Cigna Commercial |
$10,097.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,142.17
|
| Rate for Payer: Health EOS Commercial |
$9,768.64
|
| Rate for Payer: HFN Commercial |
$10,097.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,232.00
|
| Rate for Payer: Multiplan Commercial |
$8,780.80
|
| Rate for Payer: NAPHCARE Commercial |
$6,585.60
|
| Rate for Payer: Preferred Network Access Commercial |
$10,097.92
|
| Rate for Payer: Quartz Beloit One Network |
$5,378.24
|
| Rate for Payer: Quartz Commercial |
$7,134.40
|
| Rate for Payer: Quartz Medicare Advantage |
$6,585.60
|
| Rate for Payer: The Alliance Commercial |
$43,904.00
|
| Rate for Payer: WEA Trust Commercial |
$6,036.80
|
| Rate for Payer: WPS Commercial |
$8,129.92
|
|
|
HIP STEM ACCOLADE CEMENTED SZ 2 127 DEG 6057-0230D
|
Facility
|
IP
|
$10,976.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4519064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,378.24 |
| Max. Negotiated Rate |
$10,097.92 |
| Rate for Payer: Aetna Commercial |
$9,878.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,439.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,817.28
|
| Rate for Payer: Cash Price |
$3,292.80
|
| Rate for Payer: Cigna Commercial |
$10,097.92
|
| Rate for Payer: Health EOS Commercial |
$9,768.64
|
| Rate for Payer: HFN Commercial |
$10,097.92
|
| Rate for Payer: Multiplan Commercial |
$8,780.80
|
| Rate for Payer: NAPHCARE Commercial |
$6,585.60
|
| Rate for Payer: Preferred Network Access Commercial |
$10,097.92
|
| Rate for Payer: Quartz Beloit One Network |
$5,378.24
|
| Rate for Payer: Quartz Commercial |
$6,585.60
|
| Rate for Payer: WEA Trust Commercial |
$6,036.80
|
| Rate for Payer: WPS Commercial |
$8,129.92
|
|
|
HIP STEM ACCOLADE CEMENTED SZ 3 127 DEG 6057-0335D
|
Facility
|
IP
|
$9,093.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5074873
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,455.57 |
| Max. Negotiated Rate |
$8,365.56 |
| Rate for Payer: Aetna Commercial |
$8,183.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,819.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,819.29
|
| Rate for Payer: Cash Price |
$2,727.90
|
| Rate for Payer: Cigna Commercial |
$8,365.56
|
| Rate for Payer: Health EOS Commercial |
$8,092.77
|
| Rate for Payer: HFN Commercial |
$8,365.56
|
| Rate for Payer: Multiplan Commercial |
$7,274.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,455.80
|
| Rate for Payer: Preferred Network Access Commercial |
$8,365.56
|
| Rate for Payer: Quartz Beloit One Network |
$4,455.57
|
| Rate for Payer: Quartz Commercial |
$5,455.80
|
| Rate for Payer: WEA Trust Commercial |
$5,001.15
|
| Rate for Payer: WPS Commercial |
$6,735.19
|
|
|
HIP STEM ACCOLADE CEMENTED SZ 3 127 DEG 6057-0335D
|
Facility
|
OP
|
$9,093.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5074873
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,546.04 |
| Max. Negotiated Rate |
$36,372.00 |
| Rate for Payer: Aetna Commercial |
$8,183.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,819.98
|
| Rate for Payer: Aetna Managed Medicare |
$2,546.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,910.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,546.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,364.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,819.29
|
| Rate for Payer: Cash Price |
$2,727.90
|
| Rate for Payer: Cigna Commercial |
$8,365.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,088.44
|
| Rate for Payer: Health EOS Commercial |
$8,092.77
|
| Rate for Payer: HFN Commercial |
$8,365.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,819.75
|
| Rate for Payer: Multiplan Commercial |
$7,274.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,455.80
|
| Rate for Payer: Preferred Network Access Commercial |
$8,365.56
|
| Rate for Payer: Quartz Beloit One Network |
$4,455.57
|
| Rate for Payer: Quartz Commercial |
$5,910.45
|
| Rate for Payer: Quartz Medicare Advantage |
$5,455.80
|
| Rate for Payer: The Alliance Commercial |
$36,372.00
|
| Rate for Payer: WEA Trust Commercial |
$5,001.15
|
| Rate for Payer: WPS Commercial |
$6,735.19
|
|
|
HIP STEM ACCOLADE CEMENTED SZ 4 127 DEG 6057-0435D
|
Facility
|
OP
|
$9,205.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5074737
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,577.40 |
| Max. Negotiated Rate |
$36,820.00 |
| Rate for Payer: Aetna Commercial |
$8,284.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,916.30
|
| Rate for Payer: Aetna Managed Medicare |
$2,577.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,983.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,602.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,418.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,878.65
|
| Rate for Payer: Cash Price |
$2,761.50
|
| Rate for Payer: Cigna Commercial |
$8,468.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,151.12
|
| Rate for Payer: Health EOS Commercial |
$8,192.45
|
| Rate for Payer: HFN Commercial |
$8,468.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,903.75
|
| Rate for Payer: Multiplan Commercial |
$7,364.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,523.00
|
| Rate for Payer: Preferred Network Access Commercial |
$8,468.60
|
| Rate for Payer: Quartz Beloit One Network |
$4,510.45
|
| Rate for Payer: Quartz Commercial |
$5,983.25
|
| Rate for Payer: Quartz Medicare Advantage |
$5,523.00
|
| Rate for Payer: The Alliance Commercial |
$36,820.00
|
| Rate for Payer: WEA Trust Commercial |
$5,062.75
|
| Rate for Payer: WPS Commercial |
$6,818.14
|
|
|
HIP STEM ACCOLADE CEMENTED SZ 4 127 DEG 6057-0435D
|
Facility
|
IP
|
$9,205.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5074737
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,510.45 |
| Max. Negotiated Rate |
$8,468.60 |
| Rate for Payer: Aetna Commercial |
$8,284.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,916.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,878.65
|
| Rate for Payer: Cash Price |
$2,761.50
|
| Rate for Payer: Cigna Commercial |
$8,468.60
|
| Rate for Payer: Health EOS Commercial |
$8,192.45
|
| Rate for Payer: HFN Commercial |
$8,468.60
|
| Rate for Payer: Multiplan Commercial |
$7,364.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,523.00
|
| Rate for Payer: Preferred Network Access Commercial |
$8,468.60
|
| Rate for Payer: Quartz Beloit One Network |
$4,510.45
|
| Rate for Payer: Quartz Commercial |
$5,523.00
|
| Rate for Payer: WEA Trust Commercial |
$5,062.75
|
| Rate for Payer: WPS Commercial |
$6,818.14
|
|
|
HIP STEM ACCOLADE CEMENTED SZ 5 127 DEG 6057-0535D
|
Facility
|
IP
|
$9,205.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5106785
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,510.45 |
| Max. Negotiated Rate |
$8,468.60 |
| Rate for Payer: Aetna Commercial |
$8,284.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,916.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,878.65
|
| Rate for Payer: Cash Price |
$2,761.50
|
| Rate for Payer: Cigna Commercial |
$8,468.60
|
| Rate for Payer: Health EOS Commercial |
$8,192.45
|
| Rate for Payer: HFN Commercial |
$8,468.60
|
| Rate for Payer: Multiplan Commercial |
$7,364.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,523.00
|
| Rate for Payer: Preferred Network Access Commercial |
$8,468.60
|
| Rate for Payer: Quartz Beloit One Network |
$4,510.45
|
| Rate for Payer: Quartz Commercial |
$5,523.00
|
| Rate for Payer: WEA Trust Commercial |
$5,062.75
|
| Rate for Payer: WPS Commercial |
$6,818.14
|
|
|
HIP STEM ACCOLADE CEMENTED SZ 5 127 DEG 6057-0535D
|
Facility
|
OP
|
$9,205.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5106785
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,577.40 |
| Max. Negotiated Rate |
$36,820.00 |
| Rate for Payer: Aetna Commercial |
$8,284.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,916.30
|
| Rate for Payer: Aetna Managed Medicare |
$2,577.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,983.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,602.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,418.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,878.65
|
| Rate for Payer: Cash Price |
$2,761.50
|
| Rate for Payer: Cigna Commercial |
$8,468.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,151.12
|
| Rate for Payer: Health EOS Commercial |
$8,192.45
|
| Rate for Payer: HFN Commercial |
$8,468.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,903.75
|
| Rate for Payer: Multiplan Commercial |
$7,364.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,523.00
|
| Rate for Payer: Preferred Network Access Commercial |
$8,468.60
|
| Rate for Payer: Quartz Beloit One Network |
$4,510.45
|
| Rate for Payer: Quartz Commercial |
$5,983.25
|
| Rate for Payer: Quartz Medicare Advantage |
$5,523.00
|
| Rate for Payer: The Alliance Commercial |
$36,820.00
|
| Rate for Payer: WEA Trust Commercial |
$5,062.75
|
| Rate for Payer: WPS Commercial |
$6,818.14
|
|
|
HIP STEM ACCOLADE CEMENTED SZ 6 127 DEG 6057-0635D
|
Facility
|
OP
|
$9,205.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5178738
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,577.40 |
| Max. Negotiated Rate |
$36,820.00 |
| Rate for Payer: Aetna Commercial |
$8,284.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,916.30
|
| Rate for Payer: Aetna Managed Medicare |
$2,577.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,983.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,602.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,418.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,878.65
|
| Rate for Payer: Cash Price |
$2,761.50
|
| Rate for Payer: Cigna Commercial |
$8,468.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,151.12
|
| Rate for Payer: Health EOS Commercial |
$8,192.45
|
| Rate for Payer: HFN Commercial |
$8,468.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,903.75
|
| Rate for Payer: Multiplan Commercial |
$7,364.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,523.00
|
| Rate for Payer: Preferred Network Access Commercial |
$8,468.60
|
| Rate for Payer: Quartz Beloit One Network |
$4,510.45
|
| Rate for Payer: Quartz Commercial |
$5,983.25
|
| Rate for Payer: Quartz Medicare Advantage |
$5,523.00
|
| Rate for Payer: The Alliance Commercial |
$36,820.00
|
| Rate for Payer: WEA Trust Commercial |
$5,062.75
|
| Rate for Payer: WPS Commercial |
$6,818.14
|
|
