|
HIP STEM ACCOLADE CEMENTED SZ 6 127 DEG 6057-0635D
|
Facility
|
IP
|
$9,205.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5178738
|
|
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 7 127 DEG 6057-0740D
|
Facility
|
IP
|
$9,205.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5179009
|
|
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 7 127 DEG 6057-0740D
|
Facility
|
OP
|
$9,205.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5179009
|
|
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 HFX SZ 2 6077-C230
|
Facility
|
OP
|
$7,317.00
|
|
| Hospital Charge Code |
4399645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,048.76 |
| Max. Negotiated Rate |
$29,268.00 |
| Rate for Payer: Aetna Commercial |
$6,585.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,292.62
|
| Rate for Payer: Aetna Managed Medicare |
$2,048.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,756.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,658.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,512.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,878.01
|
| Rate for Payer: Cash Price |
$2,195.10
|
| Rate for Payer: Cigna Commercial |
$6,731.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,094.59
|
| Rate for Payer: Health EOS Commercial |
$6,512.13
|
| Rate for Payer: HFN Commercial |
$6,731.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,487.75
|
| Rate for Payer: Multiplan Commercial |
$5,853.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,390.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,731.64
|
| Rate for Payer: Quartz Beloit One Network |
$3,585.33
|
| Rate for Payer: Quartz Commercial |
$4,756.05
|
| Rate for Payer: Quartz Medicare Advantage |
$4,390.20
|
| Rate for Payer: The Alliance Commercial |
$29,268.00
|
| Rate for Payer: WEA Trust Commercial |
$4,024.35
|
| Rate for Payer: WPS Commercial |
$5,419.70
|
|
|
HIP STEM ACCOLADE HFX SZ 2 6077-C230
|
Facility
|
IP
|
$7,317.00
|
|
| Hospital Charge Code |
4399645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,585.33 |
| Max. Negotiated Rate |
$6,731.64 |
| Rate for Payer: Aetna Commercial |
$6,585.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,292.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,878.01
|
| Rate for Payer: Cash Price |
$2,195.10
|
| Rate for Payer: Cigna Commercial |
$6,731.64
|
| Rate for Payer: Health EOS Commercial |
$6,512.13
|
| Rate for Payer: HFN Commercial |
$6,731.64
|
| Rate for Payer: Multiplan Commercial |
$5,853.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,390.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,731.64
|
| Rate for Payer: Quartz Beloit One Network |
$3,585.33
|
| Rate for Payer: Quartz Commercial |
$4,390.20
|
| Rate for Payer: WEA Trust Commercial |
$4,024.35
|
| Rate for Payer: WPS Commercial |
$5,419.70
|
|
|
HIP STEM ACCOLADE II 132 DEG NECK SZ 10 6720-1040
|
Facility
|
IP
|
$17,074.00
|
|
| Hospital Charge Code |
4998624
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,366.26 |
| Max. Negotiated Rate |
$15,708.08 |
| Rate for Payer: Aetna Commercial |
$15,366.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,683.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,049.22
|
| Rate for Payer: Cash Price |
$5,122.20
|
| Rate for Payer: Cigna Commercial |
$15,708.08
|
| Rate for Payer: Health EOS Commercial |
$15,195.86
|
| Rate for Payer: HFN Commercial |
$15,708.08
|
| Rate for Payer: Multiplan Commercial |
$13,659.20
|
| Rate for Payer: NAPHCARE Commercial |
$10,244.40
|
| Rate for Payer: Preferred Network Access Commercial |
$15,708.08
|
| Rate for Payer: Quartz Beloit One Network |
$8,366.26
|
| Rate for Payer: Quartz Commercial |
$10,244.40
|
| Rate for Payer: WEA Trust Commercial |
$9,390.70
|
| Rate for Payer: WPS Commercial |
$12,646.71
|
|
|
HIP STEM ACCOLADE II 132 DEG NECK SZ 10 6720-1040
|
Facility
|
OP
|
$17,074.00
|
|
| Hospital Charge Code |
4998624
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,780.72 |
| Max. Negotiated Rate |
$68,296.00 |
| Rate for Payer: Aetna Commercial |
$15,366.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,683.64
|
| Rate for Payer: Aetna Managed Medicare |
$4,780.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,098.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,537.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,195.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,049.22
|
| Rate for Payer: Cash Price |
$5,122.20
|
| Rate for Payer: Cigna Commercial |
$15,708.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,554.61
|
| Rate for Payer: Health EOS Commercial |
$15,195.86
|
| Rate for Payer: HFN Commercial |
$15,708.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,805.50
|
| Rate for Payer: Multiplan Commercial |
$13,659.20
|
| Rate for Payer: NAPHCARE Commercial |
$10,244.40
|
| Rate for Payer: Preferred Network Access Commercial |
$15,708.08
|
| Rate for Payer: Quartz Beloit One Network |
$8,366.26
|
| Rate for Payer: Quartz Commercial |
$11,098.10
|
| Rate for Payer: Quartz Medicare Advantage |
$10,244.40
|
| Rate for Payer: The Alliance Commercial |
$68,296.00
|
| Rate for Payer: WEA Trust Commercial |
$9,390.70
|
| Rate for Payer: WPS Commercial |
$12,646.71
|
|
|
HIP STEM ACCOLADE II 132 DEG NECK SZ 1 6720-0127
|
Facility
|
IP
|
$17,074.00
|
|
| Hospital Charge Code |
4364701
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,366.26 |
| Max. Negotiated Rate |
$15,708.08 |
| Rate for Payer: Aetna Commercial |
$15,366.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,683.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,049.22
|
| Rate for Payer: Cash Price |
$5,122.20
|
| Rate for Payer: Cigna Commercial |
$15,708.08
|
| Rate for Payer: Health EOS Commercial |
$15,195.86
|
| Rate for Payer: HFN Commercial |
$15,708.08
|
| Rate for Payer: Multiplan Commercial |
$13,659.20
|
| Rate for Payer: NAPHCARE Commercial |
$10,244.40
|
| Rate for Payer: Preferred Network Access Commercial |
$15,708.08
|
| Rate for Payer: Quartz Beloit One Network |
$8,366.26
|
| Rate for Payer: Quartz Commercial |
$10,244.40
|
| Rate for Payer: WEA Trust Commercial |
$9,390.70
|
| Rate for Payer: WPS Commercial |
$12,646.71
|
|
|
HIP STEM ACCOLADE II 132 DEG NECK SZ 1 6720-0127
|
Facility
|
OP
|
$17,074.00
|
|
| Hospital Charge Code |
4364701
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,780.72 |
| Max. Negotiated Rate |
$68,296.00 |
| Rate for Payer: Aetna Commercial |
$15,366.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,683.64
|
| Rate for Payer: Aetna Managed Medicare |
$4,780.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,098.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,537.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,195.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,049.22
|
| Rate for Payer: Cash Price |
$5,122.20
|
| Rate for Payer: Cigna Commercial |
$15,708.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,554.61
|
| Rate for Payer: Health EOS Commercial |
$15,195.86
|
| Rate for Payer: HFN Commercial |
$15,708.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,805.50
|
| Rate for Payer: Multiplan Commercial |
$13,659.20
|
| Rate for Payer: NAPHCARE Commercial |
$10,244.40
|
| Rate for Payer: Preferred Network Access Commercial |
$15,708.08
|
| Rate for Payer: Quartz Beloit One Network |
$8,366.26
|
| Rate for Payer: Quartz Commercial |
$11,098.10
|
| Rate for Payer: Quartz Medicare Advantage |
$10,244.40
|
| Rate for Payer: The Alliance Commercial |
$68,296.00
|
| Rate for Payer: WEA Trust Commercial |
$9,390.70
|
| Rate for Payer: WPS Commercial |
$12,646.71
|
|
|
HIP STEM ACCOLADE II 132 DEG NECK SZ 3 6720-0330
|
Facility
|
IP
|
$17,074.00
|
|
| Hospital Charge Code |
4167702
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,366.26 |
| Max. Negotiated Rate |
$15,708.08 |
| Rate for Payer: Aetna Commercial |
$15,366.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,683.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,049.22
|
| Rate for Payer: Cash Price |
$5,122.20
|
| Rate for Payer: Cigna Commercial |
$15,708.08
|
| Rate for Payer: Health EOS Commercial |
$15,195.86
|
| Rate for Payer: HFN Commercial |
$15,708.08
|
| Rate for Payer: Multiplan Commercial |
$13,659.20
|
| Rate for Payer: NAPHCARE Commercial |
$10,244.40
|
| Rate for Payer: Preferred Network Access Commercial |
$15,708.08
|
| Rate for Payer: Quartz Beloit One Network |
$8,366.26
|
| Rate for Payer: Quartz Commercial |
$10,244.40
|
| Rate for Payer: WEA Trust Commercial |
$9,390.70
|
| Rate for Payer: WPS Commercial |
$12,646.71
|
|
|
HIP STEM ACCOLADE II 132 DEG NECK SZ 3 6720-0330
|
Facility
|
OP
|
$17,074.00
|
|
| Hospital Charge Code |
4167702
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,780.72 |
| Max. Negotiated Rate |
$68,296.00 |
| Rate for Payer: Aetna Commercial |
$15,366.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,683.64
|
| Rate for Payer: Aetna Managed Medicare |
$4,780.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,098.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,537.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,195.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,049.22
|
| Rate for Payer: Cash Price |
$5,122.20
|
| Rate for Payer: Cigna Commercial |
$15,708.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,554.61
|
| Rate for Payer: Health EOS Commercial |
$15,195.86
|
| Rate for Payer: HFN Commercial |
$15,708.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,805.50
|
| Rate for Payer: Multiplan Commercial |
$13,659.20
|
| Rate for Payer: NAPHCARE Commercial |
$10,244.40
|
| Rate for Payer: Preferred Network Access Commercial |
$15,708.08
|
| Rate for Payer: Quartz Beloit One Network |
$8,366.26
|
| Rate for Payer: Quartz Commercial |
$11,098.10
|
| Rate for Payer: Quartz Medicare Advantage |
$10,244.40
|
| Rate for Payer: The Alliance Commercial |
$68,296.00
|
| Rate for Payer: WEA Trust Commercial |
$9,390.70
|
| Rate for Payer: WPS Commercial |
$12,646.71
|
|
|
HIP STEM ACCOLADE II 132 DEG NECK SZ 4 6720-0435
|
Facility
|
IP
|
$17,074.00
|
|
| Hospital Charge Code |
4263458
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,366.26 |
| Max. Negotiated Rate |
$15,708.08 |
| Rate for Payer: Aetna Commercial |
$15,366.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,683.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,049.22
|
| Rate for Payer: Cash Price |
$5,122.20
|
| Rate for Payer: Cigna Commercial |
$15,708.08
|
| Rate for Payer: Health EOS Commercial |
$15,195.86
|
| Rate for Payer: HFN Commercial |
$15,708.08
|
| Rate for Payer: Multiplan Commercial |
$13,659.20
|
| Rate for Payer: NAPHCARE Commercial |
$10,244.40
|
| Rate for Payer: Preferred Network Access Commercial |
$15,708.08
|
| Rate for Payer: Quartz Beloit One Network |
$8,366.26
|
| Rate for Payer: Quartz Commercial |
$10,244.40
|
| Rate for Payer: WEA Trust Commercial |
$9,390.70
|
| Rate for Payer: WPS Commercial |
$12,646.71
|
|
|
HIP STEM ACCOLADE II 132 DEG NECK SZ 4 6720-0435
|
Facility
|
OP
|
$17,074.00
|
|
| Hospital Charge Code |
4263458
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,780.72 |
| Max. Negotiated Rate |
$68,296.00 |
| Rate for Payer: Aetna Commercial |
$15,366.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,683.64
|
| Rate for Payer: Aetna Managed Medicare |
$4,780.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,098.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,537.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,195.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,049.22
|
| Rate for Payer: Cash Price |
$5,122.20
|
| Rate for Payer: Cigna Commercial |
$15,708.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,554.61
|
| Rate for Payer: Health EOS Commercial |
$15,195.86
|
| Rate for Payer: HFN Commercial |
$15,708.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,805.50
|
| Rate for Payer: Multiplan Commercial |
$13,659.20
|
| Rate for Payer: NAPHCARE Commercial |
$10,244.40
|
| Rate for Payer: Preferred Network Access Commercial |
$15,708.08
|
| Rate for Payer: Quartz Beloit One Network |
$8,366.26
|
| Rate for Payer: Quartz Commercial |
$11,098.10
|
| Rate for Payer: Quartz Medicare Advantage |
$10,244.40
|
| Rate for Payer: The Alliance Commercial |
$68,296.00
|
| Rate for Payer: WEA Trust Commercial |
$9,390.70
|
| Rate for Payer: WPS Commercial |
$12,646.71
|
|
|
HIP STEM ACCOLADE II 132 DEG NECK SZ 5 6720-0535
|
Facility
|
OP
|
$17,074.00
|
|
| Hospital Charge Code |
4263465
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,780.72 |
| Max. Negotiated Rate |
$68,296.00 |
| Rate for Payer: Aetna Commercial |
$15,366.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,683.64
|
| Rate for Payer: Aetna Managed Medicare |
$4,780.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,098.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,537.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,195.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,049.22
|
| Rate for Payer: Cash Price |
$5,122.20
|
| Rate for Payer: Cigna Commercial |
$15,708.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,554.61
|
| Rate for Payer: Health EOS Commercial |
$15,195.86
|
| Rate for Payer: HFN Commercial |
$15,708.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,805.50
|
| Rate for Payer: Multiplan Commercial |
$13,659.20
|
| Rate for Payer: NAPHCARE Commercial |
$10,244.40
|
| Rate for Payer: Preferred Network Access Commercial |
$15,708.08
|
| Rate for Payer: Quartz Beloit One Network |
$8,366.26
|
| Rate for Payer: Quartz Commercial |
$11,098.10
|
| Rate for Payer: Quartz Medicare Advantage |
$10,244.40
|
| Rate for Payer: The Alliance Commercial |
$68,296.00
|
| Rate for Payer: WEA Trust Commercial |
$9,390.70
|
| Rate for Payer: WPS Commercial |
$12,646.71
|
|
|
HIP STEM ACCOLADE II 132 DEG NECK SZ 5 6720-0535
|
Facility
|
IP
|
$17,074.00
|
|
| Hospital Charge Code |
4263465
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,366.26 |
| Max. Negotiated Rate |
$15,708.08 |
| Rate for Payer: Aetna Commercial |
$15,366.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,683.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,049.22
|
| Rate for Payer: Cash Price |
$5,122.20
|
| Rate for Payer: Cigna Commercial |
$15,708.08
|
| Rate for Payer: Health EOS Commercial |
$15,195.86
|
| Rate for Payer: HFN Commercial |
$15,708.08
|
| Rate for Payer: Multiplan Commercial |
$13,659.20
|
| Rate for Payer: NAPHCARE Commercial |
$10,244.40
|
| Rate for Payer: Preferred Network Access Commercial |
$15,708.08
|
| Rate for Payer: Quartz Beloit One Network |
$8,366.26
|
| Rate for Payer: Quartz Commercial |
$10,244.40
|
| Rate for Payer: WEA Trust Commercial |
$9,390.70
|
| Rate for Payer: WPS Commercial |
$12,646.71
|
|
|
HIP STEM ACCOLADE II 132 DEG NECK SZ 6 6720-0635
|
Facility
|
OP
|
$17,074.00
|
|
| Hospital Charge Code |
3901349
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,780.72 |
| Max. Negotiated Rate |
$68,296.00 |
| Rate for Payer: Aetna Commercial |
$15,366.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,683.64
|
| Rate for Payer: Aetna Managed Medicare |
$4,780.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,098.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,537.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,195.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,049.22
|
| Rate for Payer: Cash Price |
$5,122.20
|
| Rate for Payer: Cigna Commercial |
$15,708.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,554.61
|
| Rate for Payer: Health EOS Commercial |
$15,195.86
|
| Rate for Payer: HFN Commercial |
$15,708.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,805.50
|
| Rate for Payer: Multiplan Commercial |
$13,659.20
|
| Rate for Payer: NAPHCARE Commercial |
$10,244.40
|
| Rate for Payer: Preferred Network Access Commercial |
$15,708.08
|
| Rate for Payer: Quartz Beloit One Network |
$8,366.26
|
| Rate for Payer: Quartz Commercial |
$11,098.10
|
| Rate for Payer: Quartz Medicare Advantage |
$10,244.40
|
| Rate for Payer: The Alliance Commercial |
$68,296.00
|
| Rate for Payer: WEA Trust Commercial |
$9,390.70
|
| Rate for Payer: WPS Commercial |
$12,646.71
|
|
|
HIP STEM ACCOLADE II 132 DEG NECK SZ 6 6720-0635
|
Facility
|
IP
|
$17,074.00
|
|
| Hospital Charge Code |
3901349
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,366.26 |
| Max. Negotiated Rate |
$15,708.08 |
| Rate for Payer: Aetna Commercial |
$15,366.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,683.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,049.22
|
| Rate for Payer: Cash Price |
$5,122.20
|
| Rate for Payer: Cigna Commercial |
$15,708.08
|
| Rate for Payer: Health EOS Commercial |
$15,195.86
|
| Rate for Payer: HFN Commercial |
$15,708.08
|
| Rate for Payer: Multiplan Commercial |
$13,659.20
|
| Rate for Payer: NAPHCARE Commercial |
$10,244.40
|
| Rate for Payer: Preferred Network Access Commercial |
$15,708.08
|
| Rate for Payer: Quartz Beloit One Network |
$8,366.26
|
| Rate for Payer: Quartz Commercial |
$10,244.40
|
| Rate for Payer: WEA Trust Commercial |
$9,390.70
|
| Rate for Payer: WPS Commercial |
$12,646.71
|
|
|
HIP STEM ACCOLADE II 132 DEG NECK SZ 7 6720-0737
|
Facility
|
IP
|
$17,074.00
|
|
| Hospital Charge Code |
4640681
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,366.26 |
| Max. Negotiated Rate |
$15,708.08 |
| Rate for Payer: Aetna Commercial |
$15,366.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,683.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,049.22
|
| Rate for Payer: Cash Price |
$5,122.20
|
| Rate for Payer: Cigna Commercial |
$15,708.08
|
| Rate for Payer: Health EOS Commercial |
$15,195.86
|
| Rate for Payer: HFN Commercial |
$15,708.08
|
| Rate for Payer: Multiplan Commercial |
$13,659.20
|
| Rate for Payer: NAPHCARE Commercial |
$10,244.40
|
| Rate for Payer: Preferred Network Access Commercial |
$15,708.08
|
| Rate for Payer: Quartz Beloit One Network |
$8,366.26
|
| Rate for Payer: Quartz Commercial |
$10,244.40
|
| Rate for Payer: WEA Trust Commercial |
$9,390.70
|
| Rate for Payer: WPS Commercial |
$12,646.71
|
|
|
HIP STEM ACCOLADE II 132 DEG NECK SZ 7 6720-0737
|
Facility
|
OP
|
$17,074.00
|
|
| Hospital Charge Code |
4640681
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,780.72 |
| Max. Negotiated Rate |
$68,296.00 |
| Rate for Payer: Aetna Commercial |
$15,366.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,683.64
|
| Rate for Payer: Aetna Managed Medicare |
$4,780.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,098.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,537.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,195.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,049.22
|
| Rate for Payer: Cash Price |
$5,122.20
|
| Rate for Payer: Cigna Commercial |
$15,708.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,554.61
|
| Rate for Payer: Health EOS Commercial |
$15,195.86
|
| Rate for Payer: HFN Commercial |
$15,708.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,805.50
|
| Rate for Payer: Multiplan Commercial |
$13,659.20
|
| Rate for Payer: NAPHCARE Commercial |
$10,244.40
|
| Rate for Payer: Preferred Network Access Commercial |
$15,708.08
|
| Rate for Payer: Quartz Beloit One Network |
$8,366.26
|
| Rate for Payer: Quartz Commercial |
$11,098.10
|
| Rate for Payer: Quartz Medicare Advantage |
$10,244.40
|
| Rate for Payer: The Alliance Commercial |
$68,296.00
|
| Rate for Payer: WEA Trust Commercial |
$9,390.70
|
| Rate for Payer: WPS Commercial |
$12,646.71
|
|
|
HIP STEM ACCOLADE II SZ11 6721-1140
|
Facility
|
IP
|
$17,074.00
|
|
| Hospital Charge Code |
4508750
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,366.26 |
| Max. Negotiated Rate |
$15,708.08 |
| Rate for Payer: Aetna Commercial |
$15,366.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,683.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,049.22
|
| Rate for Payer: Cash Price |
$5,122.20
|
| Rate for Payer: Cigna Commercial |
$15,708.08
|
| Rate for Payer: Health EOS Commercial |
$15,195.86
|
| Rate for Payer: HFN Commercial |
$15,708.08
|
| Rate for Payer: Multiplan Commercial |
$13,659.20
|
| Rate for Payer: NAPHCARE Commercial |
$10,244.40
|
| Rate for Payer: Preferred Network Access Commercial |
$15,708.08
|
| Rate for Payer: Quartz Beloit One Network |
$8,366.26
|
| Rate for Payer: Quartz Commercial |
$10,244.40
|
| Rate for Payer: WEA Trust Commercial |
$9,390.70
|
| Rate for Payer: WPS Commercial |
$12,646.71
|
|
|
HIP STEM ACCOLADE II SZ11 6721-1140
|
Facility
|
OP
|
$17,074.00
|
|
| Hospital Charge Code |
4508750
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,780.72 |
| Max. Negotiated Rate |
$68,296.00 |
| Rate for Payer: Aetna Commercial |
$15,366.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,683.64
|
| Rate for Payer: Aetna Managed Medicare |
$4,780.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,098.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,537.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,195.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,049.22
|
| Rate for Payer: Cash Price |
$5,122.20
|
| Rate for Payer: Cigna Commercial |
$15,708.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,554.61
|
| Rate for Payer: Health EOS Commercial |
$15,195.86
|
| Rate for Payer: HFN Commercial |
$15,708.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,805.50
|
| Rate for Payer: Multiplan Commercial |
$13,659.20
|
| Rate for Payer: NAPHCARE Commercial |
$10,244.40
|
| Rate for Payer: Preferred Network Access Commercial |
$15,708.08
|
| Rate for Payer: Quartz Beloit One Network |
$8,366.26
|
| Rate for Payer: Quartz Commercial |
$11,098.10
|
| Rate for Payer: Quartz Medicare Advantage |
$10,244.40
|
| Rate for Payer: The Alliance Commercial |
$68,296.00
|
| Rate for Payer: WEA Trust Commercial |
$9,390.70
|
| Rate for Payer: WPS Commercial |
$12,646.71
|
|
|
HIP STEM ACCOLADE II SZ 2 6721-0230
|
Facility
|
IP
|
$17,074.00
|
|
| Hospital Charge Code |
4035317
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,366.26 |
| Max. Negotiated Rate |
$15,708.08 |
| Rate for Payer: Aetna Commercial |
$15,366.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,683.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,049.22
|
| Rate for Payer: Cash Price |
$5,122.20
|
| Rate for Payer: Cigna Commercial |
$15,708.08
|
| Rate for Payer: Health EOS Commercial |
$15,195.86
|
| Rate for Payer: HFN Commercial |
$15,708.08
|
| Rate for Payer: Multiplan Commercial |
$13,659.20
|
| Rate for Payer: NAPHCARE Commercial |
$10,244.40
|
| Rate for Payer: Preferred Network Access Commercial |
$15,708.08
|
| Rate for Payer: Quartz Beloit One Network |
$8,366.26
|
| Rate for Payer: Quartz Commercial |
$10,244.40
|
| Rate for Payer: WEA Trust Commercial |
$9,390.70
|
| Rate for Payer: WPS Commercial |
$12,646.71
|
|
|
HIP STEM ACCOLADE II SZ 2 6721-0230
|
Facility
|
OP
|
$17,074.00
|
|
| Hospital Charge Code |
4035317
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,780.72 |
| Max. Negotiated Rate |
$68,296.00 |
| Rate for Payer: Aetna Commercial |
$15,366.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,683.64
|
| Rate for Payer: Aetna Managed Medicare |
$4,780.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,098.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,537.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,195.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,049.22
|
| Rate for Payer: Cash Price |
$5,122.20
|
| Rate for Payer: Cigna Commercial |
$15,708.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,554.61
|
| Rate for Payer: Health EOS Commercial |
$15,195.86
|
| Rate for Payer: HFN Commercial |
$15,708.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,805.50
|
| Rate for Payer: Multiplan Commercial |
$13,659.20
|
| Rate for Payer: NAPHCARE Commercial |
$10,244.40
|
| Rate for Payer: Preferred Network Access Commercial |
$15,708.08
|
| Rate for Payer: Quartz Beloit One Network |
$8,366.26
|
| Rate for Payer: Quartz Commercial |
$11,098.10
|
| Rate for Payer: Quartz Medicare Advantage |
$10,244.40
|
| Rate for Payer: The Alliance Commercial |
$68,296.00
|
| Rate for Payer: WEA Trust Commercial |
$9,390.70
|
| Rate for Payer: WPS Commercial |
$12,646.71
|
|
|
HIP STEM ACCOLADE II SZ 3 6721-0330
|
Facility
|
IP
|
$17,074.00
|
|
| Hospital Charge Code |
4493668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,366.26 |
| Max. Negotiated Rate |
$15,708.08 |
| Rate for Payer: Aetna Commercial |
$15,366.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,683.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,049.22
|
| Rate for Payer: Cash Price |
$5,122.20
|
| Rate for Payer: Cigna Commercial |
$15,708.08
|
| Rate for Payer: Health EOS Commercial |
$15,195.86
|
| Rate for Payer: HFN Commercial |
$15,708.08
|
| Rate for Payer: Multiplan Commercial |
$13,659.20
|
| Rate for Payer: NAPHCARE Commercial |
$10,244.40
|
| Rate for Payer: Preferred Network Access Commercial |
$15,708.08
|
| Rate for Payer: Quartz Beloit One Network |
$8,366.26
|
| Rate for Payer: Quartz Commercial |
$10,244.40
|
| Rate for Payer: WEA Trust Commercial |
$9,390.70
|
| Rate for Payer: WPS Commercial |
$12,646.71
|
|
|
HIP STEM ACCOLADE II SZ 3 6721-0330
|
Facility
|
OP
|
$17,074.00
|
|
| Hospital Charge Code |
4493668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,780.72 |
| Max. Negotiated Rate |
$68,296.00 |
| Rate for Payer: Aetna Commercial |
$15,366.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,683.64
|
| Rate for Payer: Aetna Managed Medicare |
$4,780.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,098.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,537.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,195.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,049.22
|
| Rate for Payer: Cash Price |
$5,122.20
|
| Rate for Payer: Cigna Commercial |
$15,708.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,554.61
|
| Rate for Payer: Health EOS Commercial |
$15,195.86
|
| Rate for Payer: HFN Commercial |
$15,708.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,805.50
|
| Rate for Payer: Multiplan Commercial |
$13,659.20
|
| Rate for Payer: NAPHCARE Commercial |
$10,244.40
|
| Rate for Payer: Preferred Network Access Commercial |
$15,708.08
|
| Rate for Payer: Quartz Beloit One Network |
$8,366.26
|
| Rate for Payer: Quartz Commercial |
$11,098.10
|
| Rate for Payer: Quartz Medicare Advantage |
$10,244.40
|
| Rate for Payer: The Alliance Commercial |
$68,296.00
|
| Rate for Payer: WEA Trust Commercial |
$9,390.70
|
| Rate for Payer: WPS Commercial |
$12,646.71
|
|
