|
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 |
$4,692.91 |
| Max. Negotiated Rate |
$8,811.17 |
| Rate for Payer: Aetna Commercial |
$8,619.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,236.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,076.00
|
| Rate for Payer: Cash Price |
$2,762.70
|
| Rate for Payer: Cigna Commercial |
$8,811.17
|
| Rate for Payer: Health EOS Commercial |
$8,523.85
|
| Rate for Payer: HFN Commercial |
$8,811.17
|
| Rate for Payer: Multiplan Commercial |
$7,661.89
|
| Rate for Payer: Preferred Network Access Commercial |
$8,811.17
|
| Rate for Payer: Quartz Beloit One Network |
$4,692.91
|
| Rate for Payer: Quartz Commercial |
$5,746.42
|
| Rate for Payer: WEA Trust Commercial |
$5,267.55
|
| Rate for Payer: WPS Commercial |
$7,093.69
|
|
|
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 |
$3,196.21 |
| Max. Negotiated Rate |
$10,501.84 |
| Rate for Payer: Aetna Commercial |
$10,273.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,816.93
|
| Rate for Payer: Aetna Managed Medicare |
$3,196.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,419.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,707.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,479.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,049.97
|
| Rate for Payer: Cash Price |
$3,292.80
|
| Rate for Payer: Cigna Commercial |
$10,501.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,388.03
|
| Rate for Payer: Health EOS Commercial |
$10,159.39
|
| Rate for Payer: HFN Commercial |
$10,501.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,561.28
|
| Rate for Payer: Multiplan Commercial |
$9,132.03
|
| Rate for Payer: NAPHCARE Commercial |
$6,849.02
|
| Rate for Payer: Preferred Network Access Commercial |
$10,501.84
|
| Rate for Payer: Quartz Beloit One Network |
$5,593.37
|
| Rate for Payer: Quartz Commercial |
$7,419.78
|
| Rate for Payer: Quartz Medicare Advantage |
$6,849.02
|
| Rate for Payer: The Alliance Commercial |
$5,707.52
|
| Rate for Payer: WEA Trust Commercial |
$6,278.27
|
| Rate for Payer: WPS Commercial |
$8,454.81
|
|
|
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 |
$5,593.37 |
| Max. Negotiated Rate |
$10,501.84 |
| Rate for Payer: Aetna Commercial |
$10,273.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,816.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,049.97
|
| Rate for Payer: Cash Price |
$3,292.80
|
| Rate for Payer: Cigna Commercial |
$10,501.84
|
| Rate for Payer: Health EOS Commercial |
$10,159.39
|
| Rate for Payer: HFN Commercial |
$10,501.84
|
| Rate for Payer: Multiplan Commercial |
$9,132.03
|
| Rate for Payer: Preferred Network Access Commercial |
$10,501.84
|
| Rate for Payer: Quartz Beloit One Network |
$5,593.37
|
| Rate for Payer: Quartz Commercial |
$6,849.02
|
| Rate for Payer: WEA Trust Commercial |
$6,278.27
|
| Rate for Payer: WPS Commercial |
$8,454.81
|
|
|
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 |
$2,647.88 |
| Max. Negotiated Rate |
$8,700.18 |
| Rate for Payer: Aetna Commercial |
$8,511.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,132.78
|
| Rate for Payer: Aetna Managed Medicare |
$2,647.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,146.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,728.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,539.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,012.06
|
| Rate for Payer: Cash Price |
$2,727.90
|
| Rate for Payer: Cigna Commercial |
$8,700.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,292.13
|
| Rate for Payer: Health EOS Commercial |
$8,416.48
|
| Rate for Payer: HFN Commercial |
$8,700.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,092.54
|
| Rate for Payer: Multiplan Commercial |
$7,565.38
|
| Rate for Payer: NAPHCARE Commercial |
$5,674.03
|
| Rate for Payer: Preferred Network Access Commercial |
$8,700.18
|
| Rate for Payer: Quartz Beloit One Network |
$4,633.79
|
| Rate for Payer: Quartz Commercial |
$6,146.87
|
| Rate for Payer: Quartz Medicare Advantage |
$5,674.03
|
| Rate for Payer: The Alliance Commercial |
$4,728.36
|
| Rate for Payer: WEA Trust Commercial |
$5,201.20
|
| Rate for Payer: WPS Commercial |
$7,004.34
|
|
|
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 |
$4,633.79 |
| Max. Negotiated Rate |
$8,700.18 |
| Rate for Payer: Aetna Commercial |
$8,511.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,132.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,012.06
|
| Rate for Payer: Cash Price |
$2,727.90
|
| Rate for Payer: Cigna Commercial |
$8,700.18
|
| Rate for Payer: Health EOS Commercial |
$8,416.48
|
| Rate for Payer: HFN Commercial |
$8,700.18
|
| Rate for Payer: Multiplan Commercial |
$7,565.38
|
| Rate for Payer: Preferred Network Access Commercial |
$8,700.18
|
| Rate for Payer: Quartz Beloit One Network |
$4,633.79
|
| Rate for Payer: Quartz Commercial |
$5,674.03
|
| Rate for Payer: WEA Trust Commercial |
$5,201.20
|
| Rate for Payer: WPS Commercial |
$7,004.34
|
|
|
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 |
$2,680.50 |
| Max. Negotiated Rate |
$8,807.34 |
| Rate for Payer: Aetna Commercial |
$8,615.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,232.95
|
| Rate for Payer: Aetna Managed Medicare |
$2,680.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,222.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,786.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,595.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,073.80
|
| Rate for Payer: Cash Price |
$2,761.50
|
| Rate for Payer: Cigna Commercial |
$8,807.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,357.31
|
| Rate for Payer: Health EOS Commercial |
$8,520.15
|
| Rate for Payer: HFN Commercial |
$8,807.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,179.90
|
| Rate for Payer: Multiplan Commercial |
$7,658.56
|
| Rate for Payer: NAPHCARE Commercial |
$5,743.92
|
| Rate for Payer: Preferred Network Access Commercial |
$8,807.34
|
| Rate for Payer: Quartz Beloit One Network |
$4,690.87
|
| Rate for Payer: Quartz Commercial |
$6,222.58
|
| Rate for Payer: Quartz Medicare Advantage |
$5,743.92
|
| Rate for Payer: The Alliance Commercial |
$4,786.60
|
| Rate for Payer: WEA Trust Commercial |
$5,265.26
|
| Rate for Payer: WPS Commercial |
$7,090.61
|
|
|
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 |
$4,690.87 |
| Max. Negotiated Rate |
$8,807.34 |
| Rate for Payer: Aetna Commercial |
$8,615.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,232.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,073.80
|
| Rate for Payer: Cash Price |
$2,761.50
|
| Rate for Payer: Cigna Commercial |
$8,807.34
|
| Rate for Payer: Health EOS Commercial |
$8,520.15
|
| Rate for Payer: HFN Commercial |
$8,807.34
|
| Rate for Payer: Multiplan Commercial |
$7,658.56
|
| Rate for Payer: Preferred Network Access Commercial |
$8,807.34
|
| Rate for Payer: Quartz Beloit One Network |
$4,690.87
|
| Rate for Payer: Quartz Commercial |
$5,743.92
|
| Rate for Payer: WEA Trust Commercial |
$5,265.26
|
| Rate for Payer: WPS Commercial |
$7,090.61
|
|
|
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 |
$2,680.50 |
| Max. Negotiated Rate |
$8,807.34 |
| Rate for Payer: Aetna Commercial |
$8,615.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,232.95
|
| Rate for Payer: Aetna Managed Medicare |
$2,680.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,222.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,786.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,595.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,073.80
|
| Rate for Payer: Cash Price |
$2,761.50
|
| Rate for Payer: Cigna Commercial |
$8,807.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,357.31
|
| Rate for Payer: Health EOS Commercial |
$8,520.15
|
| Rate for Payer: HFN Commercial |
$8,807.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,179.90
|
| Rate for Payer: Multiplan Commercial |
$7,658.56
|
| Rate for Payer: NAPHCARE Commercial |
$5,743.92
|
| Rate for Payer: Preferred Network Access Commercial |
$8,807.34
|
| Rate for Payer: Quartz Beloit One Network |
$4,690.87
|
| Rate for Payer: Quartz Commercial |
$6,222.58
|
| Rate for Payer: Quartz Medicare Advantage |
$5,743.92
|
| Rate for Payer: The Alliance Commercial |
$4,786.60
|
| Rate for Payer: WEA Trust Commercial |
$5,265.26
|
| Rate for Payer: WPS Commercial |
$7,090.61
|
|
|
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 |
$4,690.87 |
| Max. Negotiated Rate |
$8,807.34 |
| Rate for Payer: Aetna Commercial |
$8,615.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,232.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,073.80
|
| Rate for Payer: Cash Price |
$2,761.50
|
| Rate for Payer: Cigna Commercial |
$8,807.34
|
| Rate for Payer: Health EOS Commercial |
$8,520.15
|
| Rate for Payer: HFN Commercial |
$8,807.34
|
| Rate for Payer: Multiplan Commercial |
$7,658.56
|
| Rate for Payer: Preferred Network Access Commercial |
$8,807.34
|
| Rate for Payer: Quartz Beloit One Network |
$4,690.87
|
| Rate for Payer: Quartz Commercial |
$5,743.92
|
| Rate for Payer: WEA Trust Commercial |
$5,265.26
|
| Rate for Payer: WPS Commercial |
$7,090.61
|
|
|
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 |
$2,680.50 |
| Max. Negotiated Rate |
$8,807.34 |
| Rate for Payer: Aetna Commercial |
$8,615.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,232.95
|
| Rate for Payer: Aetna Managed Medicare |
$2,680.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,222.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,786.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,595.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,073.80
|
| Rate for Payer: Cash Price |
$2,761.50
|
| Rate for Payer: Cigna Commercial |
$8,807.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,357.31
|
| Rate for Payer: Health EOS Commercial |
$8,520.15
|
| Rate for Payer: HFN Commercial |
$8,807.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,179.90
|
| Rate for Payer: Multiplan Commercial |
$7,658.56
|
| Rate for Payer: NAPHCARE Commercial |
$5,743.92
|
| Rate for Payer: Preferred Network Access Commercial |
$8,807.34
|
| Rate for Payer: Quartz Beloit One Network |
$4,690.87
|
| Rate for Payer: Quartz Commercial |
$6,222.58
|
| Rate for Payer: Quartz Medicare Advantage |
$5,743.92
|
| Rate for Payer: The Alliance Commercial |
$4,786.60
|
| Rate for Payer: WEA Trust Commercial |
$5,265.26
|
| Rate for Payer: WPS Commercial |
$7,090.61
|
|
|
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 |
$4,690.87 |
| Max. Negotiated Rate |
$8,807.34 |
| Rate for Payer: Aetna Commercial |
$8,615.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,232.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,073.80
|
| Rate for Payer: Cash Price |
$2,761.50
|
| Rate for Payer: Cigna Commercial |
$8,807.34
|
| Rate for Payer: Health EOS Commercial |
$8,520.15
|
| Rate for Payer: HFN Commercial |
$8,807.34
|
| Rate for Payer: Multiplan Commercial |
$7,658.56
|
| Rate for Payer: Preferred Network Access Commercial |
$8,807.34
|
| Rate for Payer: Quartz Beloit One Network |
$4,690.87
|
| Rate for Payer: Quartz Commercial |
$5,743.92
|
| Rate for Payer: WEA Trust Commercial |
$5,265.26
|
| Rate for Payer: WPS Commercial |
$7,090.61
|
|
|
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 |
$4,690.87 |
| Max. Negotiated Rate |
$8,807.34 |
| Rate for Payer: Aetna Commercial |
$8,615.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,232.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,073.80
|
| Rate for Payer: Cash Price |
$2,761.50
|
| Rate for Payer: Cigna Commercial |
$8,807.34
|
| Rate for Payer: Health EOS Commercial |
$8,520.15
|
| Rate for Payer: HFN Commercial |
$8,807.34
|
| Rate for Payer: Multiplan Commercial |
$7,658.56
|
| Rate for Payer: Preferred Network Access Commercial |
$8,807.34
|
| Rate for Payer: Quartz Beloit One Network |
$4,690.87
|
| Rate for Payer: Quartz Commercial |
$5,743.92
|
| Rate for Payer: WEA Trust Commercial |
$5,265.26
|
| Rate for Payer: WPS Commercial |
$7,090.61
|
|
|
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 |
$2,680.50 |
| Max. Negotiated Rate |
$8,807.34 |
| Rate for Payer: Aetna Commercial |
$8,615.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,232.95
|
| Rate for Payer: Aetna Managed Medicare |
$2,680.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,222.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,786.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,595.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,073.80
|
| Rate for Payer: Cash Price |
$2,761.50
|
| Rate for Payer: Cigna Commercial |
$8,807.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,357.31
|
| Rate for Payer: Health EOS Commercial |
$8,520.15
|
| Rate for Payer: HFN Commercial |
$8,807.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,179.90
|
| Rate for Payer: Multiplan Commercial |
$7,658.56
|
| Rate for Payer: NAPHCARE Commercial |
$5,743.92
|
| Rate for Payer: Preferred Network Access Commercial |
$8,807.34
|
| Rate for Payer: Quartz Beloit One Network |
$4,690.87
|
| Rate for Payer: Quartz Commercial |
$6,222.58
|
| Rate for Payer: Quartz Medicare Advantage |
$5,743.92
|
| Rate for Payer: The Alliance Commercial |
$4,786.60
|
| Rate for Payer: WEA Trust Commercial |
$5,265.26
|
| Rate for Payer: WPS Commercial |
$7,090.61
|
|
|
HIP STEM ACCOLADE HFX SZ 2 6077-C230
|
Facility
|
OP
|
$7,317.00
|
|
| Hospital Charge Code |
4399645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,130.71 |
| Max. Negotiated Rate |
$7,000.91 |
| Rate for Payer: Aetna Commercial |
$6,848.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,544.32
|
| Rate for Payer: Aetna Managed Medicare |
$2,130.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,946.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,804.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,652.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,033.13
|
| Rate for Payer: Cash Price |
$2,195.10
|
| Rate for Payer: Cigna Commercial |
$7,000.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,258.49
|
| Rate for Payer: Health EOS Commercial |
$6,772.62
|
| Rate for Payer: HFN Commercial |
$7,000.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,707.26
|
| Rate for Payer: Multiplan Commercial |
$6,087.74
|
| Rate for Payer: NAPHCARE Commercial |
$4,565.81
|
| Rate for Payer: Preferred Network Access Commercial |
$7,000.91
|
| Rate for Payer: Quartz Beloit One Network |
$3,728.74
|
| Rate for Payer: Quartz Commercial |
$4,946.29
|
| Rate for Payer: Quartz Medicare Advantage |
$4,565.81
|
| Rate for Payer: The Alliance Commercial |
$3,804.84
|
| Rate for Payer: WEA Trust Commercial |
$4,185.32
|
| Rate for Payer: WPS Commercial |
$5,636.29
|
|
|
HIP STEM ACCOLADE HFX SZ 2 6077-C230
|
Facility
|
IP
|
$7,317.00
|
|
| Hospital Charge Code |
4399645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,728.74 |
| Max. Negotiated Rate |
$7,000.91 |
| Rate for Payer: Aetna Commercial |
$6,848.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,544.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,033.13
|
| Rate for Payer: Cash Price |
$2,195.10
|
| Rate for Payer: Cigna Commercial |
$7,000.91
|
| Rate for Payer: Health EOS Commercial |
$6,772.62
|
| Rate for Payer: HFN Commercial |
$7,000.91
|
| Rate for Payer: Multiplan Commercial |
$6,087.74
|
| Rate for Payer: Preferred Network Access Commercial |
$7,000.91
|
| Rate for Payer: Quartz Beloit One Network |
$3,728.74
|
| Rate for Payer: Quartz Commercial |
$4,565.81
|
| Rate for Payer: WEA Trust Commercial |
$4,185.32
|
| Rate for Payer: WPS Commercial |
$5,636.29
|
|
|
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 |
$4,971.95 |
| Max. Negotiated Rate |
$16,336.40 |
| Rate for Payer: Aetna Commercial |
$15,981.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,270.99
|
| Rate for Payer: Aetna Managed Medicare |
$4,971.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,542.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,878.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,523.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,411.19
|
| Rate for Payer: Cash Price |
$5,122.20
|
| Rate for Payer: Cigna Commercial |
$16,336.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,937.07
|
| Rate for Payer: Health EOS Commercial |
$15,803.69
|
| Rate for Payer: HFN Commercial |
$16,336.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,317.72
|
| Rate for Payer: Multiplan Commercial |
$14,205.57
|
| Rate for Payer: NAPHCARE Commercial |
$10,654.18
|
| Rate for Payer: Preferred Network Access Commercial |
$16,336.40
|
| Rate for Payer: Quartz Beloit One Network |
$8,700.91
|
| Rate for Payer: Quartz Commercial |
$11,542.02
|
| Rate for Payer: Quartz Medicare Advantage |
$10,654.18
|
| Rate for Payer: The Alliance Commercial |
$8,878.48
|
| Rate for Payer: WEA Trust Commercial |
$9,766.33
|
| Rate for Payer: WPS Commercial |
$13,152.10
|
|
|
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 |
$8,700.91 |
| Max. Negotiated Rate |
$16,336.40 |
| Rate for Payer: Aetna Commercial |
$15,981.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,270.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,411.19
|
| Rate for Payer: Cash Price |
$5,122.20
|
| Rate for Payer: Cigna Commercial |
$16,336.40
|
| Rate for Payer: Health EOS Commercial |
$15,803.69
|
| Rate for Payer: HFN Commercial |
$16,336.40
|
| Rate for Payer: Multiplan Commercial |
$14,205.57
|
| Rate for Payer: Preferred Network Access Commercial |
$16,336.40
|
| Rate for Payer: Quartz Beloit One Network |
$8,700.91
|
| Rate for Payer: Quartz Commercial |
$10,654.18
|
| Rate for Payer: WEA Trust Commercial |
$9,766.33
|
| Rate for Payer: WPS Commercial |
$13,152.10
|
|
|
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 |
$4,971.95 |
| Max. Negotiated Rate |
$16,336.40 |
| Rate for Payer: Aetna Commercial |
$15,981.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,270.99
|
| Rate for Payer: Aetna Managed Medicare |
$4,971.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,542.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,878.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,523.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,411.19
|
| Rate for Payer: Cash Price |
$5,122.20
|
| Rate for Payer: Cigna Commercial |
$16,336.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,937.07
|
| Rate for Payer: Health EOS Commercial |
$15,803.69
|
| Rate for Payer: HFN Commercial |
$16,336.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,317.72
|
| Rate for Payer: Multiplan Commercial |
$14,205.57
|
| Rate for Payer: NAPHCARE Commercial |
$10,654.18
|
| Rate for Payer: Preferred Network Access Commercial |
$16,336.40
|
| Rate for Payer: Quartz Beloit One Network |
$8,700.91
|
| Rate for Payer: Quartz Commercial |
$11,542.02
|
| Rate for Payer: Quartz Medicare Advantage |
$10,654.18
|
| Rate for Payer: The Alliance Commercial |
$8,878.48
|
| Rate for Payer: WEA Trust Commercial |
$9,766.33
|
| Rate for Payer: WPS Commercial |
$13,152.10
|
|
|
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 |
$8,700.91 |
| Max. Negotiated Rate |
$16,336.40 |
| Rate for Payer: Aetna Commercial |
$15,981.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,270.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,411.19
|
| Rate for Payer: Cash Price |
$5,122.20
|
| Rate for Payer: Cigna Commercial |
$16,336.40
|
| Rate for Payer: Health EOS Commercial |
$15,803.69
|
| Rate for Payer: HFN Commercial |
$16,336.40
|
| Rate for Payer: Multiplan Commercial |
$14,205.57
|
| Rate for Payer: Preferred Network Access Commercial |
$16,336.40
|
| Rate for Payer: Quartz Beloit One Network |
$8,700.91
|
| Rate for Payer: Quartz Commercial |
$10,654.18
|
| Rate for Payer: WEA Trust Commercial |
$9,766.33
|
| Rate for Payer: WPS Commercial |
$13,152.10
|
|
|
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 |
$8,700.91 |
| Max. Negotiated Rate |
$16,336.40 |
| Rate for Payer: Aetna Commercial |
$15,981.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,270.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,411.19
|
| Rate for Payer: Cash Price |
$5,122.20
|
| Rate for Payer: Cigna Commercial |
$16,336.40
|
| Rate for Payer: Health EOS Commercial |
$15,803.69
|
| Rate for Payer: HFN Commercial |
$16,336.40
|
| Rate for Payer: Multiplan Commercial |
$14,205.57
|
| Rate for Payer: Preferred Network Access Commercial |
$16,336.40
|
| Rate for Payer: Quartz Beloit One Network |
$8,700.91
|
| Rate for Payer: Quartz Commercial |
$10,654.18
|
| Rate for Payer: WEA Trust Commercial |
$9,766.33
|
| Rate for Payer: WPS Commercial |
$13,152.10
|
|
|
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 |
$4,971.95 |
| Max. Negotiated Rate |
$16,336.40 |
| Rate for Payer: Aetna Commercial |
$15,981.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,270.99
|
| Rate for Payer: Aetna Managed Medicare |
$4,971.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,542.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,878.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,523.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,411.19
|
| Rate for Payer: Cash Price |
$5,122.20
|
| Rate for Payer: Cigna Commercial |
$16,336.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,937.07
|
| Rate for Payer: Health EOS Commercial |
$15,803.69
|
| Rate for Payer: HFN Commercial |
$16,336.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,317.72
|
| Rate for Payer: Multiplan Commercial |
$14,205.57
|
| Rate for Payer: NAPHCARE Commercial |
$10,654.18
|
| Rate for Payer: Preferred Network Access Commercial |
$16,336.40
|
| Rate for Payer: Quartz Beloit One Network |
$8,700.91
|
| Rate for Payer: Quartz Commercial |
$11,542.02
|
| Rate for Payer: Quartz Medicare Advantage |
$10,654.18
|
| Rate for Payer: The Alliance Commercial |
$8,878.48
|
| Rate for Payer: WEA Trust Commercial |
$9,766.33
|
| Rate for Payer: WPS Commercial |
$13,152.10
|
|
|
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 |
$8,700.91 |
| Max. Negotiated Rate |
$16,336.40 |
| Rate for Payer: Aetna Commercial |
$15,981.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,270.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,411.19
|
| Rate for Payer: Cash Price |
$5,122.20
|
| Rate for Payer: Cigna Commercial |
$16,336.40
|
| Rate for Payer: Health EOS Commercial |
$15,803.69
|
| Rate for Payer: HFN Commercial |
$16,336.40
|
| Rate for Payer: Multiplan Commercial |
$14,205.57
|
| Rate for Payer: Preferred Network Access Commercial |
$16,336.40
|
| Rate for Payer: Quartz Beloit One Network |
$8,700.91
|
| Rate for Payer: Quartz Commercial |
$10,654.18
|
| Rate for Payer: WEA Trust Commercial |
$9,766.33
|
| Rate for Payer: WPS Commercial |
$13,152.10
|
|
|
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 |
$4,971.95 |
| Max. Negotiated Rate |
$16,336.40 |
| Rate for Payer: Aetna Commercial |
$15,981.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,270.99
|
| Rate for Payer: Aetna Managed Medicare |
$4,971.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,542.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,878.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,523.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,411.19
|
| Rate for Payer: Cash Price |
$5,122.20
|
| Rate for Payer: Cigna Commercial |
$16,336.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,937.07
|
| Rate for Payer: Health EOS Commercial |
$15,803.69
|
| Rate for Payer: HFN Commercial |
$16,336.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,317.72
|
| Rate for Payer: Multiplan Commercial |
$14,205.57
|
| Rate for Payer: NAPHCARE Commercial |
$10,654.18
|
| Rate for Payer: Preferred Network Access Commercial |
$16,336.40
|
| Rate for Payer: Quartz Beloit One Network |
$8,700.91
|
| Rate for Payer: Quartz Commercial |
$11,542.02
|
| Rate for Payer: Quartz Medicare Advantage |
$10,654.18
|
| Rate for Payer: The Alliance Commercial |
$8,878.48
|
| Rate for Payer: WEA Trust Commercial |
$9,766.33
|
| Rate for Payer: WPS Commercial |
$13,152.10
|
|
|
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 |
$4,971.95 |
| Max. Negotiated Rate |
$16,336.40 |
| Rate for Payer: Aetna Commercial |
$15,981.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,270.99
|
| Rate for Payer: Aetna Managed Medicare |
$4,971.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,542.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,878.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,523.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,411.19
|
| Rate for Payer: Cash Price |
$5,122.20
|
| Rate for Payer: Cigna Commercial |
$16,336.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,937.07
|
| Rate for Payer: Health EOS Commercial |
$15,803.69
|
| Rate for Payer: HFN Commercial |
$16,336.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,317.72
|
| Rate for Payer: Multiplan Commercial |
$14,205.57
|
| Rate for Payer: NAPHCARE Commercial |
$10,654.18
|
| Rate for Payer: Preferred Network Access Commercial |
$16,336.40
|
| Rate for Payer: Quartz Beloit One Network |
$8,700.91
|
| Rate for Payer: Quartz Commercial |
$11,542.02
|
| Rate for Payer: Quartz Medicare Advantage |
$10,654.18
|
| Rate for Payer: The Alliance Commercial |
$8,878.48
|
| Rate for Payer: WEA Trust Commercial |
$9,766.33
|
| Rate for Payer: WPS Commercial |
$13,152.10
|
|
|
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 |
$8,700.91 |
| Max. Negotiated Rate |
$16,336.40 |
| Rate for Payer: Aetna Commercial |
$15,981.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,270.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,411.19
|
| Rate for Payer: Cash Price |
$5,122.20
|
| Rate for Payer: Cigna Commercial |
$16,336.40
|
| Rate for Payer: Health EOS Commercial |
$15,803.69
|
| Rate for Payer: HFN Commercial |
$16,336.40
|
| Rate for Payer: Multiplan Commercial |
$14,205.57
|
| Rate for Payer: Preferred Network Access Commercial |
$16,336.40
|
| Rate for Payer: Quartz Beloit One Network |
$8,700.91
|
| Rate for Payer: Quartz Commercial |
$10,654.18
|
| Rate for Payer: WEA Trust Commercial |
$9,766.33
|
| Rate for Payer: WPS Commercial |
$13,152.10
|
|
