|
STEM FEMORAL ADVOCATE EXT 15 X140 7850-15-25
|
Facility
|
IP
|
$12,032.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967863
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,895.68 |
| Max. Negotiated Rate |
$11,069.44 |
| Rate for Payer: Aetna Commercial |
$10,828.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,347.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,376.96
|
| Rate for Payer: Cash Price |
$3,609.60
|
| Rate for Payer: Cigna Commercial |
$11,069.44
|
| Rate for Payer: Health EOS Commercial |
$10,708.48
|
| Rate for Payer: HFN Commercial |
$11,069.44
|
| Rate for Payer: Multiplan Commercial |
$9,625.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,219.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11,069.44
|
| Rate for Payer: Quartz Beloit One Network |
$5,895.68
|
| Rate for Payer: Quartz Commercial |
$7,219.20
|
| Rate for Payer: WEA Trust Commercial |
$6,617.60
|
| Rate for Payer: WPS Commercial |
$8,912.10
|
|
|
STEM FEMORAL ADVOCATE EXT 15 X140 7850-15-25
|
Facility
|
OP
|
$12,032.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967863
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,368.96 |
| Max. Negotiated Rate |
$48,128.00 |
| Rate for Payer: Aetna Commercial |
$10,828.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,347.52
|
| Rate for Payer: Aetna Managed Medicare |
$3,368.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,820.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,016.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,775.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,376.96
|
| Rate for Payer: Cash Price |
$3,609.60
|
| Rate for Payer: Cigna Commercial |
$11,069.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,733.11
|
| Rate for Payer: Health EOS Commercial |
$10,708.48
|
| Rate for Payer: HFN Commercial |
$11,069.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,024.00
|
| Rate for Payer: Multiplan Commercial |
$9,625.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,219.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11,069.44
|
| Rate for Payer: Quartz Beloit One Network |
$5,895.68
|
| Rate for Payer: Quartz Commercial |
$7,820.80
|
| Rate for Payer: Quartz Medicare Advantage |
$7,219.20
|
| Rate for Payer: The Alliance Commercial |
$48,128.00
|
| Rate for Payer: WEA Trust Commercial |
$6,617.60
|
| Rate for Payer: WPS Commercial |
$8,912.10
|
|
|
STEM FEMORAL ADVOCATE EXT 16 X 145 7850-16-25
|
Facility
|
OP
|
$12,032.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967864
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,368.96 |
| Max. Negotiated Rate |
$48,128.00 |
| Rate for Payer: Aetna Commercial |
$10,828.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,347.52
|
| Rate for Payer: Aetna Managed Medicare |
$3,368.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,820.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,016.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,775.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,376.96
|
| Rate for Payer: Cash Price |
$3,609.60
|
| Rate for Payer: Cigna Commercial |
$11,069.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,733.11
|
| Rate for Payer: Health EOS Commercial |
$10,708.48
|
| Rate for Payer: HFN Commercial |
$11,069.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,024.00
|
| Rate for Payer: Multiplan Commercial |
$9,625.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,219.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11,069.44
|
| Rate for Payer: Quartz Beloit One Network |
$5,895.68
|
| Rate for Payer: Quartz Commercial |
$7,820.80
|
| Rate for Payer: Quartz Medicare Advantage |
$7,219.20
|
| Rate for Payer: The Alliance Commercial |
$48,128.00
|
| Rate for Payer: WEA Trust Commercial |
$6,617.60
|
| Rate for Payer: WPS Commercial |
$8,912.10
|
|
|
STEM FEMORAL ADVOCATE EXT 16 X 145 7850-16-25
|
Facility
|
IP
|
$12,032.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967864
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,895.68 |
| Max. Negotiated Rate |
$11,069.44 |
| Rate for Payer: Aetna Commercial |
$10,828.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,347.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,376.96
|
| Rate for Payer: Cash Price |
$3,609.60
|
| Rate for Payer: Cigna Commercial |
$11,069.44
|
| Rate for Payer: Health EOS Commercial |
$10,708.48
|
| Rate for Payer: HFN Commercial |
$11,069.44
|
| Rate for Payer: Multiplan Commercial |
$9,625.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,219.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11,069.44
|
| Rate for Payer: Quartz Beloit One Network |
$5,895.68
|
| Rate for Payer: Quartz Commercial |
$7,219.20
|
| Rate for Payer: WEA Trust Commercial |
$6,617.60
|
| Rate for Payer: WPS Commercial |
$8,912.10
|
|
|
STEM FEMORAL ADVOCATE ST 12 X 125 7850-12-05
|
Facility
|
OP
|
$12,032.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967866
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,368.96 |
| Max. Negotiated Rate |
$48,128.00 |
| Rate for Payer: Aetna Commercial |
$10,828.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,347.52
|
| Rate for Payer: Aetna Managed Medicare |
$3,368.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,820.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,016.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,775.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,376.96
|
| Rate for Payer: Cash Price |
$3,609.60
|
| Rate for Payer: Cigna Commercial |
$11,069.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,733.11
|
| Rate for Payer: Health EOS Commercial |
$10,708.48
|
| Rate for Payer: HFN Commercial |
$11,069.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,024.00
|
| Rate for Payer: Multiplan Commercial |
$9,625.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,219.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11,069.44
|
| Rate for Payer: Quartz Beloit One Network |
$5,895.68
|
| Rate for Payer: Quartz Commercial |
$7,820.80
|
| Rate for Payer: Quartz Medicare Advantage |
$7,219.20
|
| Rate for Payer: The Alliance Commercial |
$48,128.00
|
| Rate for Payer: WEA Trust Commercial |
$6,617.60
|
| Rate for Payer: WPS Commercial |
$8,912.10
|
|
|
STEM FEMORAL ADVOCATE ST 12 X 125 7850-12-05
|
Facility
|
IP
|
$12,032.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967866
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,895.68 |
| Max. Negotiated Rate |
$11,069.44 |
| Rate for Payer: Aetna Commercial |
$10,828.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,347.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,376.96
|
| Rate for Payer: Cash Price |
$3,609.60
|
| Rate for Payer: Cigna Commercial |
$11,069.44
|
| Rate for Payer: Health EOS Commercial |
$10,708.48
|
| Rate for Payer: HFN Commercial |
$11,069.44
|
| Rate for Payer: Multiplan Commercial |
$9,625.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,219.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11,069.44
|
| Rate for Payer: Quartz Beloit One Network |
$5,895.68
|
| Rate for Payer: Quartz Commercial |
$7,219.20
|
| Rate for Payer: WEA Trust Commercial |
$6,617.60
|
| Rate for Payer: WPS Commercial |
$8,912.10
|
|
|
STEM FEMORAL ADVOCATE ST 13 X130 7850-13-05
|
Facility
|
IP
|
$12,032.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967867
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,895.68 |
| Max. Negotiated Rate |
$11,069.44 |
| Rate for Payer: Aetna Commercial |
$10,828.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,347.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,376.96
|
| Rate for Payer: Cash Price |
$3,609.60
|
| Rate for Payer: Cigna Commercial |
$11,069.44
|
| Rate for Payer: Health EOS Commercial |
$10,708.48
|
| Rate for Payer: HFN Commercial |
$11,069.44
|
| Rate for Payer: Multiplan Commercial |
$9,625.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,219.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11,069.44
|
| Rate for Payer: Quartz Beloit One Network |
$5,895.68
|
| Rate for Payer: Quartz Commercial |
$7,219.20
|
| Rate for Payer: WEA Trust Commercial |
$6,617.60
|
| Rate for Payer: WPS Commercial |
$8,912.10
|
|
|
STEM FEMORAL ADVOCATE ST 13 X130 7850-13-05
|
Facility
|
OP
|
$12,032.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967867
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,368.96 |
| Max. Negotiated Rate |
$48,128.00 |
| Rate for Payer: Aetna Commercial |
$10,828.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,347.52
|
| Rate for Payer: Aetna Managed Medicare |
$3,368.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,820.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,016.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,775.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,376.96
|
| Rate for Payer: Cash Price |
$3,609.60
|
| Rate for Payer: Cigna Commercial |
$11,069.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,733.11
|
| Rate for Payer: Health EOS Commercial |
$10,708.48
|
| Rate for Payer: HFN Commercial |
$11,069.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,024.00
|
| Rate for Payer: Multiplan Commercial |
$9,625.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,219.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11,069.44
|
| Rate for Payer: Quartz Beloit One Network |
$5,895.68
|
| Rate for Payer: Quartz Commercial |
$7,820.80
|
| Rate for Payer: Quartz Medicare Advantage |
$7,219.20
|
| Rate for Payer: The Alliance Commercial |
$48,128.00
|
| Rate for Payer: WEA Trust Commercial |
$6,617.60
|
| Rate for Payer: WPS Commercial |
$8,912.10
|
|
|
STEM FEMORAL ADVOCATE ST 14 X135 7850-14-05
|
Facility
|
IP
|
$12,032.00
|
|
| Hospital Charge Code |
2967868
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,895.68 |
| Max. Negotiated Rate |
$11,069.44 |
| Rate for Payer: Aetna Commercial |
$10,828.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,347.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,376.96
|
| Rate for Payer: Cash Price |
$3,609.60
|
| Rate for Payer: Cigna Commercial |
$11,069.44
|
| Rate for Payer: Health EOS Commercial |
$10,708.48
|
| Rate for Payer: HFN Commercial |
$11,069.44
|
| Rate for Payer: Multiplan Commercial |
$9,625.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,219.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11,069.44
|
| Rate for Payer: Quartz Beloit One Network |
$5,895.68
|
| Rate for Payer: Quartz Commercial |
$7,219.20
|
| Rate for Payer: WEA Trust Commercial |
$6,617.60
|
| Rate for Payer: WPS Commercial |
$8,912.10
|
|
|
STEM FEMORAL ADVOCATE ST 14 X135 7850-14-05
|
Facility
|
OP
|
$12,032.00
|
|
| Hospital Charge Code |
2967868
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,368.96 |
| Max. Negotiated Rate |
$48,128.00 |
| Rate for Payer: Aetna Commercial |
$10,828.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,347.52
|
| Rate for Payer: Aetna Managed Medicare |
$3,368.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,820.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,016.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,775.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,376.96
|
| Rate for Payer: Cash Price |
$3,609.60
|
| Rate for Payer: Cigna Commercial |
$11,069.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,733.11
|
| Rate for Payer: Health EOS Commercial |
$10,708.48
|
| Rate for Payer: HFN Commercial |
$11,069.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,024.00
|
| Rate for Payer: Multiplan Commercial |
$9,625.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,219.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11,069.44
|
| Rate for Payer: Quartz Beloit One Network |
$5,895.68
|
| Rate for Payer: Quartz Commercial |
$7,820.80
|
| Rate for Payer: Quartz Medicare Advantage |
$7,219.20
|
| Rate for Payer: The Alliance Commercial |
$48,128.00
|
| Rate for Payer: WEA Trust Commercial |
$6,617.60
|
| Rate for Payer: WPS Commercial |
$8,912.10
|
|
|
STEM FEMORAL ADVOCATE ST 15 X140 7850-15-05
|
Facility
|
IP
|
$12,032.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967869
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,895.68 |
| Max. Negotiated Rate |
$11,069.44 |
| Rate for Payer: Aetna Commercial |
$10,828.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,347.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,376.96
|
| Rate for Payer: Cash Price |
$3,609.60
|
| Rate for Payer: Cigna Commercial |
$11,069.44
|
| Rate for Payer: Health EOS Commercial |
$10,708.48
|
| Rate for Payer: HFN Commercial |
$11,069.44
|
| Rate for Payer: Multiplan Commercial |
$9,625.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,219.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11,069.44
|
| Rate for Payer: Quartz Beloit One Network |
$5,895.68
|
| Rate for Payer: Quartz Commercial |
$7,219.20
|
| Rate for Payer: WEA Trust Commercial |
$6,617.60
|
| Rate for Payer: WPS Commercial |
$8,912.10
|
|
|
STEM FEMORAL ADVOCATE ST 15 X140 7850-15-05
|
Facility
|
OP
|
$12,032.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967869
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,368.96 |
| Max. Negotiated Rate |
$48,128.00 |
| Rate for Payer: Aetna Commercial |
$10,828.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,347.52
|
| Rate for Payer: Aetna Managed Medicare |
$3,368.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,820.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,016.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,775.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,376.96
|
| Rate for Payer: Cash Price |
$3,609.60
|
| Rate for Payer: Cigna Commercial |
$11,069.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,733.11
|
| Rate for Payer: Health EOS Commercial |
$10,708.48
|
| Rate for Payer: HFN Commercial |
$11,069.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,024.00
|
| Rate for Payer: Multiplan Commercial |
$9,625.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,219.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11,069.44
|
| Rate for Payer: Quartz Beloit One Network |
$5,895.68
|
| Rate for Payer: Quartz Commercial |
$7,820.80
|
| Rate for Payer: Quartz Medicare Advantage |
$7,219.20
|
| Rate for Payer: The Alliance Commercial |
$48,128.00
|
| Rate for Payer: WEA Trust Commercial |
$6,617.60
|
| Rate for Payer: WPS Commercial |
$8,912.10
|
|
|
STEM FEMORAL ADVOCATE ST 16 X145 7850-16-05
|
Facility
|
OP
|
$12,032.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967870
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,368.96 |
| Max. Negotiated Rate |
$48,128.00 |
| Rate for Payer: Aetna Commercial |
$10,828.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,347.52
|
| Rate for Payer: Aetna Managed Medicare |
$3,368.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,820.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,016.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,775.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,376.96
|
| Rate for Payer: Cash Price |
$3,609.60
|
| Rate for Payer: Cigna Commercial |
$11,069.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,733.11
|
| Rate for Payer: Health EOS Commercial |
$10,708.48
|
| Rate for Payer: HFN Commercial |
$11,069.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,024.00
|
| Rate for Payer: Multiplan Commercial |
$9,625.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,219.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11,069.44
|
| Rate for Payer: Quartz Beloit One Network |
$5,895.68
|
| Rate for Payer: Quartz Commercial |
$7,820.80
|
| Rate for Payer: Quartz Medicare Advantage |
$7,219.20
|
| Rate for Payer: The Alliance Commercial |
$48,128.00
|
| Rate for Payer: WEA Trust Commercial |
$6,617.60
|
| Rate for Payer: WPS Commercial |
$8,912.10
|
|
|
STEM FEMORAL ADVOCATE ST 16 X145 7850-16-05
|
Facility
|
IP
|
$12,032.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967870
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,895.68 |
| Max. Negotiated Rate |
$11,069.44 |
| Rate for Payer: Aetna Commercial |
$10,828.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,347.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,376.96
|
| Rate for Payer: Cash Price |
$3,609.60
|
| Rate for Payer: Cigna Commercial |
$11,069.44
|
| Rate for Payer: Health EOS Commercial |
$10,708.48
|
| Rate for Payer: HFN Commercial |
$11,069.44
|
| Rate for Payer: Multiplan Commercial |
$9,625.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,219.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11,069.44
|
| Rate for Payer: Quartz Beloit One Network |
$5,895.68
|
| Rate for Payer: Quartz Commercial |
$7,219.20
|
| Rate for Payer: WEA Trust Commercial |
$6,617.60
|
| Rate for Payer: WPS Commercial |
$8,912.10
|
|
|
STEM FEMORAL ADVOCATE ST 17 X150 7850-17-05
|
Facility
|
IP
|
$12,032.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967871
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,895.68 |
| Max. Negotiated Rate |
$11,069.44 |
| Rate for Payer: Aetna Commercial |
$10,828.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,347.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,376.96
|
| Rate for Payer: Cash Price |
$3,609.60
|
| Rate for Payer: Cigna Commercial |
$11,069.44
|
| Rate for Payer: Health EOS Commercial |
$10,708.48
|
| Rate for Payer: HFN Commercial |
$11,069.44
|
| Rate for Payer: Multiplan Commercial |
$9,625.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,219.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11,069.44
|
| Rate for Payer: Quartz Beloit One Network |
$5,895.68
|
| Rate for Payer: Quartz Commercial |
$7,219.20
|
| Rate for Payer: WEA Trust Commercial |
$6,617.60
|
| Rate for Payer: WPS Commercial |
$8,912.10
|
|
|
STEM FEMORAL ADVOCATE ST 17 X150 7850-17-05
|
Facility
|
OP
|
$12,032.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967871
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,368.96 |
| Max. Negotiated Rate |
$48,128.00 |
| Rate for Payer: Aetna Commercial |
$10,828.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,347.52
|
| Rate for Payer: Aetna Managed Medicare |
$3,368.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,820.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,016.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,775.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,376.96
|
| Rate for Payer: Cash Price |
$3,609.60
|
| Rate for Payer: Cigna Commercial |
$11,069.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,733.11
|
| Rate for Payer: Health EOS Commercial |
$10,708.48
|
| Rate for Payer: HFN Commercial |
$11,069.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,024.00
|
| Rate for Payer: Multiplan Commercial |
$9,625.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,219.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11,069.44
|
| Rate for Payer: Quartz Beloit One Network |
$5,895.68
|
| Rate for Payer: Quartz Commercial |
$7,820.80
|
| Rate for Payer: Quartz Medicare Advantage |
$7,219.20
|
| Rate for Payer: The Alliance Commercial |
$48,128.00
|
| Rate for Payer: WEA Trust Commercial |
$6,617.60
|
| Rate for Payer: WPS Commercial |
$8,912.10
|
|
|
STEM HUMERAL FRACTURE COMPREHENSIVE REVERSE SHOULDER 10MM X 122MM 12-113560
|
Facility
|
IP
|
$16,843.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6166000
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,253.07 |
| Max. Negotiated Rate |
$15,495.56 |
| Rate for Payer: Aetna Commercial |
$15,158.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,484.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,926.79
|
| Rate for Payer: Cash Price |
$5,052.90
|
| Rate for Payer: Cigna Commercial |
$15,495.56
|
| Rate for Payer: Health EOS Commercial |
$14,990.27
|
| Rate for Payer: HFN Commercial |
$15,495.56
|
| Rate for Payer: Multiplan Commercial |
$13,474.40
|
| Rate for Payer: NAPHCARE Commercial |
$10,105.80
|
| Rate for Payer: Preferred Network Access Commercial |
$15,495.56
|
| Rate for Payer: Quartz Beloit One Network |
$8,253.07
|
| Rate for Payer: Quartz Commercial |
$10,105.80
|
| Rate for Payer: WEA Trust Commercial |
$9,263.65
|
| Rate for Payer: WPS Commercial |
$12,475.61
|
|
|
STEM HUMERAL FRACTURE COMPREHENSIVE REVERSE SHOULDER 10MM X 122MM 12-113560
|
Facility
|
OP
|
$16,843.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6166000
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,716.04 |
| Max. Negotiated Rate |
$67,372.00 |
| Rate for Payer: Aetna Commercial |
$15,158.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,484.98
|
| Rate for Payer: Aetna Managed Medicare |
$4,716.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,947.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,421.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,084.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,926.79
|
| Rate for Payer: Cash Price |
$5,052.90
|
| Rate for Payer: Cigna Commercial |
$15,495.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,425.34
|
| Rate for Payer: Health EOS Commercial |
$14,990.27
|
| Rate for Payer: HFN Commercial |
$15,495.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,632.25
|
| Rate for Payer: Multiplan Commercial |
$13,474.40
|
| Rate for Payer: NAPHCARE Commercial |
$10,105.80
|
| Rate for Payer: Preferred Network Access Commercial |
$15,495.56
|
| Rate for Payer: Quartz Beloit One Network |
$8,253.07
|
| Rate for Payer: Quartz Commercial |
$10,947.95
|
| Rate for Payer: Quartz Medicare Advantage |
$10,105.80
|
| Rate for Payer: The Alliance Commercial |
$67,372.00
|
| Rate for Payer: WEA Trust Commercial |
$9,263.65
|
| Rate for Payer: WPS Commercial |
$12,475.61
|
|
|
STEM MODULAR HUMERAL 10x130
|
Facility
|
IP
|
$17,195.00
|
|
| Hospital Charge Code |
2967538
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,425.55 |
| Max. Negotiated Rate |
$15,819.40 |
| Rate for Payer: Aetna Commercial |
$15,475.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,787.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,113.35
|
| Rate for Payer: Cash Price |
$5,158.50
|
| Rate for Payer: Cigna Commercial |
$15,819.40
|
| Rate for Payer: Health EOS Commercial |
$15,303.55
|
| Rate for Payer: HFN Commercial |
$15,819.40
|
| Rate for Payer: Multiplan Commercial |
$13,756.00
|
| Rate for Payer: NAPHCARE Commercial |
$10,317.00
|
| Rate for Payer: Preferred Network Access Commercial |
$15,819.40
|
| Rate for Payer: Quartz Beloit One Network |
$8,425.55
|
| Rate for Payer: Quartz Commercial |
$10,317.00
|
| Rate for Payer: WEA Trust Commercial |
$9,457.25
|
| Rate for Payer: WPS Commercial |
$12,736.34
|
|
|
STEM MODULAR HUMERAL 10x130
|
Facility
|
OP
|
$17,195.00
|
|
| Hospital Charge Code |
2967538
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,814.60 |
| Max. Negotiated Rate |
$68,780.00 |
| Rate for Payer: Aetna Commercial |
$15,475.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,787.70
|
| Rate for Payer: Aetna Managed Medicare |
$4,814.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,176.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,597.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,253.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,113.35
|
| Rate for Payer: Cash Price |
$5,158.50
|
| Rate for Payer: Cigna Commercial |
$15,819.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,622.32
|
| Rate for Payer: Health EOS Commercial |
$15,303.55
|
| Rate for Payer: HFN Commercial |
$15,819.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,896.25
|
| Rate for Payer: Multiplan Commercial |
$13,756.00
|
| Rate for Payer: NAPHCARE Commercial |
$10,317.00
|
| Rate for Payer: Preferred Network Access Commercial |
$15,819.40
|
| Rate for Payer: Quartz Beloit One Network |
$8,425.55
|
| Rate for Payer: Quartz Commercial |
$11,176.75
|
| Rate for Payer: Quartz Medicare Advantage |
$10,317.00
|
| Rate for Payer: The Alliance Commercial |
$68,780.00
|
| Rate for Payer: WEA Trust Commercial |
$9,457.25
|
| Rate for Payer: WPS Commercial |
$12,736.34
|
|
|
STEM RECLAIM DISTAL TAPERED 16MM X 190MM STRAIGHT 1976-16-190
|
Facility
|
OP
|
$25,044.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6151669
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,012.32 |
| Max. Negotiated Rate |
$100,176.00 |
| Rate for Payer: Aetna Commercial |
$22,539.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21,537.84
|
| Rate for Payer: Aetna Managed Medicare |
$7,012.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,278.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,522.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,021.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,273.32
|
| Rate for Payer: Cash Price |
$7,513.20
|
| Rate for Payer: Cigna Commercial |
$23,040.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14,014.62
|
| Rate for Payer: Health EOS Commercial |
$22,289.16
|
| Rate for Payer: HFN Commercial |
$23,040.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18,783.00
|
| Rate for Payer: Multiplan Commercial |
$20,035.20
|
| Rate for Payer: NAPHCARE Commercial |
$15,026.40
|
| Rate for Payer: Preferred Network Access Commercial |
$23,040.48
|
| Rate for Payer: Quartz Beloit One Network |
$12,271.56
|
| Rate for Payer: Quartz Commercial |
$16,278.60
|
| Rate for Payer: Quartz Medicare Advantage |
$15,026.40
|
| Rate for Payer: The Alliance Commercial |
$100,176.00
|
| Rate for Payer: WEA Trust Commercial |
$13,774.20
|
| Rate for Payer: WPS Commercial |
$18,550.09
|
|
|
STEM RECLAIM DISTAL TAPERED 16MM X 190MM STRAIGHT 1976-16-190
|
Facility
|
IP
|
$25,044.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6151669
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,271.56 |
| Max. Negotiated Rate |
$23,040.48 |
| Rate for Payer: Aetna Commercial |
$22,539.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21,537.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,273.32
|
| Rate for Payer: Cash Price |
$7,513.20
|
| Rate for Payer: Cigna Commercial |
$23,040.48
|
| Rate for Payer: Health EOS Commercial |
$22,289.16
|
| Rate for Payer: HFN Commercial |
$23,040.48
|
| Rate for Payer: Multiplan Commercial |
$20,035.20
|
| Rate for Payer: NAPHCARE Commercial |
$15,026.40
|
| Rate for Payer: Preferred Network Access Commercial |
$23,040.48
|
| Rate for Payer: Quartz Beloit One Network |
$12,271.56
|
| Rate for Payer: Quartz Commercial |
$15,026.40
|
| Rate for Payer: WEA Trust Commercial |
$13,774.20
|
| Rate for Payer: WPS Commercial |
$18,550.09
|
|
|
STEM REVISION CEMENTED ATTUNE 14MM X 30MM 1512-14-030
|
Facility
|
OP
|
$7,560.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563335
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,116.80 |
| Max. Negotiated Rate |
$30,240.00 |
| Rate for Payer: Aetna Commercial |
$6,804.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,501.60
|
| Rate for Payer: Aetna Managed Medicare |
$2,116.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,914.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,780.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,628.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,006.80
|
| Rate for Payer: Cash Price |
$2,268.00
|
| Rate for Payer: Cigna Commercial |
$6,955.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,230.58
|
| Rate for Payer: Health EOS Commercial |
$6,728.40
|
| Rate for Payer: HFN Commercial |
$6,955.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,670.00
|
| Rate for Payer: Multiplan Commercial |
$6,048.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,536.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,955.20
|
| Rate for Payer: Quartz Beloit One Network |
$3,704.40
|
| Rate for Payer: Quartz Commercial |
$4,914.00
|
| Rate for Payer: Quartz Medicare Advantage |
$4,536.00
|
| Rate for Payer: The Alliance Commercial |
$30,240.00
|
| Rate for Payer: WEA Trust Commercial |
$4,158.00
|
| Rate for Payer: WPS Commercial |
$5,599.69
|
|
|
STEM REVISION CEMENTED ATTUNE 14MM X 30MM 1512-14-030
|
Facility
|
IP
|
$7,560.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563335
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,704.40 |
| Max. Negotiated Rate |
$6,955.20 |
| Rate for Payer: Aetna Commercial |
$6,804.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,501.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,006.80
|
| Rate for Payer: Cash Price |
$2,268.00
|
| Rate for Payer: Cigna Commercial |
$6,955.20
|
| Rate for Payer: Health EOS Commercial |
$6,728.40
|
| Rate for Payer: HFN Commercial |
$6,955.20
|
| Rate for Payer: Multiplan Commercial |
$6,048.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,536.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,955.20
|
| Rate for Payer: Quartz Beloit One Network |
$3,704.40
|
| Rate for Payer: Quartz Commercial |
$4,536.00
|
| Rate for Payer: WEA Trust Commercial |
$4,158.00
|
| Rate for Payer: WPS Commercial |
$5,599.69
|
|
|
STEM REVISION CEMENTED ATTUNE 14MM X 50MM 1512-14-050
|
Facility
|
IP
|
$4,940.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6165879
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,420.60 |
| Max. Negotiated Rate |
$4,544.80 |
| Rate for Payer: Aetna Commercial |
$4,446.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,248.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,618.20
|
| Rate for Payer: Cash Price |
$1,482.00
|
| Rate for Payer: Cigna Commercial |
$4,544.80
|
| Rate for Payer: Health EOS Commercial |
$4,396.60
|
| Rate for Payer: HFN Commercial |
$4,544.80
|
| Rate for Payer: Multiplan Commercial |
$3,952.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,964.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,544.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,420.60
|
| Rate for Payer: Quartz Commercial |
$2,964.00
|
| Rate for Payer: WEA Trust Commercial |
$2,717.00
|
| Rate for Payer: WPS Commercial |
$3,659.06
|
|
