|
STEINMAN PIN-THREADED 9 X 5/32
|
Facility
OP
|
$269.00
|
|
| Hospital Charge Code |
2967434
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.32 |
| Max. Negotiated Rate |
$1,076.00 |
| Rate for Payer: Aetna Commercial |
$242.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$231.34
|
| Rate for Payer: Aetna Managed Medicare |
$75.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$174.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$134.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$129.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$142.57
|
| Rate for Payer: Cash Price |
$80.70
|
| Rate for Payer: Cigna Commercial |
$247.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$150.53
|
| Rate for Payer: Health EOS Commercial |
$239.41
|
| Rate for Payer: HFN Commercial |
$247.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$201.75
|
| Rate for Payer: Multiplan Commercial |
$215.20
|
| Rate for Payer: NAPHCARE Commercial |
$161.40
|
| Rate for Payer: Preferred Network Access Commercial |
$247.48
|
| Rate for Payer: Quartz Beloit One Network |
$131.81
|
| Rate for Payer: Quartz Commercial |
$174.85
|
| Rate for Payer: Quartz Medicare Advantage |
$161.40
|
| Rate for Payer: The Alliance Commercial |
$1,076.00
|
| Rate for Payer: WEA Trust Commercial |
$147.95
|
| Rate for Payer: WPS Commercial |
$199.25
|
|
|
STEINMAN PIN-THREADED 9 X 5/64
|
Facility
IP
|
$269.00
|
|
| Hospital Charge Code |
2967435
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$131.81 |
| Max. Negotiated Rate |
$247.48 |
| Rate for Payer: Aetna Commercial |
$242.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$142.57
|
| Rate for Payer: Cash Price |
$80.70
|
| Rate for Payer: Cigna Commercial |
$247.48
|
| Rate for Payer: Health EOS Commercial |
$239.41
|
| Rate for Payer: HFN Commercial |
$247.48
|
| Rate for Payer: Multiplan Commercial |
$215.20
|
| Rate for Payer: NAPHCARE Commercial |
$161.40
|
| Rate for Payer: Preferred Network Access Commercial |
$247.48
|
| Rate for Payer: Quartz Beloit One Network |
$131.81
|
| Rate for Payer: Quartz Commercial |
$161.40
|
| Rate for Payer: WEA Trust Commercial |
$147.95
|
| Rate for Payer: WPS Commercial |
$199.25
|
|
|
STEINMAN PIN-THREADED 9 X 5/64
|
Facility
OP
|
$269.00
|
|
| Hospital Charge Code |
2967435
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.32 |
| Max. Negotiated Rate |
$1,076.00 |
| Rate for Payer: Aetna Commercial |
$242.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$231.34
|
| Rate for Payer: Aetna Managed Medicare |
$75.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$174.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$134.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$129.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$142.57
|
| Rate for Payer: Cash Price |
$80.70
|
| Rate for Payer: Cigna Commercial |
$247.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$150.53
|
| Rate for Payer: Health EOS Commercial |
$239.41
|
| Rate for Payer: HFN Commercial |
$247.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$201.75
|
| Rate for Payer: Multiplan Commercial |
$215.20
|
| Rate for Payer: NAPHCARE Commercial |
$161.40
|
| Rate for Payer: Preferred Network Access Commercial |
$247.48
|
| Rate for Payer: Quartz Beloit One Network |
$131.81
|
| Rate for Payer: Quartz Commercial |
$174.85
|
| Rate for Payer: Quartz Medicare Advantage |
$161.40
|
| Rate for Payer: The Alliance Commercial |
$1,076.00
|
| Rate for Payer: WEA Trust Commercial |
$147.95
|
| Rate for Payer: WPS Commercial |
$199.25
|
|
|
STEINMAN PIN-THREADED 9 X 7/64
|
Facility
OP
|
$269.00
|
|
| Hospital Charge Code |
2967436
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.32 |
| Max. Negotiated Rate |
$1,076.00 |
| Rate for Payer: Aetna Commercial |
$242.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$231.34
|
| Rate for Payer: Aetna Managed Medicare |
$75.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$174.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$134.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$129.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$142.57
|
| Rate for Payer: Cash Price |
$80.70
|
| Rate for Payer: Cigna Commercial |
$247.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$150.53
|
| Rate for Payer: Health EOS Commercial |
$239.41
|
| Rate for Payer: HFN Commercial |
$247.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$201.75
|
| Rate for Payer: Multiplan Commercial |
$215.20
|
| Rate for Payer: NAPHCARE Commercial |
$161.40
|
| Rate for Payer: Preferred Network Access Commercial |
$247.48
|
| Rate for Payer: Quartz Beloit One Network |
$131.81
|
| Rate for Payer: Quartz Commercial |
$174.85
|
| Rate for Payer: Quartz Medicare Advantage |
$161.40
|
| Rate for Payer: The Alliance Commercial |
$1,076.00
|
| Rate for Payer: WEA Trust Commercial |
$147.95
|
| Rate for Payer: WPS Commercial |
$199.25
|
|
|
STEINMAN PIN-THREADED 9 X 7/64
|
Facility
IP
|
$269.00
|
|
| Hospital Charge Code |
2967436
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$131.81 |
| Max. Negotiated Rate |
$247.48 |
| Rate for Payer: Aetna Commercial |
$242.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$142.57
|
| Rate for Payer: Cash Price |
$80.70
|
| Rate for Payer: Cigna Commercial |
$247.48
|
| Rate for Payer: Health EOS Commercial |
$239.41
|
| Rate for Payer: HFN Commercial |
$247.48
|
| Rate for Payer: Multiplan Commercial |
$215.20
|
| Rate for Payer: NAPHCARE Commercial |
$161.40
|
| Rate for Payer: Preferred Network Access Commercial |
$247.48
|
| Rate for Payer: Quartz Beloit One Network |
$131.81
|
| Rate for Payer: Quartz Commercial |
$161.40
|
| Rate for Payer: WEA Trust Commercial |
$147.95
|
| Rate for Payer: WPS Commercial |
$199.25
|
|
|
STEINMAN PIN-THREADED 9 X 9/64
|
Facility
IP
|
$269.00
|
|
| Hospital Charge Code |
2967437
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$131.81 |
| Max. Negotiated Rate |
$247.48 |
| Rate for Payer: Aetna Commercial |
$242.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$142.57
|
| Rate for Payer: Cash Price |
$80.70
|
| Rate for Payer: Cigna Commercial |
$247.48
|
| Rate for Payer: Health EOS Commercial |
$239.41
|
| Rate for Payer: HFN Commercial |
$247.48
|
| Rate for Payer: Multiplan Commercial |
$215.20
|
| Rate for Payer: NAPHCARE Commercial |
$161.40
|
| Rate for Payer: Preferred Network Access Commercial |
$247.48
|
| Rate for Payer: Quartz Beloit One Network |
$131.81
|
| Rate for Payer: Quartz Commercial |
$161.40
|
| Rate for Payer: WEA Trust Commercial |
$147.95
|
| Rate for Payer: WPS Commercial |
$199.25
|
|
|
STEINMAN PIN-THREADED 9 X 9/64
|
Facility
OP
|
$269.00
|
|
| Hospital Charge Code |
2967437
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.32 |
| Max. Negotiated Rate |
$1,076.00 |
| Rate for Payer: Aetna Commercial |
$242.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$231.34
|
| Rate for Payer: Aetna Managed Medicare |
$75.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$174.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$134.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$129.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$142.57
|
| Rate for Payer: Cash Price |
$80.70
|
| Rate for Payer: Cigna Commercial |
$247.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$150.53
|
| Rate for Payer: Health EOS Commercial |
$239.41
|
| Rate for Payer: HFN Commercial |
$247.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$201.75
|
| Rate for Payer: Multiplan Commercial |
$215.20
|
| Rate for Payer: NAPHCARE Commercial |
$161.40
|
| Rate for Payer: Preferred Network Access Commercial |
$247.48
|
| Rate for Payer: Quartz Beloit One Network |
$131.81
|
| Rate for Payer: Quartz Commercial |
$174.85
|
| Rate for Payer: Quartz Medicare Advantage |
$161.40
|
| Rate for Payer: The Alliance Commercial |
$1,076.00
|
| Rate for Payer: WEA Trust Commercial |
$147.95
|
| Rate for Payer: WPS Commercial |
$199.25
|
|
|
STEINMMANN PIN INBONE 2.4MM 200072
|
Facility
OP
|
$778.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5831728
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$217.84 |
| Max. Negotiated Rate |
$715.76 |
| Rate for Payer: Aetna Commercial |
$700.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$669.08
|
| Rate for Payer: Aetna Managed Medicare |
$217.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$505.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$389.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$373.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$412.34
|
| Rate for Payer: Cash Price |
$233.40
|
| Rate for Payer: Cigna Commercial |
$715.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$435.37
|
| Rate for Payer: Health EOS Commercial |
$692.42
|
| Rate for Payer: HFN Commercial |
$715.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$583.50
|
| Rate for Payer: Multiplan Commercial |
$622.40
|
| Rate for Payer: NAPHCARE Commercial |
$466.80
|
| Rate for Payer: Preferred Network Access Commercial |
$715.76
|
| Rate for Payer: Quartz Beloit One Network |
$381.22
|
| Rate for Payer: Quartz Commercial |
$505.70
|
| Rate for Payer: Quartz Medicare Advantage |
$466.80
|
| Rate for Payer: WEA Trust Commercial |
$427.90
|
| Rate for Payer: WPS Commercial |
$576.26
|
|
|
STEINMMANN PIN INBONE 2.4MM 200072
|
Facility
IP
|
$778.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5831728
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$381.22 |
| Max. Negotiated Rate |
$715.76 |
| Rate for Payer: Aetna Commercial |
$700.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$412.34
|
| Rate for Payer: Cash Price |
$233.40
|
| Rate for Payer: Cigna Commercial |
$715.76
|
| Rate for Payer: Health EOS Commercial |
$692.42
|
| Rate for Payer: HFN Commercial |
$715.76
|
| Rate for Payer: Multiplan Commercial |
$622.40
|
| Rate for Payer: NAPHCARE Commercial |
$466.80
|
| Rate for Payer: Preferred Network Access Commercial |
$715.76
|
| Rate for Payer: Quartz Beloit One Network |
$381.22
|
| Rate for Payer: Quartz Commercial |
$466.80
|
| Rate for Payer: WEA Trust Commercial |
$427.90
|
| Rate for Payer: WPS Commercial |
$576.26
|
|
|
STEM 5.5MM EVOLVE RADIAL
|
Facility
IP
|
$14,790.00
|
|
| Hospital Charge Code |
2967400
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,247.10 |
| Max. Negotiated Rate |
$13,606.80 |
| Rate for Payer: Aetna Commercial |
$13,311.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,838.70
|
| Rate for Payer: Cash Price |
$4,437.00
|
| Rate for Payer: Cigna Commercial |
$13,606.80
|
| Rate for Payer: Health EOS Commercial |
$13,163.10
|
| Rate for Payer: HFN Commercial |
$13,606.80
|
| Rate for Payer: Multiplan Commercial |
$11,832.00
|
| Rate for Payer: NAPHCARE Commercial |
$8,874.00
|
| Rate for Payer: Preferred Network Access Commercial |
$13,606.80
|
| Rate for Payer: Quartz Beloit One Network |
$7,247.10
|
| Rate for Payer: Quartz Commercial |
$8,874.00
|
| Rate for Payer: WEA Trust Commercial |
$8,134.50
|
| Rate for Payer: WPS Commercial |
$10,954.95
|
|
|
STEM 5.5MM EVOLVE RADIAL
|
Facility
OP
|
$14,790.00
|
|
| Hospital Charge Code |
2967400
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,141.20 |
| Max. Negotiated Rate |
$59,160.00 |
| Rate for Payer: Aetna Commercial |
$13,311.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,719.40
|
| Rate for Payer: Aetna Managed Medicare |
$4,141.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,613.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,395.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,099.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,838.70
|
| Rate for Payer: Cash Price |
$4,437.00
|
| Rate for Payer: Cigna Commercial |
$13,606.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,276.48
|
| Rate for Payer: Health EOS Commercial |
$13,163.10
|
| Rate for Payer: HFN Commercial |
$13,606.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,092.50
|
| Rate for Payer: Multiplan Commercial |
$11,832.00
|
| Rate for Payer: NAPHCARE Commercial |
$8,874.00
|
| Rate for Payer: Preferred Network Access Commercial |
$13,606.80
|
| Rate for Payer: Quartz Beloit One Network |
$7,247.10
|
| Rate for Payer: Quartz Commercial |
$9,613.50
|
| Rate for Payer: Quartz Medicare Advantage |
$8,874.00
|
| Rate for Payer: The Alliance Commercial |
$59,160.00
|
| Rate for Payer: WEA Trust Commercial |
$8,134.50
|
| Rate for Payer: WPS Commercial |
$10,954.95
|
|
|
STEM 7.5MM EVOLVE RADIAL
|
Facility
IP
|
$14,790.00
|
|
| Hospital Charge Code |
2967401
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,247.10 |
| Max. Negotiated Rate |
$13,606.80 |
| Rate for Payer: Aetna Commercial |
$13,311.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,838.70
|
| Rate for Payer: Cash Price |
$4,437.00
|
| Rate for Payer: Cigna Commercial |
$13,606.80
|
| Rate for Payer: Health EOS Commercial |
$13,163.10
|
| Rate for Payer: HFN Commercial |
$13,606.80
|
| Rate for Payer: Multiplan Commercial |
$11,832.00
|
| Rate for Payer: NAPHCARE Commercial |
$8,874.00
|
| Rate for Payer: Preferred Network Access Commercial |
$13,606.80
|
| Rate for Payer: Quartz Beloit One Network |
$7,247.10
|
| Rate for Payer: Quartz Commercial |
$8,874.00
|
| Rate for Payer: WEA Trust Commercial |
$8,134.50
|
| Rate for Payer: WPS Commercial |
$10,954.95
|
|
|
STEM 7.5MM EVOLVE RADIAL
|
Facility
OP
|
$14,790.00
|
|
| Hospital Charge Code |
2967401
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,141.20 |
| Max. Negotiated Rate |
$59,160.00 |
| Rate for Payer: Aetna Commercial |
$13,311.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,719.40
|
| Rate for Payer: Aetna Managed Medicare |
$4,141.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,613.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,395.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,099.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,838.70
|
| Rate for Payer: Cash Price |
$4,437.00
|
| Rate for Payer: Cigna Commercial |
$13,606.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,276.48
|
| Rate for Payer: Health EOS Commercial |
$13,163.10
|
| Rate for Payer: HFN Commercial |
$13,606.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,092.50
|
| Rate for Payer: Multiplan Commercial |
$11,832.00
|
| Rate for Payer: NAPHCARE Commercial |
$8,874.00
|
| Rate for Payer: Preferred Network Access Commercial |
$13,606.80
|
| Rate for Payer: Quartz Beloit One Network |
$7,247.10
|
| Rate for Payer: Quartz Commercial |
$9,613.50
|
| Rate for Payer: Quartz Medicare Advantage |
$8,874.00
|
| Rate for Payer: The Alliance Commercial |
$59,160.00
|
| Rate for Payer: WEA Trust Commercial |
$8,134.50
|
| Rate for Payer: WPS Commercial |
$10,954.95
|
|
|
STEM 8/120 HUMERAL CEMENTED
|
Facility
OP
|
$18,749.00
|
|
| Hospital Charge Code |
2966587
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,249.72 |
| Max. Negotiated Rate |
$74,996.00 |
| Rate for Payer: Aetna Commercial |
$16,874.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,124.14
|
| Rate for Payer: Aetna Managed Medicare |
$5,249.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,186.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,374.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,999.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,936.97
|
| Rate for Payer: Cash Price |
$5,624.70
|
| Rate for Payer: Cigna Commercial |
$17,249.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,491.94
|
| Rate for Payer: Health EOS Commercial |
$16,686.61
|
| Rate for Payer: HFN Commercial |
$17,249.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,061.75
|
| Rate for Payer: Multiplan Commercial |
$14,999.20
|
| Rate for Payer: NAPHCARE Commercial |
$11,249.40
|
| Rate for Payer: Preferred Network Access Commercial |
$17,249.08
|
| Rate for Payer: Quartz Beloit One Network |
$9,187.01
|
| Rate for Payer: Quartz Commercial |
$12,186.85
|
| Rate for Payer: Quartz Medicare Advantage |
$11,249.40
|
| Rate for Payer: The Alliance Commercial |
$74,996.00
|
| Rate for Payer: WEA Trust Commercial |
$10,311.95
|
| Rate for Payer: WPS Commercial |
$13,887.38
|
|
|
STEM 8/120 HUMERAL CEMENTED
|
Facility
IP
|
$18,749.00
|
|
| Hospital Charge Code |
2966587
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,187.01 |
| Max. Negotiated Rate |
$17,249.08 |
| Rate for Payer: Aetna Commercial |
$16,874.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,936.97
|
| Rate for Payer: Cash Price |
$5,624.70
|
| Rate for Payer: Cigna Commercial |
$17,249.08
|
| Rate for Payer: Health EOS Commercial |
$16,686.61
|
| Rate for Payer: HFN Commercial |
$17,249.08
|
| Rate for Payer: Multiplan Commercial |
$14,999.20
|
| Rate for Payer: NAPHCARE Commercial |
$11,249.40
|
| Rate for Payer: Preferred Network Access Commercial |
$17,249.08
|
| Rate for Payer: Quartz Beloit One Network |
$9,187.01
|
| Rate for Payer: Quartz Commercial |
$11,249.40
|
| Rate for Payer: WEA Trust Commercial |
$10,311.95
|
| Rate for Payer: WPS Commercial |
$13,887.38
|
|
|
STEM ARCOS ONE-PIECE REVISION 14MM STD OFFSET 11-303114
|
Facility
IP
|
$51,262.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563439
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25,118.38 |
| Max. Negotiated Rate |
$47,161.04 |
| Rate for Payer: Aetna Commercial |
$46,135.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27,168.86
|
| Rate for Payer: Cash Price |
$15,378.60
|
| Rate for Payer: Cigna Commercial |
$47,161.04
|
| Rate for Payer: Health EOS Commercial |
$45,623.18
|
| Rate for Payer: HFN Commercial |
$47,161.04
|
| Rate for Payer: Multiplan Commercial |
$41,009.60
|
| Rate for Payer: NAPHCARE Commercial |
$30,757.20
|
| Rate for Payer: Preferred Network Access Commercial |
$47,161.04
|
| Rate for Payer: Quartz Beloit One Network |
$25,118.38
|
| Rate for Payer: Quartz Commercial |
$30,757.20
|
| Rate for Payer: WEA Trust Commercial |
$28,194.10
|
| Rate for Payer: WPS Commercial |
$37,969.76
|
|
|
STEM ARCOS ONE-PIECE REVISION 14MM STD OFFSET 11-303114
|
Facility
OP
|
$51,262.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563439
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14,353.36 |
| Max. Negotiated Rate |
$47,161.04 |
| Rate for Payer: Aetna Commercial |
$46,135.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$44,085.32
|
| Rate for Payer: Aetna Managed Medicare |
$14,353.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33,320.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25,631.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24,605.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27,168.86
|
| Rate for Payer: Cash Price |
$15,378.60
|
| Rate for Payer: Cigna Commercial |
$47,161.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28,686.22
|
| Rate for Payer: Health EOS Commercial |
$45,623.18
|
| Rate for Payer: HFN Commercial |
$47,161.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$38,446.50
|
| Rate for Payer: Multiplan Commercial |
$41,009.60
|
| Rate for Payer: NAPHCARE Commercial |
$30,757.20
|
| Rate for Payer: Preferred Network Access Commercial |
$47,161.04
|
| Rate for Payer: Quartz Beloit One Network |
$25,118.38
|
| Rate for Payer: Quartz Commercial |
$33,320.30
|
| Rate for Payer: Quartz Medicare Advantage |
$30,757.20
|
| Rate for Payer: WEA Trust Commercial |
$28,194.10
|
| Rate for Payer: WPS Commercial |
$37,969.76
|
|
|
STEM ARCOS ONE-PIECE REVISION 16MM STD OFFSET 11-303116
|
Facility
IP
|
$36,614.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6179800
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17,940.86 |
| Max. Negotiated Rate |
$33,684.88 |
| Rate for Payer: Aetna Commercial |
$32,952.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19,405.42
|
| Rate for Payer: Cash Price |
$10,984.20
|
| Rate for Payer: Cigna Commercial |
$33,684.88
|
| Rate for Payer: Health EOS Commercial |
$32,586.46
|
| Rate for Payer: HFN Commercial |
$33,684.88
|
| Rate for Payer: Multiplan Commercial |
$29,291.20
|
| Rate for Payer: NAPHCARE Commercial |
$21,968.40
|
| Rate for Payer: Preferred Network Access Commercial |
$33,684.88
|
| Rate for Payer: Quartz Beloit One Network |
$17,940.86
|
| Rate for Payer: Quartz Commercial |
$21,968.40
|
| Rate for Payer: WEA Trust Commercial |
$20,137.70
|
| Rate for Payer: WPS Commercial |
$27,119.99
|
|
|
STEM ARCOS ONE-PIECE REVISION 16MM STD OFFSET 11-303116
|
Facility
OP
|
$36,614.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6179800
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,251.92 |
| Max. Negotiated Rate |
$33,684.88 |
| Rate for Payer: Aetna Commercial |
$32,952.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$31,488.04
|
| Rate for Payer: Aetna Managed Medicare |
$10,251.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23,799.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,307.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,574.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19,405.42
|
| Rate for Payer: Cash Price |
$10,984.20
|
| Rate for Payer: Cigna Commercial |
$33,684.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20,489.19
|
| Rate for Payer: Health EOS Commercial |
$32,586.46
|
| Rate for Payer: HFN Commercial |
$33,684.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27,460.50
|
| Rate for Payer: Multiplan Commercial |
$29,291.20
|
| Rate for Payer: NAPHCARE Commercial |
$21,968.40
|
| Rate for Payer: Preferred Network Access Commercial |
$33,684.88
|
| Rate for Payer: Quartz Beloit One Network |
$17,940.86
|
| Rate for Payer: Quartz Commercial |
$23,799.10
|
| Rate for Payer: Quartz Medicare Advantage |
$21,968.40
|
| Rate for Payer: WEA Trust Commercial |
$20,137.70
|
| Rate for Payer: WPS Commercial |
$27,119.99
|
|
|
STEM CENTRALIZER CEMENTRALIZER 10.0MM CEMENTED 1376-48-000
|
Facility
OP
|
$1,606.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5547547
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$449.68 |
| Max. Negotiated Rate |
$1,477.52 |
| Rate for Payer: Aetna Commercial |
$1,445.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,381.16
|
| Rate for Payer: Aetna Managed Medicare |
$449.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,043.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$803.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$770.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$851.18
|
| Rate for Payer: Cash Price |
$481.80
|
| Rate for Payer: Cigna Commercial |
$1,477.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$898.72
|
| Rate for Payer: Health EOS Commercial |
$1,429.34
|
| Rate for Payer: HFN Commercial |
$1,477.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,204.50
|
| Rate for Payer: Multiplan Commercial |
$1,284.80
|
| Rate for Payer: NAPHCARE Commercial |
$963.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,477.52
|
| Rate for Payer: Quartz Beloit One Network |
$786.94
|
| Rate for Payer: Quartz Commercial |
$1,043.90
|
| Rate for Payer: Quartz Medicare Advantage |
$963.60
|
| Rate for Payer: WEA Trust Commercial |
$883.30
|
| Rate for Payer: WPS Commercial |
$1,189.56
|
|
|
STEM CENTRALIZER CEMENTRALIZER 10.0MM CEMENTED 1376-48-000
|
Facility
IP
|
$1,606.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5547547
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$786.94 |
| Max. Negotiated Rate |
$1,477.52 |
| Rate for Payer: Aetna Commercial |
$1,445.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$851.18
|
| Rate for Payer: Cash Price |
$481.80
|
| Rate for Payer: Cigna Commercial |
$1,477.52
|
| Rate for Payer: Health EOS Commercial |
$1,429.34
|
| Rate for Payer: HFN Commercial |
$1,477.52
|
| Rate for Payer: Multiplan Commercial |
$1,284.80
|
| Rate for Payer: NAPHCARE Commercial |
$963.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,477.52
|
| Rate for Payer: Quartz Beloit One Network |
$786.94
|
| Rate for Payer: Quartz Commercial |
$963.60
|
| Rate for Payer: WEA Trust Commercial |
$883.30
|
| Rate for Payer: WPS Commercial |
$1,189.56
|
|
|
STEM CENTRALIZER CEMENTRALIZER 10.5MM CEMENTED 1376-38-000
|
Facility
IP
|
$1,296.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5787631
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$635.04 |
| Max. Negotiated Rate |
$1,192.32 |
| Rate for Payer: Aetna Commercial |
$1,166.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$686.88
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cigna Commercial |
$1,192.32
|
| Rate for Payer: Health EOS Commercial |
$1,153.44
|
| Rate for Payer: HFN Commercial |
$1,192.32
|
| Rate for Payer: Multiplan Commercial |
$1,036.80
|
| Rate for Payer: NAPHCARE Commercial |
$777.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,192.32
|
| Rate for Payer: Quartz Beloit One Network |
$635.04
|
| Rate for Payer: Quartz Commercial |
$777.60
|
| Rate for Payer: WEA Trust Commercial |
$712.80
|
| Rate for Payer: WPS Commercial |
$959.95
|
|
|
STEM CENTRALIZER CEMENTRALIZER 10.5MM CEMENTED 1376-38-000
|
Facility
OP
|
$1,296.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5787631
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$362.88 |
| Max. Negotiated Rate |
$1,192.32 |
| Rate for Payer: Aetna Commercial |
$1,166.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,114.56
|
| Rate for Payer: Aetna Managed Medicare |
$362.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$842.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$648.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$622.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$686.88
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cigna Commercial |
$1,192.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$725.24
|
| Rate for Payer: Health EOS Commercial |
$1,153.44
|
| Rate for Payer: HFN Commercial |
$1,192.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$972.00
|
| Rate for Payer: Multiplan Commercial |
$1,036.80
|
| Rate for Payer: NAPHCARE Commercial |
$777.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,192.32
|
| Rate for Payer: Quartz Beloit One Network |
$635.04
|
| Rate for Payer: Quartz Commercial |
$842.40
|
| Rate for Payer: Quartz Medicare Advantage |
$777.60
|
| Rate for Payer: WEA Trust Commercial |
$712.80
|
| Rate for Payer: WPS Commercial |
$959.95
|
|
|
STEM CENTRALIZER CEMENTRALIZER 11.0MM CEMENTED 1376-20-000
|
Facility
IP
|
$1,348.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5603719
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$660.52 |
| Max. Negotiated Rate |
$1,240.16 |
| Rate for Payer: Aetna Commercial |
$1,213.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$714.44
|
| Rate for Payer: Cash Price |
$404.40
|
| Rate for Payer: Cigna Commercial |
$1,240.16
|
| Rate for Payer: Health EOS Commercial |
$1,199.72
|
| Rate for Payer: HFN Commercial |
$1,240.16
|
| Rate for Payer: Multiplan Commercial |
$1,078.40
|
| Rate for Payer: NAPHCARE Commercial |
$808.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,240.16
|
| Rate for Payer: Quartz Beloit One Network |
$660.52
|
| Rate for Payer: Quartz Commercial |
$808.80
|
| Rate for Payer: WEA Trust Commercial |
$741.40
|
| Rate for Payer: WPS Commercial |
$998.46
|
|
|
STEM CENTRALIZER CEMENTRALIZER 11.0MM CEMENTED 1376-20-000
|
Facility
OP
|
$1,348.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5603719
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$377.44 |
| Max. Negotiated Rate |
$1,240.16 |
| Rate for Payer: Quartz Medicare Advantage |
$808.80
|
| Rate for Payer: Aetna Commercial |
$1,213.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,159.28
|
| Rate for Payer: Aetna Managed Medicare |
$377.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$876.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$674.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$647.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$714.44
|
| Rate for Payer: Cash Price |
$404.40
|
| Rate for Payer: Cigna Commercial |
$1,240.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$754.34
|
| Rate for Payer: Health EOS Commercial |
$1,199.72
|
| Rate for Payer: HFN Commercial |
$1,240.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,011.00
|
| Rate for Payer: Multiplan Commercial |
$1,078.40
|
| Rate for Payer: NAPHCARE Commercial |
$808.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,240.16
|
| Rate for Payer: Quartz Beloit One Network |
$660.52
|
| Rate for Payer: Quartz Commercial |
$876.20
|
| Rate for Payer: WEA Trust Commercial |
$741.40
|
| Rate for Payer: WPS Commercial |
$998.46
|
|
