|
STEM EXTENSION STR 10 x 145mm
|
Facility
OP
|
$8,784.00
|
|
| Hospital Charge Code |
2974040
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,459.52 |
| Max. Negotiated Rate |
$35,136.00 |
| Rate for Payer: Aetna Commercial |
$7,905.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,554.24
|
| Rate for Payer: Aetna Managed Medicare |
$2,459.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,709.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,392.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,216.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,655.52
|
| Rate for Payer: Cash Price |
$2,635.20
|
| Rate for Payer: Cigna Commercial |
$8,081.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,915.53
|
| Rate for Payer: Health EOS Commercial |
$7,817.76
|
| Rate for Payer: HFN Commercial |
$8,081.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,588.00
|
| Rate for Payer: Multiplan Commercial |
$7,027.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,270.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,081.28
|
| Rate for Payer: Quartz Beloit One Network |
$4,304.16
|
| Rate for Payer: Quartz Commercial |
$5,709.60
|
| Rate for Payer: Quartz Medicare Advantage |
$5,270.40
|
| Rate for Payer: The Alliance Commercial |
$35,136.00
|
| Rate for Payer: WEA Trust Commercial |
$4,831.20
|
| Rate for Payer: WPS Commercial |
$6,506.31
|
|
|
STEM EXTENSION STR 11MM X 100MM 5988-10-11
|
Facility
IP
|
$8,784.00
|
|
| Hospital Charge Code |
2967535
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,304.16 |
| Max. Negotiated Rate |
$8,081.28 |
| Rate for Payer: Aetna Commercial |
$7,905.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,655.52
|
| Rate for Payer: Cash Price |
$2,635.20
|
| Rate for Payer: Cigna Commercial |
$8,081.28
|
| Rate for Payer: Health EOS Commercial |
$7,817.76
|
| Rate for Payer: HFN Commercial |
$8,081.28
|
| Rate for Payer: Multiplan Commercial |
$7,027.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,270.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,081.28
|
| Rate for Payer: Quartz Beloit One Network |
$4,304.16
|
| Rate for Payer: Quartz Commercial |
$5,270.40
|
| Rate for Payer: WEA Trust Commercial |
$4,831.20
|
| Rate for Payer: WPS Commercial |
$6,506.31
|
|
|
STEM EXTENSION STR 11MM X 100MM 5988-10-11
|
Facility
OP
|
$8,784.00
|
|
| Hospital Charge Code |
2967535
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,459.52 |
| Max. Negotiated Rate |
$35,136.00 |
| Rate for Payer: Aetna Commercial |
$7,905.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,554.24
|
| Rate for Payer: Aetna Managed Medicare |
$2,459.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,709.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,392.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,216.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,655.52
|
| Rate for Payer: Cash Price |
$2,635.20
|
| Rate for Payer: Cigna Commercial |
$8,081.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,915.53
|
| Rate for Payer: Health EOS Commercial |
$7,817.76
|
| Rate for Payer: HFN Commercial |
$8,081.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,588.00
|
| Rate for Payer: Multiplan Commercial |
$7,027.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,270.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,081.28
|
| Rate for Payer: Quartz Beloit One Network |
$4,304.16
|
| Rate for Payer: Quartz Commercial |
$5,709.60
|
| Rate for Payer: Quartz Medicare Advantage |
$5,270.40
|
| Rate for Payer: The Alliance Commercial |
$35,136.00
|
| Rate for Payer: WEA Trust Commercial |
$4,831.20
|
| Rate for Payer: WPS Commercial |
$6,506.31
|
|
|
STEM EXTENSION STR 13MM x 100MM 5988-10-13
|
Facility
OP
|
$8,784.00
|
|
| Hospital Charge Code |
2973974
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,459.52 |
| Max. Negotiated Rate |
$35,136.00 |
| Rate for Payer: Aetna Commercial |
$7,905.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,554.24
|
| Rate for Payer: Aetna Managed Medicare |
$2,459.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,709.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,392.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,216.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,655.52
|
| Rate for Payer: Cash Price |
$2,635.20
|
| Rate for Payer: Cigna Commercial |
$8,081.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,915.53
|
| Rate for Payer: Health EOS Commercial |
$7,817.76
|
| Rate for Payer: HFN Commercial |
$8,081.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,588.00
|
| Rate for Payer: Multiplan Commercial |
$7,027.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,270.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,081.28
|
| Rate for Payer: Quartz Beloit One Network |
$4,304.16
|
| Rate for Payer: Quartz Commercial |
$5,709.60
|
| Rate for Payer: Quartz Medicare Advantage |
$5,270.40
|
| Rate for Payer: The Alliance Commercial |
$35,136.00
|
| Rate for Payer: WEA Trust Commercial |
$4,831.20
|
| Rate for Payer: WPS Commercial |
$6,506.31
|
|
|
STEM EXTENSION STR 13MM x 100MM 5988-10-13
|
Facility
IP
|
$8,784.00
|
|
| Hospital Charge Code |
2973974
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,304.16 |
| Max. Negotiated Rate |
$8,081.28 |
| Rate for Payer: Aetna Commercial |
$7,905.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,655.52
|
| Rate for Payer: Cash Price |
$2,635.20
|
| Rate for Payer: Cigna Commercial |
$8,081.28
|
| Rate for Payer: Health EOS Commercial |
$7,817.76
|
| Rate for Payer: HFN Commercial |
$8,081.28
|
| Rate for Payer: Multiplan Commercial |
$7,027.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,270.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,081.28
|
| Rate for Payer: Quartz Beloit One Network |
$4,304.16
|
| Rate for Payer: Quartz Commercial |
$5,270.40
|
| Rate for Payer: WEA Trust Commercial |
$4,831.20
|
| Rate for Payer: WPS Commercial |
$6,506.31
|
|
|
STEM EXTENSION STR 15MM X 100MM 5988-10-15
|
Facility
IP
|
$8,784.00
|
|
| Hospital Charge Code |
2973970
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,304.16 |
| Max. Negotiated Rate |
$8,081.28 |
| Rate for Payer: Aetna Commercial |
$7,905.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,655.52
|
| Rate for Payer: Cash Price |
$2,635.20
|
| Rate for Payer: Cigna Commercial |
$8,081.28
|
| Rate for Payer: Health EOS Commercial |
$7,817.76
|
| Rate for Payer: HFN Commercial |
$8,081.28
|
| Rate for Payer: Multiplan Commercial |
$7,027.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,270.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,081.28
|
| Rate for Payer: Quartz Beloit One Network |
$4,304.16
|
| Rate for Payer: Quartz Commercial |
$5,270.40
|
| Rate for Payer: WEA Trust Commercial |
$4,831.20
|
| Rate for Payer: WPS Commercial |
$6,506.31
|
|
|
STEM EXTENSION STR 15MM X 100MM 5988-10-15
|
Facility
OP
|
$8,784.00
|
|
| Hospital Charge Code |
2973970
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,459.52 |
| Max. Negotiated Rate |
$35,136.00 |
| Rate for Payer: Aetna Commercial |
$7,905.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,554.24
|
| Rate for Payer: Aetna Managed Medicare |
$2,459.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,709.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,392.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,216.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,655.52
|
| Rate for Payer: Cash Price |
$2,635.20
|
| Rate for Payer: Cigna Commercial |
$8,081.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,915.53
|
| Rate for Payer: Health EOS Commercial |
$7,817.76
|
| Rate for Payer: HFN Commercial |
$8,081.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,588.00
|
| Rate for Payer: Multiplan Commercial |
$7,027.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,270.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,081.28
|
| Rate for Payer: Quartz Beloit One Network |
$4,304.16
|
| Rate for Payer: Quartz Commercial |
$5,709.60
|
| Rate for Payer: Quartz Medicare Advantage |
$5,270.40
|
| Rate for Payer: The Alliance Commercial |
$35,136.00
|
| Rate for Payer: WEA Trust Commercial |
$4,831.20
|
| Rate for Payer: WPS Commercial |
$6,506.31
|
|
|
STEM EXTENSION STR 15MM X 30MM 5988-12-15
|
Facility
IP
|
$8,784.00
|
|
| Hospital Charge Code |
2973969
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,304.16 |
| Max. Negotiated Rate |
$8,081.28 |
| Rate for Payer: Aetna Commercial |
$7,905.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,655.52
|
| Rate for Payer: Cash Price |
$2,635.20
|
| Rate for Payer: Cigna Commercial |
$8,081.28
|
| Rate for Payer: Health EOS Commercial |
$7,817.76
|
| Rate for Payer: HFN Commercial |
$8,081.28
|
| Rate for Payer: Multiplan Commercial |
$7,027.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,270.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,081.28
|
| Rate for Payer: Quartz Beloit One Network |
$4,304.16
|
| Rate for Payer: Quartz Commercial |
$5,270.40
|
| Rate for Payer: WEA Trust Commercial |
$4,831.20
|
| Rate for Payer: WPS Commercial |
$6,506.31
|
|
|
STEM EXTENSION STR 15MM X 30MM 5988-12-15
|
Facility
OP
|
$8,784.00
|
|
| Hospital Charge Code |
2973969
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,459.52 |
| Max. Negotiated Rate |
$35,136.00 |
| Rate for Payer: Aetna Commercial |
$7,905.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,554.24
|
| Rate for Payer: Aetna Managed Medicare |
$2,459.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,709.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,392.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,216.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,655.52
|
| Rate for Payer: Cash Price |
$2,635.20
|
| Rate for Payer: Cigna Commercial |
$8,081.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,915.53
|
| Rate for Payer: Health EOS Commercial |
$7,817.76
|
| Rate for Payer: HFN Commercial |
$8,081.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,588.00
|
| Rate for Payer: Multiplan Commercial |
$7,027.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,270.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,081.28
|
| Rate for Payer: Quartz Beloit One Network |
$4,304.16
|
| Rate for Payer: Quartz Commercial |
$5,709.60
|
| Rate for Payer: Quartz Medicare Advantage |
$5,270.40
|
| Rate for Payer: The Alliance Commercial |
$35,136.00
|
| Rate for Payer: WEA Trust Commercial |
$4,831.20
|
| Rate for Payer: WPS Commercial |
$6,506.31
|
|
|
STEM EXTENTION PERSONA HYBRID STR 14 X 30 42-5570-001-14
|
Facility
IP
|
$8,138.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4079274
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,987.62 |
| Max. Negotiated Rate |
$7,486.96 |
| Rate for Payer: Aetna Commercial |
$7,324.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,313.14
|
| Rate for Payer: Cash Price |
$2,441.40
|
| Rate for Payer: Cigna Commercial |
$7,486.96
|
| Rate for Payer: Health EOS Commercial |
$7,242.82
|
| Rate for Payer: HFN Commercial |
$7,486.96
|
| Rate for Payer: Multiplan Commercial |
$6,510.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,882.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,486.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,987.62
|
| Rate for Payer: Quartz Commercial |
$4,882.80
|
| Rate for Payer: WEA Trust Commercial |
$4,475.90
|
| Rate for Payer: WPS Commercial |
$6,027.82
|
|
|
STEM EXTENTION PERSONA HYBRID STR 14 X 30 42-5570-001-14
|
Facility
OP
|
$8,138.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4079274
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,278.64 |
| Max. Negotiated Rate |
$7,486.96 |
| Rate for Payer: Aetna Commercial |
$7,324.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,998.68
|
| Rate for Payer: Aetna Managed Medicare |
$2,278.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,289.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,069.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,906.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,313.14
|
| Rate for Payer: Cash Price |
$2,441.40
|
| Rate for Payer: Cigna Commercial |
$7,486.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,554.02
|
| Rate for Payer: Health EOS Commercial |
$7,242.82
|
| Rate for Payer: HFN Commercial |
$7,486.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,103.50
|
| Rate for Payer: Multiplan Commercial |
$6,510.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,882.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,486.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,987.62
|
| Rate for Payer: Quartz Commercial |
$5,289.70
|
| Rate for Payer: Quartz Medicare Advantage |
$4,882.80
|
| Rate for Payer: WEA Trust Commercial |
$4,475.90
|
| Rate for Payer: WPS Commercial |
$6,027.82
|
|
|
STEM EXT OFFSET TRABEC 11MM 00-7864-011-20
|
Facility
OP
|
$26,131.00
|
|
| Hospital Charge Code |
2967841
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,316.68 |
| Max. Negotiated Rate |
$104,524.00 |
| Rate for Payer: Aetna Commercial |
$23,517.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$22,472.66
|
| Rate for Payer: Aetna Managed Medicare |
$7,316.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,985.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,065.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,542.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,849.43
|
| Rate for Payer: Cash Price |
$7,839.30
|
| Rate for Payer: Cigna Commercial |
$24,040.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14,622.91
|
| Rate for Payer: Health EOS Commercial |
$23,256.59
|
| Rate for Payer: HFN Commercial |
$24,040.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19,598.25
|
| Rate for Payer: Multiplan Commercial |
$20,904.80
|
| Rate for Payer: NAPHCARE Commercial |
$15,678.60
|
| Rate for Payer: Preferred Network Access Commercial |
$24,040.52
|
| Rate for Payer: Quartz Beloit One Network |
$12,804.19
|
| Rate for Payer: Quartz Commercial |
$16,985.15
|
| Rate for Payer: Quartz Medicare Advantage |
$15,678.60
|
| Rate for Payer: The Alliance Commercial |
$104,524.00
|
| Rate for Payer: WEA Trust Commercial |
$14,372.05
|
| Rate for Payer: WPS Commercial |
$19,355.23
|
|
|
STEM EXT OFFSET TRABEC 11MM 00-7864-011-20
|
Facility
IP
|
$26,131.00
|
|
| Hospital Charge Code |
2967841
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,804.19 |
| Max. Negotiated Rate |
$24,040.52 |
| Rate for Payer: Aetna Commercial |
$23,517.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,849.43
|
| Rate for Payer: Cash Price |
$7,839.30
|
| Rate for Payer: Cigna Commercial |
$24,040.52
|
| Rate for Payer: Health EOS Commercial |
$23,256.59
|
| Rate for Payer: HFN Commercial |
$24,040.52
|
| Rate for Payer: Multiplan Commercial |
$20,904.80
|
| Rate for Payer: NAPHCARE Commercial |
$15,678.60
|
| Rate for Payer: Preferred Network Access Commercial |
$24,040.52
|
| Rate for Payer: Quartz Beloit One Network |
$12,804.19
|
| Rate for Payer: Quartz Commercial |
$15,678.60
|
| Rate for Payer: WEA Trust Commercial |
$14,372.05
|
| Rate for Payer: WPS Commercial |
$19,355.23
|
|
|
STEM EXT OFFSET TRABEC 12MM 00-7864-12-20
|
Facility
OP
|
$25,164.00
|
|
| Hospital Charge Code |
2967843
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,045.92 |
| Max. Negotiated Rate |
$100,656.00 |
| Rate for Payer: Aetna Commercial |
$22,647.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21,641.04
|
| Rate for Payer: Aetna Managed Medicare |
$7,045.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,356.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,582.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,078.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,336.92
|
| Rate for Payer: Cash Price |
$7,549.20
|
| Rate for Payer: Cigna Commercial |
$23,150.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14,081.77
|
| Rate for Payer: Health EOS Commercial |
$22,395.96
|
| Rate for Payer: HFN Commercial |
$23,150.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18,873.00
|
| Rate for Payer: Multiplan Commercial |
$20,131.20
|
| Rate for Payer: NAPHCARE Commercial |
$15,098.40
|
| Rate for Payer: Preferred Network Access Commercial |
$23,150.88
|
| Rate for Payer: Quartz Beloit One Network |
$12,330.36
|
| Rate for Payer: Quartz Commercial |
$16,356.60
|
| Rate for Payer: Quartz Medicare Advantage |
$15,098.40
|
| Rate for Payer: The Alliance Commercial |
$100,656.00
|
| Rate for Payer: WEA Trust Commercial |
$13,840.20
|
| Rate for Payer: WPS Commercial |
$18,638.97
|
|
|
STEM EXT OFFSET TRABEC 12MM 00-7864-12-20
|
Facility
IP
|
$25,164.00
|
|
| Hospital Charge Code |
2967843
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,330.36 |
| Max. Negotiated Rate |
$23,150.88 |
| Rate for Payer: Aetna Commercial |
$22,647.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,336.92
|
| Rate for Payer: Cash Price |
$7,549.20
|
| Rate for Payer: Cigna Commercial |
$23,150.88
|
| Rate for Payer: Health EOS Commercial |
$22,395.96
|
| Rate for Payer: HFN Commercial |
$23,150.88
|
| Rate for Payer: Multiplan Commercial |
$20,131.20
|
| Rate for Payer: NAPHCARE Commercial |
$15,098.40
|
| Rate for Payer: Preferred Network Access Commercial |
$23,150.88
|
| Rate for Payer: Quartz Beloit One Network |
$12,330.36
|
| Rate for Payer: Quartz Commercial |
$15,098.40
|
| Rate for Payer: WEA Trust Commercial |
$13,840.20
|
| Rate for Payer: WPS Commercial |
$18,638.97
|
|
|
STEM EXT OFFSET TRABEC 14MM 00-7864-014-20
|
Facility
OP
|
$25,164.00
|
|
| Hospital Charge Code |
2967847
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,045.92 |
| Max. Negotiated Rate |
$100,656.00 |
| Rate for Payer: Aetna Commercial |
$22,647.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21,641.04
|
| Rate for Payer: Aetna Managed Medicare |
$7,045.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,356.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,582.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,078.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,336.92
|
| Rate for Payer: Cash Price |
$7,549.20
|
| Rate for Payer: Cigna Commercial |
$23,150.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14,081.77
|
| Rate for Payer: Health EOS Commercial |
$22,395.96
|
| Rate for Payer: HFN Commercial |
$23,150.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18,873.00
|
| Rate for Payer: Multiplan Commercial |
$20,131.20
|
| Rate for Payer: NAPHCARE Commercial |
$15,098.40
|
| Rate for Payer: Preferred Network Access Commercial |
$23,150.88
|
| Rate for Payer: Quartz Beloit One Network |
$12,330.36
|
| Rate for Payer: Quartz Commercial |
$16,356.60
|
| Rate for Payer: Quartz Medicare Advantage |
$15,098.40
|
| Rate for Payer: The Alliance Commercial |
$100,656.00
|
| Rate for Payer: WEA Trust Commercial |
$13,840.20
|
| Rate for Payer: WPS Commercial |
$18,638.97
|
|
|
STEM EXT OFFSET TRABEC 14MM 00-7864-014-20
|
Facility
IP
|
$25,164.00
|
|
| Hospital Charge Code |
2967847
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,330.36 |
| Max. Negotiated Rate |
$23,150.88 |
| Rate for Payer: Aetna Commercial |
$22,647.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,336.92
|
| Rate for Payer: Cash Price |
$7,549.20
|
| Rate for Payer: Cigna Commercial |
$23,150.88
|
| Rate for Payer: Health EOS Commercial |
$22,395.96
|
| Rate for Payer: HFN Commercial |
$23,150.88
|
| Rate for Payer: Multiplan Commercial |
$20,131.20
|
| Rate for Payer: NAPHCARE Commercial |
$15,098.40
|
| Rate for Payer: Preferred Network Access Commercial |
$23,150.88
|
| Rate for Payer: Quartz Beloit One Network |
$12,330.36
|
| Rate for Payer: Quartz Commercial |
$15,098.40
|
| Rate for Payer: WEA Trust Commercial |
$13,840.20
|
| Rate for Payer: WPS Commercial |
$18,638.97
|
|
|
STEM EXT OFFSET TRABEC 15MM 00-7864-15-20
|
Facility
IP
|
$25,164.00
|
|
| Hospital Charge Code |
2967849
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,330.36 |
| Max. Negotiated Rate |
$23,150.88 |
| Rate for Payer: Aetna Commercial |
$22,647.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,336.92
|
| Rate for Payer: Cash Price |
$7,549.20
|
| Rate for Payer: Cigna Commercial |
$23,150.88
|
| Rate for Payer: Health EOS Commercial |
$22,395.96
|
| Rate for Payer: HFN Commercial |
$23,150.88
|
| Rate for Payer: Multiplan Commercial |
$20,131.20
|
| Rate for Payer: NAPHCARE Commercial |
$15,098.40
|
| Rate for Payer: Preferred Network Access Commercial |
$23,150.88
|
| Rate for Payer: Quartz Beloit One Network |
$12,330.36
|
| Rate for Payer: Quartz Commercial |
$15,098.40
|
| Rate for Payer: WEA Trust Commercial |
$13,840.20
|
| Rate for Payer: WPS Commercial |
$18,638.97
|
|
|
STEM EXT OFFSET TRABEC 15MM 00-7864-15-20
|
Facility
OP
|
$25,164.00
|
|
| Hospital Charge Code |
2967849
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,045.92 |
| Max. Negotiated Rate |
$100,656.00 |
| Rate for Payer: Aetna Commercial |
$22,647.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21,641.04
|
| Rate for Payer: Aetna Managed Medicare |
$7,045.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,356.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,582.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,078.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,336.92
|
| Rate for Payer: Cash Price |
$7,549.20
|
| Rate for Payer: Cigna Commercial |
$23,150.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14,081.77
|
| Rate for Payer: Health EOS Commercial |
$22,395.96
|
| Rate for Payer: HFN Commercial |
$23,150.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18,873.00
|
| Rate for Payer: Multiplan Commercial |
$20,131.20
|
| Rate for Payer: NAPHCARE Commercial |
$15,098.40
|
| Rate for Payer: Preferred Network Access Commercial |
$23,150.88
|
| Rate for Payer: Quartz Beloit One Network |
$12,330.36
|
| Rate for Payer: Quartz Commercial |
$16,356.60
|
| Rate for Payer: Quartz Medicare Advantage |
$15,098.40
|
| Rate for Payer: The Alliance Commercial |
$100,656.00
|
| Rate for Payer: WEA Trust Commercial |
$13,840.20
|
| Rate for Payer: WPS Commercial |
$18,638.97
|
|
|
STEM EXT OFFSET TRABEC 16MM 00-7864-16-20
|
Facility
OP
|
$25,164.00
|
|
| Hospital Charge Code |
2967851
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,045.92 |
| Max. Negotiated Rate |
$100,656.00 |
| Rate for Payer: Aetna Commercial |
$22,647.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21,641.04
|
| Rate for Payer: Aetna Managed Medicare |
$7,045.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,356.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,582.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,078.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,336.92
|
| Rate for Payer: Cash Price |
$7,549.20
|
| Rate for Payer: Cigna Commercial |
$23,150.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14,081.77
|
| Rate for Payer: Health EOS Commercial |
$22,395.96
|
| Rate for Payer: HFN Commercial |
$23,150.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18,873.00
|
| Rate for Payer: Multiplan Commercial |
$20,131.20
|
| Rate for Payer: NAPHCARE Commercial |
$15,098.40
|
| Rate for Payer: Preferred Network Access Commercial |
$23,150.88
|
| Rate for Payer: Quartz Beloit One Network |
$12,330.36
|
| Rate for Payer: Quartz Commercial |
$16,356.60
|
| Rate for Payer: Quartz Medicare Advantage |
$15,098.40
|
| Rate for Payer: The Alliance Commercial |
$100,656.00
|
| Rate for Payer: WEA Trust Commercial |
$13,840.20
|
| Rate for Payer: WPS Commercial |
$18,638.97
|
|
|
STEM EXT OFFSET TRABEC 16MM 00-7864-16-20
|
Facility
IP
|
$25,164.00
|
|
| Hospital Charge Code |
2967851
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,330.36 |
| Max. Negotiated Rate |
$23,150.88 |
| Rate for Payer: Aetna Commercial |
$22,647.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,336.92
|
| Rate for Payer: Cash Price |
$7,549.20
|
| Rate for Payer: Cigna Commercial |
$23,150.88
|
| Rate for Payer: Health EOS Commercial |
$22,395.96
|
| Rate for Payer: HFN Commercial |
$23,150.88
|
| Rate for Payer: Multiplan Commercial |
$20,131.20
|
| Rate for Payer: NAPHCARE Commercial |
$15,098.40
|
| Rate for Payer: Preferred Network Access Commercial |
$23,150.88
|
| Rate for Payer: Quartz Beloit One Network |
$12,330.36
|
| Rate for Payer: Quartz Commercial |
$15,098.40
|
| Rate for Payer: WEA Trust Commercial |
$13,840.20
|
| Rate for Payer: WPS Commercial |
$18,638.97
|
|
|
STEM EXT OFFSET TRABEC 17MM 00-7864-17-20
|
Facility
OP
|
$25,164.00
|
|
| Hospital Charge Code |
2967853
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,045.92 |
| Max. Negotiated Rate |
$100,656.00 |
| Rate for Payer: Aetna Commercial |
$22,647.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21,641.04
|
| Rate for Payer: Aetna Managed Medicare |
$7,045.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,356.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,582.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,078.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,336.92
|
| Rate for Payer: Cash Price |
$7,549.20
|
| Rate for Payer: Cigna Commercial |
$23,150.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14,081.77
|
| Rate for Payer: Health EOS Commercial |
$22,395.96
|
| Rate for Payer: HFN Commercial |
$23,150.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18,873.00
|
| Rate for Payer: Multiplan Commercial |
$20,131.20
|
| Rate for Payer: NAPHCARE Commercial |
$15,098.40
|
| Rate for Payer: Preferred Network Access Commercial |
$23,150.88
|
| Rate for Payer: Quartz Beloit One Network |
$12,330.36
|
| Rate for Payer: Quartz Commercial |
$16,356.60
|
| Rate for Payer: Quartz Medicare Advantage |
$15,098.40
|
| Rate for Payer: The Alliance Commercial |
$100,656.00
|
| Rate for Payer: WEA Trust Commercial |
$13,840.20
|
| Rate for Payer: WPS Commercial |
$18,638.97
|
|
|
STEM EXT OFFSET TRABEC 17MM 00-7864-17-20
|
Facility
IP
|
$25,164.00
|
|
| Hospital Charge Code |
2967853
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,330.36 |
| Max. Negotiated Rate |
$23,150.88 |
| Rate for Payer: Aetna Commercial |
$22,647.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,336.92
|
| Rate for Payer: Cash Price |
$7,549.20
|
| Rate for Payer: Cigna Commercial |
$23,150.88
|
| Rate for Payer: Health EOS Commercial |
$22,395.96
|
| Rate for Payer: HFN Commercial |
$23,150.88
|
| Rate for Payer: Multiplan Commercial |
$20,131.20
|
| Rate for Payer: NAPHCARE Commercial |
$15,098.40
|
| Rate for Payer: Preferred Network Access Commercial |
$23,150.88
|
| Rate for Payer: Quartz Beloit One Network |
$12,330.36
|
| Rate for Payer: Quartz Commercial |
$15,098.40
|
| Rate for Payer: WEA Trust Commercial |
$13,840.20
|
| Rate for Payer: WPS Commercial |
$18,638.97
|
|
|
STEM EXT OFFSET TRABEC 18MM 00-7864-18-20
|
Facility
IP
|
$25,164.00
|
|
| Hospital Charge Code |
2967855
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,330.36 |
| Max. Negotiated Rate |
$23,150.88 |
| Rate for Payer: Aetna Commercial |
$22,647.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,336.92
|
| Rate for Payer: Cash Price |
$7,549.20
|
| Rate for Payer: Cigna Commercial |
$23,150.88
|
| Rate for Payer: Health EOS Commercial |
$22,395.96
|
| Rate for Payer: HFN Commercial |
$23,150.88
|
| Rate for Payer: Multiplan Commercial |
$20,131.20
|
| Rate for Payer: NAPHCARE Commercial |
$15,098.40
|
| Rate for Payer: Preferred Network Access Commercial |
$23,150.88
|
| Rate for Payer: Quartz Beloit One Network |
$12,330.36
|
| Rate for Payer: Quartz Commercial |
$15,098.40
|
| Rate for Payer: WEA Trust Commercial |
$13,840.20
|
| Rate for Payer: WPS Commercial |
$18,638.97
|
|
|
STEM EXT OFFSET TRABEC 18MM 00-7864-18-20
|
Facility
OP
|
$25,164.00
|
|
| Hospital Charge Code |
2967855
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,045.92 |
| Max. Negotiated Rate |
$100,656.00 |
| Rate for Payer: Aetna Commercial |
$22,647.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21,641.04
|
| Rate for Payer: Aetna Managed Medicare |
$7,045.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,356.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,582.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,078.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,336.92
|
| Rate for Payer: Cash Price |
$7,549.20
|
| Rate for Payer: Cigna Commercial |
$23,150.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14,081.77
|
| Rate for Payer: Health EOS Commercial |
$22,395.96
|
| Rate for Payer: HFN Commercial |
$23,150.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18,873.00
|
| Rate for Payer: Multiplan Commercial |
$20,131.20
|
| Rate for Payer: NAPHCARE Commercial |
$15,098.40
|
| Rate for Payer: Preferred Network Access Commercial |
$23,150.88
|
| Rate for Payer: Quartz Beloit One Network |
$12,330.36
|
| Rate for Payer: Quartz Commercial |
$16,356.60
|
| Rate for Payer: Quartz Medicare Advantage |
$15,098.40
|
| Rate for Payer: The Alliance Commercial |
$100,656.00
|
| Rate for Payer: WEA Trust Commercial |
$13,840.20
|
| Rate for Payer: WPS Commercial |
$18,638.97
|
|
