|
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 |
$23,040.48 |
| 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: 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 |
$6,955.20 |
| 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: 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: 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: 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
|
|
|
STEM REVISION CEMENTED ATTUNE 14MM X 50MM 1512-14-050
|
Facility
OP
|
$4,940.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6165879
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,383.20 |
| 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: Aetna Managed Medicare |
$1,383.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,211.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,470.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,371.20
|
| 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: Dean Health DHI/DHP/ASO |
$2,764.42
|
| Rate for Payer: Health EOS Commercial |
$4,396.60
|
| Rate for Payer: HFN Commercial |
$4,544.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,705.00
|
| 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 |
$3,211.00
|
| Rate for Payer: Quartz Medicare Advantage |
$2,964.00
|
| Rate for Payer: WEA Trust Commercial |
$2,717.00
|
| Rate for Payer: WPS Commercial |
$3,659.06
|
|
|
STEM REVISION CEMENTED ATTUNE 14MM X 80MM 1512-14-080
|
Facility
IP
|
$7,862.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5521073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,852.38 |
| Max. Negotiated Rate |
$7,233.04 |
| Rate for Payer: Aetna Commercial |
$7,075.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,166.86
|
| Rate for Payer: Cash Price |
$2,358.60
|
| Rate for Payer: Cigna Commercial |
$7,233.04
|
| Rate for Payer: Health EOS Commercial |
$6,997.18
|
| Rate for Payer: HFN Commercial |
$7,233.04
|
| Rate for Payer: Multiplan Commercial |
$6,289.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,717.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,233.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,852.38
|
| Rate for Payer: Quartz Commercial |
$4,717.20
|
| Rate for Payer: WEA Trust Commercial |
$4,324.10
|
| Rate for Payer: WPS Commercial |
$5,823.38
|
|
|
STEM REVISION CEMENTED ATTUNE 14MM X 80MM 1512-14-080
|
Facility
OP
|
$7,862.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5521073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,201.36 |
| Max. Negotiated Rate |
$7,233.04 |
| Rate for Payer: Aetna Commercial |
$7,075.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,761.32
|
| Rate for Payer: Aetna Managed Medicare |
$2,201.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,110.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,931.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,773.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,166.86
|
| Rate for Payer: Cash Price |
$2,358.60
|
| Rate for Payer: Cigna Commercial |
$7,233.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,399.58
|
| Rate for Payer: Health EOS Commercial |
$6,997.18
|
| Rate for Payer: HFN Commercial |
$7,233.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,896.50
|
| Rate for Payer: Multiplan Commercial |
$6,289.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,717.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,233.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,852.38
|
| Rate for Payer: Quartz Commercial |
$5,110.30
|
| Rate for Payer: Quartz Medicare Advantage |
$4,717.20
|
| Rate for Payer: WEA Trust Commercial |
$4,324.10
|
| Rate for Payer: WPS Commercial |
$5,823.38
|
|
|
STEM REVISION PRESSFIT ATTUNE 12MM X 60MM 1513-12-060
|
Facility
OP
|
$7,943.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6244178
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,224.05 |
| Max. Negotiated Rate |
$7,307.59 |
| Rate for Payer: Aetna Commercial |
$7,148.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,831.01
|
| Rate for Payer: Aetna Managed Medicare |
$2,224.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,162.97
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,971.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,812.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,209.81
|
| Rate for Payer: Cash Price |
$2,382.91
|
| Rate for Payer: Cigna Commercial |
$7,307.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,444.92
|
| Rate for Payer: Health EOS Commercial |
$7,069.30
|
| Rate for Payer: HFN Commercial |
$7,307.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,957.27
|
| Rate for Payer: Multiplan Commercial |
$6,354.42
|
| Rate for Payer: NAPHCARE Commercial |
$4,765.82
|
| Rate for Payer: Preferred Network Access Commercial |
$7,307.59
|
| Rate for Payer: Quartz Beloit One Network |
$3,892.08
|
| Rate for Payer: Quartz Commercial |
$5,162.97
|
| Rate for Payer: Quartz Medicare Advantage |
$4,765.82
|
| Rate for Payer: WEA Trust Commercial |
$4,368.67
|
| Rate for Payer: WPS Commercial |
$5,883.40
|
|
|
STEM REVISION PRESSFIT ATTUNE 12MM X 60MM 1513-12-060
|
Facility
IP
|
$7,943.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6244178
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,892.08 |
| Max. Negotiated Rate |
$7,307.59 |
| Rate for Payer: Aetna Commercial |
$7,148.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,209.81
|
| Rate for Payer: Cash Price |
$2,382.91
|
| Rate for Payer: Cigna Commercial |
$7,307.59
|
| Rate for Payer: Health EOS Commercial |
$7,069.30
|
| Rate for Payer: HFN Commercial |
$7,307.59
|
| Rate for Payer: Multiplan Commercial |
$6,354.42
|
| Rate for Payer: NAPHCARE Commercial |
$4,765.82
|
| Rate for Payer: Preferred Network Access Commercial |
$7,307.59
|
| Rate for Payer: Quartz Beloit One Network |
$3,892.08
|
| Rate for Payer: Quartz Commercial |
$4,765.82
|
| Rate for Payer: WEA Trust Commercial |
$4,368.67
|
| Rate for Payer: WPS Commercial |
$5,883.40
|
|
|
STEM REVISION PRESSFIT ATTUNE 14MM X 110MM 1513-14-110
|
Facility
IP
|
$8,444.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563683
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,137.56 |
| Max. Negotiated Rate |
$7,768.48 |
| Rate for Payer: Aetna Commercial |
$7,599.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,475.32
|
| Rate for Payer: Cash Price |
$2,533.20
|
| Rate for Payer: Cigna Commercial |
$7,768.48
|
| Rate for Payer: Health EOS Commercial |
$7,515.16
|
| Rate for Payer: HFN Commercial |
$7,768.48
|
| Rate for Payer: Multiplan Commercial |
$6,755.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,066.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,768.48
|
| Rate for Payer: Quartz Beloit One Network |
$4,137.56
|
| Rate for Payer: Quartz Commercial |
$5,066.40
|
| Rate for Payer: WEA Trust Commercial |
$4,644.20
|
| Rate for Payer: WPS Commercial |
$6,254.47
|
|
|
STEM REVISION PRESSFIT ATTUNE 14MM X 110MM 1513-14-110
|
Facility
OP
|
$8,444.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563683
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,364.32 |
| Max. Negotiated Rate |
$7,768.48 |
| Rate for Payer: Aetna Commercial |
$7,599.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,261.84
|
| Rate for Payer: Aetna Managed Medicare |
$2,364.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,488.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,222.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,053.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,475.32
|
| Rate for Payer: Cash Price |
$2,533.20
|
| Rate for Payer: Cigna Commercial |
$7,768.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,725.26
|
| Rate for Payer: Health EOS Commercial |
$7,515.16
|
| Rate for Payer: HFN Commercial |
$7,768.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,333.00
|
| Rate for Payer: Multiplan Commercial |
$6,755.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,066.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,768.48
|
| Rate for Payer: Quartz Beloit One Network |
$4,137.56
|
| Rate for Payer: Quartz Commercial |
$5,488.60
|
| Rate for Payer: Quartz Medicare Advantage |
$5,066.40
|
| Rate for Payer: WEA Trust Commercial |
$4,644.20
|
| Rate for Payer: WPS Commercial |
$6,254.47
|
|
|
STEM REVISION PRESSFIT ATTUNE 14MM X 60MM 1513-14-060
|
Facility
OP
|
$12,426.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5528740
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,479.28 |
| Max. Negotiated Rate |
$11,431.92 |
| Rate for Payer: Aetna Commercial |
$11,183.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,686.36
|
| Rate for Payer: Aetna Managed Medicare |
$3,479.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,076.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,213.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,964.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,585.78
|
| Rate for Payer: Cash Price |
$3,727.80
|
| Rate for Payer: Cigna Commercial |
$11,431.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,953.59
|
| Rate for Payer: Health EOS Commercial |
$11,059.14
|
| Rate for Payer: HFN Commercial |
$11,431.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,319.50
|
| Rate for Payer: Multiplan Commercial |
$9,940.80
|
| Rate for Payer: NAPHCARE Commercial |
$7,455.60
|
| Rate for Payer: Preferred Network Access Commercial |
$11,431.92
|
| Rate for Payer: Quartz Beloit One Network |
$6,088.74
|
| Rate for Payer: Quartz Commercial |
$8,076.90
|
| Rate for Payer: Quartz Medicare Advantage |
$7,455.60
|
| Rate for Payer: WEA Trust Commercial |
$6,834.30
|
| Rate for Payer: WPS Commercial |
$9,203.94
|
|
|
STEM REVISION PRESSFIT ATTUNE 14MM X 60MM 1513-14-060
|
Facility
IP
|
$12,426.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5528740
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,088.74 |
| Max. Negotiated Rate |
$11,431.92 |
| Rate for Payer: Aetna Commercial |
$11,183.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,585.78
|
| Rate for Payer: Cash Price |
$3,727.80
|
| Rate for Payer: Cigna Commercial |
$11,431.92
|
| Rate for Payer: Health EOS Commercial |
$11,059.14
|
| Rate for Payer: HFN Commercial |
$11,431.92
|
| Rate for Payer: Multiplan Commercial |
$9,940.80
|
| Rate for Payer: NAPHCARE Commercial |
$7,455.60
|
| Rate for Payer: Preferred Network Access Commercial |
$11,431.92
|
| Rate for Payer: Quartz Beloit One Network |
$6,088.74
|
| Rate for Payer: Quartz Commercial |
$7,455.60
|
| Rate for Payer: WEA Trust Commercial |
$6,834.30
|
| Rate for Payer: WPS Commercial |
$9,203.94
|
|
|
STEM REVISION PRESSFIT ATTUNE 16MM X 60MM 1513-16-060
|
Facility
OP
|
$12,426.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5528744
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,479.28 |
| Max. Negotiated Rate |
$11,431.92 |
| Rate for Payer: Aetna Commercial |
$11,183.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,686.36
|
| Rate for Payer: Aetna Managed Medicare |
$3,479.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,076.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,213.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,964.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,585.78
|
| Rate for Payer: Cash Price |
$3,727.80
|
| Rate for Payer: Cigna Commercial |
$11,431.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,953.59
|
| Rate for Payer: Health EOS Commercial |
$11,059.14
|
| Rate for Payer: HFN Commercial |
$11,431.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,319.50
|
| Rate for Payer: Multiplan Commercial |
$9,940.80
|
| Rate for Payer: NAPHCARE Commercial |
$7,455.60
|
| Rate for Payer: Preferred Network Access Commercial |
$11,431.92
|
| Rate for Payer: Quartz Beloit One Network |
$6,088.74
|
| Rate for Payer: Quartz Commercial |
$8,076.90
|
| Rate for Payer: Quartz Medicare Advantage |
$7,455.60
|
| Rate for Payer: WEA Trust Commercial |
$6,834.30
|
| Rate for Payer: WPS Commercial |
$9,203.94
|
|
|
STEM REVISION PRESSFIT ATTUNE 16MM X 60MM 1513-16-060
|
Facility
IP
|
$12,426.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5528744
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,088.74 |
| Max. Negotiated Rate |
$11,431.92 |
| Rate for Payer: Aetna Commercial |
$11,183.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,585.78
|
| Rate for Payer: Cash Price |
$3,727.80
|
| Rate for Payer: Cigna Commercial |
$11,431.92
|
| Rate for Payer: Health EOS Commercial |
$11,059.14
|
| Rate for Payer: HFN Commercial |
$11,431.92
|
| Rate for Payer: Multiplan Commercial |
$9,940.80
|
| Rate for Payer: NAPHCARE Commercial |
$7,455.60
|
| Rate for Payer: Preferred Network Access Commercial |
$11,431.92
|
| Rate for Payer: Quartz Beloit One Network |
$6,088.74
|
| Rate for Payer: Quartz Commercial |
$7,455.60
|
| Rate for Payer: WEA Trust Commercial |
$6,834.30
|
| Rate for Payer: WPS Commercial |
$9,203.94
|
|
|
STEM REVISION PRESSFIT ATTUNE 20MM X 110MM 1513-20-110
|
Facility
OP
|
$8,119.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5831783
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,273.32 |
| Max. Negotiated Rate |
$7,469.48 |
| Rate for Payer: Aetna Commercial |
$7,307.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,982.34
|
| Rate for Payer: Aetna Managed Medicare |
$2,273.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,277.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,059.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,897.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,303.07
|
| Rate for Payer: Cash Price |
$2,435.70
|
| Rate for Payer: Cigna Commercial |
$7,469.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,543.39
|
| Rate for Payer: Health EOS Commercial |
$7,225.91
|
| Rate for Payer: HFN Commercial |
$7,469.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,089.25
|
| Rate for Payer: Multiplan Commercial |
$6,495.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,871.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,469.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,978.31
|
| Rate for Payer: Quartz Commercial |
$5,277.35
|
| Rate for Payer: Quartz Medicare Advantage |
$4,871.40
|
| Rate for Payer: WEA Trust Commercial |
$4,465.45
|
| Rate for Payer: WPS Commercial |
$6,013.74
|
|
|
STEM REVISION PRESSFIT ATTUNE 20MM X 110MM 1513-20-110
|
Facility
IP
|
$8,119.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5831783
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,978.31 |
| Max. Negotiated Rate |
$7,469.48 |
| Rate for Payer: Aetna Commercial |
$7,307.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,303.07
|
| Rate for Payer: Cash Price |
$2,435.70
|
| Rate for Payer: Cigna Commercial |
$7,469.48
|
| Rate for Payer: Health EOS Commercial |
$7,225.91
|
| Rate for Payer: HFN Commercial |
$7,469.48
|
| Rate for Payer: Multiplan Commercial |
$6,495.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,871.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,469.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,978.31
|
| Rate for Payer: Quartz Commercial |
$4,871.40
|
| Rate for Payer: WEA Trust Commercial |
$4,465.45
|
| Rate for Payer: WPS Commercial |
$6,013.74
|
|
|
STEM STD OFFSE TRABEC 10MM 00-7864-10-00
|
Facility
IP
|
$25,164.00
|
|
| Hospital Charge Code |
2967840
|
|
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 STD OFFSE TRABEC 10MM 00-7864-10-00
|
Facility
OP
|
$25,164.00
|
|
| Hospital Charge Code |
2967840
|
|
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 STD OFFSE TRABEC 15MM 00-7864-15-00
|
Facility
IP
|
$26,131.00
|
|
| Hospital Charge Code |
2967850
|
|
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 STD OFFSE TRABEC 15MM 00-7864-15-00
|
Facility
OP
|
$26,131.00
|
|
| Hospital Charge Code |
2967850
|
|
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 STD OFFSE TRABEC 16MM 00-7864-016-00
|
Facility
OP
|
$25,164.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967852
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,045.92 |
| Max. Negotiated Rate |
$23,150.88 |
| 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: WEA Trust Commercial |
$13,840.20
|
| Rate for Payer: WPS Commercial |
$18,638.97
|
|
|
STEM STD OFFSE TRABEC 16MM 00-7864-016-00
|
Facility
IP
|
$25,164.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967852
|
|
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 STD OFFSE TRABEC 17MM 00-7864-017-00
|
Facility
OP
|
$25,164.00
|
|
| Hospital Charge Code |
2967854
|
|
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 STD OFFSE TRABEC 17MM 00-7864-017-00
|
Facility
IP
|
$25,164.00
|
|
| Hospital Charge Code |
2967854
|
|
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
|
|
