|
STEM EXTENSION OFFSET 15MM X 100MM 5988-20-15
|
Facility
|
IP
|
$7,651.00
|
|
| Hospital Charge Code |
2973972
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,898.95 |
| Max. Negotiated Rate |
$7,320.48 |
| Rate for Payer: Aetna Commercial |
$7,161.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,843.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,217.23
|
| Rate for Payer: Cash Price |
$2,295.30
|
| Rate for Payer: Cigna Commercial |
$7,320.48
|
| Rate for Payer: Health EOS Commercial |
$7,081.77
|
| Rate for Payer: HFN Commercial |
$7,320.48
|
| Rate for Payer: Multiplan Commercial |
$6,365.63
|
| Rate for Payer: Preferred Network Access Commercial |
$7,320.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,898.95
|
| Rate for Payer: Quartz Commercial |
$4,774.22
|
| Rate for Payer: WEA Trust Commercial |
$4,376.37
|
| Rate for Payer: WPS Commercial |
$5,893.57
|
|
|
STEM EXTENSION STR 10 x 145mm
|
Facility
|
IP
|
$8,784.00
|
|
| Hospital Charge Code |
2974040
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,476.33 |
| Max. Negotiated Rate |
$8,404.53 |
| Rate for Payer: Aetna Commercial |
$8,221.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,856.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,841.74
|
| Rate for Payer: Cash Price |
$2,635.20
|
| Rate for Payer: Cigna Commercial |
$8,404.53
|
| Rate for Payer: Health EOS Commercial |
$8,130.47
|
| Rate for Payer: HFN Commercial |
$8,404.53
|
| Rate for Payer: Multiplan Commercial |
$7,308.29
|
| Rate for Payer: Preferred Network Access Commercial |
$8,404.53
|
| Rate for Payer: Quartz Beloit One Network |
$4,476.33
|
| Rate for Payer: Quartz Commercial |
$5,481.22
|
| Rate for Payer: WEA Trust Commercial |
$5,024.45
|
| Rate for Payer: WPS Commercial |
$6,766.32
|
|
|
STEM EXTENSION STR 10 x 145mm
|
Facility
|
OP
|
$8,784.00
|
|
| Hospital Charge Code |
2974040
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,557.90 |
| Max. Negotiated Rate |
$8,404.53 |
| Rate for Payer: Aetna Commercial |
$8,221.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,856.41
|
| Rate for Payer: Aetna Managed Medicare |
$2,557.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,937.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,567.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,384.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,841.74
|
| Rate for Payer: Cash Price |
$2,635.20
|
| Rate for Payer: Cigna Commercial |
$8,404.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,112.29
|
| Rate for Payer: Health EOS Commercial |
$8,130.47
|
| Rate for Payer: HFN Commercial |
$8,404.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,851.52
|
| Rate for Payer: Multiplan Commercial |
$7,308.29
|
| Rate for Payer: NAPHCARE Commercial |
$5,481.22
|
| Rate for Payer: Preferred Network Access Commercial |
$8,404.53
|
| Rate for Payer: Quartz Beloit One Network |
$4,476.33
|
| Rate for Payer: Quartz Commercial |
$5,937.98
|
| Rate for Payer: Quartz Medicare Advantage |
$5,481.22
|
| Rate for Payer: The Alliance Commercial |
$4,567.68
|
| Rate for Payer: WEA Trust Commercial |
$5,024.45
|
| Rate for Payer: WPS Commercial |
$6,766.32
|
|
|
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 |
$2,557.90 |
| Max. Negotiated Rate |
$8,404.53 |
| Rate for Payer: Aetna Commercial |
$8,221.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,856.41
|
| Rate for Payer: Aetna Managed Medicare |
$2,557.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,937.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,567.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,384.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,841.74
|
| Rate for Payer: Cash Price |
$2,635.20
|
| Rate for Payer: Cigna Commercial |
$8,404.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,112.29
|
| Rate for Payer: Health EOS Commercial |
$8,130.47
|
| Rate for Payer: HFN Commercial |
$8,404.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,851.52
|
| Rate for Payer: Multiplan Commercial |
$7,308.29
|
| Rate for Payer: NAPHCARE Commercial |
$5,481.22
|
| Rate for Payer: Preferred Network Access Commercial |
$8,404.53
|
| Rate for Payer: Quartz Beloit One Network |
$4,476.33
|
| Rate for Payer: Quartz Commercial |
$5,937.98
|
| Rate for Payer: Quartz Medicare Advantage |
$5,481.22
|
| Rate for Payer: The Alliance Commercial |
$4,567.68
|
| Rate for Payer: WEA Trust Commercial |
$5,024.45
|
| Rate for Payer: WPS Commercial |
$6,766.32
|
|
|
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 |
$4,476.33 |
| Max. Negotiated Rate |
$8,404.53 |
| Rate for Payer: Aetna Commercial |
$8,221.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,856.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,841.74
|
| Rate for Payer: Cash Price |
$2,635.20
|
| Rate for Payer: Cigna Commercial |
$8,404.53
|
| Rate for Payer: Health EOS Commercial |
$8,130.47
|
| Rate for Payer: HFN Commercial |
$8,404.53
|
| Rate for Payer: Multiplan Commercial |
$7,308.29
|
| Rate for Payer: Preferred Network Access Commercial |
$8,404.53
|
| Rate for Payer: Quartz Beloit One Network |
$4,476.33
|
| Rate for Payer: Quartz Commercial |
$5,481.22
|
| Rate for Payer: WEA Trust Commercial |
$5,024.45
|
| Rate for Payer: WPS Commercial |
$6,766.32
|
|
|
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 |
$2,557.90 |
| Max. Negotiated Rate |
$8,404.53 |
| Rate for Payer: Aetna Commercial |
$8,221.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,856.41
|
| Rate for Payer: Aetna Managed Medicare |
$2,557.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,937.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,567.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,384.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,841.74
|
| Rate for Payer: Cash Price |
$2,635.20
|
| Rate for Payer: Cigna Commercial |
$8,404.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,112.29
|
| Rate for Payer: Health EOS Commercial |
$8,130.47
|
| Rate for Payer: HFN Commercial |
$8,404.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,851.52
|
| Rate for Payer: Multiplan Commercial |
$7,308.29
|
| Rate for Payer: NAPHCARE Commercial |
$5,481.22
|
| Rate for Payer: Preferred Network Access Commercial |
$8,404.53
|
| Rate for Payer: Quartz Beloit One Network |
$4,476.33
|
| Rate for Payer: Quartz Commercial |
$5,937.98
|
| Rate for Payer: Quartz Medicare Advantage |
$5,481.22
|
| Rate for Payer: The Alliance Commercial |
$4,567.68
|
| Rate for Payer: WEA Trust Commercial |
$5,024.45
|
| Rate for Payer: WPS Commercial |
$6,766.32
|
|
|
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 |
$4,476.33 |
| Max. Negotiated Rate |
$8,404.53 |
| Rate for Payer: Aetna Commercial |
$8,221.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,856.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,841.74
|
| Rate for Payer: Cash Price |
$2,635.20
|
| Rate for Payer: Cigna Commercial |
$8,404.53
|
| Rate for Payer: Health EOS Commercial |
$8,130.47
|
| Rate for Payer: HFN Commercial |
$8,404.53
|
| Rate for Payer: Multiplan Commercial |
$7,308.29
|
| Rate for Payer: Preferred Network Access Commercial |
$8,404.53
|
| Rate for Payer: Quartz Beloit One Network |
$4,476.33
|
| Rate for Payer: Quartz Commercial |
$5,481.22
|
| Rate for Payer: WEA Trust Commercial |
$5,024.45
|
| Rate for Payer: WPS Commercial |
$6,766.32
|
|
|
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 |
$2,557.90 |
| Max. Negotiated Rate |
$8,404.53 |
| Rate for Payer: Aetna Commercial |
$8,221.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,856.41
|
| Rate for Payer: Aetna Managed Medicare |
$2,557.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,937.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,567.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,384.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,841.74
|
| Rate for Payer: Cash Price |
$2,635.20
|
| Rate for Payer: Cigna Commercial |
$8,404.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,112.29
|
| Rate for Payer: Health EOS Commercial |
$8,130.47
|
| Rate for Payer: HFN Commercial |
$8,404.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,851.52
|
| Rate for Payer: Multiplan Commercial |
$7,308.29
|
| Rate for Payer: NAPHCARE Commercial |
$5,481.22
|
| Rate for Payer: Preferred Network Access Commercial |
$8,404.53
|
| Rate for Payer: Quartz Beloit One Network |
$4,476.33
|
| Rate for Payer: Quartz Commercial |
$5,937.98
|
| Rate for Payer: Quartz Medicare Advantage |
$5,481.22
|
| Rate for Payer: The Alliance Commercial |
$4,567.68
|
| Rate for Payer: WEA Trust Commercial |
$5,024.45
|
| Rate for Payer: WPS Commercial |
$6,766.32
|
|
|
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 |
$4,476.33 |
| Max. Negotiated Rate |
$8,404.53 |
| Rate for Payer: Aetna Commercial |
$8,221.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,856.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,841.74
|
| Rate for Payer: Cash Price |
$2,635.20
|
| Rate for Payer: Cigna Commercial |
$8,404.53
|
| Rate for Payer: Health EOS Commercial |
$8,130.47
|
| Rate for Payer: HFN Commercial |
$8,404.53
|
| Rate for Payer: Multiplan Commercial |
$7,308.29
|
| Rate for Payer: Preferred Network Access Commercial |
$8,404.53
|
| Rate for Payer: Quartz Beloit One Network |
$4,476.33
|
| Rate for Payer: Quartz Commercial |
$5,481.22
|
| Rate for Payer: WEA Trust Commercial |
$5,024.45
|
| Rate for Payer: WPS Commercial |
$6,766.32
|
|
|
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 |
$2,557.90 |
| Max. Negotiated Rate |
$8,404.53 |
| Rate for Payer: Aetna Commercial |
$8,221.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,856.41
|
| Rate for Payer: Aetna Managed Medicare |
$2,557.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,937.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,567.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,384.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,841.74
|
| Rate for Payer: Cash Price |
$2,635.20
|
| Rate for Payer: Cigna Commercial |
$8,404.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,112.29
|
| Rate for Payer: Health EOS Commercial |
$8,130.47
|
| Rate for Payer: HFN Commercial |
$8,404.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,851.52
|
| Rate for Payer: Multiplan Commercial |
$7,308.29
|
| Rate for Payer: NAPHCARE Commercial |
$5,481.22
|
| Rate for Payer: Preferred Network Access Commercial |
$8,404.53
|
| Rate for Payer: Quartz Beloit One Network |
$4,476.33
|
| Rate for Payer: Quartz Commercial |
$5,937.98
|
| Rate for Payer: Quartz Medicare Advantage |
$5,481.22
|
| Rate for Payer: The Alliance Commercial |
$4,567.68
|
| Rate for Payer: WEA Trust Commercial |
$5,024.45
|
| Rate for Payer: WPS Commercial |
$6,766.32
|
|
|
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 |
$4,476.33 |
| Max. Negotiated Rate |
$8,404.53 |
| Rate for Payer: Aetna Commercial |
$8,221.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,856.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,841.74
|
| Rate for Payer: Cash Price |
$2,635.20
|
| Rate for Payer: Cigna Commercial |
$8,404.53
|
| Rate for Payer: Health EOS Commercial |
$8,130.47
|
| Rate for Payer: HFN Commercial |
$8,404.53
|
| Rate for Payer: Multiplan Commercial |
$7,308.29
|
| Rate for Payer: Preferred Network Access Commercial |
$8,404.53
|
| Rate for Payer: Quartz Beloit One Network |
$4,476.33
|
| Rate for Payer: Quartz Commercial |
$5,481.22
|
| Rate for Payer: WEA Trust Commercial |
$5,024.45
|
| Rate for Payer: WPS Commercial |
$6,766.32
|
|
|
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 |
$4,147.12 |
| Max. Negotiated Rate |
$7,786.44 |
| Rate for Payer: Aetna Commercial |
$7,617.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,278.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,485.67
|
| Rate for Payer: Cash Price |
$2,441.40
|
| Rate for Payer: Cigna Commercial |
$7,786.44
|
| Rate for Payer: Health EOS Commercial |
$7,532.53
|
| Rate for Payer: HFN Commercial |
$7,786.44
|
| Rate for Payer: Multiplan Commercial |
$6,770.82
|
| Rate for Payer: Preferred Network Access Commercial |
$7,786.44
|
| Rate for Payer: Quartz Beloit One Network |
$4,147.12
|
| Rate for Payer: Quartz Commercial |
$5,078.11
|
| Rate for Payer: WEA Trust Commercial |
$4,654.94
|
| Rate for Payer: WPS Commercial |
$6,268.70
|
|
|
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 |
$2,369.79 |
| Max. Negotiated Rate |
$7,786.44 |
| Rate for Payer: Aetna Commercial |
$7,617.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,278.63
|
| Rate for Payer: Aetna Managed Medicare |
$2,369.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,501.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,231.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,062.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,485.67
|
| Rate for Payer: Cash Price |
$2,441.40
|
| Rate for Payer: Cigna Commercial |
$7,786.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,736.32
|
| Rate for Payer: Health EOS Commercial |
$7,532.53
|
| Rate for Payer: HFN Commercial |
$7,786.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,347.64
|
| Rate for Payer: Multiplan Commercial |
$6,770.82
|
| Rate for Payer: NAPHCARE Commercial |
$5,078.11
|
| Rate for Payer: Preferred Network Access Commercial |
$7,786.44
|
| Rate for Payer: Quartz Beloit One Network |
$4,147.12
|
| Rate for Payer: Quartz Commercial |
$5,501.29
|
| Rate for Payer: Quartz Medicare Advantage |
$5,078.11
|
| Rate for Payer: The Alliance Commercial |
$4,231.76
|
| Rate for Payer: WEA Trust Commercial |
$4,654.94
|
| Rate for Payer: WPS Commercial |
$6,268.70
|
|
|
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 |
$7,609.35 |
| Max. Negotiated Rate |
$25,002.14 |
| Rate for Payer: Aetna Commercial |
$24,458.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$23,371.57
|
| Rate for Payer: Aetna Managed Medicare |
$7,609.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17,664.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,588.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,044.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14,403.41
|
| Rate for Payer: Cash Price |
$7,839.30
|
| Rate for Payer: Cigna Commercial |
$25,002.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15,208.24
|
| Rate for Payer: Health EOS Commercial |
$24,186.85
|
| Rate for Payer: HFN Commercial |
$25,002.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,382.18
|
| Rate for Payer: Multiplan Commercial |
$21,740.99
|
| Rate for Payer: NAPHCARE Commercial |
$16,305.74
|
| Rate for Payer: Preferred Network Access Commercial |
$25,002.14
|
| Rate for Payer: Quartz Beloit One Network |
$13,316.36
|
| Rate for Payer: Quartz Commercial |
$17,664.56
|
| Rate for Payer: Quartz Medicare Advantage |
$16,305.74
|
| Rate for Payer: The Alliance Commercial |
$13,588.12
|
| Rate for Payer: WEA Trust Commercial |
$14,946.93
|
| Rate for Payer: WPS Commercial |
$20,128.71
|
|
|
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 |
$13,316.36 |
| Max. Negotiated Rate |
$25,002.14 |
| Rate for Payer: Aetna Commercial |
$24,458.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$23,371.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14,403.41
|
| Rate for Payer: Cash Price |
$7,839.30
|
| Rate for Payer: Cigna Commercial |
$25,002.14
|
| Rate for Payer: Health EOS Commercial |
$24,186.85
|
| Rate for Payer: HFN Commercial |
$25,002.14
|
| Rate for Payer: Multiplan Commercial |
$21,740.99
|
| Rate for Payer: Preferred Network Access Commercial |
$25,002.14
|
| Rate for Payer: Quartz Beloit One Network |
$13,316.36
|
| Rate for Payer: Quartz Commercial |
$16,305.74
|
| Rate for Payer: WEA Trust Commercial |
$14,946.93
|
| Rate for Payer: WPS Commercial |
$20,128.71
|
|
|
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 |
$12,823.57 |
| Max. Negotiated Rate |
$24,076.92 |
| Rate for Payer: Aetna Commercial |
$23,553.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$22,506.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,870.40
|
| Rate for Payer: Cash Price |
$7,549.20
|
| Rate for Payer: Cigna Commercial |
$24,076.92
|
| Rate for Payer: Health EOS Commercial |
$23,291.80
|
| Rate for Payer: HFN Commercial |
$24,076.92
|
| Rate for Payer: Multiplan Commercial |
$20,936.45
|
| Rate for Payer: Preferred Network Access Commercial |
$24,076.92
|
| Rate for Payer: Quartz Beloit One Network |
$12,823.57
|
| Rate for Payer: Quartz Commercial |
$15,702.34
|
| Rate for Payer: WEA Trust Commercial |
$14,393.81
|
| Rate for Payer: WPS Commercial |
$19,383.83
|
|
|
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 |
$7,327.76 |
| Max. Negotiated Rate |
$24,076.92 |
| Rate for Payer: Aetna Commercial |
$23,553.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$22,506.68
|
| Rate for Payer: Aetna Managed Medicare |
$7,327.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17,010.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,085.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,561.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,870.40
|
| Rate for Payer: Cash Price |
$7,549.20
|
| Rate for Payer: Cigna Commercial |
$24,076.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14,645.45
|
| Rate for Payer: Health EOS Commercial |
$23,291.80
|
| Rate for Payer: HFN Commercial |
$24,076.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19,627.92
|
| Rate for Payer: Multiplan Commercial |
$20,936.45
|
| Rate for Payer: NAPHCARE Commercial |
$15,702.34
|
| Rate for Payer: Preferred Network Access Commercial |
$24,076.92
|
| Rate for Payer: Quartz Beloit One Network |
$12,823.57
|
| Rate for Payer: Quartz Commercial |
$17,010.86
|
| Rate for Payer: Quartz Medicare Advantage |
$15,702.34
|
| Rate for Payer: The Alliance Commercial |
$13,085.28
|
| Rate for Payer: WEA Trust Commercial |
$14,393.81
|
| Rate for Payer: WPS Commercial |
$19,383.83
|
|
|
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 |
$7,327.76 |
| Max. Negotiated Rate |
$24,076.92 |
| Rate for Payer: Aetna Commercial |
$23,553.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$22,506.68
|
| Rate for Payer: Aetna Managed Medicare |
$7,327.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17,010.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,085.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,561.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,870.40
|
| Rate for Payer: Cash Price |
$7,549.20
|
| Rate for Payer: Cigna Commercial |
$24,076.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14,645.45
|
| Rate for Payer: Health EOS Commercial |
$23,291.80
|
| Rate for Payer: HFN Commercial |
$24,076.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19,627.92
|
| Rate for Payer: Multiplan Commercial |
$20,936.45
|
| Rate for Payer: NAPHCARE Commercial |
$15,702.34
|
| Rate for Payer: Preferred Network Access Commercial |
$24,076.92
|
| Rate for Payer: Quartz Beloit One Network |
$12,823.57
|
| Rate for Payer: Quartz Commercial |
$17,010.86
|
| Rate for Payer: Quartz Medicare Advantage |
$15,702.34
|
| Rate for Payer: The Alliance Commercial |
$13,085.28
|
| Rate for Payer: WEA Trust Commercial |
$14,393.81
|
| Rate for Payer: WPS Commercial |
$19,383.83
|
|
|
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 |
$12,823.57 |
| Max. Negotiated Rate |
$24,076.92 |
| Rate for Payer: Aetna Commercial |
$23,553.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$22,506.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,870.40
|
| Rate for Payer: Cash Price |
$7,549.20
|
| Rate for Payer: Cigna Commercial |
$24,076.92
|
| Rate for Payer: Health EOS Commercial |
$23,291.80
|
| Rate for Payer: HFN Commercial |
$24,076.92
|
| Rate for Payer: Multiplan Commercial |
$20,936.45
|
| Rate for Payer: Preferred Network Access Commercial |
$24,076.92
|
| Rate for Payer: Quartz Beloit One Network |
$12,823.57
|
| Rate for Payer: Quartz Commercial |
$15,702.34
|
| Rate for Payer: WEA Trust Commercial |
$14,393.81
|
| Rate for Payer: WPS Commercial |
$19,383.83
|
|
|
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 |
$7,327.76 |
| Max. Negotiated Rate |
$24,076.92 |
| Rate for Payer: Aetna Commercial |
$23,553.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$22,506.68
|
| Rate for Payer: Aetna Managed Medicare |
$7,327.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17,010.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,085.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,561.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,870.40
|
| Rate for Payer: Cash Price |
$7,549.20
|
| Rate for Payer: Cigna Commercial |
$24,076.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14,645.45
|
| Rate for Payer: Health EOS Commercial |
$23,291.80
|
| Rate for Payer: HFN Commercial |
$24,076.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19,627.92
|
| Rate for Payer: Multiplan Commercial |
$20,936.45
|
| Rate for Payer: NAPHCARE Commercial |
$15,702.34
|
| Rate for Payer: Preferred Network Access Commercial |
$24,076.92
|
| Rate for Payer: Quartz Beloit One Network |
$12,823.57
|
| Rate for Payer: Quartz Commercial |
$17,010.86
|
| Rate for Payer: Quartz Medicare Advantage |
$15,702.34
|
| Rate for Payer: The Alliance Commercial |
$13,085.28
|
| Rate for Payer: WEA Trust Commercial |
$14,393.81
|
| Rate for Payer: WPS Commercial |
$19,383.83
|
|
|
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 |
$12,823.57 |
| Max. Negotiated Rate |
$24,076.92 |
| Rate for Payer: Aetna Commercial |
$23,553.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$22,506.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,870.40
|
| Rate for Payer: Cash Price |
$7,549.20
|
| Rate for Payer: Cigna Commercial |
$24,076.92
|
| Rate for Payer: Health EOS Commercial |
$23,291.80
|
| Rate for Payer: HFN Commercial |
$24,076.92
|
| Rate for Payer: Multiplan Commercial |
$20,936.45
|
| Rate for Payer: Preferred Network Access Commercial |
$24,076.92
|
| Rate for Payer: Quartz Beloit One Network |
$12,823.57
|
| Rate for Payer: Quartz Commercial |
$15,702.34
|
| Rate for Payer: WEA Trust Commercial |
$14,393.81
|
| Rate for Payer: WPS Commercial |
$19,383.83
|
|
|
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 |
$7,327.76 |
| Max. Negotiated Rate |
$24,076.92 |
| Rate for Payer: Aetna Commercial |
$23,553.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$22,506.68
|
| Rate for Payer: Aetna Managed Medicare |
$7,327.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17,010.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,085.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,561.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,870.40
|
| Rate for Payer: Cash Price |
$7,549.20
|
| Rate for Payer: Cigna Commercial |
$24,076.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14,645.45
|
| Rate for Payer: Health EOS Commercial |
$23,291.80
|
| Rate for Payer: HFN Commercial |
$24,076.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19,627.92
|
| Rate for Payer: Multiplan Commercial |
$20,936.45
|
| Rate for Payer: NAPHCARE Commercial |
$15,702.34
|
| Rate for Payer: Preferred Network Access Commercial |
$24,076.92
|
| Rate for Payer: Quartz Beloit One Network |
$12,823.57
|
| Rate for Payer: Quartz Commercial |
$17,010.86
|
| Rate for Payer: Quartz Medicare Advantage |
$15,702.34
|
| Rate for Payer: The Alliance Commercial |
$13,085.28
|
| Rate for Payer: WEA Trust Commercial |
$14,393.81
|
| Rate for Payer: WPS Commercial |
$19,383.83
|
|
|
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 |
$12,823.57 |
| Max. Negotiated Rate |
$24,076.92 |
| Rate for Payer: Aetna Commercial |
$23,553.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$22,506.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,870.40
|
| Rate for Payer: Cash Price |
$7,549.20
|
| Rate for Payer: Cigna Commercial |
$24,076.92
|
| Rate for Payer: Health EOS Commercial |
$23,291.80
|
| Rate for Payer: HFN Commercial |
$24,076.92
|
| Rate for Payer: Multiplan Commercial |
$20,936.45
|
| Rate for Payer: Preferred Network Access Commercial |
$24,076.92
|
| Rate for Payer: Quartz Beloit One Network |
$12,823.57
|
| Rate for Payer: Quartz Commercial |
$15,702.34
|
| Rate for Payer: WEA Trust Commercial |
$14,393.81
|
| Rate for Payer: WPS Commercial |
$19,383.83
|
|
|
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 |
$12,823.57 |
| Max. Negotiated Rate |
$24,076.92 |
| Rate for Payer: Aetna Commercial |
$23,553.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$22,506.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,870.40
|
| Rate for Payer: Cash Price |
$7,549.20
|
| Rate for Payer: Cigna Commercial |
$24,076.92
|
| Rate for Payer: Health EOS Commercial |
$23,291.80
|
| Rate for Payer: HFN Commercial |
$24,076.92
|
| Rate for Payer: Multiplan Commercial |
$20,936.45
|
| Rate for Payer: Preferred Network Access Commercial |
$24,076.92
|
| Rate for Payer: Quartz Beloit One Network |
$12,823.57
|
| Rate for Payer: Quartz Commercial |
$15,702.34
|
| Rate for Payer: WEA Trust Commercial |
$14,393.81
|
| Rate for Payer: WPS Commercial |
$19,383.83
|
|
|
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 |
$7,327.76 |
| Max. Negotiated Rate |
$24,076.92 |
| Rate for Payer: Aetna Commercial |
$23,553.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$22,506.68
|
| Rate for Payer: Aetna Managed Medicare |
$7,327.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17,010.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,085.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,561.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,870.40
|
| Rate for Payer: Cash Price |
$7,549.20
|
| Rate for Payer: Cigna Commercial |
$24,076.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14,645.45
|
| Rate for Payer: Health EOS Commercial |
$23,291.80
|
| Rate for Payer: HFN Commercial |
$24,076.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19,627.92
|
| Rate for Payer: Multiplan Commercial |
$20,936.45
|
| Rate for Payer: NAPHCARE Commercial |
$15,702.34
|
| Rate for Payer: Preferred Network Access Commercial |
$24,076.92
|
| Rate for Payer: Quartz Beloit One Network |
$12,823.57
|
| Rate for Payer: Quartz Commercial |
$17,010.86
|
| Rate for Payer: Quartz Medicare Advantage |
$15,702.34
|
| Rate for Payer: The Alliance Commercial |
$13,085.28
|
| Rate for Payer: WEA Trust Commercial |
$14,393.81
|
| Rate for Payer: WPS Commercial |
$19,383.83
|
|
