|
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 |
$12,823.57 |
| 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 18MM 00-7864-18-20
|
Facility
|
OP
|
$25,164.00
|
|
| Hospital Charge Code |
2967855
|
|
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 TRABECULAR 13MM 00-7864-013-20
|
Facility
|
OP
|
$26,131.00
|
|
| Hospital Charge Code |
2967845
|
|
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 TRABECULAR 13MM 00-7864-013-20
|
Facility
|
IP
|
$26,131.00
|
|
| Hospital Charge Code |
2967845
|
|
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 FEMORAL ADVOCATE EXT 12 X 125 7850-12-25
|
Facility
|
OP
|
$12,032.00
|
|
| Hospital Charge Code |
2967860
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,503.72 |
| Max. Negotiated Rate |
$11,512.22 |
| Rate for Payer: Aetna Commercial |
$11,261.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,761.42
|
| Rate for Payer: Aetna Managed Medicare |
$3,503.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,133.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,256.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,006.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,632.04
|
| Rate for Payer: Cash Price |
$3,609.60
|
| Rate for Payer: Cigna Commercial |
$11,512.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,002.62
|
| Rate for Payer: Health EOS Commercial |
$11,136.82
|
| Rate for Payer: HFN Commercial |
$11,512.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,384.96
|
| Rate for Payer: Multiplan Commercial |
$10,010.62
|
| Rate for Payer: NAPHCARE Commercial |
$7,507.97
|
| Rate for Payer: Preferred Network Access Commercial |
$11,512.22
|
| Rate for Payer: Quartz Beloit One Network |
$6,131.51
|
| Rate for Payer: Quartz Commercial |
$8,133.63
|
| Rate for Payer: Quartz Medicare Advantage |
$7,507.97
|
| Rate for Payer: The Alliance Commercial |
$6,256.64
|
| Rate for Payer: WEA Trust Commercial |
$6,882.30
|
| Rate for Payer: WPS Commercial |
$9,268.25
|
|
|
STEM FEMORAL ADVOCATE EXT 12 X 125 7850-12-25
|
Facility
|
IP
|
$12,032.00
|
|
| Hospital Charge Code |
2967860
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,131.51 |
| Max. Negotiated Rate |
$11,512.22 |
| Rate for Payer: Aetna Commercial |
$11,261.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,761.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,632.04
|
| Rate for Payer: Cash Price |
$3,609.60
|
| Rate for Payer: Cigna Commercial |
$11,512.22
|
| Rate for Payer: Health EOS Commercial |
$11,136.82
|
| Rate for Payer: HFN Commercial |
$11,512.22
|
| Rate for Payer: Multiplan Commercial |
$10,010.62
|
| Rate for Payer: Preferred Network Access Commercial |
$11,512.22
|
| Rate for Payer: Quartz Beloit One Network |
$6,131.51
|
| Rate for Payer: Quartz Commercial |
$7,507.97
|
| Rate for Payer: WEA Trust Commercial |
$6,882.30
|
| Rate for Payer: WPS Commercial |
$9,268.25
|
|
|
STEM FEMORAL ADVOCATE EXT 13 X130 7850-13-25
|
Facility
|
OP
|
$12,032.00
|
|
| Hospital Charge Code |
2967861
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,503.72 |
| Max. Negotiated Rate |
$11,512.22 |
| Rate for Payer: Aetna Commercial |
$11,261.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,761.42
|
| Rate for Payer: Aetna Managed Medicare |
$3,503.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,133.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,256.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,006.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,632.04
|
| Rate for Payer: Cash Price |
$3,609.60
|
| Rate for Payer: Cigna Commercial |
$11,512.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,002.62
|
| Rate for Payer: Health EOS Commercial |
$11,136.82
|
| Rate for Payer: HFN Commercial |
$11,512.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,384.96
|
| Rate for Payer: Multiplan Commercial |
$10,010.62
|
| Rate for Payer: NAPHCARE Commercial |
$7,507.97
|
| Rate for Payer: Preferred Network Access Commercial |
$11,512.22
|
| Rate for Payer: Quartz Beloit One Network |
$6,131.51
|
| Rate for Payer: Quartz Commercial |
$8,133.63
|
| Rate for Payer: Quartz Medicare Advantage |
$7,507.97
|
| Rate for Payer: The Alliance Commercial |
$6,256.64
|
| Rate for Payer: WEA Trust Commercial |
$6,882.30
|
| Rate for Payer: WPS Commercial |
$9,268.25
|
|
|
STEM FEMORAL ADVOCATE EXT 13 X130 7850-13-25
|
Facility
|
IP
|
$12,032.00
|
|
| Hospital Charge Code |
2967861
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,131.51 |
| Max. Negotiated Rate |
$11,512.22 |
| Rate for Payer: Aetna Commercial |
$11,261.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,761.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,632.04
|
| Rate for Payer: Cash Price |
$3,609.60
|
| Rate for Payer: Cigna Commercial |
$11,512.22
|
| Rate for Payer: Health EOS Commercial |
$11,136.82
|
| Rate for Payer: HFN Commercial |
$11,512.22
|
| Rate for Payer: Multiplan Commercial |
$10,010.62
|
| Rate for Payer: Preferred Network Access Commercial |
$11,512.22
|
| Rate for Payer: Quartz Beloit One Network |
$6,131.51
|
| Rate for Payer: Quartz Commercial |
$7,507.97
|
| Rate for Payer: WEA Trust Commercial |
$6,882.30
|
| Rate for Payer: WPS Commercial |
$9,268.25
|
|
|
STEM FEMORAL ADVOCATE EXT 14 X135 7850-14-25
|
Facility
|
OP
|
$12,032.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967862
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,503.72 |
| Max. Negotiated Rate |
$11,512.22 |
| Rate for Payer: Aetna Commercial |
$11,261.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,761.42
|
| Rate for Payer: Aetna Managed Medicare |
$3,503.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,133.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,256.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,006.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,632.04
|
| Rate for Payer: Cash Price |
$3,609.60
|
| Rate for Payer: Cigna Commercial |
$11,512.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,002.62
|
| Rate for Payer: Health EOS Commercial |
$11,136.82
|
| Rate for Payer: HFN Commercial |
$11,512.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,384.96
|
| Rate for Payer: Multiplan Commercial |
$10,010.62
|
| Rate for Payer: NAPHCARE Commercial |
$7,507.97
|
| Rate for Payer: Preferred Network Access Commercial |
$11,512.22
|
| Rate for Payer: Quartz Beloit One Network |
$6,131.51
|
| Rate for Payer: Quartz Commercial |
$8,133.63
|
| Rate for Payer: Quartz Medicare Advantage |
$7,507.97
|
| Rate for Payer: The Alliance Commercial |
$6,256.64
|
| Rate for Payer: WEA Trust Commercial |
$6,882.30
|
| Rate for Payer: WPS Commercial |
$9,268.25
|
|
|
STEM FEMORAL ADVOCATE EXT 14 X135 7850-14-25
|
Facility
|
IP
|
$12,032.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967862
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,131.51 |
| Max. Negotiated Rate |
$11,512.22 |
| Rate for Payer: Aetna Commercial |
$11,261.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,761.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,632.04
|
| Rate for Payer: Cash Price |
$3,609.60
|
| Rate for Payer: Cigna Commercial |
$11,512.22
|
| Rate for Payer: Health EOS Commercial |
$11,136.82
|
| Rate for Payer: HFN Commercial |
$11,512.22
|
| Rate for Payer: Multiplan Commercial |
$10,010.62
|
| Rate for Payer: Preferred Network Access Commercial |
$11,512.22
|
| Rate for Payer: Quartz Beloit One Network |
$6,131.51
|
| Rate for Payer: Quartz Commercial |
$7,507.97
|
| Rate for Payer: WEA Trust Commercial |
$6,882.30
|
| Rate for Payer: WPS Commercial |
$9,268.25
|
|
|
STEM FEMORAL ADVOCATE EXT 15 X140 7850-15-25
|
Facility
|
IP
|
$12,032.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967863
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,131.51 |
| Max. Negotiated Rate |
$11,512.22 |
| Rate for Payer: Aetna Commercial |
$11,261.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,761.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,632.04
|
| Rate for Payer: Cash Price |
$3,609.60
|
| Rate for Payer: Cigna Commercial |
$11,512.22
|
| Rate for Payer: Health EOS Commercial |
$11,136.82
|
| Rate for Payer: HFN Commercial |
$11,512.22
|
| Rate for Payer: Multiplan Commercial |
$10,010.62
|
| Rate for Payer: Preferred Network Access Commercial |
$11,512.22
|
| Rate for Payer: Quartz Beloit One Network |
$6,131.51
|
| Rate for Payer: Quartz Commercial |
$7,507.97
|
| Rate for Payer: WEA Trust Commercial |
$6,882.30
|
| Rate for Payer: WPS Commercial |
$9,268.25
|
|
|
STEM FEMORAL ADVOCATE EXT 15 X140 7850-15-25
|
Facility
|
OP
|
$12,032.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967863
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,503.72 |
| Max. Negotiated Rate |
$11,512.22 |
| Rate for Payer: Aetna Commercial |
$11,261.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,761.42
|
| Rate for Payer: Aetna Managed Medicare |
$3,503.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,133.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,256.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,006.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,632.04
|
| Rate for Payer: Cash Price |
$3,609.60
|
| Rate for Payer: Cigna Commercial |
$11,512.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,002.62
|
| Rate for Payer: Health EOS Commercial |
$11,136.82
|
| Rate for Payer: HFN Commercial |
$11,512.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,384.96
|
| Rate for Payer: Multiplan Commercial |
$10,010.62
|
| Rate for Payer: NAPHCARE Commercial |
$7,507.97
|
| Rate for Payer: Preferred Network Access Commercial |
$11,512.22
|
| Rate for Payer: Quartz Beloit One Network |
$6,131.51
|
| Rate for Payer: Quartz Commercial |
$8,133.63
|
| Rate for Payer: Quartz Medicare Advantage |
$7,507.97
|
| Rate for Payer: The Alliance Commercial |
$6,256.64
|
| Rate for Payer: WEA Trust Commercial |
$6,882.30
|
| Rate for Payer: WPS Commercial |
$9,268.25
|
|
|
STEM FEMORAL ADVOCATE EXT 16 X 145 7850-16-25
|
Facility
|
IP
|
$12,032.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967864
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,131.51 |
| Max. Negotiated Rate |
$11,512.22 |
| Rate for Payer: Aetna Commercial |
$11,261.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,761.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,632.04
|
| Rate for Payer: Cash Price |
$3,609.60
|
| Rate for Payer: Cigna Commercial |
$11,512.22
|
| Rate for Payer: Health EOS Commercial |
$11,136.82
|
| Rate for Payer: HFN Commercial |
$11,512.22
|
| Rate for Payer: Multiplan Commercial |
$10,010.62
|
| Rate for Payer: Preferred Network Access Commercial |
$11,512.22
|
| Rate for Payer: Quartz Beloit One Network |
$6,131.51
|
| Rate for Payer: Quartz Commercial |
$7,507.97
|
| Rate for Payer: WEA Trust Commercial |
$6,882.30
|
| Rate for Payer: WPS Commercial |
$9,268.25
|
|
|
STEM FEMORAL ADVOCATE EXT 16 X 145 7850-16-25
|
Facility
|
OP
|
$12,032.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967864
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,503.72 |
| Max. Negotiated Rate |
$11,512.22 |
| Rate for Payer: Aetna Commercial |
$11,261.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,761.42
|
| Rate for Payer: Aetna Managed Medicare |
$3,503.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,133.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,256.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,006.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,632.04
|
| Rate for Payer: Cash Price |
$3,609.60
|
| Rate for Payer: Cigna Commercial |
$11,512.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,002.62
|
| Rate for Payer: Health EOS Commercial |
$11,136.82
|
| Rate for Payer: HFN Commercial |
$11,512.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,384.96
|
| Rate for Payer: Multiplan Commercial |
$10,010.62
|
| Rate for Payer: NAPHCARE Commercial |
$7,507.97
|
| Rate for Payer: Preferred Network Access Commercial |
$11,512.22
|
| Rate for Payer: Quartz Beloit One Network |
$6,131.51
|
| Rate for Payer: Quartz Commercial |
$8,133.63
|
| Rate for Payer: Quartz Medicare Advantage |
$7,507.97
|
| Rate for Payer: The Alliance Commercial |
$6,256.64
|
| Rate for Payer: WEA Trust Commercial |
$6,882.30
|
| Rate for Payer: WPS Commercial |
$9,268.25
|
|
|
STEM FEMORAL ADVOCATE ST 12 X 125 7850-12-05
|
Facility
|
IP
|
$12,032.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967866
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,131.51 |
| Max. Negotiated Rate |
$11,512.22 |
| Rate for Payer: Aetna Commercial |
$11,261.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,761.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,632.04
|
| Rate for Payer: Cash Price |
$3,609.60
|
| Rate for Payer: Cigna Commercial |
$11,512.22
|
| Rate for Payer: Health EOS Commercial |
$11,136.82
|
| Rate for Payer: HFN Commercial |
$11,512.22
|
| Rate for Payer: Multiplan Commercial |
$10,010.62
|
| Rate for Payer: Preferred Network Access Commercial |
$11,512.22
|
| Rate for Payer: Quartz Beloit One Network |
$6,131.51
|
| Rate for Payer: Quartz Commercial |
$7,507.97
|
| Rate for Payer: WEA Trust Commercial |
$6,882.30
|
| Rate for Payer: WPS Commercial |
$9,268.25
|
|
|
STEM FEMORAL ADVOCATE ST 12 X 125 7850-12-05
|
Facility
|
OP
|
$12,032.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967866
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,503.72 |
| Max. Negotiated Rate |
$11,512.22 |
| Rate for Payer: Aetna Commercial |
$11,261.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,761.42
|
| Rate for Payer: Aetna Managed Medicare |
$3,503.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,133.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,256.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,006.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,632.04
|
| Rate for Payer: Cash Price |
$3,609.60
|
| Rate for Payer: Cigna Commercial |
$11,512.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,002.62
|
| Rate for Payer: Health EOS Commercial |
$11,136.82
|
| Rate for Payer: HFN Commercial |
$11,512.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,384.96
|
| Rate for Payer: Multiplan Commercial |
$10,010.62
|
| Rate for Payer: NAPHCARE Commercial |
$7,507.97
|
| Rate for Payer: Preferred Network Access Commercial |
$11,512.22
|
| Rate for Payer: Quartz Beloit One Network |
$6,131.51
|
| Rate for Payer: Quartz Commercial |
$8,133.63
|
| Rate for Payer: Quartz Medicare Advantage |
$7,507.97
|
| Rate for Payer: The Alliance Commercial |
$6,256.64
|
| Rate for Payer: WEA Trust Commercial |
$6,882.30
|
| Rate for Payer: WPS Commercial |
$9,268.25
|
|
|
STEM FEMORAL ADVOCATE ST 13 X130 7850-13-05
|
Facility
|
IP
|
$12,032.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967867
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,131.51 |
| Max. Negotiated Rate |
$11,512.22 |
| Rate for Payer: Aetna Commercial |
$11,261.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,761.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,632.04
|
| Rate for Payer: Cash Price |
$3,609.60
|
| Rate for Payer: Cigna Commercial |
$11,512.22
|
| Rate for Payer: Health EOS Commercial |
$11,136.82
|
| Rate for Payer: HFN Commercial |
$11,512.22
|
| Rate for Payer: Multiplan Commercial |
$10,010.62
|
| Rate for Payer: Preferred Network Access Commercial |
$11,512.22
|
| Rate for Payer: Quartz Beloit One Network |
$6,131.51
|
| Rate for Payer: Quartz Commercial |
$7,507.97
|
| Rate for Payer: WEA Trust Commercial |
$6,882.30
|
| Rate for Payer: WPS Commercial |
$9,268.25
|
|
|
STEM FEMORAL ADVOCATE ST 13 X130 7850-13-05
|
Facility
|
OP
|
$12,032.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967867
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,503.72 |
| Max. Negotiated Rate |
$11,512.22 |
| Rate for Payer: Aetna Commercial |
$11,261.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,761.42
|
| Rate for Payer: Aetna Managed Medicare |
$3,503.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,133.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,256.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,006.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,632.04
|
| Rate for Payer: Cash Price |
$3,609.60
|
| Rate for Payer: Cigna Commercial |
$11,512.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,002.62
|
| Rate for Payer: Health EOS Commercial |
$11,136.82
|
| Rate for Payer: HFN Commercial |
$11,512.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,384.96
|
| Rate for Payer: Multiplan Commercial |
$10,010.62
|
| Rate for Payer: NAPHCARE Commercial |
$7,507.97
|
| Rate for Payer: Preferred Network Access Commercial |
$11,512.22
|
| Rate for Payer: Quartz Beloit One Network |
$6,131.51
|
| Rate for Payer: Quartz Commercial |
$8,133.63
|
| Rate for Payer: Quartz Medicare Advantage |
$7,507.97
|
| Rate for Payer: The Alliance Commercial |
$6,256.64
|
| Rate for Payer: WEA Trust Commercial |
$6,882.30
|
| Rate for Payer: WPS Commercial |
$9,268.25
|
|
|
STEM FEMORAL ADVOCATE ST 14 X135 7850-14-05
|
Facility
|
OP
|
$12,032.00
|
|
| Hospital Charge Code |
2967868
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,503.72 |
| Max. Negotiated Rate |
$11,512.22 |
| Rate for Payer: Aetna Commercial |
$11,261.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,761.42
|
| Rate for Payer: Aetna Managed Medicare |
$3,503.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,133.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,256.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,006.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,632.04
|
| Rate for Payer: Cash Price |
$3,609.60
|
| Rate for Payer: Cigna Commercial |
$11,512.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,002.62
|
| Rate for Payer: Health EOS Commercial |
$11,136.82
|
| Rate for Payer: HFN Commercial |
$11,512.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,384.96
|
| Rate for Payer: Multiplan Commercial |
$10,010.62
|
| Rate for Payer: NAPHCARE Commercial |
$7,507.97
|
| Rate for Payer: Preferred Network Access Commercial |
$11,512.22
|
| Rate for Payer: Quartz Beloit One Network |
$6,131.51
|
| Rate for Payer: Quartz Commercial |
$8,133.63
|
| Rate for Payer: Quartz Medicare Advantage |
$7,507.97
|
| Rate for Payer: The Alliance Commercial |
$6,256.64
|
| Rate for Payer: WEA Trust Commercial |
$6,882.30
|
| Rate for Payer: WPS Commercial |
$9,268.25
|
|
|
STEM FEMORAL ADVOCATE ST 14 X135 7850-14-05
|
Facility
|
IP
|
$12,032.00
|
|
| Hospital Charge Code |
2967868
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,131.51 |
| Max. Negotiated Rate |
$11,512.22 |
| Rate for Payer: Aetna Commercial |
$11,261.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,761.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,632.04
|
| Rate for Payer: Cash Price |
$3,609.60
|
| Rate for Payer: Cigna Commercial |
$11,512.22
|
| Rate for Payer: Health EOS Commercial |
$11,136.82
|
| Rate for Payer: HFN Commercial |
$11,512.22
|
| Rate for Payer: Multiplan Commercial |
$10,010.62
|
| Rate for Payer: Preferred Network Access Commercial |
$11,512.22
|
| Rate for Payer: Quartz Beloit One Network |
$6,131.51
|
| Rate for Payer: Quartz Commercial |
$7,507.97
|
| Rate for Payer: WEA Trust Commercial |
$6,882.30
|
| Rate for Payer: WPS Commercial |
$9,268.25
|
|
|
STEM FEMORAL ADVOCATE ST 15 X140 7850-15-05
|
Facility
|
IP
|
$12,032.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967869
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,131.51 |
| Max. Negotiated Rate |
$11,512.22 |
| Rate for Payer: Aetna Commercial |
$11,261.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,761.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,632.04
|
| Rate for Payer: Cash Price |
$3,609.60
|
| Rate for Payer: Cigna Commercial |
$11,512.22
|
| Rate for Payer: Health EOS Commercial |
$11,136.82
|
| Rate for Payer: HFN Commercial |
$11,512.22
|
| Rate for Payer: Multiplan Commercial |
$10,010.62
|
| Rate for Payer: Preferred Network Access Commercial |
$11,512.22
|
| Rate for Payer: Quartz Beloit One Network |
$6,131.51
|
| Rate for Payer: Quartz Commercial |
$7,507.97
|
| Rate for Payer: WEA Trust Commercial |
$6,882.30
|
| Rate for Payer: WPS Commercial |
$9,268.25
|
|
|
STEM FEMORAL ADVOCATE ST 15 X140 7850-15-05
|
Facility
|
OP
|
$12,032.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967869
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,503.72 |
| Max. Negotiated Rate |
$11,512.22 |
| Rate for Payer: Aetna Commercial |
$11,261.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,761.42
|
| Rate for Payer: Aetna Managed Medicare |
$3,503.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,133.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,256.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,006.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,632.04
|
| Rate for Payer: Cash Price |
$3,609.60
|
| Rate for Payer: Cigna Commercial |
$11,512.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,002.62
|
| Rate for Payer: Health EOS Commercial |
$11,136.82
|
| Rate for Payer: HFN Commercial |
$11,512.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,384.96
|
| Rate for Payer: Multiplan Commercial |
$10,010.62
|
| Rate for Payer: NAPHCARE Commercial |
$7,507.97
|
| Rate for Payer: Preferred Network Access Commercial |
$11,512.22
|
| Rate for Payer: Quartz Beloit One Network |
$6,131.51
|
| Rate for Payer: Quartz Commercial |
$8,133.63
|
| Rate for Payer: Quartz Medicare Advantage |
$7,507.97
|
| Rate for Payer: The Alliance Commercial |
$6,256.64
|
| Rate for Payer: WEA Trust Commercial |
$6,882.30
|
| Rate for Payer: WPS Commercial |
$9,268.25
|
|
|
STEM FEMORAL ADVOCATE ST 16 X145 7850-16-05
|
Facility
|
IP
|
$12,032.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967870
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,131.51 |
| Max. Negotiated Rate |
$11,512.22 |
| Rate for Payer: Aetna Commercial |
$11,261.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,761.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,632.04
|
| Rate for Payer: Cash Price |
$3,609.60
|
| Rate for Payer: Cigna Commercial |
$11,512.22
|
| Rate for Payer: Health EOS Commercial |
$11,136.82
|
| Rate for Payer: HFN Commercial |
$11,512.22
|
| Rate for Payer: Multiplan Commercial |
$10,010.62
|
| Rate for Payer: Preferred Network Access Commercial |
$11,512.22
|
| Rate for Payer: Quartz Beloit One Network |
$6,131.51
|
| Rate for Payer: Quartz Commercial |
$7,507.97
|
| Rate for Payer: WEA Trust Commercial |
$6,882.30
|
| Rate for Payer: WPS Commercial |
$9,268.25
|
|
|
STEM FEMORAL ADVOCATE ST 16 X145 7850-16-05
|
Facility
|
OP
|
$12,032.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967870
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,503.72 |
| Max. Negotiated Rate |
$11,512.22 |
| Rate for Payer: Aetna Commercial |
$11,261.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,761.42
|
| Rate for Payer: Aetna Managed Medicare |
$3,503.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,133.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,256.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,006.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,632.04
|
| Rate for Payer: Cash Price |
$3,609.60
|
| Rate for Payer: Cigna Commercial |
$11,512.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,002.62
|
| Rate for Payer: Health EOS Commercial |
$11,136.82
|
| Rate for Payer: HFN Commercial |
$11,512.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,384.96
|
| Rate for Payer: Multiplan Commercial |
$10,010.62
|
| Rate for Payer: NAPHCARE Commercial |
$7,507.97
|
| Rate for Payer: Preferred Network Access Commercial |
$11,512.22
|
| Rate for Payer: Quartz Beloit One Network |
$6,131.51
|
| Rate for Payer: Quartz Commercial |
$8,133.63
|
| Rate for Payer: Quartz Medicare Advantage |
$7,507.97
|
| Rate for Payer: The Alliance Commercial |
$6,256.64
|
| Rate for Payer: WEA Trust Commercial |
$6,882.30
|
| Rate for Payer: WPS Commercial |
$9,268.25
|
|
|
STEM FEMORAL ADVOCATE ST 17 X150 7850-17-05
|
Facility
|
IP
|
$12,032.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967871
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,131.51 |
| Max. Negotiated Rate |
$11,512.22 |
| Rate for Payer: Aetna Commercial |
$11,261.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,761.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,632.04
|
| Rate for Payer: Cash Price |
$3,609.60
|
| Rate for Payer: Cigna Commercial |
$11,512.22
|
| Rate for Payer: Health EOS Commercial |
$11,136.82
|
| Rate for Payer: HFN Commercial |
$11,512.22
|
| Rate for Payer: Multiplan Commercial |
$10,010.62
|
| Rate for Payer: Preferred Network Access Commercial |
$11,512.22
|
| Rate for Payer: Quartz Beloit One Network |
$6,131.51
|
| Rate for Payer: Quartz Commercial |
$7,507.97
|
| Rate for Payer: WEA Trust Commercial |
$6,882.30
|
| Rate for Payer: WPS Commercial |
$9,268.25
|
|
