|
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 |
$7,609.35 |
| 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 STD OFFSE TRABEC 15MM 00-7864-15-00
|
Facility
|
IP
|
$26,131.00
|
|
| Hospital Charge Code |
2967850
|
|
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 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 |
$7,327.76 |
| 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 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 |
$12,823.57 |
| 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 STD OFFSE TRABEC 17MM 00-7864-017-00
|
Facility
|
IP
|
$25,164.00
|
|
| Hospital Charge Code |
2967854
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,823.57 |
| 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 STD OFFSE TRABEC 17MM 00-7864-017-00
|
Facility
|
OP
|
$25,164.00
|
|
| Hospital Charge Code |
2967854
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,327.76 |
| 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 STD OFFSE TRABEC 18MM 007864-18-00
|
Facility
|
IP
|
$25,164.00
|
|
| Hospital Charge Code |
2967856
|
|
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 STD OFFSE TRABEC 18MM 007864-18-00
|
Facility
|
OP
|
$25,164.00
|
|
| Hospital Charge Code |
2967856
|
|
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 STD OFFSET TRABEC 14MM 00-7864-014-00
|
Facility
|
IP
|
$26,131.00
|
|
| Hospital Charge Code |
2967848
|
|
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 STD OFFSET TRABEC 14MM 00-7864-014-00
|
Facility
|
OP
|
$26,131.00
|
|
| Hospital Charge Code |
2967848
|
|
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 STD OFFSET TRABEC 9MM 00-7864-09-00
|
Facility
|
IP
|
$25,164.00
|
|
| Hospital Charge Code |
2967857
|
|
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 STD OFFSET TRABEC 9MM 00-7864-09-00
|
Facility
|
OP
|
$25,164.00
|
|
| Hospital Charge Code |
2967857
|
|
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 TRIATHLON TOTAL KNEE CEMENTED 12MM X 100MM 5560-S-212
|
Facility
|
IP
|
$6,609.00
|
|
| Hospital Charge Code |
3983347
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,367.95 |
| Max. Negotiated Rate |
$6,323.49 |
| Rate for Payer: Aetna Commercial |
$6,186.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,911.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,642.88
|
| Rate for Payer: Cash Price |
$1,982.70
|
| Rate for Payer: Cigna Commercial |
$6,323.49
|
| Rate for Payer: Health EOS Commercial |
$6,117.29
|
| Rate for Payer: HFN Commercial |
$6,323.49
|
| Rate for Payer: Multiplan Commercial |
$5,498.69
|
| Rate for Payer: Preferred Network Access Commercial |
$6,323.49
|
| Rate for Payer: Quartz Beloit One Network |
$3,367.95
|
| Rate for Payer: Quartz Commercial |
$4,124.02
|
| Rate for Payer: WEA Trust Commercial |
$3,780.35
|
| Rate for Payer: WPS Commercial |
$5,090.91
|
|
|
STEM TRIATHLON TOTAL KNEE CEMENTED 12MM X 100MM 5560-S-212
|
Facility
|
OP
|
$6,609.00
|
|
| Hospital Charge Code |
3983347
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,924.54 |
| Max. Negotiated Rate |
$6,323.49 |
| Rate for Payer: Aetna Commercial |
$6,186.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,911.09
|
| Rate for Payer: Aetna Managed Medicare |
$1,924.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,467.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,436.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,299.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,642.88
|
| Rate for Payer: Cash Price |
$1,982.70
|
| Rate for Payer: Cigna Commercial |
$6,323.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,846.44
|
| Rate for Payer: Health EOS Commercial |
$6,117.29
|
| Rate for Payer: HFN Commercial |
$6,323.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,155.02
|
| Rate for Payer: Multiplan Commercial |
$5,498.69
|
| Rate for Payer: NAPHCARE Commercial |
$4,124.02
|
| Rate for Payer: Preferred Network Access Commercial |
$6,323.49
|
| Rate for Payer: Quartz Beloit One Network |
$3,367.95
|
| Rate for Payer: Quartz Commercial |
$4,467.68
|
| Rate for Payer: Quartz Medicare Advantage |
$4,124.02
|
| Rate for Payer: The Alliance Commercial |
$3,436.68
|
| Rate for Payer: WEA Trust Commercial |
$3,780.35
|
| Rate for Payer: WPS Commercial |
$5,090.91
|
|
|
STEM TRIATHLON TOTAL KNEE CEMENTED 12MM X 50MM 5560-S-112
|
Facility
|
OP
|
$6,864.00
|
|
| Hospital Charge Code |
4100375
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,998.80 |
| Max. Negotiated Rate |
$6,567.48 |
| Rate for Payer: Aetna Commercial |
$6,424.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,139.16
|
| Rate for Payer: Aetna Managed Medicare |
$1,998.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,640.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,569.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,426.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,783.44
|
| Rate for Payer: Cash Price |
$2,059.20
|
| Rate for Payer: Cigna Commercial |
$6,567.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,994.85
|
| Rate for Payer: Health EOS Commercial |
$6,353.32
|
| Rate for Payer: HFN Commercial |
$6,567.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,353.92
|
| Rate for Payer: Multiplan Commercial |
$5,710.85
|
| Rate for Payer: NAPHCARE Commercial |
$4,283.14
|
| Rate for Payer: Preferred Network Access Commercial |
$6,567.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,497.89
|
| Rate for Payer: Quartz Commercial |
$4,640.06
|
| Rate for Payer: Quartz Medicare Advantage |
$4,283.14
|
| Rate for Payer: The Alliance Commercial |
$3,569.28
|
| Rate for Payer: WEA Trust Commercial |
$3,926.21
|
| Rate for Payer: WPS Commercial |
$5,287.34
|
|
|
STEM TRIATHLON TOTAL KNEE CEMENTED 12MM X 50MM 5560-S-112
|
Facility
|
IP
|
$6,864.00
|
|
| Hospital Charge Code |
4100375
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,497.89 |
| Max. Negotiated Rate |
$6,567.48 |
| Rate for Payer: Aetna Commercial |
$6,424.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,139.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,783.44
|
| Rate for Payer: Cash Price |
$2,059.20
|
| Rate for Payer: Cigna Commercial |
$6,567.48
|
| Rate for Payer: Health EOS Commercial |
$6,353.32
|
| Rate for Payer: HFN Commercial |
$6,567.48
|
| Rate for Payer: Multiplan Commercial |
$5,710.85
|
| Rate for Payer: Preferred Network Access Commercial |
$6,567.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,497.89
|
| Rate for Payer: Quartz Commercial |
$4,283.14
|
| Rate for Payer: WEA Trust Commercial |
$3,926.21
|
| Rate for Payer: WPS Commercial |
$5,287.34
|
|
|
STEM TRIATHLON TOTAL KNEE CEMENTED 15MM X 50MM 5560-S-115
|
Facility
|
OP
|
$6,609.00
|
|
| Hospital Charge Code |
3827377
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,924.54 |
| Max. Negotiated Rate |
$6,323.49 |
| Rate for Payer: Aetna Commercial |
$6,186.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,911.09
|
| Rate for Payer: Aetna Managed Medicare |
$1,924.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,467.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,436.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,299.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,642.88
|
| Rate for Payer: Cash Price |
$1,982.70
|
| Rate for Payer: Cigna Commercial |
$6,323.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,846.44
|
| Rate for Payer: Health EOS Commercial |
$6,117.29
|
| Rate for Payer: HFN Commercial |
$6,323.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,155.02
|
| Rate for Payer: Multiplan Commercial |
$5,498.69
|
| Rate for Payer: NAPHCARE Commercial |
$4,124.02
|
| Rate for Payer: Preferred Network Access Commercial |
$6,323.49
|
| Rate for Payer: Quartz Beloit One Network |
$3,367.95
|
| Rate for Payer: Quartz Commercial |
$4,467.68
|
| Rate for Payer: Quartz Medicare Advantage |
$4,124.02
|
| Rate for Payer: The Alliance Commercial |
$3,436.68
|
| Rate for Payer: WEA Trust Commercial |
$3,780.35
|
| Rate for Payer: WPS Commercial |
$5,090.91
|
|
|
STEM TRIATHLON TOTAL KNEE CEMENTED 15MM X 50MM 5560-S-115
|
Facility
|
IP
|
$6,609.00
|
|
| Hospital Charge Code |
3827377
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,367.95 |
| Max. Negotiated Rate |
$6,323.49 |
| Rate for Payer: Aetna Commercial |
$6,186.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,911.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,642.88
|
| Rate for Payer: Cash Price |
$1,982.70
|
| Rate for Payer: Cigna Commercial |
$6,323.49
|
| Rate for Payer: Health EOS Commercial |
$6,117.29
|
| Rate for Payer: HFN Commercial |
$6,323.49
|
| Rate for Payer: Multiplan Commercial |
$5,498.69
|
| Rate for Payer: Preferred Network Access Commercial |
$6,323.49
|
| Rate for Payer: Quartz Beloit One Network |
$3,367.95
|
| Rate for Payer: Quartz Commercial |
$4,124.02
|
| Rate for Payer: WEA Trust Commercial |
$3,780.35
|
| Rate for Payer: WPS Commercial |
$5,090.91
|
|
|
STEM TRIATHLON TOTAL KNEE CEMENTED 9MM X 100MM 5560-S-209
|
Facility
|
OP
|
$6,609.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3827374
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,924.54 |
| Max. Negotiated Rate |
$6,323.49 |
| Rate for Payer: Aetna Commercial |
$6,186.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,911.09
|
| Rate for Payer: Aetna Managed Medicare |
$1,924.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,467.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,436.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,299.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,642.88
|
| Rate for Payer: Cash Price |
$1,982.70
|
| Rate for Payer: Cigna Commercial |
$6,323.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,846.44
|
| Rate for Payer: Health EOS Commercial |
$6,117.29
|
| Rate for Payer: HFN Commercial |
$6,323.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,155.02
|
| Rate for Payer: Multiplan Commercial |
$5,498.69
|
| Rate for Payer: NAPHCARE Commercial |
$4,124.02
|
| Rate for Payer: Preferred Network Access Commercial |
$6,323.49
|
| Rate for Payer: Quartz Beloit One Network |
$3,367.95
|
| Rate for Payer: Quartz Commercial |
$4,467.68
|
| Rate for Payer: Quartz Medicare Advantage |
$4,124.02
|
| Rate for Payer: The Alliance Commercial |
$3,436.68
|
| Rate for Payer: WEA Trust Commercial |
$3,780.35
|
| Rate for Payer: WPS Commercial |
$5,090.91
|
|
|
STEM TRIATHLON TOTAL KNEE CEMENTED 9MM X 100MM 5560-S-209
|
Facility
|
IP
|
$6,609.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3827374
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,367.95 |
| Max. Negotiated Rate |
$6,323.49 |
| Rate for Payer: Aetna Commercial |
$6,186.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,911.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,642.88
|
| Rate for Payer: Cash Price |
$1,982.70
|
| Rate for Payer: Cigna Commercial |
$6,323.49
|
| Rate for Payer: Health EOS Commercial |
$6,117.29
|
| Rate for Payer: HFN Commercial |
$6,323.49
|
| Rate for Payer: Multiplan Commercial |
$5,498.69
|
| Rate for Payer: Preferred Network Access Commercial |
$6,323.49
|
| Rate for Payer: Quartz Beloit One Network |
$3,367.95
|
| Rate for Payer: Quartz Commercial |
$4,124.02
|
| Rate for Payer: WEA Trust Commercial |
$3,780.35
|
| Rate for Payer: WPS Commercial |
$5,090.91
|
|
|
STEM UNIVERSAL FLUTED 75MM X 14MM 86-7414
|
Facility
|
IP
|
$7,580.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5641693
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,862.77 |
| Max. Negotiated Rate |
$7,252.54 |
| Rate for Payer: Aetna Commercial |
$7,094.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,779.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,178.10
|
| Rate for Payer: Cash Price |
$2,274.00
|
| Rate for Payer: Cigna Commercial |
$7,252.54
|
| Rate for Payer: Health EOS Commercial |
$7,016.05
|
| Rate for Payer: HFN Commercial |
$7,252.54
|
| Rate for Payer: Multiplan Commercial |
$6,306.56
|
| Rate for Payer: Preferred Network Access Commercial |
$7,252.54
|
| Rate for Payer: Quartz Beloit One Network |
$3,862.77
|
| Rate for Payer: Quartz Commercial |
$4,729.92
|
| Rate for Payer: WEA Trust Commercial |
$4,335.76
|
| Rate for Payer: WPS Commercial |
$5,838.87
|
|
|
STEM UNIVERSAL FLUTED 75MM X 14MM 86-7414
|
Facility
|
OP
|
$7,580.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5641693
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,207.30 |
| Max. Negotiated Rate |
$7,252.54 |
| Rate for Payer: Aetna Commercial |
$7,094.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,779.55
|
| Rate for Payer: Aetna Managed Medicare |
$2,207.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,124.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,941.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,783.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,178.10
|
| Rate for Payer: Cash Price |
$2,274.00
|
| Rate for Payer: Cigna Commercial |
$7,252.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,411.56
|
| Rate for Payer: Health EOS Commercial |
$7,016.05
|
| Rate for Payer: HFN Commercial |
$7,252.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,912.40
|
| Rate for Payer: Multiplan Commercial |
$6,306.56
|
| Rate for Payer: NAPHCARE Commercial |
$4,729.92
|
| Rate for Payer: Preferred Network Access Commercial |
$7,252.54
|
| Rate for Payer: Quartz Beloit One Network |
$3,862.77
|
| Rate for Payer: Quartz Commercial |
$5,124.08
|
| Rate for Payer: Quartz Medicare Advantage |
$4,729.92
|
| Rate for Payer: The Alliance Commercial |
$3,941.60
|
| Rate for Payer: WEA Trust Commercial |
$4,335.76
|
| Rate for Payer: WPS Commercial |
$5,838.87
|
|
|
STEM UNIVERSAL FLUTED 75MM X 16MM 86-7416
|
Facility
|
OP
|
$7,580.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5813627
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,207.30 |
| Max. Negotiated Rate |
$7,252.54 |
| Rate for Payer: Aetna Commercial |
$7,094.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,779.55
|
| Rate for Payer: Aetna Managed Medicare |
$2,207.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,124.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,941.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,783.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,178.10
|
| Rate for Payer: Cash Price |
$2,274.00
|
| Rate for Payer: Cigna Commercial |
$7,252.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,411.56
|
| Rate for Payer: Health EOS Commercial |
$7,016.05
|
| Rate for Payer: HFN Commercial |
$7,252.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,912.40
|
| Rate for Payer: Multiplan Commercial |
$6,306.56
|
| Rate for Payer: NAPHCARE Commercial |
$4,729.92
|
| Rate for Payer: Preferred Network Access Commercial |
$7,252.54
|
| Rate for Payer: Quartz Beloit One Network |
$3,862.77
|
| Rate for Payer: Quartz Commercial |
$5,124.08
|
| Rate for Payer: Quartz Medicare Advantage |
$4,729.92
|
| Rate for Payer: The Alliance Commercial |
$3,941.60
|
| Rate for Payer: WEA Trust Commercial |
$4,335.76
|
| Rate for Payer: WPS Commercial |
$5,838.87
|
|
|
STEM UNIVERSAL FLUTED 75MM X 16MM 86-7416
|
Facility
|
IP
|
$7,580.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5813627
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,862.77 |
| Max. Negotiated Rate |
$7,252.54 |
| Rate for Payer: Aetna Commercial |
$7,094.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,779.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,178.10
|
| Rate for Payer: Cash Price |
$2,274.00
|
| Rate for Payer: Cigna Commercial |
$7,252.54
|
| Rate for Payer: Health EOS Commercial |
$7,016.05
|
| Rate for Payer: HFN Commercial |
$7,252.54
|
| Rate for Payer: Multiplan Commercial |
$6,306.56
|
| Rate for Payer: Preferred Network Access Commercial |
$7,252.54
|
| Rate for Payer: Quartz Beloit One Network |
$3,862.77
|
| Rate for Payer: Quartz Commercial |
$4,729.92
|
| Rate for Payer: WEA Trust Commercial |
$4,335.76
|
| Rate for Payer: WPS Commercial |
$5,838.87
|
|
|
Stenger Test, Pure Tone
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
CPT 92565
|
| Hospital Charge Code |
1188818
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$75.42 |
| Max. Negotiated Rate |
$141.61 |
| Rate for Payer: Aetna Commercial |
$138.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$132.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.58
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cigna Commercial |
$141.61
|
| Rate for Payer: Health EOS Commercial |
$136.99
|
| Rate for Payer: HFN Commercial |
$141.61
|
| Rate for Payer: Multiplan Commercial |
$123.14
|
| Rate for Payer: Preferred Network Access Commercial |
$141.61
|
| Rate for Payer: Quartz Beloit One Network |
$75.42
|
| Rate for Payer: Quartz Commercial |
$92.35
|
| Rate for Payer: WEA Trust Commercial |
$84.66
|
| Rate for Payer: WPS Commercial |
$114.00
|
|
