|
STEINMMANN PIN INBONE 2.4MM 200072
|
Facility
|
IP
|
$778.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5831728
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$396.47 |
| Max. Negotiated Rate |
$744.39 |
| Rate for Payer: Aetna Commercial |
$728.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$695.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$428.83
|
| Rate for Payer: Cash Price |
$233.40
|
| Rate for Payer: Cigna Commercial |
$744.39
|
| Rate for Payer: Health EOS Commercial |
$720.12
|
| Rate for Payer: HFN Commercial |
$744.39
|
| Rate for Payer: Multiplan Commercial |
$647.30
|
| Rate for Payer: Preferred Network Access Commercial |
$744.39
|
| Rate for Payer: Quartz Beloit One Network |
$396.47
|
| Rate for Payer: Quartz Commercial |
$485.47
|
| Rate for Payer: WEA Trust Commercial |
$445.02
|
| Rate for Payer: WPS Commercial |
$599.29
|
|
|
STEINMMANN PIN INBONE 2.4MM 200072
|
Facility
|
OP
|
$778.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5831728
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$226.55 |
| Max. Negotiated Rate |
$744.39 |
| Rate for Payer: Aetna Commercial |
$728.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$695.84
|
| Rate for Payer: Aetna Managed Medicare |
$226.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$525.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$404.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$388.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$428.83
|
| Rate for Payer: Cash Price |
$233.40
|
| Rate for Payer: Cigna Commercial |
$744.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$452.80
|
| Rate for Payer: Health EOS Commercial |
$720.12
|
| Rate for Payer: HFN Commercial |
$744.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$606.84
|
| Rate for Payer: Multiplan Commercial |
$647.30
|
| Rate for Payer: NAPHCARE Commercial |
$485.47
|
| Rate for Payer: Preferred Network Access Commercial |
$744.39
|
| Rate for Payer: Quartz Beloit One Network |
$396.47
|
| Rate for Payer: Quartz Commercial |
$525.93
|
| Rate for Payer: Quartz Medicare Advantage |
$485.47
|
| Rate for Payer: The Alliance Commercial |
$404.56
|
| Rate for Payer: WEA Trust Commercial |
$445.02
|
| Rate for Payer: WPS Commercial |
$599.29
|
|
|
STEM 5.5MM EVOLVE RADIAL
|
Facility
|
IP
|
$14,790.00
|
|
| Hospital Charge Code |
2967400
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,536.98 |
| Max. Negotiated Rate |
$14,151.07 |
| Rate for Payer: Aetna Commercial |
$13,843.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,228.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,152.25
|
| Rate for Payer: Cash Price |
$4,437.00
|
| Rate for Payer: Cigna Commercial |
$14,151.07
|
| Rate for Payer: Health EOS Commercial |
$13,689.62
|
| Rate for Payer: HFN Commercial |
$14,151.07
|
| Rate for Payer: Multiplan Commercial |
$12,305.28
|
| Rate for Payer: Preferred Network Access Commercial |
$14,151.07
|
| Rate for Payer: Quartz Beloit One Network |
$7,536.98
|
| Rate for Payer: Quartz Commercial |
$9,228.96
|
| Rate for Payer: WEA Trust Commercial |
$8,459.88
|
| Rate for Payer: WPS Commercial |
$11,392.74
|
|
|
STEM 5.5MM EVOLVE RADIAL
|
Facility
|
OP
|
$14,790.00
|
|
| Hospital Charge Code |
2967400
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,306.85 |
| Max. Negotiated Rate |
$14,151.07 |
| Rate for Payer: Aetna Commercial |
$13,843.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,228.18
|
| Rate for Payer: Aetna Managed Medicare |
$4,306.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,998.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,690.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,383.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,152.25
|
| Rate for Payer: Cash Price |
$4,437.00
|
| Rate for Payer: Cigna Commercial |
$14,151.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,607.78
|
| Rate for Payer: Health EOS Commercial |
$13,689.62
|
| Rate for Payer: HFN Commercial |
$14,151.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,536.20
|
| Rate for Payer: Multiplan Commercial |
$12,305.28
|
| Rate for Payer: NAPHCARE Commercial |
$9,228.96
|
| Rate for Payer: Preferred Network Access Commercial |
$14,151.07
|
| Rate for Payer: Quartz Beloit One Network |
$7,536.98
|
| Rate for Payer: Quartz Commercial |
$9,998.04
|
| Rate for Payer: Quartz Medicare Advantage |
$9,228.96
|
| Rate for Payer: The Alliance Commercial |
$7,690.80
|
| Rate for Payer: WEA Trust Commercial |
$8,459.88
|
| Rate for Payer: WPS Commercial |
$11,392.74
|
|
|
STEM 7.5MM EVOLVE RADIAL
|
Facility
|
OP
|
$14,790.00
|
|
| Hospital Charge Code |
2967401
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,306.85 |
| Max. Negotiated Rate |
$14,151.07 |
| Rate for Payer: Aetna Commercial |
$13,843.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,228.18
|
| Rate for Payer: Aetna Managed Medicare |
$4,306.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,998.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,690.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,383.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,152.25
|
| Rate for Payer: Cash Price |
$4,437.00
|
| Rate for Payer: Cigna Commercial |
$14,151.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,607.78
|
| Rate for Payer: Health EOS Commercial |
$13,689.62
|
| Rate for Payer: HFN Commercial |
$14,151.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,536.20
|
| Rate for Payer: Multiplan Commercial |
$12,305.28
|
| Rate for Payer: NAPHCARE Commercial |
$9,228.96
|
| Rate for Payer: Preferred Network Access Commercial |
$14,151.07
|
| Rate for Payer: Quartz Beloit One Network |
$7,536.98
|
| Rate for Payer: Quartz Commercial |
$9,998.04
|
| Rate for Payer: Quartz Medicare Advantage |
$9,228.96
|
| Rate for Payer: The Alliance Commercial |
$7,690.80
|
| Rate for Payer: WEA Trust Commercial |
$8,459.88
|
| Rate for Payer: WPS Commercial |
$11,392.74
|
|
|
STEM 7.5MM EVOLVE RADIAL
|
Facility
|
IP
|
$14,790.00
|
|
| Hospital Charge Code |
2967401
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,536.98 |
| Max. Negotiated Rate |
$14,151.07 |
| Rate for Payer: Aetna Commercial |
$13,843.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,228.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,152.25
|
| Rate for Payer: Cash Price |
$4,437.00
|
| Rate for Payer: Cigna Commercial |
$14,151.07
|
| Rate for Payer: Health EOS Commercial |
$13,689.62
|
| Rate for Payer: HFN Commercial |
$14,151.07
|
| Rate for Payer: Multiplan Commercial |
$12,305.28
|
| Rate for Payer: Preferred Network Access Commercial |
$14,151.07
|
| Rate for Payer: Quartz Beloit One Network |
$7,536.98
|
| Rate for Payer: Quartz Commercial |
$9,228.96
|
| Rate for Payer: WEA Trust Commercial |
$8,459.88
|
| Rate for Payer: WPS Commercial |
$11,392.74
|
|
|
STEM 8/120 HUMERAL CEMENTED
|
Facility
|
IP
|
$18,749.00
|
|
| Hospital Charge Code |
2966587
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,554.49 |
| Max. Negotiated Rate |
$17,939.04 |
| Rate for Payer: Aetna Commercial |
$17,549.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,769.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,334.45
|
| Rate for Payer: Cash Price |
$5,624.70
|
| Rate for Payer: Cigna Commercial |
$17,939.04
|
| Rate for Payer: Health EOS Commercial |
$17,354.07
|
| Rate for Payer: HFN Commercial |
$17,939.04
|
| Rate for Payer: Multiplan Commercial |
$15,599.17
|
| Rate for Payer: Preferred Network Access Commercial |
$17,939.04
|
| Rate for Payer: Quartz Beloit One Network |
$9,554.49
|
| Rate for Payer: Quartz Commercial |
$11,699.38
|
| Rate for Payer: WEA Trust Commercial |
$10,724.43
|
| Rate for Payer: WPS Commercial |
$14,442.35
|
|
|
STEM 8/120 HUMERAL CEMENTED
|
Facility
|
OP
|
$18,749.00
|
|
| Hospital Charge Code |
2966587
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,459.71 |
| Max. Negotiated Rate |
$17,939.04 |
| Rate for Payer: Aetna Commercial |
$17,549.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,769.11
|
| Rate for Payer: Aetna Managed Medicare |
$5,459.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,674.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,749.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,359.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,334.45
|
| Rate for Payer: Cash Price |
$5,624.70
|
| Rate for Payer: Cigna Commercial |
$17,939.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,911.92
|
| Rate for Payer: Health EOS Commercial |
$17,354.07
|
| Rate for Payer: HFN Commercial |
$17,939.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,624.22
|
| Rate for Payer: Multiplan Commercial |
$15,599.17
|
| Rate for Payer: NAPHCARE Commercial |
$11,699.38
|
| Rate for Payer: Preferred Network Access Commercial |
$17,939.04
|
| Rate for Payer: Quartz Beloit One Network |
$9,554.49
|
| Rate for Payer: Quartz Commercial |
$12,674.32
|
| Rate for Payer: Quartz Medicare Advantage |
$11,699.38
|
| Rate for Payer: The Alliance Commercial |
$9,749.48
|
| Rate for Payer: WEA Trust Commercial |
$10,724.43
|
| Rate for Payer: WPS Commercial |
$14,442.35
|
|
|
STEM ARCOS ONE-PIECE REVISION 14MM STD OFFSET 11-303114
|
Facility
|
IP
|
$51,262.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563439
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$26,123.12 |
| Max. Negotiated Rate |
$49,047.48 |
| Rate for Payer: Aetna Commercial |
$47,981.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$45,848.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28,255.61
|
| Rate for Payer: Cash Price |
$15,378.60
|
| Rate for Payer: Cigna Commercial |
$49,047.48
|
| Rate for Payer: Health EOS Commercial |
$47,448.11
|
| Rate for Payer: HFN Commercial |
$49,047.48
|
| Rate for Payer: Multiplan Commercial |
$42,649.98
|
| Rate for Payer: Preferred Network Access Commercial |
$49,047.48
|
| Rate for Payer: Quartz Beloit One Network |
$26,123.12
|
| Rate for Payer: Quartz Commercial |
$31,987.49
|
| Rate for Payer: WEA Trust Commercial |
$29,321.86
|
| Rate for Payer: WPS Commercial |
$39,487.12
|
|
|
STEM ARCOS ONE-PIECE REVISION 14MM STD OFFSET 11-303114
|
Facility
|
OP
|
$51,262.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563439
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14,927.49 |
| Max. Negotiated Rate |
$49,047.48 |
| Rate for Payer: Aetna Commercial |
$47,981.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$45,848.73
|
| Rate for Payer: Aetna Managed Medicare |
$14,927.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$34,653.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26,656.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25,589.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28,255.61
|
| Rate for Payer: Cash Price |
$15,378.60
|
| Rate for Payer: Cigna Commercial |
$49,047.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29,834.48
|
| Rate for Payer: Health EOS Commercial |
$47,448.11
|
| Rate for Payer: HFN Commercial |
$49,047.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39,984.36
|
| Rate for Payer: Multiplan Commercial |
$42,649.98
|
| Rate for Payer: NAPHCARE Commercial |
$31,987.49
|
| Rate for Payer: Preferred Network Access Commercial |
$49,047.48
|
| Rate for Payer: Quartz Beloit One Network |
$26,123.12
|
| Rate for Payer: Quartz Commercial |
$34,653.11
|
| Rate for Payer: Quartz Medicare Advantage |
$31,987.49
|
| Rate for Payer: The Alliance Commercial |
$26,656.24
|
| Rate for Payer: WEA Trust Commercial |
$29,321.86
|
| Rate for Payer: WPS Commercial |
$39,487.12
|
|
|
STEM ARCOS ONE-PIECE REVISION 16MM STD OFFSET 11-303116
|
Facility
|
OP
|
$36,614.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6179800
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,662.00 |
| Max. Negotiated Rate |
$35,032.28 |
| Rate for Payer: Aetna Commercial |
$34,270.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$32,747.56
|
| Rate for Payer: Aetna Managed Medicare |
$10,662.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$24,751.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,039.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18,277.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$20,181.64
|
| Rate for Payer: Cash Price |
$10,984.20
|
| Rate for Payer: Cigna Commercial |
$35,032.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21,309.35
|
| Rate for Payer: Health EOS Commercial |
$33,889.92
|
| Rate for Payer: HFN Commercial |
$35,032.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28,558.92
|
| Rate for Payer: Multiplan Commercial |
$30,462.85
|
| Rate for Payer: NAPHCARE Commercial |
$22,847.14
|
| Rate for Payer: Preferred Network Access Commercial |
$35,032.28
|
| Rate for Payer: Quartz Beloit One Network |
$18,658.49
|
| Rate for Payer: Quartz Commercial |
$24,751.06
|
| Rate for Payer: Quartz Medicare Advantage |
$22,847.14
|
| Rate for Payer: The Alliance Commercial |
$19,039.28
|
| Rate for Payer: WEA Trust Commercial |
$20,943.21
|
| Rate for Payer: WPS Commercial |
$28,203.76
|
|
|
STEM ARCOS ONE-PIECE REVISION 16MM STD OFFSET 11-303116
|
Facility
|
IP
|
$36,614.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6179800
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18,658.49 |
| Max. Negotiated Rate |
$35,032.28 |
| Rate for Payer: Aetna Commercial |
$34,270.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$32,747.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$20,181.64
|
| Rate for Payer: Cash Price |
$10,984.20
|
| Rate for Payer: Cigna Commercial |
$35,032.28
|
| Rate for Payer: Health EOS Commercial |
$33,889.92
|
| Rate for Payer: HFN Commercial |
$35,032.28
|
| Rate for Payer: Multiplan Commercial |
$30,462.85
|
| Rate for Payer: Preferred Network Access Commercial |
$35,032.28
|
| Rate for Payer: Quartz Beloit One Network |
$18,658.49
|
| Rate for Payer: Quartz Commercial |
$22,847.14
|
| Rate for Payer: WEA Trust Commercial |
$20,943.21
|
| Rate for Payer: WPS Commercial |
$28,203.76
|
|
|
STEM CENTRALIZER CEMENTRALIZER 10.0MM CEMENTED 1376-48-000
|
Facility
|
OP
|
$1,606.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5547547
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$467.67 |
| Max. Negotiated Rate |
$1,536.62 |
| Rate for Payer: Aetna Commercial |
$1,503.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,436.41
|
| Rate for Payer: Aetna Managed Medicare |
$467.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,085.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$835.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$801.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$885.23
|
| Rate for Payer: Cash Price |
$481.80
|
| Rate for Payer: Cigna Commercial |
$1,536.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$934.69
|
| Rate for Payer: Health EOS Commercial |
$1,486.51
|
| Rate for Payer: HFN Commercial |
$1,536.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,252.68
|
| Rate for Payer: Multiplan Commercial |
$1,336.19
|
| Rate for Payer: NAPHCARE Commercial |
$1,002.14
|
| Rate for Payer: Preferred Network Access Commercial |
$1,536.62
|
| Rate for Payer: Quartz Beloit One Network |
$818.42
|
| Rate for Payer: Quartz Commercial |
$1,085.66
|
| Rate for Payer: Quartz Medicare Advantage |
$1,002.14
|
| Rate for Payer: The Alliance Commercial |
$835.12
|
| Rate for Payer: WEA Trust Commercial |
$918.63
|
| Rate for Payer: WPS Commercial |
$1,237.10
|
|
|
STEM CENTRALIZER CEMENTRALIZER 10.0MM CEMENTED 1376-48-000
|
Facility
|
IP
|
$1,606.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5547547
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$818.42 |
| Max. Negotiated Rate |
$1,536.62 |
| Rate for Payer: Aetna Commercial |
$1,503.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,436.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$885.23
|
| Rate for Payer: Cash Price |
$481.80
|
| Rate for Payer: Cigna Commercial |
$1,536.62
|
| Rate for Payer: Health EOS Commercial |
$1,486.51
|
| Rate for Payer: HFN Commercial |
$1,536.62
|
| Rate for Payer: Multiplan Commercial |
$1,336.19
|
| Rate for Payer: Preferred Network Access Commercial |
$1,536.62
|
| Rate for Payer: Quartz Beloit One Network |
$818.42
|
| Rate for Payer: Quartz Commercial |
$1,002.14
|
| Rate for Payer: WEA Trust Commercial |
$918.63
|
| Rate for Payer: WPS Commercial |
$1,237.10
|
|
|
STEM CENTRALIZER CEMENTRALIZER 10.5MM CEMENTED 1376-38-000
|
Facility
|
OP
|
$1,296.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5787631
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$377.40 |
| Max. Negotiated Rate |
$1,240.01 |
| Rate for Payer: Aetna Commercial |
$1,213.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,159.14
|
| Rate for Payer: Aetna Managed Medicare |
$377.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$876.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$673.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$646.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$714.36
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cigna Commercial |
$1,240.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$754.27
|
| Rate for Payer: Health EOS Commercial |
$1,199.58
|
| Rate for Payer: HFN Commercial |
$1,240.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,010.88
|
| Rate for Payer: Multiplan Commercial |
$1,078.27
|
| Rate for Payer: NAPHCARE Commercial |
$808.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,240.01
|
| Rate for Payer: Quartz Beloit One Network |
$660.44
|
| Rate for Payer: Quartz Commercial |
$876.10
|
| Rate for Payer: Quartz Medicare Advantage |
$808.70
|
| Rate for Payer: The Alliance Commercial |
$673.92
|
| Rate for Payer: WEA Trust Commercial |
$741.31
|
| Rate for Payer: WPS Commercial |
$998.31
|
|
|
STEM CENTRALIZER CEMENTRALIZER 10.5MM CEMENTED 1376-38-000
|
Facility
|
IP
|
$1,296.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5787631
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$660.44 |
| Max. Negotiated Rate |
$1,240.01 |
| Rate for Payer: Aetna Commercial |
$1,213.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,159.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$714.36
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cigna Commercial |
$1,240.01
|
| Rate for Payer: Health EOS Commercial |
$1,199.58
|
| Rate for Payer: HFN Commercial |
$1,240.01
|
| Rate for Payer: Multiplan Commercial |
$1,078.27
|
| Rate for Payer: Preferred Network Access Commercial |
$1,240.01
|
| Rate for Payer: Quartz Beloit One Network |
$660.44
|
| Rate for Payer: Quartz Commercial |
$808.70
|
| Rate for Payer: WEA Trust Commercial |
$741.31
|
| Rate for Payer: WPS Commercial |
$998.31
|
|
|
STEM CENTRALIZER CEMENTRALIZER 11.0MM CEMENTED 1376-20-000
|
Facility
|
OP
|
$1,348.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5603719
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$392.54 |
| Max. Negotiated Rate |
$1,289.77 |
| Rate for Payer: Aetna Commercial |
$1,261.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,205.65
|
| Rate for Payer: Aetna Managed Medicare |
$392.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$911.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$700.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$672.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$743.02
|
| Rate for Payer: Cash Price |
$404.40
|
| Rate for Payer: Cigna Commercial |
$1,289.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$784.54
|
| Rate for Payer: Health EOS Commercial |
$1,247.71
|
| Rate for Payer: HFN Commercial |
$1,289.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,051.44
|
| Rate for Payer: Multiplan Commercial |
$1,121.54
|
| Rate for Payer: NAPHCARE Commercial |
$841.15
|
| Rate for Payer: Preferred Network Access Commercial |
$1,289.77
|
| Rate for Payer: Quartz Beloit One Network |
$686.94
|
| Rate for Payer: Quartz Commercial |
$911.25
|
| Rate for Payer: Quartz Medicare Advantage |
$841.15
|
| Rate for Payer: The Alliance Commercial |
$700.96
|
| Rate for Payer: WEA Trust Commercial |
$771.06
|
| Rate for Payer: WPS Commercial |
$1,038.36
|
|
|
STEM CENTRALIZER CEMENTRALIZER 11.0MM CEMENTED 1376-20-000
|
Facility
|
IP
|
$1,348.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5603719
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$686.94 |
| Max. Negotiated Rate |
$1,289.77 |
| Rate for Payer: Aetna Commercial |
$1,261.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,205.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$743.02
|
| Rate for Payer: Cash Price |
$404.40
|
| Rate for Payer: Cigna Commercial |
$1,289.77
|
| Rate for Payer: Health EOS Commercial |
$1,247.71
|
| Rate for Payer: HFN Commercial |
$1,289.77
|
| Rate for Payer: Multiplan Commercial |
$1,121.54
|
| Rate for Payer: Preferred Network Access Commercial |
$1,289.77
|
| Rate for Payer: Quartz Beloit One Network |
$686.94
|
| Rate for Payer: Quartz Commercial |
$841.15
|
| Rate for Payer: WEA Trust Commercial |
$771.06
|
| Rate for Payer: WPS Commercial |
$1,038.36
|
|
|
STEM CENTRALIZER CEMENTRALIZER 12.0.MM CEMENTED 1376-21-000
|
Facility
|
IP
|
$1,606.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5520921
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$818.42 |
| Max. Negotiated Rate |
$1,536.62 |
| Rate for Payer: Aetna Commercial |
$1,503.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,436.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$885.23
|
| Rate for Payer: Cash Price |
$481.80
|
| Rate for Payer: Cigna Commercial |
$1,536.62
|
| Rate for Payer: Health EOS Commercial |
$1,486.51
|
| Rate for Payer: HFN Commercial |
$1,536.62
|
| Rate for Payer: Multiplan Commercial |
$1,336.19
|
| Rate for Payer: Preferred Network Access Commercial |
$1,536.62
|
| Rate for Payer: Quartz Beloit One Network |
$818.42
|
| Rate for Payer: Quartz Commercial |
$1,002.14
|
| Rate for Payer: WEA Trust Commercial |
$918.63
|
| Rate for Payer: WPS Commercial |
$1,237.10
|
|
|
STEM CENTRALIZER CEMENTRALIZER 12.0.MM CEMENTED 1376-21-000
|
Facility
|
OP
|
$1,606.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5520921
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$467.67 |
| Max. Negotiated Rate |
$1,536.62 |
| Rate for Payer: Aetna Commercial |
$1,503.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,436.41
|
| Rate for Payer: Aetna Managed Medicare |
$467.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,085.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$835.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$801.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$885.23
|
| Rate for Payer: Cash Price |
$481.80
|
| Rate for Payer: Cigna Commercial |
$1,536.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$934.69
|
| Rate for Payer: Health EOS Commercial |
$1,486.51
|
| Rate for Payer: HFN Commercial |
$1,536.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,252.68
|
| Rate for Payer: Multiplan Commercial |
$1,336.19
|
| Rate for Payer: NAPHCARE Commercial |
$1,002.14
|
| Rate for Payer: Preferred Network Access Commercial |
$1,536.62
|
| Rate for Payer: Quartz Beloit One Network |
$818.42
|
| Rate for Payer: Quartz Commercial |
$1,085.66
|
| Rate for Payer: Quartz Medicare Advantage |
$1,002.14
|
| Rate for Payer: The Alliance Commercial |
$835.12
|
| Rate for Payer: WEA Trust Commercial |
$918.63
|
| Rate for Payer: WPS Commercial |
$1,237.10
|
|
|
STEM CENTRALIZER CEMENTRALIZER 13.0MM CEMENTED 1376-22-000
|
Facility
|
OP
|
$1,198.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6202964
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$348.86 |
| Max. Negotiated Rate |
$1,146.25 |
| Rate for Payer: Aetna Commercial |
$1,121.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,071.49
|
| Rate for Payer: Aetna Managed Medicare |
$348.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$809.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$622.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$598.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$660.34
|
| Rate for Payer: Cash Price |
$359.40
|
| Rate for Payer: Cigna Commercial |
$1,146.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$697.24
|
| Rate for Payer: Health EOS Commercial |
$1,108.87
|
| Rate for Payer: HFN Commercial |
$1,146.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$934.44
|
| Rate for Payer: Multiplan Commercial |
$996.74
|
| Rate for Payer: NAPHCARE Commercial |
$747.55
|
| Rate for Payer: Preferred Network Access Commercial |
$1,146.25
|
| Rate for Payer: Quartz Beloit One Network |
$610.50
|
| Rate for Payer: Quartz Commercial |
$809.85
|
| Rate for Payer: Quartz Medicare Advantage |
$747.55
|
| Rate for Payer: The Alliance Commercial |
$622.96
|
| Rate for Payer: WEA Trust Commercial |
$685.26
|
| Rate for Payer: WPS Commercial |
$922.82
|
|
|
STEM CENTRALIZER CEMENTRALIZER 13.0MM CEMENTED 1376-22-000
|
Facility
|
IP
|
$1,198.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6202964
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.50 |
| Max. Negotiated Rate |
$1,146.25 |
| Rate for Payer: Aetna Commercial |
$1,121.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,071.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$660.34
|
| Rate for Payer: Cash Price |
$359.40
|
| Rate for Payer: Cigna Commercial |
$1,146.25
|
| Rate for Payer: Health EOS Commercial |
$1,108.87
|
| Rate for Payer: HFN Commercial |
$1,146.25
|
| Rate for Payer: Multiplan Commercial |
$996.74
|
| Rate for Payer: Preferred Network Access Commercial |
$1,146.25
|
| Rate for Payer: Quartz Beloit One Network |
$610.50
|
| Rate for Payer: Quartz Commercial |
$747.55
|
| Rate for Payer: WEA Trust Commercial |
$685.26
|
| Rate for Payer: WPS Commercial |
$922.82
|
|
|
STEM CENTRALIZER CEMENTRALIZER 8.5MM CEMENTED 1376-46-000
|
Facility
|
IP
|
$1,544.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563461
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$786.82 |
| Max. Negotiated Rate |
$1,477.30 |
| Rate for Payer: Aetna Commercial |
$1,445.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,380.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$851.05
|
| Rate for Payer: Cash Price |
$463.20
|
| Rate for Payer: Cigna Commercial |
$1,477.30
|
| Rate for Payer: Health EOS Commercial |
$1,429.13
|
| Rate for Payer: HFN Commercial |
$1,477.30
|
| Rate for Payer: Multiplan Commercial |
$1,284.61
|
| Rate for Payer: Preferred Network Access Commercial |
$1,477.30
|
| Rate for Payer: Quartz Beloit One Network |
$786.82
|
| Rate for Payer: Quartz Commercial |
$963.46
|
| Rate for Payer: WEA Trust Commercial |
$883.17
|
| Rate for Payer: WPS Commercial |
$1,189.34
|
|
|
STEM CENTRALIZER CEMENTRALIZER 8.5MM CEMENTED 1376-46-000
|
Facility
|
OP
|
$1,544.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563461
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$449.61 |
| Max. Negotiated Rate |
$1,477.30 |
| Rate for Payer: Aetna Commercial |
$1,445.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,380.95
|
| Rate for Payer: Aetna Managed Medicare |
$449.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,043.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$802.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$770.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$851.05
|
| Rate for Payer: Cash Price |
$463.20
|
| Rate for Payer: Cigna Commercial |
$1,477.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$898.61
|
| Rate for Payer: Health EOS Commercial |
$1,429.13
|
| Rate for Payer: HFN Commercial |
$1,477.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,204.32
|
| Rate for Payer: Multiplan Commercial |
$1,284.61
|
| Rate for Payer: NAPHCARE Commercial |
$963.46
|
| Rate for Payer: Preferred Network Access Commercial |
$1,477.30
|
| Rate for Payer: Quartz Beloit One Network |
$786.82
|
| Rate for Payer: Quartz Commercial |
$1,043.74
|
| Rate for Payer: Quartz Medicare Advantage |
$963.46
|
| Rate for Payer: The Alliance Commercial |
$802.88
|
| Rate for Payer: WEA Trust Commercial |
$883.17
|
| Rate for Payer: WPS Commercial |
$1,189.34
|
|
|
STEM CENTRALIZER CEMENTRALIZER 9.25MM CEMENTED 1376-47-000
|
Facility
|
IP
|
$1,606.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5490784
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$818.42 |
| Max. Negotiated Rate |
$1,536.62 |
| Rate for Payer: Aetna Commercial |
$1,503.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,436.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$885.23
|
| Rate for Payer: Cash Price |
$481.80
|
| Rate for Payer: Cigna Commercial |
$1,536.62
|
| Rate for Payer: Health EOS Commercial |
$1,486.51
|
| Rate for Payer: HFN Commercial |
$1,536.62
|
| Rate for Payer: Multiplan Commercial |
$1,336.19
|
| Rate for Payer: Preferred Network Access Commercial |
$1,536.62
|
| Rate for Payer: Quartz Beloit One Network |
$818.42
|
| Rate for Payer: Quartz Commercial |
$1,002.14
|
| Rate for Payer: WEA Trust Commercial |
$918.63
|
| Rate for Payer: WPS Commercial |
$1,237.10
|
|
