|
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 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
|
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 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 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
|
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 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 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 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 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
|
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 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 17 X150 7850-17-05
|
Facility
|
OP
|
$12,032.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967871
|
|
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
|
|
|
STEM HUMERAL FRACTURE COMPREHENSIVE REVERSE SHOULDER 10MM X 122MM 12-113560
|
Facility
|
IP
|
$16,843.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6166000
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,583.19 |
| Max. Negotiated Rate |
$16,115.38 |
| Rate for Payer: Aetna Commercial |
$15,765.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,064.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,283.86
|
| Rate for Payer: Cash Price |
$5,052.90
|
| Rate for Payer: Cigna Commercial |
$16,115.38
|
| Rate for Payer: Health EOS Commercial |
$15,589.88
|
| Rate for Payer: HFN Commercial |
$16,115.38
|
| Rate for Payer: Multiplan Commercial |
$14,013.38
|
| Rate for Payer: Preferred Network Access Commercial |
$16,115.38
|
| Rate for Payer: Quartz Beloit One Network |
$8,583.19
|
| Rate for Payer: Quartz Commercial |
$10,510.03
|
| Rate for Payer: WEA Trust Commercial |
$9,634.20
|
| Rate for Payer: WPS Commercial |
$12,974.16
|
|
|
STEM HUMERAL FRACTURE COMPREHENSIVE REVERSE SHOULDER 10MM X 122MM 12-113560
|
Facility
|
OP
|
$16,843.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6166000
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,904.68 |
| Max. Negotiated Rate |
$16,115.38 |
| Rate for Payer: Aetna Commercial |
$15,765.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,064.38
|
| Rate for Payer: Aetna Managed Medicare |
$4,904.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,385.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,758.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,408.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,283.86
|
| Rate for Payer: Cash Price |
$5,052.90
|
| Rate for Payer: Cigna Commercial |
$16,115.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,802.63
|
| Rate for Payer: Health EOS Commercial |
$15,589.88
|
| Rate for Payer: HFN Commercial |
$16,115.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,137.54
|
| Rate for Payer: Multiplan Commercial |
$14,013.38
|
| Rate for Payer: NAPHCARE Commercial |
$10,510.03
|
| Rate for Payer: Preferred Network Access Commercial |
$16,115.38
|
| Rate for Payer: Quartz Beloit One Network |
$8,583.19
|
| Rate for Payer: Quartz Commercial |
$11,385.87
|
| Rate for Payer: Quartz Medicare Advantage |
$10,510.03
|
| Rate for Payer: The Alliance Commercial |
$8,758.36
|
| Rate for Payer: WEA Trust Commercial |
$9,634.20
|
| Rate for Payer: WPS Commercial |
$12,974.16
|
|
|
STEM MODULAR HUMERAL 10x130
|
Facility
|
OP
|
$17,195.00
|
|
| Hospital Charge Code |
2967538
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,007.18 |
| Max. Negotiated Rate |
$16,452.18 |
| Rate for Payer: Aetna Commercial |
$16,094.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,379.21
|
| Rate for Payer: Aetna Managed Medicare |
$5,007.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,623.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,941.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,583.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,477.88
|
| Rate for Payer: Cash Price |
$5,158.50
|
| Rate for Payer: Cigna Commercial |
$16,452.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,007.49
|
| Rate for Payer: Health EOS Commercial |
$15,915.69
|
| Rate for Payer: HFN Commercial |
$16,452.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,412.10
|
| Rate for Payer: Multiplan Commercial |
$14,306.24
|
| Rate for Payer: NAPHCARE Commercial |
$10,729.68
|
| Rate for Payer: Preferred Network Access Commercial |
$16,452.18
|
| Rate for Payer: Quartz Beloit One Network |
$8,762.57
|
| Rate for Payer: Quartz Commercial |
$11,623.82
|
| Rate for Payer: Quartz Medicare Advantage |
$10,729.68
|
| Rate for Payer: The Alliance Commercial |
$8,941.40
|
| Rate for Payer: WEA Trust Commercial |
$9,835.54
|
| Rate for Payer: WPS Commercial |
$13,245.31
|
|
|
STEM MODULAR HUMERAL 10x130
|
Facility
|
IP
|
$17,195.00
|
|
| Hospital Charge Code |
2967538
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,762.57 |
| Max. Negotiated Rate |
$16,452.18 |
| Rate for Payer: Aetna Commercial |
$16,094.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,379.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,477.88
|
| Rate for Payer: Cash Price |
$5,158.50
|
| Rate for Payer: Cigna Commercial |
$16,452.18
|
| Rate for Payer: Health EOS Commercial |
$15,915.69
|
| Rate for Payer: HFN Commercial |
$16,452.18
|
| Rate for Payer: Multiplan Commercial |
$14,306.24
|
| Rate for Payer: Preferred Network Access Commercial |
$16,452.18
|
| Rate for Payer: Quartz Beloit One Network |
$8,762.57
|
| Rate for Payer: Quartz Commercial |
$10,729.68
|
| Rate for Payer: WEA Trust Commercial |
$9,835.54
|
| Rate for Payer: WPS Commercial |
$13,245.31
|
|
|
STEM RECLAIM DISTAL TAPERED 16MM X 190MM STRAIGHT 1976-16-190
|
Facility
|
OP
|
$25,044.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6151669
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,292.81 |
| Max. Negotiated Rate |
$23,962.10 |
| Rate for Payer: Aetna Commercial |
$23,441.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$22,399.35
|
| Rate for Payer: Aetna Managed Medicare |
$7,292.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,929.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,022.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,501.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,804.25
|
| Rate for Payer: Cash Price |
$7,513.20
|
| Rate for Payer: Cigna Commercial |
$23,962.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14,575.61
|
| Rate for Payer: Health EOS Commercial |
$23,180.73
|
| Rate for Payer: HFN Commercial |
$23,962.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19,534.32
|
| Rate for Payer: Multiplan Commercial |
$20,836.61
|
| Rate for Payer: NAPHCARE Commercial |
$15,627.46
|
| Rate for Payer: Preferred Network Access Commercial |
$23,962.10
|
| Rate for Payer: Quartz Beloit One Network |
$12,762.42
|
| Rate for Payer: Quartz Commercial |
$16,929.74
|
| Rate for Payer: Quartz Medicare Advantage |
$15,627.46
|
| Rate for Payer: The Alliance Commercial |
$13,022.88
|
| Rate for Payer: WEA Trust Commercial |
$14,325.17
|
| Rate for Payer: WPS Commercial |
$19,291.39
|
|
|
STEM RECLAIM DISTAL TAPERED 16MM X 190MM STRAIGHT 1976-16-190
|
Facility
|
IP
|
$25,044.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6151669
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,762.42 |
| Max. Negotiated Rate |
$23,962.10 |
| Rate for Payer: Aetna Commercial |
$23,441.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$22,399.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,804.25
|
| Rate for Payer: Cash Price |
$7,513.20
|
| Rate for Payer: Cigna Commercial |
$23,962.10
|
| Rate for Payer: Health EOS Commercial |
$23,180.73
|
| Rate for Payer: HFN Commercial |
$23,962.10
|
| Rate for Payer: Multiplan Commercial |
$20,836.61
|
| Rate for Payer: Preferred Network Access Commercial |
$23,962.10
|
| Rate for Payer: Quartz Beloit One Network |
$12,762.42
|
| Rate for Payer: Quartz Commercial |
$15,627.46
|
| Rate for Payer: WEA Trust Commercial |
$14,325.17
|
| Rate for Payer: WPS Commercial |
$19,291.39
|
|
|
STEM REVISION CEMENTED ATTUNE 14MM X 30MM 1512-14-030
|
Facility
|
OP
|
$7,560.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563335
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,201.47 |
| Max. Negotiated Rate |
$7,233.41 |
| Rate for Payer: Aetna Commercial |
$7,076.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,761.66
|
| Rate for Payer: Aetna Managed Medicare |
$2,201.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,110.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,931.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,773.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,167.07
|
| Rate for Payer: Cash Price |
$2,268.00
|
| Rate for Payer: Cigna Commercial |
$7,233.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,399.92
|
| Rate for Payer: Health EOS Commercial |
$6,997.54
|
| Rate for Payer: HFN Commercial |
$7,233.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,896.80
|
| Rate for Payer: Multiplan Commercial |
$6,289.92
|
| Rate for Payer: NAPHCARE Commercial |
$4,717.44
|
| Rate for Payer: Preferred Network Access Commercial |
$7,233.41
|
| Rate for Payer: Quartz Beloit One Network |
$3,852.58
|
| Rate for Payer: Quartz Commercial |
$5,110.56
|
| Rate for Payer: Quartz Medicare Advantage |
$4,717.44
|
| Rate for Payer: The Alliance Commercial |
$3,931.20
|
| Rate for Payer: WEA Trust Commercial |
$4,324.32
|
| Rate for Payer: WPS Commercial |
$5,823.47
|
|
|
STEM REVISION CEMENTED ATTUNE 14MM X 30MM 1512-14-030
|
Facility
|
IP
|
$7,560.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563335
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,852.58 |
| Max. Negotiated Rate |
$7,233.41 |
| Rate for Payer: Aetna Commercial |
$7,076.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,761.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,167.07
|
| Rate for Payer: Cash Price |
$2,268.00
|
| Rate for Payer: Cigna Commercial |
$7,233.41
|
| Rate for Payer: Health EOS Commercial |
$6,997.54
|
| Rate for Payer: HFN Commercial |
$7,233.41
|
| Rate for Payer: Multiplan Commercial |
$6,289.92
|
| Rate for Payer: Preferred Network Access Commercial |
$7,233.41
|
| Rate for Payer: Quartz Beloit One Network |
$3,852.58
|
| Rate for Payer: Quartz Commercial |
$4,717.44
|
| Rate for Payer: WEA Trust Commercial |
$4,324.32
|
| Rate for Payer: WPS Commercial |
$5,823.47
|
|
