|
FEMORAL SIGMA CRUCIATE RETAINTING CEMENTED SZ 6 RT 96-0015
|
Facility
|
IP
|
$6,176.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5803648
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,147.29 |
| Max. Negotiated Rate |
$5,909.20 |
| Rate for Payer: Aetna Commercial |
$5,780.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,523.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,404.21
|
| Rate for Payer: Cash Price |
$1,852.80
|
| Rate for Payer: Cigna Commercial |
$5,909.20
|
| Rate for Payer: Health EOS Commercial |
$5,716.51
|
| Rate for Payer: HFN Commercial |
$5,909.20
|
| Rate for Payer: Multiplan Commercial |
$5,138.43
|
| Rate for Payer: Preferred Network Access Commercial |
$5,909.20
|
| Rate for Payer: Quartz Beloit One Network |
$3,147.29
|
| Rate for Payer: Quartz Commercial |
$3,853.82
|
| Rate for Payer: WEA Trust Commercial |
$3,532.67
|
| Rate for Payer: WPS Commercial |
$4,757.37
|
|
|
FEMORAL SIGMA CRUCIATE RETAINTING CEMENTED SZ 6 RT 96-0015
|
Facility
|
OP
|
$6,176.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5803648
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,798.45 |
| Max. Negotiated Rate |
$5,909.20 |
| Rate for Payer: Aetna Commercial |
$5,780.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,523.81
|
| Rate for Payer: Aetna Managed Medicare |
$1,798.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,174.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,211.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,083.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,404.21
|
| Rate for Payer: Cash Price |
$1,852.80
|
| Rate for Payer: Cigna Commercial |
$5,909.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,594.43
|
| Rate for Payer: Health EOS Commercial |
$5,716.51
|
| Rate for Payer: HFN Commercial |
$5,909.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,817.28
|
| Rate for Payer: Multiplan Commercial |
$5,138.43
|
| Rate for Payer: NAPHCARE Commercial |
$3,853.82
|
| Rate for Payer: Preferred Network Access Commercial |
$5,909.20
|
| Rate for Payer: Quartz Beloit One Network |
$3,147.29
|
| Rate for Payer: Quartz Commercial |
$4,174.98
|
| Rate for Payer: Quartz Medicare Advantage |
$3,853.82
|
| Rate for Payer: The Alliance Commercial |
$3,211.52
|
| Rate for Payer: WEA Trust Commercial |
$3,532.67
|
| Rate for Payer: WPS Commercial |
$4,757.37
|
|
|
FEMORAL SLEEVE FULL POROUS ATTUNE 31MM 1294-53-216
|
Facility
|
IP
|
$16,891.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5641692
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,607.65 |
| Max. Negotiated Rate |
$16,161.31 |
| Rate for Payer: Aetna Commercial |
$15,809.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,107.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,310.32
|
| Rate for Payer: Cash Price |
$5,067.30
|
| Rate for Payer: Cigna Commercial |
$16,161.31
|
| Rate for Payer: Health EOS Commercial |
$15,634.31
|
| Rate for Payer: HFN Commercial |
$16,161.31
|
| Rate for Payer: Multiplan Commercial |
$14,053.31
|
| Rate for Payer: Preferred Network Access Commercial |
$16,161.31
|
| Rate for Payer: Quartz Beloit One Network |
$8,607.65
|
| Rate for Payer: Quartz Commercial |
$10,539.98
|
| Rate for Payer: WEA Trust Commercial |
$9,661.65
|
| Rate for Payer: WPS Commercial |
$13,011.14
|
|
|
FEMORAL SLEEVE FULL POROUS ATTUNE 31MM 1294-53-216
|
Facility
|
OP
|
$16,891.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5641692
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,918.66 |
| Max. Negotiated Rate |
$16,161.31 |
| Rate for Payer: Aetna Commercial |
$15,809.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,107.31
|
| Rate for Payer: Aetna Managed Medicare |
$4,918.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,418.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,783.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,431.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,310.32
|
| Rate for Payer: Cash Price |
$5,067.30
|
| Rate for Payer: Cigna Commercial |
$16,161.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,830.56
|
| Rate for Payer: Health EOS Commercial |
$15,634.31
|
| Rate for Payer: HFN Commercial |
$16,161.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,174.98
|
| Rate for Payer: Multiplan Commercial |
$14,053.31
|
| Rate for Payer: NAPHCARE Commercial |
$10,539.98
|
| Rate for Payer: Preferred Network Access Commercial |
$16,161.31
|
| Rate for Payer: Quartz Beloit One Network |
$8,607.65
|
| Rate for Payer: Quartz Commercial |
$11,418.32
|
| Rate for Payer: Quartz Medicare Advantage |
$10,539.98
|
| Rate for Payer: The Alliance Commercial |
$8,783.32
|
| Rate for Payer: WEA Trust Commercial |
$9,661.65
|
| Rate for Payer: WPS Commercial |
$13,011.14
|
|
|
FEMORAL SLEEVE FULL POROUS ATTUNE 34MM 1294-53-226
|
Facility
|
OP
|
$23,225.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5459697
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,763.12 |
| Max. Negotiated Rate |
$22,221.68 |
| Rate for Payer: Aetna Commercial |
$21,738.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20,772.44
|
| Rate for Payer: Aetna Managed Medicare |
$6,763.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,700.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,077.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,593.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12,801.62
|
| Rate for Payer: Cash Price |
$6,967.50
|
| Rate for Payer: Cigna Commercial |
$22,221.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13,516.95
|
| Rate for Payer: Health EOS Commercial |
$21,497.06
|
| Rate for Payer: HFN Commercial |
$22,221.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18,115.50
|
| Rate for Payer: Multiplan Commercial |
$19,323.20
|
| Rate for Payer: NAPHCARE Commercial |
$14,492.40
|
| Rate for Payer: Preferred Network Access Commercial |
$22,221.68
|
| Rate for Payer: Quartz Beloit One Network |
$11,835.46
|
| Rate for Payer: Quartz Commercial |
$15,700.10
|
| Rate for Payer: Quartz Medicare Advantage |
$14,492.40
|
| Rate for Payer: The Alliance Commercial |
$12,077.00
|
| Rate for Payer: WEA Trust Commercial |
$13,284.70
|
| Rate for Payer: WPS Commercial |
$17,890.22
|
|
|
FEMORAL SLEEVE FULL POROUS ATTUNE 34MM 1294-53-226
|
Facility
|
IP
|
$23,225.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5459697
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,835.46 |
| Max. Negotiated Rate |
$22,221.68 |
| Rate for Payer: Aetna Commercial |
$21,738.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20,772.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12,801.62
|
| Rate for Payer: Cash Price |
$6,967.50
|
| Rate for Payer: Cigna Commercial |
$22,221.68
|
| Rate for Payer: Health EOS Commercial |
$21,497.06
|
| Rate for Payer: HFN Commercial |
$22,221.68
|
| Rate for Payer: Multiplan Commercial |
$19,323.20
|
| Rate for Payer: Preferred Network Access Commercial |
$22,221.68
|
| Rate for Payer: Quartz Beloit One Network |
$11,835.46
|
| Rate for Payer: Quartz Commercial |
$14,492.40
|
| Rate for Payer: WEA Trust Commercial |
$13,284.70
|
| Rate for Payer: WPS Commercial |
$17,890.22
|
|
|
FEMORAL SLEEVE REVISION FULLY COATED ATTUNE 35MM 1511-01-203
|
Facility
|
OP
|
$24,279.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5528742
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,070.04 |
| Max. Negotiated Rate |
$23,230.15 |
| Rate for Payer: Aetna Commercial |
$22,725.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21,715.14
|
| Rate for Payer: Aetna Managed Medicare |
$7,070.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,412.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,625.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,120.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,382.58
|
| Rate for Payer: Cash Price |
$7,283.70
|
| Rate for Payer: Cigna Commercial |
$23,230.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14,130.38
|
| Rate for Payer: Health EOS Commercial |
$22,472.64
|
| Rate for Payer: HFN Commercial |
$23,230.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18,937.62
|
| Rate for Payer: Multiplan Commercial |
$20,200.13
|
| Rate for Payer: NAPHCARE Commercial |
$15,150.10
|
| Rate for Payer: Preferred Network Access Commercial |
$23,230.15
|
| Rate for Payer: Quartz Beloit One Network |
$12,372.58
|
| Rate for Payer: Quartz Commercial |
$16,412.60
|
| Rate for Payer: Quartz Medicare Advantage |
$15,150.10
|
| Rate for Payer: The Alliance Commercial |
$12,625.08
|
| Rate for Payer: WEA Trust Commercial |
$13,887.59
|
| Rate for Payer: WPS Commercial |
$18,702.11
|
|
|
FEMORAL SLEEVE REVISION FULLY COATED ATTUNE 35MM 1511-01-203
|
Facility
|
IP
|
$24,279.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5528742
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,372.58 |
| Max. Negotiated Rate |
$23,230.15 |
| Rate for Payer: Aetna Commercial |
$22,725.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21,715.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,382.58
|
| Rate for Payer: Cash Price |
$7,283.70
|
| Rate for Payer: Cigna Commercial |
$23,230.15
|
| Rate for Payer: Health EOS Commercial |
$22,472.64
|
| Rate for Payer: HFN Commercial |
$23,230.15
|
| Rate for Payer: Multiplan Commercial |
$20,200.13
|
| Rate for Payer: Preferred Network Access Commercial |
$23,230.15
|
| Rate for Payer: Quartz Beloit One Network |
$12,372.58
|
| Rate for Payer: Quartz Commercial |
$15,150.10
|
| Rate for Payer: WEA Trust Commercial |
$13,887.59
|
| Rate for Payer: WPS Commercial |
$18,702.11
|
|
|
FEMORAL STEM ACTIS DUOFIX SZ 10 12/14 TAPER HIGH COLLAR 1010-12-100
|
Facility
|
OP
|
$11,230.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6178523
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,270.18 |
| Max. Negotiated Rate |
$10,744.86 |
| Rate for Payer: Aetna Commercial |
$10,511.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,044.11
|
| Rate for Payer: Aetna Managed Medicare |
$3,270.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,591.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,839.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,606.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,189.98
|
| Rate for Payer: Cash Price |
$3,369.00
|
| Rate for Payer: Cigna Commercial |
$10,744.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,535.86
|
| Rate for Payer: Health EOS Commercial |
$10,394.49
|
| Rate for Payer: HFN Commercial |
$10,744.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,759.40
|
| Rate for Payer: Multiplan Commercial |
$9,343.36
|
| Rate for Payer: NAPHCARE Commercial |
$7,007.52
|
| Rate for Payer: Preferred Network Access Commercial |
$10,744.86
|
| Rate for Payer: Quartz Beloit One Network |
$5,722.81
|
| Rate for Payer: Quartz Commercial |
$7,591.48
|
| Rate for Payer: Quartz Medicare Advantage |
$7,007.52
|
| Rate for Payer: The Alliance Commercial |
$5,839.60
|
| Rate for Payer: WEA Trust Commercial |
$6,423.56
|
| Rate for Payer: WPS Commercial |
$8,650.47
|
|
|
FEMORAL STEM ACTIS DUOFIX SZ 10 12/14 TAPER HIGH COLLAR 1010-12-100
|
Facility
|
IP
|
$11,230.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6178523
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,722.81 |
| Max. Negotiated Rate |
$10,744.86 |
| Rate for Payer: Aetna Commercial |
$10,511.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,044.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,189.98
|
| Rate for Payer: Cash Price |
$3,369.00
|
| Rate for Payer: Cigna Commercial |
$10,744.86
|
| Rate for Payer: Health EOS Commercial |
$10,394.49
|
| Rate for Payer: HFN Commercial |
$10,744.86
|
| Rate for Payer: Multiplan Commercial |
$9,343.36
|
| Rate for Payer: Preferred Network Access Commercial |
$10,744.86
|
| Rate for Payer: Quartz Beloit One Network |
$5,722.81
|
| Rate for Payer: Quartz Commercial |
$7,007.52
|
| Rate for Payer: WEA Trust Commercial |
$6,423.56
|
| Rate for Payer: WPS Commercial |
$8,650.47
|
|
|
FEMORAL STEM ACTIS DUOFIX SZ 2 12/14 TAPER HIGH COLLAR 1010-12-020
|
Facility
|
OP
|
$11,230.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6181472
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,270.18 |
| Max. Negotiated Rate |
$10,744.86 |
| Rate for Payer: Aetna Commercial |
$10,511.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,044.11
|
| Rate for Payer: Aetna Managed Medicare |
$3,270.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,591.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,839.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,606.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,189.98
|
| Rate for Payer: Cash Price |
$3,369.00
|
| Rate for Payer: Cigna Commercial |
$10,744.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,535.86
|
| Rate for Payer: Health EOS Commercial |
$10,394.49
|
| Rate for Payer: HFN Commercial |
$10,744.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,759.40
|
| Rate for Payer: Multiplan Commercial |
$9,343.36
|
| Rate for Payer: NAPHCARE Commercial |
$7,007.52
|
| Rate for Payer: Preferred Network Access Commercial |
$10,744.86
|
| Rate for Payer: Quartz Beloit One Network |
$5,722.81
|
| Rate for Payer: Quartz Commercial |
$7,591.48
|
| Rate for Payer: Quartz Medicare Advantage |
$7,007.52
|
| Rate for Payer: The Alliance Commercial |
$5,839.60
|
| Rate for Payer: WEA Trust Commercial |
$6,423.56
|
| Rate for Payer: WPS Commercial |
$8,650.47
|
|
|
FEMORAL STEM ACTIS DUOFIX SZ 2 12/14 TAPER HIGH COLLAR 1010-12-020
|
Facility
|
IP
|
$11,230.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6181472
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,722.81 |
| Max. Negotiated Rate |
$10,744.86 |
| Rate for Payer: Aetna Commercial |
$10,511.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,044.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,189.98
|
| Rate for Payer: Cash Price |
$3,369.00
|
| Rate for Payer: Cigna Commercial |
$10,744.86
|
| Rate for Payer: Health EOS Commercial |
$10,394.49
|
| Rate for Payer: HFN Commercial |
$10,744.86
|
| Rate for Payer: Multiplan Commercial |
$9,343.36
|
| Rate for Payer: Preferred Network Access Commercial |
$10,744.86
|
| Rate for Payer: Quartz Beloit One Network |
$5,722.81
|
| Rate for Payer: Quartz Commercial |
$7,007.52
|
| Rate for Payer: WEA Trust Commercial |
$6,423.56
|
| Rate for Payer: WPS Commercial |
$8,650.47
|
|
|
FEMORAL STEM ACTIS DUOFIX SZ 2 12/14 TAPER STD COLLAR 1010-11-020
|
Facility
|
IP
|
$11,679.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6172433
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,951.62 |
| Max. Negotiated Rate |
$11,174.47 |
| Rate for Payer: Aetna Commercial |
$10,931.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,445.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,437.46
|
| Rate for Payer: Cash Price |
$3,503.70
|
| Rate for Payer: Cigna Commercial |
$11,174.47
|
| Rate for Payer: Health EOS Commercial |
$10,810.08
|
| Rate for Payer: HFN Commercial |
$11,174.47
|
| Rate for Payer: Multiplan Commercial |
$9,716.93
|
| Rate for Payer: Preferred Network Access Commercial |
$11,174.47
|
| Rate for Payer: Quartz Beloit One Network |
$5,951.62
|
| Rate for Payer: Quartz Commercial |
$7,287.70
|
| Rate for Payer: WEA Trust Commercial |
$6,680.39
|
| Rate for Payer: WPS Commercial |
$8,996.33
|
|
|
FEMORAL STEM ACTIS DUOFIX SZ 2 12/14 TAPER STD COLLAR 1010-11-020
|
Facility
|
OP
|
$11,679.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6172433
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,400.92 |
| Max. Negotiated Rate |
$11,174.47 |
| Rate for Payer: Aetna Commercial |
$10,931.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,445.70
|
| Rate for Payer: Aetna Managed Medicare |
$3,400.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,895.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,073.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,830.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,437.46
|
| Rate for Payer: Cash Price |
$3,503.70
|
| Rate for Payer: Cigna Commercial |
$11,174.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,797.18
|
| Rate for Payer: Health EOS Commercial |
$10,810.08
|
| Rate for Payer: HFN Commercial |
$11,174.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,109.62
|
| Rate for Payer: Multiplan Commercial |
$9,716.93
|
| Rate for Payer: NAPHCARE Commercial |
$7,287.70
|
| Rate for Payer: Preferred Network Access Commercial |
$11,174.47
|
| Rate for Payer: Quartz Beloit One Network |
$5,951.62
|
| Rate for Payer: Quartz Commercial |
$7,895.00
|
| Rate for Payer: Quartz Medicare Advantage |
$7,287.70
|
| Rate for Payer: The Alliance Commercial |
$6,073.08
|
| Rate for Payer: WEA Trust Commercial |
$6,680.39
|
| Rate for Payer: WPS Commercial |
$8,996.33
|
|
|
FEMORAL STEM ACTIS DUOFIX SZ 3 12/14 TAPER HIGH COLLAR 1010-12-030
|
Facility
|
OP
|
$11,679.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6089645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,400.92 |
| Max. Negotiated Rate |
$11,174.47 |
| Rate for Payer: Aetna Commercial |
$10,931.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,445.70
|
| Rate for Payer: Aetna Managed Medicare |
$3,400.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,895.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,073.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,830.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,437.46
|
| Rate for Payer: Cash Price |
$3,503.70
|
| Rate for Payer: Cigna Commercial |
$11,174.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,797.18
|
| Rate for Payer: Health EOS Commercial |
$10,810.08
|
| Rate for Payer: HFN Commercial |
$11,174.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,109.62
|
| Rate for Payer: Multiplan Commercial |
$9,716.93
|
| Rate for Payer: NAPHCARE Commercial |
$7,287.70
|
| Rate for Payer: Preferred Network Access Commercial |
$11,174.47
|
| Rate for Payer: Quartz Beloit One Network |
$5,951.62
|
| Rate for Payer: Quartz Commercial |
$7,895.00
|
| Rate for Payer: Quartz Medicare Advantage |
$7,287.70
|
| Rate for Payer: The Alliance Commercial |
$6,073.08
|
| Rate for Payer: WEA Trust Commercial |
$6,680.39
|
| Rate for Payer: WPS Commercial |
$8,996.33
|
|
|
FEMORAL STEM ACTIS DUOFIX SZ 3 12/14 TAPER HIGH COLLAR 1010-12-030
|
Facility
|
IP
|
$11,679.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6089645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,951.62 |
| Max. Negotiated Rate |
$11,174.47 |
| Rate for Payer: Aetna Commercial |
$10,931.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,445.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,437.46
|
| Rate for Payer: Cash Price |
$3,503.70
|
| Rate for Payer: Cigna Commercial |
$11,174.47
|
| Rate for Payer: Health EOS Commercial |
$10,810.08
|
| Rate for Payer: HFN Commercial |
$11,174.47
|
| Rate for Payer: Multiplan Commercial |
$9,716.93
|
| Rate for Payer: Preferred Network Access Commercial |
$11,174.47
|
| Rate for Payer: Quartz Beloit One Network |
$5,951.62
|
| Rate for Payer: Quartz Commercial |
$7,287.70
|
| Rate for Payer: WEA Trust Commercial |
$6,680.39
|
| Rate for Payer: WPS Commercial |
$8,996.33
|
|
|
FEMORAL STEM ACTIS DUOFIX SZ 3 12/14 TAPER STD COLLAR 1010-11-030
|
Facility
|
IP
|
$11,679.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6177671
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,951.62 |
| Max. Negotiated Rate |
$11,174.47 |
| Rate for Payer: Aetna Commercial |
$10,931.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,445.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,437.46
|
| Rate for Payer: Cash Price |
$3,503.70
|
| Rate for Payer: Cigna Commercial |
$11,174.47
|
| Rate for Payer: Health EOS Commercial |
$10,810.08
|
| Rate for Payer: HFN Commercial |
$11,174.47
|
| Rate for Payer: Multiplan Commercial |
$9,716.93
|
| Rate for Payer: Preferred Network Access Commercial |
$11,174.47
|
| Rate for Payer: Quartz Beloit One Network |
$5,951.62
|
| Rate for Payer: Quartz Commercial |
$7,287.70
|
| Rate for Payer: WEA Trust Commercial |
$6,680.39
|
| Rate for Payer: WPS Commercial |
$8,996.33
|
|
|
FEMORAL STEM ACTIS DUOFIX SZ 3 12/14 TAPER STD COLLAR 1010-11-030
|
Facility
|
OP
|
$11,679.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6177671
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,400.92 |
| Max. Negotiated Rate |
$11,174.47 |
| Rate for Payer: Aetna Commercial |
$10,931.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,445.70
|
| Rate for Payer: Aetna Managed Medicare |
$3,400.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,895.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,073.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,830.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,437.46
|
| Rate for Payer: Cash Price |
$3,503.70
|
| Rate for Payer: Cigna Commercial |
$11,174.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,797.18
|
| Rate for Payer: Health EOS Commercial |
$10,810.08
|
| Rate for Payer: HFN Commercial |
$11,174.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,109.62
|
| Rate for Payer: Multiplan Commercial |
$9,716.93
|
| Rate for Payer: NAPHCARE Commercial |
$7,287.70
|
| Rate for Payer: Preferred Network Access Commercial |
$11,174.47
|
| Rate for Payer: Quartz Beloit One Network |
$5,951.62
|
| Rate for Payer: Quartz Commercial |
$7,895.00
|
| Rate for Payer: Quartz Medicare Advantage |
$7,287.70
|
| Rate for Payer: The Alliance Commercial |
$6,073.08
|
| Rate for Payer: WEA Trust Commercial |
$6,680.39
|
| Rate for Payer: WPS Commercial |
$8,996.33
|
|
|
FEMORAL STEM ACTIS DUOFIX SZ 4 12/14 TAPER HIGH COLLAR 1010-12-040
|
Facility
|
IP
|
$11,679.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6089630
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,951.62 |
| Max. Negotiated Rate |
$11,174.47 |
| Rate for Payer: Aetna Commercial |
$10,931.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,445.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,437.46
|
| Rate for Payer: Cash Price |
$3,503.70
|
| Rate for Payer: Cigna Commercial |
$11,174.47
|
| Rate for Payer: Health EOS Commercial |
$10,810.08
|
| Rate for Payer: HFN Commercial |
$11,174.47
|
| Rate for Payer: Multiplan Commercial |
$9,716.93
|
| Rate for Payer: Preferred Network Access Commercial |
$11,174.47
|
| Rate for Payer: Quartz Beloit One Network |
$5,951.62
|
| Rate for Payer: Quartz Commercial |
$7,287.70
|
| Rate for Payer: WEA Trust Commercial |
$6,680.39
|
| Rate for Payer: WPS Commercial |
$8,996.33
|
|
|
FEMORAL STEM ACTIS DUOFIX SZ 4 12/14 TAPER HIGH COLLAR 1010-12-040
|
Facility
|
OP
|
$11,679.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6089630
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,400.92 |
| Max. Negotiated Rate |
$11,174.47 |
| Rate for Payer: Aetna Commercial |
$10,931.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,445.70
|
| Rate for Payer: Aetna Managed Medicare |
$3,400.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,895.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,073.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,830.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,437.46
|
| Rate for Payer: Cash Price |
$3,503.70
|
| Rate for Payer: Cigna Commercial |
$11,174.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,797.18
|
| Rate for Payer: Health EOS Commercial |
$10,810.08
|
| Rate for Payer: HFN Commercial |
$11,174.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,109.62
|
| Rate for Payer: Multiplan Commercial |
$9,716.93
|
| Rate for Payer: NAPHCARE Commercial |
$7,287.70
|
| Rate for Payer: Preferred Network Access Commercial |
$11,174.47
|
| Rate for Payer: Quartz Beloit One Network |
$5,951.62
|
| Rate for Payer: Quartz Commercial |
$7,895.00
|
| Rate for Payer: Quartz Medicare Advantage |
$7,287.70
|
| Rate for Payer: The Alliance Commercial |
$6,073.08
|
| Rate for Payer: WEA Trust Commercial |
$6,680.39
|
| Rate for Payer: WPS Commercial |
$8,996.33
|
|
|
FEMORAL STEM ACTIS DUOFIX SZ 4 12/14 TAPER STD COLLAR 1010-11-040
|
Facility
|
IP
|
$11,679.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6037660
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,951.62 |
| Max. Negotiated Rate |
$11,174.47 |
| Rate for Payer: Aetna Commercial |
$10,931.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,445.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,437.46
|
| Rate for Payer: Cash Price |
$3,503.70
|
| Rate for Payer: Cigna Commercial |
$11,174.47
|
| Rate for Payer: Health EOS Commercial |
$10,810.08
|
| Rate for Payer: HFN Commercial |
$11,174.47
|
| Rate for Payer: Multiplan Commercial |
$9,716.93
|
| Rate for Payer: Preferred Network Access Commercial |
$11,174.47
|
| Rate for Payer: Quartz Beloit One Network |
$5,951.62
|
| Rate for Payer: Quartz Commercial |
$7,287.70
|
| Rate for Payer: WEA Trust Commercial |
$6,680.39
|
| Rate for Payer: WPS Commercial |
$8,996.33
|
|
|
FEMORAL STEM ACTIS DUOFIX SZ 4 12/14 TAPER STD COLLAR 1010-11-040
|
Facility
|
OP
|
$11,679.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6037660
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,400.92 |
| Max. Negotiated Rate |
$11,174.47 |
| Rate for Payer: Aetna Commercial |
$10,931.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,445.70
|
| Rate for Payer: Aetna Managed Medicare |
$3,400.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,895.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,073.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,830.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,437.46
|
| Rate for Payer: Cash Price |
$3,503.70
|
| Rate for Payer: Cigna Commercial |
$11,174.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,797.18
|
| Rate for Payer: Health EOS Commercial |
$10,810.08
|
| Rate for Payer: HFN Commercial |
$11,174.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,109.62
|
| Rate for Payer: Multiplan Commercial |
$9,716.93
|
| Rate for Payer: NAPHCARE Commercial |
$7,287.70
|
| Rate for Payer: Preferred Network Access Commercial |
$11,174.47
|
| Rate for Payer: Quartz Beloit One Network |
$5,951.62
|
| Rate for Payer: Quartz Commercial |
$7,895.00
|
| Rate for Payer: Quartz Medicare Advantage |
$7,287.70
|
| Rate for Payer: The Alliance Commercial |
$6,073.08
|
| Rate for Payer: WEA Trust Commercial |
$6,680.39
|
| Rate for Payer: WPS Commercial |
$8,996.33
|
|
|
FEMORAL STEM ACTIS DUOFIX SZ 5 12/14 TAPER HIGH COLLAR 1010-12-050
|
Facility
|
OP
|
$11,679.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6170100
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,400.92 |
| Max. Negotiated Rate |
$11,174.47 |
| Rate for Payer: Aetna Commercial |
$10,931.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,445.70
|
| Rate for Payer: Aetna Managed Medicare |
$3,400.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,895.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,073.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,830.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,437.46
|
| Rate for Payer: Cash Price |
$3,503.70
|
| Rate for Payer: Cigna Commercial |
$11,174.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,797.18
|
| Rate for Payer: Health EOS Commercial |
$10,810.08
|
| Rate for Payer: HFN Commercial |
$11,174.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,109.62
|
| Rate for Payer: Multiplan Commercial |
$9,716.93
|
| Rate for Payer: NAPHCARE Commercial |
$7,287.70
|
| Rate for Payer: Preferred Network Access Commercial |
$11,174.47
|
| Rate for Payer: Quartz Beloit One Network |
$5,951.62
|
| Rate for Payer: Quartz Commercial |
$7,895.00
|
| Rate for Payer: Quartz Medicare Advantage |
$7,287.70
|
| Rate for Payer: The Alliance Commercial |
$6,073.08
|
| Rate for Payer: WEA Trust Commercial |
$6,680.39
|
| Rate for Payer: WPS Commercial |
$8,996.33
|
|
|
FEMORAL STEM ACTIS DUOFIX SZ 5 12/14 TAPER HIGH COLLAR 1010-12-050
|
Facility
|
IP
|
$11,679.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6170100
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,951.62 |
| Max. Negotiated Rate |
$11,174.47 |
| Rate for Payer: Aetna Commercial |
$10,931.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,445.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,437.46
|
| Rate for Payer: Cash Price |
$3,503.70
|
| Rate for Payer: Cigna Commercial |
$11,174.47
|
| Rate for Payer: Health EOS Commercial |
$10,810.08
|
| Rate for Payer: HFN Commercial |
$11,174.47
|
| Rate for Payer: Multiplan Commercial |
$9,716.93
|
| Rate for Payer: Preferred Network Access Commercial |
$11,174.47
|
| Rate for Payer: Quartz Beloit One Network |
$5,951.62
|
| Rate for Payer: Quartz Commercial |
$7,287.70
|
| Rate for Payer: WEA Trust Commercial |
$6,680.39
|
| Rate for Payer: WPS Commercial |
$8,996.33
|
|
|
FEMORAL STEM ACTIS DUOFIX SZ 5 12/14 TAPER STD COLLAR 1010-11-050
|
Facility
|
IP
|
$11,679.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6141628
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,951.62 |
| Max. Negotiated Rate |
$11,174.47 |
| Rate for Payer: Aetna Commercial |
$10,931.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,445.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,437.46
|
| Rate for Payer: Cash Price |
$3,503.70
|
| Rate for Payer: Cigna Commercial |
$11,174.47
|
| Rate for Payer: Health EOS Commercial |
$10,810.08
|
| Rate for Payer: HFN Commercial |
$11,174.47
|
| Rate for Payer: Multiplan Commercial |
$9,716.93
|
| Rate for Payer: Preferred Network Access Commercial |
$11,174.47
|
| Rate for Payer: Quartz Beloit One Network |
$5,951.62
|
| Rate for Payer: Quartz Commercial |
$7,287.70
|
| Rate for Payer: WEA Trust Commercial |
$6,680.39
|
| Rate for Payer: WPS Commercial |
$8,996.33
|
|
