|
FEMORAL STEM ACTIS DUOFIX SZ 5 12/14 TAPER STD COLLAR 1010-11-050
|
Facility
|
OP
|
$11,679.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6141628
|
|
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 6 12/14 TAPER HIGH COLLAR 1010-12-060
|
Facility
|
OP
|
$11,679.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6170127
|
|
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 6 12/14 TAPER HIGH COLLAR 1010-12-060
|
Facility
|
IP
|
$11,679.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6170127
|
|
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 6 12/14 TAPER STD COLLAR 1010-11-060
|
Facility
|
IP
|
$11,679.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6037630
|
|
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 6 12/14 TAPER STD COLLAR 1010-11-060
|
Facility
|
OP
|
$11,679.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6037630
|
|
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 7 12/14 TAPER HIGH COLLAR 1010-12-070
|
Facility
|
OP
|
$11,230.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6179725
|
|
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 7 12/14 TAPER HIGH COLLAR 1010-12-070
|
Facility
|
IP
|
$11,230.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6179725
|
|
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 7 12/14 TAPER STD COLLAR 1010-11-070
|
Facility
|
OP
|
$11,679.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6111642
|
|
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 7 12/14 TAPER STD COLLAR 1010-11-070
|
Facility
|
IP
|
$11,679.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6111642
|
|
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 8 12/14 TAPER HIGH COLLAR 1010-12-080
|
Facility
|
IP
|
$11,679.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6169702
|
|
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 8 12/14 TAPER HIGH COLLAR 1010-12-080
|
Facility
|
OP
|
$11,679.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6169702
|
|
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 8 12/14 TAPER STD COLLAR 1010-11-080
|
Facility
|
OP
|
$11,679.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6174938
|
|
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 8 12/14 TAPER STD COLLAR 1010-11-080
|
Facility
|
IP
|
$11,679.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6174938
|
|
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 9 12/14 TAPER STD COLLAR 1010-11-090
|
Facility
|
OP
|
$11,679.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6173255
|
|
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 9 12/14 TAPER STD COLLAR 1010-11-090
|
Facility
|
IP
|
$11,679.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6173255
|
|
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 ADVOCATE CMTD EXT 12 X 125 7850-12-20
|
Facility
|
OP
|
$13,780.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5286899
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,012.74 |
| Max. Negotiated Rate |
$13,184.70 |
| Rate for Payer: Aetna Commercial |
$12,898.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,324.83
|
| Rate for Payer: Aetna Managed Medicare |
$4,012.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,315.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,165.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,878.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,595.54
|
| Rate for Payer: Cash Price |
$4,134.00
|
| Rate for Payer: Cigna Commercial |
$13,184.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,019.96
|
| Rate for Payer: Health EOS Commercial |
$12,754.77
|
| Rate for Payer: HFN Commercial |
$13,184.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,748.40
|
| Rate for Payer: Multiplan Commercial |
$11,464.96
|
| Rate for Payer: NAPHCARE Commercial |
$8,598.72
|
| Rate for Payer: Preferred Network Access Commercial |
$13,184.70
|
| Rate for Payer: Quartz Beloit One Network |
$7,022.29
|
| Rate for Payer: Quartz Commercial |
$9,315.28
|
| Rate for Payer: Quartz Medicare Advantage |
$8,598.72
|
| Rate for Payer: The Alliance Commercial |
$7,165.60
|
| Rate for Payer: WEA Trust Commercial |
$7,882.16
|
| Rate for Payer: WPS Commercial |
$10,614.73
|
|
|
FEMORAL STEM ADVOCATE CMTD EXT 12 X 125 7850-12-20
|
Facility
|
IP
|
$13,780.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5286899
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,022.29 |
| Max. Negotiated Rate |
$13,184.70 |
| Rate for Payer: Aetna Commercial |
$12,898.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,324.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,595.54
|
| Rate for Payer: Cash Price |
$4,134.00
|
| Rate for Payer: Cigna Commercial |
$13,184.70
|
| Rate for Payer: Health EOS Commercial |
$12,754.77
|
| Rate for Payer: HFN Commercial |
$13,184.70
|
| Rate for Payer: Multiplan Commercial |
$11,464.96
|
| Rate for Payer: Preferred Network Access Commercial |
$13,184.70
|
| Rate for Payer: Quartz Beloit One Network |
$7,022.29
|
| Rate for Payer: Quartz Commercial |
$8,598.72
|
| Rate for Payer: WEA Trust Commercial |
$7,882.16
|
| Rate for Payer: WPS Commercial |
$10,614.73
|
|
|
FEMORAL STEM ADVOCATE CMTD EXT 13 X 130 7850-13-20
|
Facility
|
IP
|
$13,780.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5286898
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,022.29 |
| Max. Negotiated Rate |
$13,184.70 |
| Rate for Payer: Aetna Commercial |
$12,898.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,324.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,595.54
|
| Rate for Payer: Cash Price |
$4,134.00
|
| Rate for Payer: Cigna Commercial |
$13,184.70
|
| Rate for Payer: Health EOS Commercial |
$12,754.77
|
| Rate for Payer: HFN Commercial |
$13,184.70
|
| Rate for Payer: Multiplan Commercial |
$11,464.96
|
| Rate for Payer: Preferred Network Access Commercial |
$13,184.70
|
| Rate for Payer: Quartz Beloit One Network |
$7,022.29
|
| Rate for Payer: Quartz Commercial |
$8,598.72
|
| Rate for Payer: WEA Trust Commercial |
$7,882.16
|
| Rate for Payer: WPS Commercial |
$10,614.73
|
|
|
FEMORAL STEM ADVOCATE CMTD EXT 13 X 130 7850-13-20
|
Facility
|
OP
|
$13,780.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5286898
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,012.74 |
| Max. Negotiated Rate |
$13,184.70 |
| Rate for Payer: Aetna Commercial |
$12,898.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,324.83
|
| Rate for Payer: Aetna Managed Medicare |
$4,012.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,315.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,165.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,878.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,595.54
|
| Rate for Payer: Cash Price |
$4,134.00
|
| Rate for Payer: Cigna Commercial |
$13,184.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,019.96
|
| Rate for Payer: Health EOS Commercial |
$12,754.77
|
| Rate for Payer: HFN Commercial |
$13,184.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,748.40
|
| Rate for Payer: Multiplan Commercial |
$11,464.96
|
| Rate for Payer: NAPHCARE Commercial |
$8,598.72
|
| Rate for Payer: Preferred Network Access Commercial |
$13,184.70
|
| Rate for Payer: Quartz Beloit One Network |
$7,022.29
|
| Rate for Payer: Quartz Commercial |
$9,315.28
|
| Rate for Payer: Quartz Medicare Advantage |
$8,598.72
|
| Rate for Payer: The Alliance Commercial |
$7,165.60
|
| Rate for Payer: WEA Trust Commercial |
$7,882.16
|
| Rate for Payer: WPS Commercial |
$10,614.73
|
|
|
FEMORAL STEM ADVOCATE CMTD EXT 14 X 135 7850-14-20
|
Facility
|
OP
|
$13,780.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5286897
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,012.74 |
| Max. Negotiated Rate |
$13,184.70 |
| Rate for Payer: Aetna Commercial |
$12,898.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,324.83
|
| Rate for Payer: Aetna Managed Medicare |
$4,012.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,315.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,165.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,878.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,595.54
|
| Rate for Payer: Cash Price |
$4,134.00
|
| Rate for Payer: Cigna Commercial |
$13,184.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,019.96
|
| Rate for Payer: Health EOS Commercial |
$12,754.77
|
| Rate for Payer: HFN Commercial |
$13,184.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,748.40
|
| Rate for Payer: Multiplan Commercial |
$11,464.96
|
| Rate for Payer: NAPHCARE Commercial |
$8,598.72
|
| Rate for Payer: Preferred Network Access Commercial |
$13,184.70
|
| Rate for Payer: Quartz Beloit One Network |
$7,022.29
|
| Rate for Payer: Quartz Commercial |
$9,315.28
|
| Rate for Payer: Quartz Medicare Advantage |
$8,598.72
|
| Rate for Payer: The Alliance Commercial |
$7,165.60
|
| Rate for Payer: WEA Trust Commercial |
$7,882.16
|
| Rate for Payer: WPS Commercial |
$10,614.73
|
|
|
FEMORAL STEM ADVOCATE CMTD EXT 14 X 135 7850-14-20
|
Facility
|
IP
|
$13,780.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5286897
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,022.29 |
| Max. Negotiated Rate |
$13,184.70 |
| Rate for Payer: Aetna Commercial |
$12,898.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,324.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,595.54
|
| Rate for Payer: Cash Price |
$4,134.00
|
| Rate for Payer: Cigna Commercial |
$13,184.70
|
| Rate for Payer: Health EOS Commercial |
$12,754.77
|
| Rate for Payer: HFN Commercial |
$13,184.70
|
| Rate for Payer: Multiplan Commercial |
$11,464.96
|
| Rate for Payer: Preferred Network Access Commercial |
$13,184.70
|
| Rate for Payer: Quartz Beloit One Network |
$7,022.29
|
| Rate for Payer: Quartz Commercial |
$8,598.72
|
| Rate for Payer: WEA Trust Commercial |
$7,882.16
|
| Rate for Payer: WPS Commercial |
$10,614.73
|
|
|
FEMORAL STEM ADVOCATE CMTD EXT 15 X 140 7850-15-20
|
Facility
|
IP
|
$13,780.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5286896
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,022.29 |
| Max. Negotiated Rate |
$13,184.70 |
| Rate for Payer: Aetna Commercial |
$12,898.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,324.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,595.54
|
| Rate for Payer: Cash Price |
$4,134.00
|
| Rate for Payer: Cigna Commercial |
$13,184.70
|
| Rate for Payer: Health EOS Commercial |
$12,754.77
|
| Rate for Payer: HFN Commercial |
$13,184.70
|
| Rate for Payer: Multiplan Commercial |
$11,464.96
|
| Rate for Payer: Preferred Network Access Commercial |
$13,184.70
|
| Rate for Payer: Quartz Beloit One Network |
$7,022.29
|
| Rate for Payer: Quartz Commercial |
$8,598.72
|
| Rate for Payer: WEA Trust Commercial |
$7,882.16
|
| Rate for Payer: WPS Commercial |
$10,614.73
|
|
|
FEMORAL STEM ADVOCATE CMTD EXT 15 X 140 7850-15-20
|
Facility
|
OP
|
$13,780.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5286896
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,012.74 |
| Max. Negotiated Rate |
$13,184.70 |
| Rate for Payer: Aetna Commercial |
$12,898.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,324.83
|
| Rate for Payer: Aetna Managed Medicare |
$4,012.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,315.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,165.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,878.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,595.54
|
| Rate for Payer: Cash Price |
$4,134.00
|
| Rate for Payer: Cigna Commercial |
$13,184.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,019.96
|
| Rate for Payer: Health EOS Commercial |
$12,754.77
|
| Rate for Payer: HFN Commercial |
$13,184.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,748.40
|
| Rate for Payer: Multiplan Commercial |
$11,464.96
|
| Rate for Payer: NAPHCARE Commercial |
$8,598.72
|
| Rate for Payer: Preferred Network Access Commercial |
$13,184.70
|
| Rate for Payer: Quartz Beloit One Network |
$7,022.29
|
| Rate for Payer: Quartz Commercial |
$9,315.28
|
| Rate for Payer: Quartz Medicare Advantage |
$8,598.72
|
| Rate for Payer: The Alliance Commercial |
$7,165.60
|
| Rate for Payer: WEA Trust Commercial |
$7,882.16
|
| Rate for Payer: WPS Commercial |
$10,614.73
|
|
|
FEMORAL STEM ADVOCATE CMTD EXT 16 X 145 7850-16-20
|
Facility
|
IP
|
$13,780.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5286895
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,022.29 |
| Max. Negotiated Rate |
$13,184.70 |
| Rate for Payer: Aetna Commercial |
$12,898.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,324.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,595.54
|
| Rate for Payer: Cash Price |
$4,134.00
|
| Rate for Payer: Cigna Commercial |
$13,184.70
|
| Rate for Payer: Health EOS Commercial |
$12,754.77
|
| Rate for Payer: HFN Commercial |
$13,184.70
|
| Rate for Payer: Multiplan Commercial |
$11,464.96
|
| Rate for Payer: Preferred Network Access Commercial |
$13,184.70
|
| Rate for Payer: Quartz Beloit One Network |
$7,022.29
|
| Rate for Payer: Quartz Commercial |
$8,598.72
|
| Rate for Payer: WEA Trust Commercial |
$7,882.16
|
| Rate for Payer: WPS Commercial |
$10,614.73
|
|
|
FEMORAL STEM ADVOCATE CMTD EXT 16 X 145 7850-16-20
|
Facility
|
OP
|
$13,780.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5286895
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,012.74 |
| Max. Negotiated Rate |
$13,184.70 |
| Rate for Payer: Aetna Commercial |
$12,898.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,324.83
|
| Rate for Payer: Aetna Managed Medicare |
$4,012.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,315.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,165.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,878.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,595.54
|
| Rate for Payer: Cash Price |
$4,134.00
|
| Rate for Payer: Cigna Commercial |
$13,184.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,019.96
|
| Rate for Payer: Health EOS Commercial |
$12,754.77
|
| Rate for Payer: HFN Commercial |
$13,184.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,748.40
|
| Rate for Payer: Multiplan Commercial |
$11,464.96
|
| Rate for Payer: NAPHCARE Commercial |
$8,598.72
|
| Rate for Payer: Preferred Network Access Commercial |
$13,184.70
|
| Rate for Payer: Quartz Beloit One Network |
$7,022.29
|
| Rate for Payer: Quartz Commercial |
$9,315.28
|
| Rate for Payer: Quartz Medicare Advantage |
$8,598.72
|
| Rate for Payer: The Alliance Commercial |
$7,165.60
|
| Rate for Payer: WEA Trust Commercial |
$7,882.16
|
| Rate for Payer: WPS Commercial |
$10,614.73
|
|
