|
FEMORAL STEM ADVOCATE CMTD STD 11 X 120 7850-11
|
Facility
|
IP
|
$14,309.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5286889
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,291.87 |
| Max. Negotiated Rate |
$13,690.85 |
| Rate for Payer: Aetna Commercial |
$13,393.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,797.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,887.12
|
| Rate for Payer: Cash Price |
$4,292.70
|
| Rate for Payer: Cigna Commercial |
$13,690.85
|
| Rate for Payer: Health EOS Commercial |
$13,244.41
|
| Rate for Payer: HFN Commercial |
$13,690.85
|
| Rate for Payer: Multiplan Commercial |
$11,905.09
|
| Rate for Payer: Preferred Network Access Commercial |
$13,690.85
|
| Rate for Payer: Quartz Beloit One Network |
$7,291.87
|
| Rate for Payer: Quartz Commercial |
$8,928.82
|
| Rate for Payer: WEA Trust Commercial |
$8,184.75
|
| Rate for Payer: WPS Commercial |
$11,022.22
|
|
|
FEMORAL STEM ADVOCATE CMTD STD 11 X 120 7850-11
|
Facility
|
OP
|
$14,309.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5286889
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,166.78 |
| Max. Negotiated Rate |
$13,690.85 |
| Rate for Payer: Aetna Commercial |
$13,393.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,797.97
|
| Rate for Payer: Aetna Managed Medicare |
$4,166.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,672.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,440.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,143.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,887.12
|
| Rate for Payer: Cash Price |
$4,292.70
|
| Rate for Payer: Cigna Commercial |
$13,690.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,327.84
|
| Rate for Payer: Health EOS Commercial |
$13,244.41
|
| Rate for Payer: HFN Commercial |
$13,690.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,161.02
|
| Rate for Payer: Multiplan Commercial |
$11,905.09
|
| Rate for Payer: NAPHCARE Commercial |
$8,928.82
|
| Rate for Payer: Preferred Network Access Commercial |
$13,690.85
|
| Rate for Payer: Quartz Beloit One Network |
$7,291.87
|
| Rate for Payer: Quartz Commercial |
$9,672.88
|
| Rate for Payer: Quartz Medicare Advantage |
$8,928.82
|
| Rate for Payer: The Alliance Commercial |
$7,440.68
|
| Rate for Payer: WEA Trust Commercial |
$8,184.75
|
| Rate for Payer: WPS Commercial |
$11,022.22
|
|
|
FEMORAL STEM ADVOCATE CMTD STD 12 X 125 7850-12
|
Facility
|
OP
|
$14,309.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5286890
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,166.78 |
| Max. Negotiated Rate |
$13,690.85 |
| Rate for Payer: Aetna Commercial |
$13,393.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,797.97
|
| Rate for Payer: Aetna Managed Medicare |
$4,166.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,672.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,440.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,143.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,887.12
|
| Rate for Payer: Cash Price |
$4,292.70
|
| Rate for Payer: Cigna Commercial |
$13,690.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,327.84
|
| Rate for Payer: Health EOS Commercial |
$13,244.41
|
| Rate for Payer: HFN Commercial |
$13,690.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,161.02
|
| Rate for Payer: Multiplan Commercial |
$11,905.09
|
| Rate for Payer: NAPHCARE Commercial |
$8,928.82
|
| Rate for Payer: Preferred Network Access Commercial |
$13,690.85
|
| Rate for Payer: Quartz Beloit One Network |
$7,291.87
|
| Rate for Payer: Quartz Commercial |
$9,672.88
|
| Rate for Payer: Quartz Medicare Advantage |
$8,928.82
|
| Rate for Payer: The Alliance Commercial |
$7,440.68
|
| Rate for Payer: WEA Trust Commercial |
$8,184.75
|
| Rate for Payer: WPS Commercial |
$11,022.22
|
|
|
FEMORAL STEM ADVOCATE CMTD STD 12 X 125 7850-12
|
Facility
|
IP
|
$14,309.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5286890
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,291.87 |
| Max. Negotiated Rate |
$13,690.85 |
| Rate for Payer: Aetna Commercial |
$13,393.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,797.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,887.12
|
| Rate for Payer: Cash Price |
$4,292.70
|
| Rate for Payer: Cigna Commercial |
$13,690.85
|
| Rate for Payer: Health EOS Commercial |
$13,244.41
|
| Rate for Payer: HFN Commercial |
$13,690.85
|
| Rate for Payer: Multiplan Commercial |
$11,905.09
|
| Rate for Payer: Preferred Network Access Commercial |
$13,690.85
|
| Rate for Payer: Quartz Beloit One Network |
$7,291.87
|
| Rate for Payer: Quartz Commercial |
$8,928.82
|
| Rate for Payer: WEA Trust Commercial |
$8,184.75
|
| Rate for Payer: WPS Commercial |
$11,022.22
|
|
|
FEMORAL STEM ADVOCATE CMTD STD 13 X 130 7850-13
|
Facility
|
IP
|
$14,309.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4366038
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,291.87 |
| Max. Negotiated Rate |
$13,690.85 |
| Rate for Payer: Aetna Commercial |
$13,393.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,797.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,887.12
|
| Rate for Payer: Cash Price |
$4,292.70
|
| Rate for Payer: Cigna Commercial |
$13,690.85
|
| Rate for Payer: Health EOS Commercial |
$13,244.41
|
| Rate for Payer: HFN Commercial |
$13,690.85
|
| Rate for Payer: Multiplan Commercial |
$11,905.09
|
| Rate for Payer: Preferred Network Access Commercial |
$13,690.85
|
| Rate for Payer: Quartz Beloit One Network |
$7,291.87
|
| Rate for Payer: Quartz Commercial |
$8,928.82
|
| Rate for Payer: WEA Trust Commercial |
$8,184.75
|
| Rate for Payer: WPS Commercial |
$11,022.22
|
|
|
FEMORAL STEM ADVOCATE CMTD STD 13 X 130 7850-13
|
Facility
|
OP
|
$14,309.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4366038
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,166.78 |
| Max. Negotiated Rate |
$13,690.85 |
| Rate for Payer: Aetna Commercial |
$13,393.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,797.97
|
| Rate for Payer: Aetna Managed Medicare |
$4,166.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,672.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,440.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,143.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,887.12
|
| Rate for Payer: Cash Price |
$4,292.70
|
| Rate for Payer: Cigna Commercial |
$13,690.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,327.84
|
| Rate for Payer: Health EOS Commercial |
$13,244.41
|
| Rate for Payer: HFN Commercial |
$13,690.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,161.02
|
| Rate for Payer: Multiplan Commercial |
$11,905.09
|
| Rate for Payer: NAPHCARE Commercial |
$8,928.82
|
| Rate for Payer: Preferred Network Access Commercial |
$13,690.85
|
| Rate for Payer: Quartz Beloit One Network |
$7,291.87
|
| Rate for Payer: Quartz Commercial |
$9,672.88
|
| Rate for Payer: Quartz Medicare Advantage |
$8,928.82
|
| Rate for Payer: The Alliance Commercial |
$7,440.68
|
| Rate for Payer: WEA Trust Commercial |
$8,184.75
|
| Rate for Payer: WPS Commercial |
$11,022.22
|
|
|
FEMORAL STEM ADVOCATE CMTD STD 14 X 135 7850-14
|
Facility
|
OP
|
$14,309.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5286891
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,166.78 |
| Max. Negotiated Rate |
$13,690.85 |
| Rate for Payer: Aetna Commercial |
$13,393.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,797.97
|
| Rate for Payer: Aetna Managed Medicare |
$4,166.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,672.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,440.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,143.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,887.12
|
| Rate for Payer: Cash Price |
$4,292.70
|
| Rate for Payer: Cigna Commercial |
$13,690.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,327.84
|
| Rate for Payer: Health EOS Commercial |
$13,244.41
|
| Rate for Payer: HFN Commercial |
$13,690.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,161.02
|
| Rate for Payer: Multiplan Commercial |
$11,905.09
|
| Rate for Payer: NAPHCARE Commercial |
$8,928.82
|
| Rate for Payer: Preferred Network Access Commercial |
$13,690.85
|
| Rate for Payer: Quartz Beloit One Network |
$7,291.87
|
| Rate for Payer: Quartz Commercial |
$9,672.88
|
| Rate for Payer: Quartz Medicare Advantage |
$8,928.82
|
| Rate for Payer: The Alliance Commercial |
$7,440.68
|
| Rate for Payer: WEA Trust Commercial |
$8,184.75
|
| Rate for Payer: WPS Commercial |
$11,022.22
|
|
|
FEMORAL STEM ADVOCATE CMTD STD 14 X 135 7850-14
|
Facility
|
IP
|
$14,309.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5286891
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,291.87 |
| Max. Negotiated Rate |
$13,690.85 |
| Rate for Payer: Aetna Commercial |
$13,393.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,797.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,887.12
|
| Rate for Payer: Cash Price |
$4,292.70
|
| Rate for Payer: Cigna Commercial |
$13,690.85
|
| Rate for Payer: Health EOS Commercial |
$13,244.41
|
| Rate for Payer: HFN Commercial |
$13,690.85
|
| Rate for Payer: Multiplan Commercial |
$11,905.09
|
| Rate for Payer: Preferred Network Access Commercial |
$13,690.85
|
| Rate for Payer: Quartz Beloit One Network |
$7,291.87
|
| Rate for Payer: Quartz Commercial |
$8,928.82
|
| Rate for Payer: WEA Trust Commercial |
$8,184.75
|
| Rate for Payer: WPS Commercial |
$11,022.22
|
|
|
FEMORAL STEM ADVOCATE CMTD STD 15 X 140 7850-15
|
Facility
|
OP
|
$14,309.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5286892
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,166.78 |
| Max. Negotiated Rate |
$13,690.85 |
| Rate for Payer: Aetna Commercial |
$13,393.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,797.97
|
| Rate for Payer: Aetna Managed Medicare |
$4,166.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,672.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,440.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,143.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,887.12
|
| Rate for Payer: Cash Price |
$4,292.70
|
| Rate for Payer: Cigna Commercial |
$13,690.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,327.84
|
| Rate for Payer: Health EOS Commercial |
$13,244.41
|
| Rate for Payer: HFN Commercial |
$13,690.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,161.02
|
| Rate for Payer: Multiplan Commercial |
$11,905.09
|
| Rate for Payer: NAPHCARE Commercial |
$8,928.82
|
| Rate for Payer: Preferred Network Access Commercial |
$13,690.85
|
| Rate for Payer: Quartz Beloit One Network |
$7,291.87
|
| Rate for Payer: Quartz Commercial |
$9,672.88
|
| Rate for Payer: Quartz Medicare Advantage |
$8,928.82
|
| Rate for Payer: The Alliance Commercial |
$7,440.68
|
| Rate for Payer: WEA Trust Commercial |
$8,184.75
|
| Rate for Payer: WPS Commercial |
$11,022.22
|
|
|
FEMORAL STEM ADVOCATE CMTD STD 15 X 140 7850-15
|
Facility
|
IP
|
$14,309.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5286892
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,291.87 |
| Max. Negotiated Rate |
$13,690.85 |
| Rate for Payer: Aetna Commercial |
$13,393.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,797.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,887.12
|
| Rate for Payer: Cash Price |
$4,292.70
|
| Rate for Payer: Cigna Commercial |
$13,690.85
|
| Rate for Payer: Health EOS Commercial |
$13,244.41
|
| Rate for Payer: HFN Commercial |
$13,690.85
|
| Rate for Payer: Multiplan Commercial |
$11,905.09
|
| Rate for Payer: Preferred Network Access Commercial |
$13,690.85
|
| Rate for Payer: Quartz Beloit One Network |
$7,291.87
|
| Rate for Payer: Quartz Commercial |
$8,928.82
|
| Rate for Payer: WEA Trust Commercial |
$8,184.75
|
| Rate for Payer: WPS Commercial |
$11,022.22
|
|
|
FEMORAL STEM ADVOCATE CMTD STD 16 X 145 7850-16
|
Facility
|
IP
|
$13,780.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5286893
|
|
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 STD 16 X 145 7850-16
|
Facility
|
OP
|
$13,780.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5286893
|
|
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 STD 17 X 150 7850-17
|
Facility
|
IP
|
$13,780.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5286894
|
|
Hospital Revenue Code
|
510
|
| 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 STD 17 X 150 7850-17
|
Facility
|
OP
|
$13,780.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5286894
|
|
Hospital Revenue Code
|
510
|
| 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 STD NECK OFFSET SZ 11 7850-11-05
|
Facility
|
IP
|
$12,495.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967865
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,367.45 |
| Max. Negotiated Rate |
$11,955.22 |
| Rate for Payer: Aetna Commercial |
$11,695.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,175.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,887.24
|
| Rate for Payer: Cash Price |
$3,748.50
|
| Rate for Payer: Cigna Commercial |
$11,955.22
|
| Rate for Payer: Health EOS Commercial |
$11,565.37
|
| Rate for Payer: HFN Commercial |
$11,955.22
|
| Rate for Payer: Multiplan Commercial |
$10,395.84
|
| Rate for Payer: Preferred Network Access Commercial |
$11,955.22
|
| Rate for Payer: Quartz Beloit One Network |
$6,367.45
|
| Rate for Payer: Quartz Commercial |
$7,796.88
|
| Rate for Payer: WEA Trust Commercial |
$7,147.14
|
| Rate for Payer: WPS Commercial |
$9,624.90
|
|
|
FEMORAL STEM ADVOCATE STD NECK OFFSET SZ 11 7850-11-05
|
Facility
|
OP
|
$12,495.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967865
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,638.54 |
| Max. Negotiated Rate |
$11,955.22 |
| Rate for Payer: Aetna Commercial |
$11,695.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,175.53
|
| Rate for Payer: Aetna Managed Medicare |
$3,638.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,446.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,497.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,237.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,887.24
|
| Rate for Payer: Cash Price |
$3,748.50
|
| Rate for Payer: Cigna Commercial |
$11,955.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,272.09
|
| Rate for Payer: Health EOS Commercial |
$11,565.37
|
| Rate for Payer: HFN Commercial |
$11,955.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,746.10
|
| Rate for Payer: Multiplan Commercial |
$10,395.84
|
| Rate for Payer: NAPHCARE Commercial |
$7,796.88
|
| Rate for Payer: Preferred Network Access Commercial |
$11,955.22
|
| Rate for Payer: Quartz Beloit One Network |
$6,367.45
|
| Rate for Payer: Quartz Commercial |
$8,446.62
|
| Rate for Payer: Quartz Medicare Advantage |
$7,796.88
|
| Rate for Payer: The Alliance Commercial |
$6,497.40
|
| Rate for Payer: WEA Trust Commercial |
$7,147.14
|
| Rate for Payer: WPS Commercial |
$9,624.90
|
|
|
FEMORAL STEM AML 12/14 TAPER 12.0MM 6IN LG STATURE 160MM LENGTH 40MM OFFSET 1554-02-121
|
Facility
|
OP
|
$11,212.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6172811
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,264.93 |
| Max. Negotiated Rate |
$10,727.64 |
| Rate for Payer: Aetna Commercial |
$10,494.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,028.01
|
| Rate for Payer: Aetna Managed Medicare |
$3,264.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,579.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,830.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,597.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,180.05
|
| Rate for Payer: Cash Price |
$3,363.60
|
| Rate for Payer: Cigna Commercial |
$10,727.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,525.38
|
| Rate for Payer: Health EOS Commercial |
$10,377.83
|
| Rate for Payer: HFN Commercial |
$10,727.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,745.36
|
| Rate for Payer: Multiplan Commercial |
$9,328.38
|
| Rate for Payer: NAPHCARE Commercial |
$6,996.29
|
| Rate for Payer: Preferred Network Access Commercial |
$10,727.64
|
| Rate for Payer: Quartz Beloit One Network |
$5,713.64
|
| Rate for Payer: Quartz Commercial |
$7,579.31
|
| Rate for Payer: Quartz Medicare Advantage |
$6,996.29
|
| Rate for Payer: The Alliance Commercial |
$5,830.24
|
| Rate for Payer: WEA Trust Commercial |
$6,413.26
|
| Rate for Payer: WPS Commercial |
$8,636.60
|
|
|
FEMORAL STEM AML 12/14 TAPER 12.0MM 6IN LG STATURE 160MM LENGTH 40MM OFFSET 1554-02-121
|
Facility
|
IP
|
$11,212.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6172811
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,713.64 |
| Max. Negotiated Rate |
$10,727.64 |
| Rate for Payer: Aetna Commercial |
$10,494.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,028.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,180.05
|
| Rate for Payer: Cash Price |
$3,363.60
|
| Rate for Payer: Cigna Commercial |
$10,727.64
|
| Rate for Payer: Health EOS Commercial |
$10,377.83
|
| Rate for Payer: HFN Commercial |
$10,727.64
|
| Rate for Payer: Multiplan Commercial |
$9,328.38
|
| Rate for Payer: Preferred Network Access Commercial |
$10,727.64
|
| Rate for Payer: Quartz Beloit One Network |
$5,713.64
|
| Rate for Payer: Quartz Commercial |
$6,996.29
|
| Rate for Payer: WEA Trust Commercial |
$6,413.26
|
| Rate for Payer: WPS Commercial |
$8,636.60
|
|
|
FEMORAL STEM AML 12/14 TAPER 13.5 SMALL STATURE 155MM LENGTH 43MM OFFSET 1554-01-135
|
Facility
|
IP
|
$11,212.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6165645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,713.64 |
| Max. Negotiated Rate |
$10,727.64 |
| Rate for Payer: Aetna Commercial |
$10,494.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,028.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,180.05
|
| Rate for Payer: Cash Price |
$3,363.60
|
| Rate for Payer: Cigna Commercial |
$10,727.64
|
| Rate for Payer: Health EOS Commercial |
$10,377.83
|
| Rate for Payer: HFN Commercial |
$10,727.64
|
| Rate for Payer: Multiplan Commercial |
$9,328.38
|
| Rate for Payer: Preferred Network Access Commercial |
$10,727.64
|
| Rate for Payer: Quartz Beloit One Network |
$5,713.64
|
| Rate for Payer: Quartz Commercial |
$6,996.29
|
| Rate for Payer: WEA Trust Commercial |
$6,413.26
|
| Rate for Payer: WPS Commercial |
$8,636.60
|
|
|
FEMORAL STEM AML 12/14 TAPER 13.5 SMALL STATURE 155MM LENGTH 43MM OFFSET 1554-01-135
|
Facility
|
OP
|
$11,212.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6165645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,264.93 |
| Max. Negotiated Rate |
$10,727.64 |
| Rate for Payer: Aetna Commercial |
$10,494.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,028.01
|
| Rate for Payer: Aetna Managed Medicare |
$3,264.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,579.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,830.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,597.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,180.05
|
| Rate for Payer: Cash Price |
$3,363.60
|
| Rate for Payer: Cigna Commercial |
$10,727.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,525.38
|
| Rate for Payer: Health EOS Commercial |
$10,377.83
|
| Rate for Payer: HFN Commercial |
$10,727.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,745.36
|
| Rate for Payer: Multiplan Commercial |
$9,328.38
|
| Rate for Payer: NAPHCARE Commercial |
$6,996.29
|
| Rate for Payer: Preferred Network Access Commercial |
$10,727.64
|
| Rate for Payer: Quartz Beloit One Network |
$5,713.64
|
| Rate for Payer: Quartz Commercial |
$7,579.31
|
| Rate for Payer: Quartz Medicare Advantage |
$6,996.29
|
| Rate for Payer: The Alliance Commercial |
$5,830.24
|
| Rate for Payer: WEA Trust Commercial |
$6,413.26
|
| Rate for Payer: WPS Commercial |
$8,636.60
|
|
|
FEMORAL STEM AVENIR MULLER LATERAL SZ 2 01.06010.102
|
Facility
|
OP
|
$15,490.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5456725
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,510.69 |
| Max. Negotiated Rate |
$14,820.83 |
| Rate for Payer: Aetna Commercial |
$14,498.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,854.26
|
| Rate for Payer: Aetna Managed Medicare |
$4,510.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,471.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,054.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,732.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,538.09
|
| Rate for Payer: Cash Price |
$4,647.00
|
| Rate for Payer: Cigna Commercial |
$14,820.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,015.18
|
| Rate for Payer: Health EOS Commercial |
$14,337.54
|
| Rate for Payer: HFN Commercial |
$14,820.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,082.20
|
| Rate for Payer: Multiplan Commercial |
$12,887.68
|
| Rate for Payer: NAPHCARE Commercial |
$9,665.76
|
| Rate for Payer: Preferred Network Access Commercial |
$14,820.83
|
| Rate for Payer: Quartz Beloit One Network |
$7,893.70
|
| Rate for Payer: Quartz Commercial |
$10,471.24
|
| Rate for Payer: Quartz Medicare Advantage |
$9,665.76
|
| Rate for Payer: The Alliance Commercial |
$8,054.80
|
| Rate for Payer: WEA Trust Commercial |
$8,860.28
|
| Rate for Payer: WPS Commercial |
$11,931.95
|
|
|
FEMORAL STEM AVENIR MULLER LATERAL SZ 2 01.06010.102
|
Facility
|
IP
|
$15,490.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5456725
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,893.70 |
| Max. Negotiated Rate |
$14,820.83 |
| Rate for Payer: Aetna Commercial |
$14,498.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,854.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,538.09
|
| Rate for Payer: Cash Price |
$4,647.00
|
| Rate for Payer: Cigna Commercial |
$14,820.83
|
| Rate for Payer: Health EOS Commercial |
$14,337.54
|
| Rate for Payer: HFN Commercial |
$14,820.83
|
| Rate for Payer: Multiplan Commercial |
$12,887.68
|
| Rate for Payer: Preferred Network Access Commercial |
$14,820.83
|
| Rate for Payer: Quartz Beloit One Network |
$7,893.70
|
| Rate for Payer: Quartz Commercial |
$9,665.76
|
| Rate for Payer: WEA Trust Commercial |
$8,860.28
|
| Rate for Payer: WPS Commercial |
$11,931.95
|
|
|
FEMORAL STEM AVENIR MULLER STD SZ 2 01.06010.002
|
Facility
|
OP
|
$12,244.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6220164
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,565.45 |
| Max. Negotiated Rate |
$11,715.06 |
| Rate for Payer: Aetna Commercial |
$11,460.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,951.03
|
| Rate for Payer: Aetna Managed Medicare |
$3,565.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,276.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,366.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,112.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,748.89
|
| Rate for Payer: Cash Price |
$3,673.20
|
| Rate for Payer: Cigna Commercial |
$11,715.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,126.01
|
| Rate for Payer: Health EOS Commercial |
$11,333.05
|
| Rate for Payer: HFN Commercial |
$11,715.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,550.32
|
| Rate for Payer: Multiplan Commercial |
$10,187.01
|
| Rate for Payer: NAPHCARE Commercial |
$7,640.26
|
| Rate for Payer: Preferred Network Access Commercial |
$11,715.06
|
| Rate for Payer: Quartz Beloit One Network |
$6,239.54
|
| Rate for Payer: Quartz Commercial |
$8,276.94
|
| Rate for Payer: Quartz Medicare Advantage |
$7,640.26
|
| Rate for Payer: The Alliance Commercial |
$6,366.88
|
| Rate for Payer: WEA Trust Commercial |
$7,003.57
|
| Rate for Payer: WPS Commercial |
$9,431.55
|
|
|
FEMORAL STEM AVENIR MULLER STD SZ 2 01.06010.002
|
Facility
|
IP
|
$12,244.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6220164
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,239.54 |
| Max. Negotiated Rate |
$11,715.06 |
| Rate for Payer: Aetna Commercial |
$11,460.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,951.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,748.89
|
| Rate for Payer: Cash Price |
$3,673.20
|
| Rate for Payer: Cigna Commercial |
$11,715.06
|
| Rate for Payer: Health EOS Commercial |
$11,333.05
|
| Rate for Payer: HFN Commercial |
$11,715.06
|
| Rate for Payer: Multiplan Commercial |
$10,187.01
|
| Rate for Payer: Preferred Network Access Commercial |
$11,715.06
|
| Rate for Payer: Quartz Beloit One Network |
$6,239.54
|
| Rate for Payer: Quartz Commercial |
$7,640.26
|
| Rate for Payer: WEA Trust Commercial |
$7,003.57
|
| Rate for Payer: WPS Commercial |
$9,431.55
|
|
|
FEMORAL STEM AVENIR MULLER STD SZ 2 01.06010.202
|
Facility
|
OP
|
$15,490.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4858762
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,510.69 |
| Max. Negotiated Rate |
$14,820.83 |
| Rate for Payer: Aetna Commercial |
$14,498.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,854.26
|
| Rate for Payer: Aetna Managed Medicare |
$4,510.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,471.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,054.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,732.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,538.09
|
| Rate for Payer: Cash Price |
$4,647.00
|
| Rate for Payer: Cigna Commercial |
$14,820.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,015.18
|
| Rate for Payer: Health EOS Commercial |
$14,337.54
|
| Rate for Payer: HFN Commercial |
$14,820.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,082.20
|
| Rate for Payer: Multiplan Commercial |
$12,887.68
|
| Rate for Payer: NAPHCARE Commercial |
$9,665.76
|
| Rate for Payer: Preferred Network Access Commercial |
$14,820.83
|
| Rate for Payer: Quartz Beloit One Network |
$7,893.70
|
| Rate for Payer: Quartz Commercial |
$10,471.24
|
| Rate for Payer: Quartz Medicare Advantage |
$9,665.76
|
| Rate for Payer: The Alliance Commercial |
$8,054.80
|
| Rate for Payer: WEA Trust Commercial |
$8,860.28
|
| Rate for Payer: WPS Commercial |
$11,931.95
|
|
