|
FEMORAL STEM SUMMIT SZ 4 12/14 TAPER 1570-11-100
|
Facility
|
OP
|
$12,126.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5591261
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,531.09 |
| Max. Negotiated Rate |
$11,602.16 |
| Rate for Payer: Aetna Commercial |
$11,349.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,845.49
|
| Rate for Payer: Aetna Managed Medicare |
$3,531.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,197.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,305.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,053.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,683.85
|
| Rate for Payer: Cash Price |
$3,637.80
|
| Rate for Payer: Cigna Commercial |
$11,602.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,057.33
|
| Rate for Payer: Health EOS Commercial |
$11,223.83
|
| Rate for Payer: HFN Commercial |
$11,602.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,458.28
|
| Rate for Payer: Multiplan Commercial |
$10,088.83
|
| Rate for Payer: NAPHCARE Commercial |
$7,566.62
|
| Rate for Payer: Preferred Network Access Commercial |
$11,602.16
|
| Rate for Payer: Quartz Beloit One Network |
$6,179.41
|
| Rate for Payer: Quartz Commercial |
$8,197.18
|
| Rate for Payer: Quartz Medicare Advantage |
$7,566.62
|
| Rate for Payer: The Alliance Commercial |
$6,305.52
|
| Rate for Payer: WEA Trust Commercial |
$6,936.07
|
| Rate for Payer: WPS Commercial |
$9,340.66
|
|
|
FEMORAL STEM SUMMIT SZ 4 12/14 TAPER 1570-11-100
|
Facility
|
IP
|
$12,126.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5591261
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,179.41 |
| Max. Negotiated Rate |
$11,602.16 |
| Rate for Payer: Aetna Commercial |
$11,349.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,845.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,683.85
|
| Rate for Payer: Cash Price |
$3,637.80
|
| Rate for Payer: Cigna Commercial |
$11,602.16
|
| Rate for Payer: Health EOS Commercial |
$11,223.83
|
| Rate for Payer: HFN Commercial |
$11,602.16
|
| Rate for Payer: Multiplan Commercial |
$10,088.83
|
| Rate for Payer: Preferred Network Access Commercial |
$11,602.16
|
| Rate for Payer: Quartz Beloit One Network |
$6,179.41
|
| Rate for Payer: Quartz Commercial |
$7,566.62
|
| Rate for Payer: WEA Trust Commercial |
$6,936.07
|
| Rate for Payer: WPS Commercial |
$9,340.66
|
|
|
FEMORAL STEM SUMMIT SZ 4 STD 12/14 TAPER 1570-01-100
|
Facility
|
OP
|
$15,511.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5496705
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,516.80 |
| Max. Negotiated Rate |
$14,840.92 |
| Rate for Payer: Aetna Commercial |
$14,518.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,873.04
|
| Rate for Payer: Aetna Managed Medicare |
$4,516.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,485.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,065.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,743.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,549.66
|
| Rate for Payer: Cash Price |
$4,653.30
|
| Rate for Payer: Cigna Commercial |
$14,840.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,027.40
|
| Rate for Payer: Health EOS Commercial |
$14,356.98
|
| Rate for Payer: HFN Commercial |
$14,840.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,098.58
|
| Rate for Payer: Multiplan Commercial |
$12,905.15
|
| Rate for Payer: NAPHCARE Commercial |
$9,678.86
|
| Rate for Payer: Preferred Network Access Commercial |
$14,840.92
|
| Rate for Payer: Quartz Beloit One Network |
$7,904.41
|
| Rate for Payer: Quartz Commercial |
$10,485.44
|
| Rate for Payer: Quartz Medicare Advantage |
$9,678.86
|
| Rate for Payer: The Alliance Commercial |
$8,065.72
|
| Rate for Payer: WEA Trust Commercial |
$8,872.29
|
| Rate for Payer: WPS Commercial |
$11,948.12
|
|
|
FEMORAL STEM SUMMIT SZ 4 STD 12/14 TAPER 1570-01-100
|
Facility
|
IP
|
$15,511.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5496705
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,904.41 |
| Max. Negotiated Rate |
$14,840.92 |
| Rate for Payer: Aetna Commercial |
$14,518.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,873.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,549.66
|
| Rate for Payer: Cash Price |
$4,653.30
|
| Rate for Payer: Cigna Commercial |
$14,840.92
|
| Rate for Payer: Health EOS Commercial |
$14,356.98
|
| Rate for Payer: HFN Commercial |
$14,840.92
|
| Rate for Payer: Multiplan Commercial |
$12,905.15
|
| Rate for Payer: Preferred Network Access Commercial |
$14,840.92
|
| Rate for Payer: Quartz Beloit One Network |
$7,904.41
|
| Rate for Payer: Quartz Commercial |
$9,678.86
|
| Rate for Payer: WEA Trust Commercial |
$8,872.29
|
| Rate for Payer: WPS Commercial |
$11,948.12
|
|
|
FEMORAL STEM SUMMIT SZ 4 STD CEMENTED 1570-03-100
|
Facility
|
OP
|
$9,573.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563324
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,787.66 |
| Max. Negotiated Rate |
$9,159.45 |
| Rate for Payer: Aetna Commercial |
$8,960.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,562.09
|
| Rate for Payer: Aetna Managed Medicare |
$2,787.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,471.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,977.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,778.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,276.64
|
| Rate for Payer: Cash Price |
$2,871.90
|
| Rate for Payer: Cigna Commercial |
$9,159.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,571.49
|
| Rate for Payer: Health EOS Commercial |
$8,860.77
|
| Rate for Payer: HFN Commercial |
$9,159.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,466.94
|
| Rate for Payer: Multiplan Commercial |
$7,964.74
|
| Rate for Payer: NAPHCARE Commercial |
$5,973.55
|
| Rate for Payer: Preferred Network Access Commercial |
$9,159.45
|
| Rate for Payer: Quartz Beloit One Network |
$4,878.40
|
| Rate for Payer: Quartz Commercial |
$6,471.35
|
| Rate for Payer: Quartz Medicare Advantage |
$5,973.55
|
| Rate for Payer: The Alliance Commercial |
$4,977.96
|
| Rate for Payer: WEA Trust Commercial |
$5,475.76
|
| Rate for Payer: WPS Commercial |
$7,374.08
|
|
|
FEMORAL STEM SUMMIT SZ 4 STD CEMENTED 1570-03-100
|
Facility
|
IP
|
$9,573.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563324
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,878.40 |
| Max. Negotiated Rate |
$9,159.45 |
| Rate for Payer: Aetna Commercial |
$8,960.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,562.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,276.64
|
| Rate for Payer: Cash Price |
$2,871.90
|
| Rate for Payer: Cigna Commercial |
$9,159.45
|
| Rate for Payer: Health EOS Commercial |
$8,860.77
|
| Rate for Payer: HFN Commercial |
$9,159.45
|
| Rate for Payer: Multiplan Commercial |
$7,964.74
|
| Rate for Payer: Preferred Network Access Commercial |
$9,159.45
|
| Rate for Payer: Quartz Beloit One Network |
$4,878.40
|
| Rate for Payer: Quartz Commercial |
$5,973.55
|
| Rate for Payer: WEA Trust Commercial |
$5,475.76
|
| Rate for Payer: WPS Commercial |
$7,374.08
|
|
|
FEMORAL STEM SUMMIT SZ 5 12/14 TAPER 1570-11-110
|
Facility
|
OP
|
$14,935.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5496772
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,349.07 |
| Max. Negotiated Rate |
$14,289.81 |
| Rate for Payer: Aetna Commercial |
$13,979.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,357.86
|
| Rate for Payer: Aetna Managed Medicare |
$4,349.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,096.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,766.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,455.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,232.17
|
| Rate for Payer: Cash Price |
$4,480.50
|
| Rate for Payer: Cigna Commercial |
$14,289.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,692.17
|
| Rate for Payer: Health EOS Commercial |
$13,823.84
|
| Rate for Payer: HFN Commercial |
$14,289.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,649.30
|
| Rate for Payer: Multiplan Commercial |
$12,425.92
|
| Rate for Payer: NAPHCARE Commercial |
$9,319.44
|
| Rate for Payer: Preferred Network Access Commercial |
$14,289.81
|
| Rate for Payer: Quartz Beloit One Network |
$7,610.88
|
| Rate for Payer: Quartz Commercial |
$10,096.06
|
| Rate for Payer: Quartz Medicare Advantage |
$9,319.44
|
| Rate for Payer: The Alliance Commercial |
$7,766.20
|
| Rate for Payer: WEA Trust Commercial |
$8,542.82
|
| Rate for Payer: WPS Commercial |
$11,504.43
|
|
|
FEMORAL STEM SUMMIT SZ 5 12/14 TAPER 1570-11-110
|
Facility
|
IP
|
$14,935.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5496772
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,610.88 |
| Max. Negotiated Rate |
$14,289.81 |
| Rate for Payer: Aetna Commercial |
$13,979.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,357.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,232.17
|
| Rate for Payer: Cash Price |
$4,480.50
|
| Rate for Payer: Cigna Commercial |
$14,289.81
|
| Rate for Payer: Health EOS Commercial |
$13,823.84
|
| Rate for Payer: HFN Commercial |
$14,289.81
|
| Rate for Payer: Multiplan Commercial |
$12,425.92
|
| Rate for Payer: Preferred Network Access Commercial |
$14,289.81
|
| Rate for Payer: Quartz Beloit One Network |
$7,610.88
|
| Rate for Payer: Quartz Commercial |
$9,319.44
|
| Rate for Payer: WEA Trust Commercial |
$8,542.82
|
| Rate for Payer: WPS Commercial |
$11,504.43
|
|
|
FEMORAL STEM SUMMIT SZ 5 12/14 TAPER 1570-13-110
|
Facility
|
OP
|
$9,956.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5547546
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,899.19 |
| Max. Negotiated Rate |
$9,525.90 |
| Rate for Payer: Aetna Commercial |
$9,318.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,904.65
|
| Rate for Payer: Aetna Managed Medicare |
$2,899.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,730.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,177.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,970.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,487.75
|
| Rate for Payer: Cash Price |
$2,986.80
|
| Rate for Payer: Cigna Commercial |
$9,525.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,794.39
|
| Rate for Payer: Health EOS Commercial |
$9,215.27
|
| Rate for Payer: HFN Commercial |
$9,525.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,765.68
|
| Rate for Payer: Multiplan Commercial |
$8,283.39
|
| Rate for Payer: NAPHCARE Commercial |
$6,212.54
|
| Rate for Payer: Preferred Network Access Commercial |
$9,525.90
|
| Rate for Payer: Quartz Beloit One Network |
$5,073.58
|
| Rate for Payer: Quartz Commercial |
$6,730.26
|
| Rate for Payer: Quartz Medicare Advantage |
$6,212.54
|
| Rate for Payer: The Alliance Commercial |
$5,177.12
|
| Rate for Payer: WEA Trust Commercial |
$5,694.83
|
| Rate for Payer: WPS Commercial |
$7,669.11
|
|
|
FEMORAL STEM SUMMIT SZ 5 12/14 TAPER 1570-13-110
|
Facility
|
IP
|
$9,956.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5547546
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,073.58 |
| Max. Negotiated Rate |
$9,525.90 |
| Rate for Payer: Aetna Commercial |
$9,318.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,904.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,487.75
|
| Rate for Payer: Cash Price |
$2,986.80
|
| Rate for Payer: Cigna Commercial |
$9,525.90
|
| Rate for Payer: Health EOS Commercial |
$9,215.27
|
| Rate for Payer: HFN Commercial |
$9,525.90
|
| Rate for Payer: Multiplan Commercial |
$8,283.39
|
| Rate for Payer: Preferred Network Access Commercial |
$9,525.90
|
| Rate for Payer: Quartz Beloit One Network |
$5,073.58
|
| Rate for Payer: Quartz Commercial |
$6,212.54
|
| Rate for Payer: WEA Trust Commercial |
$5,694.83
|
| Rate for Payer: WPS Commercial |
$7,669.11
|
|
|
FEMORAL STEM SUMMIT SZ 5 STD 12/14 TAPER 1570-01-110
|
Facility
|
OP
|
$17,234.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5459768
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,018.54 |
| Max. Negotiated Rate |
$16,489.49 |
| Rate for Payer: Aetna Commercial |
$16,131.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,414.09
|
| Rate for Payer: Aetna Managed Medicare |
$5,018.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,650.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,961.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,603.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,499.38
|
| Rate for Payer: Cash Price |
$5,170.20
|
| Rate for Payer: Cigna Commercial |
$16,489.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,030.19
|
| Rate for Payer: Health EOS Commercial |
$15,951.79
|
| Rate for Payer: HFN Commercial |
$16,489.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,442.52
|
| Rate for Payer: Multiplan Commercial |
$14,338.69
|
| Rate for Payer: NAPHCARE Commercial |
$10,754.02
|
| Rate for Payer: Preferred Network Access Commercial |
$16,489.49
|
| Rate for Payer: Quartz Beloit One Network |
$8,782.45
|
| Rate for Payer: Quartz Commercial |
$11,650.18
|
| Rate for Payer: Quartz Medicare Advantage |
$10,754.02
|
| Rate for Payer: The Alliance Commercial |
$8,961.68
|
| Rate for Payer: WEA Trust Commercial |
$9,857.85
|
| Rate for Payer: WPS Commercial |
$13,275.35
|
|
|
FEMORAL STEM SUMMIT SZ 5 STD 12/14 TAPER 1570-01-110
|
Facility
|
IP
|
$17,234.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5459768
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,782.45 |
| Max. Negotiated Rate |
$16,489.49 |
| Rate for Payer: Aetna Commercial |
$16,131.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,414.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,499.38
|
| Rate for Payer: Cash Price |
$5,170.20
|
| Rate for Payer: Cigna Commercial |
$16,489.49
|
| Rate for Payer: Health EOS Commercial |
$15,951.79
|
| Rate for Payer: HFN Commercial |
$16,489.49
|
| Rate for Payer: Multiplan Commercial |
$14,338.69
|
| Rate for Payer: Preferred Network Access Commercial |
$16,489.49
|
| Rate for Payer: Quartz Beloit One Network |
$8,782.45
|
| Rate for Payer: Quartz Commercial |
$10,754.02
|
| Rate for Payer: WEA Trust Commercial |
$9,857.85
|
| Rate for Payer: WPS Commercial |
$13,275.35
|
|
|
FEMORAL STEM SUMMIT SZ 5 STD CEMENTED 1570-03-110
|
Facility
|
OP
|
$8,673.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5787623
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,525.58 |
| Max. Negotiated Rate |
$8,298.33 |
| Rate for Payer: Aetna Commercial |
$8,117.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,757.13
|
| Rate for Payer: Aetna Managed Medicare |
$2,525.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,862.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,509.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,329.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,780.56
|
| Rate for Payer: Cash Price |
$2,601.90
|
| Rate for Payer: Cigna Commercial |
$8,298.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,047.69
|
| Rate for Payer: Health EOS Commercial |
$8,027.73
|
| Rate for Payer: HFN Commercial |
$8,298.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,764.94
|
| Rate for Payer: Multiplan Commercial |
$7,215.94
|
| Rate for Payer: NAPHCARE Commercial |
$5,411.95
|
| Rate for Payer: Preferred Network Access Commercial |
$8,298.33
|
| Rate for Payer: Quartz Beloit One Network |
$4,419.76
|
| Rate for Payer: Quartz Commercial |
$5,862.95
|
| Rate for Payer: Quartz Medicare Advantage |
$5,411.95
|
| Rate for Payer: The Alliance Commercial |
$4,509.96
|
| Rate for Payer: WEA Trust Commercial |
$4,960.96
|
| Rate for Payer: WPS Commercial |
$6,680.81
|
|
|
FEMORAL STEM SUMMIT SZ 5 STD CEMENTED 1570-03-110
|
Facility
|
IP
|
$8,673.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5787623
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,419.76 |
| Max. Negotiated Rate |
$8,298.33 |
| Rate for Payer: Aetna Commercial |
$8,117.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,757.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,780.56
|
| Rate for Payer: Cash Price |
$2,601.90
|
| Rate for Payer: Cigna Commercial |
$8,298.33
|
| Rate for Payer: Health EOS Commercial |
$8,027.73
|
| Rate for Payer: HFN Commercial |
$8,298.33
|
| Rate for Payer: Multiplan Commercial |
$7,215.94
|
| Rate for Payer: Preferred Network Access Commercial |
$8,298.33
|
| Rate for Payer: Quartz Beloit One Network |
$4,419.76
|
| Rate for Payer: Quartz Commercial |
$5,411.95
|
| Rate for Payer: WEA Trust Commercial |
$4,960.96
|
| Rate for Payer: WPS Commercial |
$6,680.81
|
|
|
FEMORAL STEM SUMMIT SZ 6 12/14 TAPER 1570-11-120
|
Facility
|
IP
|
$17,234.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5459307
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,782.45 |
| Max. Negotiated Rate |
$16,489.49 |
| Rate for Payer: Aetna Commercial |
$16,131.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,414.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,499.38
|
| Rate for Payer: Cash Price |
$5,170.20
|
| Rate for Payer: Cigna Commercial |
$16,489.49
|
| Rate for Payer: Health EOS Commercial |
$15,951.79
|
| Rate for Payer: HFN Commercial |
$16,489.49
|
| Rate for Payer: Multiplan Commercial |
$14,338.69
|
| Rate for Payer: Preferred Network Access Commercial |
$16,489.49
|
| Rate for Payer: Quartz Beloit One Network |
$8,782.45
|
| Rate for Payer: Quartz Commercial |
$10,754.02
|
| Rate for Payer: WEA Trust Commercial |
$9,857.85
|
| Rate for Payer: WPS Commercial |
$13,275.35
|
|
|
FEMORAL STEM SUMMIT SZ 6 12/14 TAPER 1570-11-120
|
Facility
|
OP
|
$17,234.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5459307
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,018.54 |
| Max. Negotiated Rate |
$16,489.49 |
| Rate for Payer: Aetna Commercial |
$16,131.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,414.09
|
| Rate for Payer: Aetna Managed Medicare |
$5,018.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,650.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,961.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,603.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,499.38
|
| Rate for Payer: Cash Price |
$5,170.20
|
| Rate for Payer: Cigna Commercial |
$16,489.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,030.19
|
| Rate for Payer: Health EOS Commercial |
$15,951.79
|
| Rate for Payer: HFN Commercial |
$16,489.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,442.52
|
| Rate for Payer: Multiplan Commercial |
$14,338.69
|
| Rate for Payer: NAPHCARE Commercial |
$10,754.02
|
| Rate for Payer: Preferred Network Access Commercial |
$16,489.49
|
| Rate for Payer: Quartz Beloit One Network |
$8,782.45
|
| Rate for Payer: Quartz Commercial |
$11,650.18
|
| Rate for Payer: Quartz Medicare Advantage |
$10,754.02
|
| Rate for Payer: The Alliance Commercial |
$8,961.68
|
| Rate for Payer: WEA Trust Commercial |
$9,857.85
|
| Rate for Payer: WPS Commercial |
$13,275.35
|
|
|
FEMORAL STEM SUMMIT SZ 6 12/14 TAPER 1570-13-120
|
Facility
|
IP
|
$8,673.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5729684
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,419.76 |
| Max. Negotiated Rate |
$8,298.33 |
| Rate for Payer: Aetna Commercial |
$8,117.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,757.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,780.56
|
| Rate for Payer: Cash Price |
$2,601.90
|
| Rate for Payer: Cigna Commercial |
$8,298.33
|
| Rate for Payer: Health EOS Commercial |
$8,027.73
|
| Rate for Payer: HFN Commercial |
$8,298.33
|
| Rate for Payer: Multiplan Commercial |
$7,215.94
|
| Rate for Payer: Preferred Network Access Commercial |
$8,298.33
|
| Rate for Payer: Quartz Beloit One Network |
$4,419.76
|
| Rate for Payer: Quartz Commercial |
$5,411.95
|
| Rate for Payer: WEA Trust Commercial |
$4,960.96
|
| Rate for Payer: WPS Commercial |
$6,680.81
|
|
|
FEMORAL STEM SUMMIT SZ 6 12/14 TAPER 1570-13-120
|
Facility
|
OP
|
$8,673.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5729684
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,525.58 |
| Max. Negotiated Rate |
$8,298.33 |
| Rate for Payer: Aetna Commercial |
$8,117.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,757.13
|
| Rate for Payer: Aetna Managed Medicare |
$2,525.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,862.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,509.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,329.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,780.56
|
| Rate for Payer: Cash Price |
$2,601.90
|
| Rate for Payer: Cigna Commercial |
$8,298.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,047.69
|
| Rate for Payer: Health EOS Commercial |
$8,027.73
|
| Rate for Payer: HFN Commercial |
$8,298.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,764.94
|
| Rate for Payer: Multiplan Commercial |
$7,215.94
|
| Rate for Payer: NAPHCARE Commercial |
$5,411.95
|
| Rate for Payer: Preferred Network Access Commercial |
$8,298.33
|
| Rate for Payer: Quartz Beloit One Network |
$4,419.76
|
| Rate for Payer: Quartz Commercial |
$5,862.95
|
| Rate for Payer: Quartz Medicare Advantage |
$5,411.95
|
| Rate for Payer: The Alliance Commercial |
$4,509.96
|
| Rate for Payer: WEA Trust Commercial |
$4,960.96
|
| Rate for Payer: WPS Commercial |
$6,680.81
|
|
|
FEMORAL STEM SUMMIT SZ 6 STD 12/14 TAPER 1570-01-120
|
Facility
|
OP
|
$12,126.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5547327
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,531.09 |
| Max. Negotiated Rate |
$11,602.16 |
| Rate for Payer: Aetna Commercial |
$11,349.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,845.49
|
| Rate for Payer: Aetna Managed Medicare |
$3,531.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,197.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,305.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,053.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,683.85
|
| Rate for Payer: Cash Price |
$3,637.80
|
| Rate for Payer: Cigna Commercial |
$11,602.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,057.33
|
| Rate for Payer: Health EOS Commercial |
$11,223.83
|
| Rate for Payer: HFN Commercial |
$11,602.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,458.28
|
| Rate for Payer: Multiplan Commercial |
$10,088.83
|
| Rate for Payer: NAPHCARE Commercial |
$7,566.62
|
| Rate for Payer: Preferred Network Access Commercial |
$11,602.16
|
| Rate for Payer: Quartz Beloit One Network |
$6,179.41
|
| Rate for Payer: Quartz Commercial |
$8,197.18
|
| Rate for Payer: Quartz Medicare Advantage |
$7,566.62
|
| Rate for Payer: The Alliance Commercial |
$6,305.52
|
| Rate for Payer: WEA Trust Commercial |
$6,936.07
|
| Rate for Payer: WPS Commercial |
$9,340.66
|
|
|
FEMORAL STEM SUMMIT SZ 6 STD 12/14 TAPER 1570-01-120
|
Facility
|
IP
|
$12,126.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5547327
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,179.41 |
| Max. Negotiated Rate |
$11,602.16 |
| Rate for Payer: Aetna Commercial |
$11,349.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,845.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,683.85
|
| Rate for Payer: Cash Price |
$3,637.80
|
| Rate for Payer: Cigna Commercial |
$11,602.16
|
| Rate for Payer: Health EOS Commercial |
$11,223.83
|
| Rate for Payer: HFN Commercial |
$11,602.16
|
| Rate for Payer: Multiplan Commercial |
$10,088.83
|
| Rate for Payer: Preferred Network Access Commercial |
$11,602.16
|
| Rate for Payer: Quartz Beloit One Network |
$6,179.41
|
| Rate for Payer: Quartz Commercial |
$7,566.62
|
| Rate for Payer: WEA Trust Commercial |
$6,936.07
|
| Rate for Payer: WPS Commercial |
$9,340.66
|
|
|
FEMORAL STEM SUMMIT SZ 6 STD CEMENTED 1570-03-120
|
Facility
|
OP
|
$9,956.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5520919
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,899.19 |
| Max. Negotiated Rate |
$9,525.90 |
| Rate for Payer: Aetna Commercial |
$9,318.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,904.65
|
| Rate for Payer: Aetna Managed Medicare |
$2,899.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,730.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,177.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,970.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,487.75
|
| Rate for Payer: Cash Price |
$2,986.80
|
| Rate for Payer: Cigna Commercial |
$9,525.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,794.39
|
| Rate for Payer: Health EOS Commercial |
$9,215.27
|
| Rate for Payer: HFN Commercial |
$9,525.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,765.68
|
| Rate for Payer: Multiplan Commercial |
$8,283.39
|
| Rate for Payer: NAPHCARE Commercial |
$6,212.54
|
| Rate for Payer: Preferred Network Access Commercial |
$9,525.90
|
| Rate for Payer: Quartz Beloit One Network |
$5,073.58
|
| Rate for Payer: Quartz Commercial |
$6,730.26
|
| Rate for Payer: Quartz Medicare Advantage |
$6,212.54
|
| Rate for Payer: The Alliance Commercial |
$5,177.12
|
| Rate for Payer: WEA Trust Commercial |
$5,694.83
|
| Rate for Payer: WPS Commercial |
$7,669.11
|
|
|
FEMORAL STEM SUMMIT SZ 6 STD CEMENTED 1570-03-120
|
Facility
|
IP
|
$9,956.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5520919
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,073.58 |
| Max. Negotiated Rate |
$9,525.90 |
| Rate for Payer: Aetna Commercial |
$9,318.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,904.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,487.75
|
| Rate for Payer: Cash Price |
$2,986.80
|
| Rate for Payer: Cigna Commercial |
$9,525.90
|
| Rate for Payer: Health EOS Commercial |
$9,215.27
|
| Rate for Payer: HFN Commercial |
$9,525.90
|
| Rate for Payer: Multiplan Commercial |
$8,283.39
|
| Rate for Payer: Preferred Network Access Commercial |
$9,525.90
|
| Rate for Payer: Quartz Beloit One Network |
$5,073.58
|
| Rate for Payer: Quartz Commercial |
$6,212.54
|
| Rate for Payer: WEA Trust Commercial |
$5,694.83
|
| Rate for Payer: WPS Commercial |
$7,669.11
|
|
|
FEMORAL STEM SUMMIT SZ 7 12/14 TAPER 1570-11-135
|
Facility
|
OP
|
$12,126.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5597545
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,531.09 |
| Max. Negotiated Rate |
$11,602.16 |
| Rate for Payer: Aetna Commercial |
$11,349.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,845.49
|
| Rate for Payer: Aetna Managed Medicare |
$3,531.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,197.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,305.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,053.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,683.85
|
| Rate for Payer: Cash Price |
$3,637.80
|
| Rate for Payer: Cigna Commercial |
$11,602.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,057.33
|
| Rate for Payer: Health EOS Commercial |
$11,223.83
|
| Rate for Payer: HFN Commercial |
$11,602.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,458.28
|
| Rate for Payer: Multiplan Commercial |
$10,088.83
|
| Rate for Payer: NAPHCARE Commercial |
$7,566.62
|
| Rate for Payer: Preferred Network Access Commercial |
$11,602.16
|
| Rate for Payer: Quartz Beloit One Network |
$6,179.41
|
| Rate for Payer: Quartz Commercial |
$8,197.18
|
| Rate for Payer: Quartz Medicare Advantage |
$7,566.62
|
| Rate for Payer: The Alliance Commercial |
$6,305.52
|
| Rate for Payer: WEA Trust Commercial |
$6,936.07
|
| Rate for Payer: WPS Commercial |
$9,340.66
|
|
|
FEMORAL STEM SUMMIT SZ 7 12/14 TAPER 1570-11-135
|
Facility
|
IP
|
$12,126.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5597545
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,179.41 |
| Max. Negotiated Rate |
$11,602.16 |
| Rate for Payer: Aetna Commercial |
$11,349.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,845.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,683.85
|
| Rate for Payer: Cash Price |
$3,637.80
|
| Rate for Payer: Cigna Commercial |
$11,602.16
|
| Rate for Payer: Health EOS Commercial |
$11,223.83
|
| Rate for Payer: HFN Commercial |
$11,602.16
|
| Rate for Payer: Multiplan Commercial |
$10,088.83
|
| Rate for Payer: Preferred Network Access Commercial |
$11,602.16
|
| Rate for Payer: Quartz Beloit One Network |
$6,179.41
|
| Rate for Payer: Quartz Commercial |
$7,566.62
|
| Rate for Payer: WEA Trust Commercial |
$6,936.07
|
| Rate for Payer: WPS Commercial |
$9,340.66
|
|
|
FEMORAL STEM SUMMIT SZ 7 STD 12/14 TAPER 1570-01-135
|
Facility
|
IP
|
$15,511.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5497009
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,904.41 |
| Max. Negotiated Rate |
$14,840.92 |
| Rate for Payer: Aetna Commercial |
$14,518.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,873.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,549.66
|
| Rate for Payer: Cash Price |
$4,653.30
|
| Rate for Payer: Cigna Commercial |
$14,840.92
|
| Rate for Payer: Health EOS Commercial |
$14,356.98
|
| Rate for Payer: HFN Commercial |
$14,840.92
|
| Rate for Payer: Multiplan Commercial |
$12,905.15
|
| Rate for Payer: Preferred Network Access Commercial |
$14,840.92
|
| Rate for Payer: Quartz Beloit One Network |
$7,904.41
|
| Rate for Payer: Quartz Commercial |
$9,678.86
|
| Rate for Payer: WEA Trust Commercial |
$8,872.29
|
| Rate for Payer: WPS Commercial |
$11,948.12
|
|
