|
FEMORAL STEM SUMMIT SZ 7 STD 12/14 TAPER 1570-01-135
|
Facility
|
OP
|
$15,511.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5497009
|
|
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 7 STD CEMENTED 1570-03-135
|
Facility
|
IP
|
$9,020.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5603614
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,596.59 |
| Max. Negotiated Rate |
$8,630.34 |
| Rate for Payer: Aetna Commercial |
$8,442.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,067.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,971.82
|
| Rate for Payer: Cash Price |
$2,706.00
|
| Rate for Payer: Cigna Commercial |
$8,630.34
|
| Rate for Payer: Health EOS Commercial |
$8,348.91
|
| Rate for Payer: HFN Commercial |
$8,630.34
|
| Rate for Payer: Multiplan Commercial |
$7,504.64
|
| Rate for Payer: Preferred Network Access Commercial |
$8,630.34
|
| Rate for Payer: Quartz Beloit One Network |
$4,596.59
|
| Rate for Payer: Quartz Commercial |
$5,628.48
|
| Rate for Payer: WEA Trust Commercial |
$5,159.44
|
| Rate for Payer: WPS Commercial |
$6,948.11
|
|
|
FEMORAL STEM SUMMIT SZ 7 STD CEMENTED 1570-03-135
|
Facility
|
OP
|
$9,020.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5603614
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,626.62 |
| Max. Negotiated Rate |
$8,630.34 |
| Rate for Payer: Aetna Commercial |
$8,442.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,067.49
|
| Rate for Payer: Aetna Managed Medicare |
$2,626.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,097.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,690.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,502.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,971.82
|
| Rate for Payer: Cash Price |
$2,706.00
|
| Rate for Payer: Cigna Commercial |
$8,630.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,249.64
|
| Rate for Payer: Health EOS Commercial |
$8,348.91
|
| Rate for Payer: HFN Commercial |
$8,630.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,035.60
|
| Rate for Payer: Multiplan Commercial |
$7,504.64
|
| Rate for Payer: NAPHCARE Commercial |
$5,628.48
|
| Rate for Payer: Preferred Network Access Commercial |
$8,630.34
|
| Rate for Payer: Quartz Beloit One Network |
$4,596.59
|
| Rate for Payer: Quartz Commercial |
$6,097.52
|
| Rate for Payer: Quartz Medicare Advantage |
$5,628.48
|
| Rate for Payer: The Alliance Commercial |
$4,690.40
|
| Rate for Payer: WEA Trust Commercial |
$5,159.44
|
| Rate for Payer: WPS Commercial |
$6,948.11
|
|
|
FEMORAL STEM SUMMIT SZ 8 STD 12/14 TAPER 1570-01-150
|
Facility
|
IP
|
$14,935.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5496711
|
|
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 8 STD 12/14 TAPER 1570-01-150
|
Facility
|
OP
|
$14,935.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5496711
|
|
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 8 STD CEMENTED 1570-03-150
|
Facility
|
IP
|
$8,018.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6202963
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,085.97 |
| Max. Negotiated Rate |
$7,671.62 |
| Rate for Payer: Aetna Commercial |
$7,504.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,171.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,419.52
|
| Rate for Payer: Cash Price |
$2,405.40
|
| Rate for Payer: Cigna Commercial |
$7,671.62
|
| Rate for Payer: Health EOS Commercial |
$7,421.46
|
| Rate for Payer: HFN Commercial |
$7,671.62
|
| Rate for Payer: Multiplan Commercial |
$6,670.98
|
| Rate for Payer: Preferred Network Access Commercial |
$7,671.62
|
| Rate for Payer: Quartz Beloit One Network |
$4,085.97
|
| Rate for Payer: Quartz Commercial |
$5,003.23
|
| Rate for Payer: WEA Trust Commercial |
$4,586.30
|
| Rate for Payer: WPS Commercial |
$6,176.27
|
|
|
FEMORAL STEM SUMMIT SZ 8 STD CEMENTED 1570-03-150
|
Facility
|
OP
|
$8,018.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6202963
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,334.84 |
| Max. Negotiated Rate |
$7,671.62 |
| Rate for Payer: Aetna Commercial |
$7,504.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,171.30
|
| Rate for Payer: Aetna Managed Medicare |
$2,334.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,420.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,169.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,002.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,419.52
|
| Rate for Payer: Cash Price |
$2,405.40
|
| Rate for Payer: Cigna Commercial |
$7,671.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,666.48
|
| Rate for Payer: Health EOS Commercial |
$7,421.46
|
| Rate for Payer: HFN Commercial |
$7,671.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,254.04
|
| Rate for Payer: Multiplan Commercial |
$6,670.98
|
| Rate for Payer: NAPHCARE Commercial |
$5,003.23
|
| Rate for Payer: Preferred Network Access Commercial |
$7,671.62
|
| Rate for Payer: Quartz Beloit One Network |
$4,085.97
|
| Rate for Payer: Quartz Commercial |
$5,420.17
|
| Rate for Payer: Quartz Medicare Advantage |
$5,003.23
|
| Rate for Payer: The Alliance Commercial |
$4,169.36
|
| Rate for Payer: WEA Trust Commercial |
$4,586.30
|
| Rate for Payer: WPS Commercial |
$6,176.27
|
|
|
FEMORAL STEM SUMMIT SZ 9 STD 12/14 TAPER 1570-01-165
|
Facility
|
IP
|
$11,660.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5659716
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,941.94 |
| Max. Negotiated Rate |
$11,156.29 |
| Rate for Payer: Aetna Commercial |
$10,913.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,428.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,426.99
|
| Rate for Payer: Cash Price |
$3,498.00
|
| Rate for Payer: Cigna Commercial |
$11,156.29
|
| Rate for Payer: Health EOS Commercial |
$10,792.50
|
| Rate for Payer: HFN Commercial |
$11,156.29
|
| Rate for Payer: Multiplan Commercial |
$9,701.12
|
| Rate for Payer: Preferred Network Access Commercial |
$11,156.29
|
| Rate for Payer: Quartz Beloit One Network |
$5,941.94
|
| Rate for Payer: Quartz Commercial |
$7,275.84
|
| Rate for Payer: WEA Trust Commercial |
$6,669.52
|
| Rate for Payer: WPS Commercial |
$8,981.70
|
|
|
FEMORAL STEM SUMMIT SZ 9 STD 12/14 TAPER 1570-01-165
|
Facility
|
OP
|
$11,660.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5659716
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,395.39 |
| Max. Negotiated Rate |
$11,156.29 |
| Rate for Payer: Aetna Commercial |
$10,913.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,428.70
|
| Rate for Payer: Aetna Managed Medicare |
$3,395.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,882.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,063.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,820.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,426.99
|
| Rate for Payer: Cash Price |
$3,498.00
|
| Rate for Payer: Cigna Commercial |
$11,156.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,786.12
|
| Rate for Payer: Health EOS Commercial |
$10,792.50
|
| Rate for Payer: HFN Commercial |
$11,156.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,094.80
|
| Rate for Payer: Multiplan Commercial |
$9,701.12
|
| Rate for Payer: NAPHCARE Commercial |
$7,275.84
|
| Rate for Payer: Preferred Network Access Commercial |
$11,156.29
|
| Rate for Payer: Quartz Beloit One Network |
$5,941.94
|
| Rate for Payer: Quartz Commercial |
$7,882.16
|
| Rate for Payer: Quartz Medicare Advantage |
$7,275.84
|
| Rate for Payer: The Alliance Commercial |
$6,063.20
|
| Rate for Payer: WEA Trust Commercial |
$6,669.52
|
| Rate for Payer: WPS Commercial |
$8,981.70
|
|
|
FEMORAL STEM TAPERLOC PRIMARY STD OFFSET SZ 6 X 132MM 51-100060
|
Facility
|
IP
|
$12,612.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5861667
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,427.08 |
| Max. Negotiated Rate |
$12,067.16 |
| Rate for Payer: Aetna Commercial |
$11,804.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,280.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,951.73
|
| Rate for Payer: Cash Price |
$3,783.60
|
| Rate for Payer: Cigna Commercial |
$12,067.16
|
| Rate for Payer: Health EOS Commercial |
$11,673.67
|
| Rate for Payer: HFN Commercial |
$12,067.16
|
| Rate for Payer: Multiplan Commercial |
$10,493.18
|
| Rate for Payer: Preferred Network Access Commercial |
$12,067.16
|
| Rate for Payer: Quartz Beloit One Network |
$6,427.08
|
| Rate for Payer: Quartz Commercial |
$7,869.89
|
| Rate for Payer: WEA Trust Commercial |
$7,214.06
|
| Rate for Payer: WPS Commercial |
$9,715.02
|
|
|
FEMORAL STEM TAPERLOC PRIMARY STD OFFSET SZ 6 X 132MM 51-100060
|
Facility
|
OP
|
$12,612.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5861667
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,672.61 |
| Max. Negotiated Rate |
$12,067.16 |
| Rate for Payer: Aetna Commercial |
$11,804.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,280.17
|
| Rate for Payer: Aetna Managed Medicare |
$3,672.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,525.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,558.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,295.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,951.73
|
| Rate for Payer: Cash Price |
$3,783.60
|
| Rate for Payer: Cigna Commercial |
$12,067.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,340.18
|
| Rate for Payer: Health EOS Commercial |
$11,673.67
|
| Rate for Payer: HFN Commercial |
$12,067.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,837.36
|
| Rate for Payer: Multiplan Commercial |
$10,493.18
|
| Rate for Payer: NAPHCARE Commercial |
$7,869.89
|
| Rate for Payer: Preferred Network Access Commercial |
$12,067.16
|
| Rate for Payer: Quartz Beloit One Network |
$6,427.08
|
| Rate for Payer: Quartz Commercial |
$8,525.71
|
| Rate for Payer: Quartz Medicare Advantage |
$7,869.89
|
| Rate for Payer: The Alliance Commercial |
$6,558.24
|
| Rate for Payer: WEA Trust Commercial |
$7,214.06
|
| Rate for Payer: WPS Commercial |
$9,715.02
|
|
|
FEMORAL STEM TAPERLOC STD OFFSET SZ 12 X 144MM 51-103120
|
Facility
|
IP
|
$12,612.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5685730
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,427.08 |
| Max. Negotiated Rate |
$12,067.16 |
| Rate for Payer: Aetna Commercial |
$11,804.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,280.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,951.73
|
| Rate for Payer: Cash Price |
$3,783.60
|
| Rate for Payer: Cigna Commercial |
$12,067.16
|
| Rate for Payer: Health EOS Commercial |
$11,673.67
|
| Rate for Payer: HFN Commercial |
$12,067.16
|
| Rate for Payer: Multiplan Commercial |
$10,493.18
|
| Rate for Payer: Preferred Network Access Commercial |
$12,067.16
|
| Rate for Payer: Quartz Beloit One Network |
$6,427.08
|
| Rate for Payer: Quartz Commercial |
$7,869.89
|
| Rate for Payer: WEA Trust Commercial |
$7,214.06
|
| Rate for Payer: WPS Commercial |
$9,715.02
|
|
|
FEMORAL STEM TAPERLOC STD OFFSET SZ 12 X 144MM 51-103120
|
Facility
|
OP
|
$12,612.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5685730
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,672.61 |
| Max. Negotiated Rate |
$12,067.16 |
| Rate for Payer: Aetna Commercial |
$11,804.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,280.17
|
| Rate for Payer: Aetna Managed Medicare |
$3,672.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,525.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,558.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,295.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,951.73
|
| Rate for Payer: Cash Price |
$3,783.60
|
| Rate for Payer: Cigna Commercial |
$12,067.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,340.18
|
| Rate for Payer: Health EOS Commercial |
$11,673.67
|
| Rate for Payer: HFN Commercial |
$12,067.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,837.36
|
| Rate for Payer: Multiplan Commercial |
$10,493.18
|
| Rate for Payer: NAPHCARE Commercial |
$7,869.89
|
| Rate for Payer: Preferred Network Access Commercial |
$12,067.16
|
| Rate for Payer: Quartz Beloit One Network |
$6,427.08
|
| Rate for Payer: Quartz Commercial |
$8,525.71
|
| Rate for Payer: Quartz Medicare Advantage |
$7,869.89
|
| Rate for Payer: The Alliance Commercial |
$6,558.24
|
| Rate for Payer: WEA Trust Commercial |
$7,214.06
|
| Rate for Payer: WPS Commercial |
$9,715.02
|
|
|
FEMORAL STEM TAPERLOC STD OFFSET SZ 17 X 154MM 51-103170
|
Facility
|
OP
|
$12,612.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5729652
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,672.61 |
| Max. Negotiated Rate |
$12,067.16 |
| Rate for Payer: Aetna Commercial |
$11,804.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,280.17
|
| Rate for Payer: Aetna Managed Medicare |
$3,672.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,525.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,558.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,295.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,951.73
|
| Rate for Payer: Cash Price |
$3,783.60
|
| Rate for Payer: Cigna Commercial |
$12,067.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,340.18
|
| Rate for Payer: Health EOS Commercial |
$11,673.67
|
| Rate for Payer: HFN Commercial |
$12,067.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,837.36
|
| Rate for Payer: Multiplan Commercial |
$10,493.18
|
| Rate for Payer: NAPHCARE Commercial |
$7,869.89
|
| Rate for Payer: Preferred Network Access Commercial |
$12,067.16
|
| Rate for Payer: Quartz Beloit One Network |
$6,427.08
|
| Rate for Payer: Quartz Commercial |
$8,525.71
|
| Rate for Payer: Quartz Medicare Advantage |
$7,869.89
|
| Rate for Payer: The Alliance Commercial |
$6,558.24
|
| Rate for Payer: WEA Trust Commercial |
$7,214.06
|
| Rate for Payer: WPS Commercial |
$9,715.02
|
|
|
FEMORAL STEM TAPERLOC STD OFFSET SZ 17 X 154MM 51-103170
|
Facility
|
IP
|
$12,612.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5729652
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,427.08 |
| Max. Negotiated Rate |
$12,067.16 |
| Rate for Payer: Aetna Commercial |
$11,804.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,280.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,951.73
|
| Rate for Payer: Cash Price |
$3,783.60
|
| Rate for Payer: Cigna Commercial |
$12,067.16
|
| Rate for Payer: Health EOS Commercial |
$11,673.67
|
| Rate for Payer: HFN Commercial |
$12,067.16
|
| Rate for Payer: Multiplan Commercial |
$10,493.18
|
| Rate for Payer: Preferred Network Access Commercial |
$12,067.16
|
| Rate for Payer: Quartz Beloit One Network |
$6,427.08
|
| Rate for Payer: Quartz Commercial |
$7,869.89
|
| Rate for Payer: WEA Trust Commercial |
$7,214.06
|
| Rate for Payer: WPS Commercial |
$9,715.02
|
|
|
FEMORAL STEM TRABECULAR METAL 13MM STD OFFSET 00-7864-013-00
|
Facility
|
OP
|
$26,131.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967846
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,609.35 |
| Max. Negotiated Rate |
$25,002.14 |
| Rate for Payer: Aetna Commercial |
$24,458.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$23,371.57
|
| Rate for Payer: Aetna Managed Medicare |
$7,609.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17,664.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,588.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,044.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14,403.41
|
| Rate for Payer: Cash Price |
$7,839.30
|
| Rate for Payer: Cigna Commercial |
$25,002.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15,208.24
|
| Rate for Payer: Health EOS Commercial |
$24,186.85
|
| Rate for Payer: HFN Commercial |
$25,002.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,382.18
|
| Rate for Payer: Multiplan Commercial |
$21,740.99
|
| Rate for Payer: NAPHCARE Commercial |
$16,305.74
|
| Rate for Payer: Preferred Network Access Commercial |
$25,002.14
|
| Rate for Payer: Quartz Beloit One Network |
$13,316.36
|
| Rate for Payer: Quartz Commercial |
$17,664.56
|
| Rate for Payer: Quartz Medicare Advantage |
$16,305.74
|
| Rate for Payer: The Alliance Commercial |
$13,588.12
|
| Rate for Payer: WEA Trust Commercial |
$14,946.93
|
| Rate for Payer: WPS Commercial |
$20,128.71
|
|
|
FEMORAL STEM TRABECULAR METAL 13MM STD OFFSET 00-7864-013-00
|
Facility
|
IP
|
$26,131.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967846
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13,316.36 |
| Max. Negotiated Rate |
$25,002.14 |
| Rate for Payer: Aetna Commercial |
$24,458.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$23,371.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14,403.41
|
| Rate for Payer: Cash Price |
$7,839.30
|
| Rate for Payer: Cigna Commercial |
$25,002.14
|
| Rate for Payer: Health EOS Commercial |
$24,186.85
|
| Rate for Payer: HFN Commercial |
$25,002.14
|
| Rate for Payer: Multiplan Commercial |
$21,740.99
|
| Rate for Payer: Preferred Network Access Commercial |
$25,002.14
|
| Rate for Payer: Quartz Beloit One Network |
$13,316.36
|
| Rate for Payer: Quartz Commercial |
$16,305.74
|
| Rate for Payer: WEA Trust Commercial |
$14,946.93
|
| Rate for Payer: WPS Commercial |
$20,128.71
|
|
|
FEMORAL STEM TRABECULAR METAL STD NECK OFFSET 11MM 00-7864-011-00
|
Facility
|
IP
|
$26,131.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967842
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13,316.36 |
| Max. Negotiated Rate |
$25,002.14 |
| Rate for Payer: Aetna Commercial |
$24,458.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$23,371.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14,403.41
|
| Rate for Payer: Cash Price |
$7,839.30
|
| Rate for Payer: Cigna Commercial |
$25,002.14
|
| Rate for Payer: Health EOS Commercial |
$24,186.85
|
| Rate for Payer: HFN Commercial |
$25,002.14
|
| Rate for Payer: Multiplan Commercial |
$21,740.99
|
| Rate for Payer: Preferred Network Access Commercial |
$25,002.14
|
| Rate for Payer: Quartz Beloit One Network |
$13,316.36
|
| Rate for Payer: Quartz Commercial |
$16,305.74
|
| Rate for Payer: WEA Trust Commercial |
$14,946.93
|
| Rate for Payer: WPS Commercial |
$20,128.71
|
|
|
FEMORAL STEM TRABECULAR METAL STD NECK OFFSET 11MM 00-7864-011-00
|
Facility
|
OP
|
$26,131.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967842
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,609.35 |
| Max. Negotiated Rate |
$25,002.14 |
| Rate for Payer: Aetna Commercial |
$24,458.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$23,371.57
|
| Rate for Payer: Aetna Managed Medicare |
$7,609.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17,664.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,588.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,044.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14,403.41
|
| Rate for Payer: Cash Price |
$7,839.30
|
| Rate for Payer: Cigna Commercial |
$25,002.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15,208.24
|
| Rate for Payer: Health EOS Commercial |
$24,186.85
|
| Rate for Payer: HFN Commercial |
$25,002.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,382.18
|
| Rate for Payer: Multiplan Commercial |
$21,740.99
|
| Rate for Payer: NAPHCARE Commercial |
$16,305.74
|
| Rate for Payer: Preferred Network Access Commercial |
$25,002.14
|
| Rate for Payer: Quartz Beloit One Network |
$13,316.36
|
| Rate for Payer: Quartz Commercial |
$17,664.56
|
| Rate for Payer: Quartz Medicare Advantage |
$16,305.74
|
| Rate for Payer: The Alliance Commercial |
$13,588.12
|
| Rate for Payer: WEA Trust Commercial |
$14,946.93
|
| Rate for Payer: WPS Commercial |
$20,128.71
|
|
|
FEMORAL STEM TRABECULAR METAL STD OFFSET 12MM 00-7864-012-00
|
Facility
|
IP
|
$26,131.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967844
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13,316.36 |
| Max. Negotiated Rate |
$25,002.14 |
| Rate for Payer: Aetna Commercial |
$24,458.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$23,371.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14,403.41
|
| Rate for Payer: Cash Price |
$7,839.30
|
| Rate for Payer: Cigna Commercial |
$25,002.14
|
| Rate for Payer: Health EOS Commercial |
$24,186.85
|
| Rate for Payer: HFN Commercial |
$25,002.14
|
| Rate for Payer: Multiplan Commercial |
$21,740.99
|
| Rate for Payer: Preferred Network Access Commercial |
$25,002.14
|
| Rate for Payer: Quartz Beloit One Network |
$13,316.36
|
| Rate for Payer: Quartz Commercial |
$16,305.74
|
| Rate for Payer: WEA Trust Commercial |
$14,946.93
|
| Rate for Payer: WPS Commercial |
$20,128.71
|
|
|
FEMORAL STEM TRABECULAR METAL STD OFFSET 12MM 00-7864-012-00
|
Facility
|
OP
|
$26,131.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967844
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,609.35 |
| Max. Negotiated Rate |
$25,002.14 |
| Rate for Payer: Aetna Commercial |
$24,458.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$23,371.57
|
| Rate for Payer: Aetna Managed Medicare |
$7,609.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17,664.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,588.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,044.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14,403.41
|
| Rate for Payer: Cash Price |
$7,839.30
|
| Rate for Payer: Cigna Commercial |
$25,002.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15,208.24
|
| Rate for Payer: Health EOS Commercial |
$24,186.85
|
| Rate for Payer: HFN Commercial |
$25,002.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,382.18
|
| Rate for Payer: Multiplan Commercial |
$21,740.99
|
| Rate for Payer: NAPHCARE Commercial |
$16,305.74
|
| Rate for Payer: Preferred Network Access Commercial |
$25,002.14
|
| Rate for Payer: Quartz Beloit One Network |
$13,316.36
|
| Rate for Payer: Quartz Commercial |
$17,664.56
|
| Rate for Payer: Quartz Medicare Advantage |
$16,305.74
|
| Rate for Payer: The Alliance Commercial |
$13,588.12
|
| Rate for Payer: WEA Trust Commercial |
$14,946.93
|
| Rate for Payer: WPS Commercial |
$20,128.71
|
|
|
FEMORAL STEM TRI-LOCK BPS W GRIPTION SZ 2 STD 1012-04-020
|
Facility
|
IP
|
$14,894.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563226
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,589.98 |
| Max. Negotiated Rate |
$14,250.58 |
| Rate for Payer: Aetna Commercial |
$13,940.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,321.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,209.57
|
| Rate for Payer: Cash Price |
$4,468.20
|
| Rate for Payer: Cigna Commercial |
$14,250.58
|
| Rate for Payer: Health EOS Commercial |
$13,785.89
|
| Rate for Payer: HFN Commercial |
$14,250.58
|
| Rate for Payer: Multiplan Commercial |
$12,391.81
|
| Rate for Payer: Preferred Network Access Commercial |
$14,250.58
|
| Rate for Payer: Quartz Beloit One Network |
$7,589.98
|
| Rate for Payer: Quartz Commercial |
$9,293.86
|
| Rate for Payer: WEA Trust Commercial |
$8,519.37
|
| Rate for Payer: WPS Commercial |
$11,472.85
|
|
|
FEMORAL STEM TRI-LOCK BPS W GRIPTION SZ 2 STD 1012-04-020
|
Facility
|
OP
|
$14,894.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563226
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,337.13 |
| Max. Negotiated Rate |
$14,250.58 |
| Rate for Payer: Aetna Commercial |
$13,940.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,321.19
|
| Rate for Payer: Aetna Managed Medicare |
$4,337.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,068.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,744.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,435.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,209.57
|
| Rate for Payer: Cash Price |
$4,468.20
|
| Rate for Payer: Cigna Commercial |
$14,250.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,668.31
|
| Rate for Payer: Health EOS Commercial |
$13,785.89
|
| Rate for Payer: HFN Commercial |
$14,250.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,617.32
|
| Rate for Payer: Multiplan Commercial |
$12,391.81
|
| Rate for Payer: NAPHCARE Commercial |
$9,293.86
|
| Rate for Payer: Preferred Network Access Commercial |
$14,250.58
|
| Rate for Payer: Quartz Beloit One Network |
$7,589.98
|
| Rate for Payer: Quartz Commercial |
$10,068.34
|
| Rate for Payer: Quartz Medicare Advantage |
$9,293.86
|
| Rate for Payer: The Alliance Commercial |
$7,744.88
|
| Rate for Payer: WEA Trust Commercial |
$8,519.37
|
| Rate for Payer: WPS Commercial |
$11,472.85
|
|
|
FEMORAL STEM TRI-LOCK BPS W GRIPTION SZ 3 STD 1012-04-030
|
Facility
|
OP
|
$15,490.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5497005
|
|
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 TRI-LOCK BPS W GRIPTION SZ 3 STD 1012-04-030
|
Facility
|
IP
|
$15,490.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5497005
|
|
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
|
|
