|
FEMORAL STEM ACTIS DUOFIX SZ 2 12/14 TAPER STD COLLAR 1010-11-020
|
Facility
|
OP
|
$11,679.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6172433
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,270.12 |
| Max. Negotiated Rate |
$46,716.00 |
| Rate for Payer: Aetna Commercial |
$10,511.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,043.94
|
| Rate for Payer: Aetna Managed Medicare |
$3,270.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,591.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,839.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,605.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,189.87
|
| Rate for Payer: Cash Price |
$3,503.70
|
| Rate for Payer: Cigna Commercial |
$10,744.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,535.57
|
| Rate for Payer: Health EOS Commercial |
$10,394.31
|
| Rate for Payer: HFN Commercial |
$10,744.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,759.25
|
| Rate for Payer: Multiplan Commercial |
$9,343.20
|
| Rate for Payer: NAPHCARE Commercial |
$7,007.40
|
| Rate for Payer: Preferred Network Access Commercial |
$10,744.68
|
| Rate for Payer: Quartz Beloit One Network |
$5,722.71
|
| Rate for Payer: Quartz Commercial |
$7,591.35
|
| Rate for Payer: Quartz Medicare Advantage |
$7,007.40
|
| Rate for Payer: The Alliance Commercial |
$46,716.00
|
| Rate for Payer: WEA Trust Commercial |
$6,423.45
|
| Rate for Payer: WPS Commercial |
$8,650.64
|
|
|
FEMORAL STEM ACTIS DUOFIX SZ 2 12/14 TAPER STD COLLAR 1010-11-020
|
Facility
|
IP
|
$11,679.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6172433
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,722.71 |
| Max. Negotiated Rate |
$10,744.68 |
| Rate for Payer: Aetna Commercial |
$10,511.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,043.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,189.87
|
| Rate for Payer: Cash Price |
$3,503.70
|
| Rate for Payer: Cigna Commercial |
$10,744.68
|
| Rate for Payer: Health EOS Commercial |
$10,394.31
|
| Rate for Payer: HFN Commercial |
$10,744.68
|
| Rate for Payer: Multiplan Commercial |
$9,343.20
|
| Rate for Payer: NAPHCARE Commercial |
$7,007.40
|
| Rate for Payer: Preferred Network Access Commercial |
$10,744.68
|
| Rate for Payer: Quartz Beloit One Network |
$5,722.71
|
| Rate for Payer: Quartz Commercial |
$7,007.40
|
| Rate for Payer: WEA Trust Commercial |
$6,423.45
|
| Rate for Payer: WPS Commercial |
$8,650.64
|
|
|
FEMORAL STEM ACTIS DUOFIX SZ 3 12/14 TAPER HIGH COLLAR 1010-12-030
|
Facility
|
OP
|
$11,679.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6089645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,270.12 |
| Max. Negotiated Rate |
$46,716.00 |
| Rate for Payer: Aetna Commercial |
$10,511.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,043.94
|
| Rate for Payer: Aetna Managed Medicare |
$3,270.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,591.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,839.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,605.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,189.87
|
| Rate for Payer: Cash Price |
$3,503.70
|
| Rate for Payer: Cigna Commercial |
$10,744.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,535.57
|
| Rate for Payer: Health EOS Commercial |
$10,394.31
|
| Rate for Payer: HFN Commercial |
$10,744.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,759.25
|
| Rate for Payer: Multiplan Commercial |
$9,343.20
|
| Rate for Payer: NAPHCARE Commercial |
$7,007.40
|
| Rate for Payer: Preferred Network Access Commercial |
$10,744.68
|
| Rate for Payer: Quartz Beloit One Network |
$5,722.71
|
| Rate for Payer: Quartz Commercial |
$7,591.35
|
| Rate for Payer: Quartz Medicare Advantage |
$7,007.40
|
| Rate for Payer: The Alliance Commercial |
$46,716.00
|
| Rate for Payer: WEA Trust Commercial |
$6,423.45
|
| Rate for Payer: WPS Commercial |
$8,650.64
|
|
|
FEMORAL STEM ACTIS DUOFIX SZ 3 12/14 TAPER HIGH COLLAR 1010-12-030
|
Facility
|
IP
|
$11,679.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6089645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,722.71 |
| Max. Negotiated Rate |
$10,744.68 |
| Rate for Payer: Aetna Commercial |
$10,511.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,043.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,189.87
|
| Rate for Payer: Cash Price |
$3,503.70
|
| Rate for Payer: Cigna Commercial |
$10,744.68
|
| Rate for Payer: Health EOS Commercial |
$10,394.31
|
| Rate for Payer: HFN Commercial |
$10,744.68
|
| Rate for Payer: Multiplan Commercial |
$9,343.20
|
| Rate for Payer: NAPHCARE Commercial |
$7,007.40
|
| Rate for Payer: Preferred Network Access Commercial |
$10,744.68
|
| Rate for Payer: Quartz Beloit One Network |
$5,722.71
|
| Rate for Payer: Quartz Commercial |
$7,007.40
|
| Rate for Payer: WEA Trust Commercial |
$6,423.45
|
| Rate for Payer: WPS Commercial |
$8,650.64
|
|
|
FEMORAL STEM ACTIS DUOFIX SZ 3 12/14 TAPER STD COLLAR 1010-11-030
|
Facility
|
IP
|
$11,679.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6177671
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,722.71 |
| Max. Negotiated Rate |
$10,744.68 |
| Rate for Payer: Aetna Commercial |
$10,511.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,043.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,189.87
|
| Rate for Payer: Cash Price |
$3,503.70
|
| Rate for Payer: Cigna Commercial |
$10,744.68
|
| Rate for Payer: Health EOS Commercial |
$10,394.31
|
| Rate for Payer: HFN Commercial |
$10,744.68
|
| Rate for Payer: Multiplan Commercial |
$9,343.20
|
| Rate for Payer: NAPHCARE Commercial |
$7,007.40
|
| Rate for Payer: Preferred Network Access Commercial |
$10,744.68
|
| Rate for Payer: Quartz Beloit One Network |
$5,722.71
|
| Rate for Payer: Quartz Commercial |
$7,007.40
|
| Rate for Payer: WEA Trust Commercial |
$6,423.45
|
| Rate for Payer: WPS Commercial |
$8,650.64
|
|
|
FEMORAL STEM ACTIS DUOFIX SZ 3 12/14 TAPER STD COLLAR 1010-11-030
|
Facility
|
OP
|
$11,679.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6177671
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,270.12 |
| Max. Negotiated Rate |
$46,716.00 |
| Rate for Payer: Aetna Commercial |
$10,511.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,043.94
|
| Rate for Payer: Aetna Managed Medicare |
$3,270.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,591.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,839.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,605.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,189.87
|
| Rate for Payer: Cash Price |
$3,503.70
|
| Rate for Payer: Cigna Commercial |
$10,744.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,535.57
|
| Rate for Payer: Health EOS Commercial |
$10,394.31
|
| Rate for Payer: HFN Commercial |
$10,744.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,759.25
|
| Rate for Payer: Multiplan Commercial |
$9,343.20
|
| Rate for Payer: NAPHCARE Commercial |
$7,007.40
|
| Rate for Payer: Preferred Network Access Commercial |
$10,744.68
|
| Rate for Payer: Quartz Beloit One Network |
$5,722.71
|
| Rate for Payer: Quartz Commercial |
$7,591.35
|
| Rate for Payer: Quartz Medicare Advantage |
$7,007.40
|
| Rate for Payer: The Alliance Commercial |
$46,716.00
|
| Rate for Payer: WEA Trust Commercial |
$6,423.45
|
| Rate for Payer: WPS Commercial |
$8,650.64
|
|
|
FEMORAL STEM ACTIS DUOFIX SZ 4 12/14 TAPER HIGH COLLAR 1010-12-040
|
Facility
|
IP
|
$11,679.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6089630
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,722.71 |
| Max. Negotiated Rate |
$10,744.68 |
| Rate for Payer: Aetna Commercial |
$10,511.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,043.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,189.87
|
| Rate for Payer: Cash Price |
$3,503.70
|
| Rate for Payer: Cigna Commercial |
$10,744.68
|
| Rate for Payer: Health EOS Commercial |
$10,394.31
|
| Rate for Payer: HFN Commercial |
$10,744.68
|
| Rate for Payer: Multiplan Commercial |
$9,343.20
|
| Rate for Payer: NAPHCARE Commercial |
$7,007.40
|
| Rate for Payer: Preferred Network Access Commercial |
$10,744.68
|
| Rate for Payer: Quartz Beloit One Network |
$5,722.71
|
| Rate for Payer: Quartz Commercial |
$7,007.40
|
| Rate for Payer: WEA Trust Commercial |
$6,423.45
|
| Rate for Payer: WPS Commercial |
$8,650.64
|
|
|
FEMORAL STEM ACTIS DUOFIX SZ 4 12/14 TAPER HIGH COLLAR 1010-12-040
|
Facility
|
OP
|
$11,679.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6089630
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,270.12 |
| Max. Negotiated Rate |
$46,716.00 |
| Rate for Payer: Aetna Commercial |
$10,511.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,043.94
|
| Rate for Payer: Aetna Managed Medicare |
$3,270.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,591.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,839.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,605.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,189.87
|
| Rate for Payer: Cash Price |
$3,503.70
|
| Rate for Payer: Cigna Commercial |
$10,744.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,535.57
|
| Rate for Payer: Health EOS Commercial |
$10,394.31
|
| Rate for Payer: HFN Commercial |
$10,744.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,759.25
|
| Rate for Payer: Multiplan Commercial |
$9,343.20
|
| Rate for Payer: NAPHCARE Commercial |
$7,007.40
|
| Rate for Payer: Preferred Network Access Commercial |
$10,744.68
|
| Rate for Payer: Quartz Beloit One Network |
$5,722.71
|
| Rate for Payer: Quartz Commercial |
$7,591.35
|
| Rate for Payer: Quartz Medicare Advantage |
$7,007.40
|
| Rate for Payer: The Alliance Commercial |
$46,716.00
|
| Rate for Payer: WEA Trust Commercial |
$6,423.45
|
| Rate for Payer: WPS Commercial |
$8,650.64
|
|
|
FEMORAL STEM ACTIS DUOFIX SZ 4 12/14 TAPER STD COLLAR 1010-11-040
|
Facility
|
IP
|
$11,679.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6037660
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,722.71 |
| Max. Negotiated Rate |
$10,744.68 |
| Rate for Payer: Aetna Commercial |
$10,511.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,043.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,189.87
|
| Rate for Payer: Cash Price |
$3,503.70
|
| Rate for Payer: Cigna Commercial |
$10,744.68
|
| Rate for Payer: Health EOS Commercial |
$10,394.31
|
| Rate for Payer: HFN Commercial |
$10,744.68
|
| Rate for Payer: Multiplan Commercial |
$9,343.20
|
| Rate for Payer: NAPHCARE Commercial |
$7,007.40
|
| Rate for Payer: Preferred Network Access Commercial |
$10,744.68
|
| Rate for Payer: Quartz Beloit One Network |
$5,722.71
|
| Rate for Payer: Quartz Commercial |
$7,007.40
|
| Rate for Payer: WEA Trust Commercial |
$6,423.45
|
| Rate for Payer: WPS Commercial |
$8,650.64
|
|
|
FEMORAL STEM ACTIS DUOFIX SZ 4 12/14 TAPER STD COLLAR 1010-11-040
|
Facility
|
OP
|
$11,679.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6037660
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,270.12 |
| Max. Negotiated Rate |
$46,716.00 |
| Rate for Payer: Aetna Commercial |
$10,511.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,043.94
|
| Rate for Payer: Aetna Managed Medicare |
$3,270.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,591.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,839.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,605.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,189.87
|
| Rate for Payer: Cash Price |
$3,503.70
|
| Rate for Payer: Cigna Commercial |
$10,744.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,535.57
|
| Rate for Payer: Health EOS Commercial |
$10,394.31
|
| Rate for Payer: HFN Commercial |
$10,744.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,759.25
|
| Rate for Payer: Multiplan Commercial |
$9,343.20
|
| Rate for Payer: NAPHCARE Commercial |
$7,007.40
|
| Rate for Payer: Preferred Network Access Commercial |
$10,744.68
|
| Rate for Payer: Quartz Beloit One Network |
$5,722.71
|
| Rate for Payer: Quartz Commercial |
$7,591.35
|
| Rate for Payer: Quartz Medicare Advantage |
$7,007.40
|
| Rate for Payer: The Alliance Commercial |
$46,716.00
|
| Rate for Payer: WEA Trust Commercial |
$6,423.45
|
| Rate for Payer: WPS Commercial |
$8,650.64
|
|
|
FEMORAL STEM ACTIS DUOFIX SZ 5 12/14 TAPER HIGH COLLAR 1010-12-050
|
Facility
|
OP
|
$11,679.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6170100
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,270.12 |
| Max. Negotiated Rate |
$46,716.00 |
| Rate for Payer: Aetna Commercial |
$10,511.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,043.94
|
| Rate for Payer: Aetna Managed Medicare |
$3,270.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,591.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,839.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,605.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,189.87
|
| Rate for Payer: Cash Price |
$3,503.70
|
| Rate for Payer: Cigna Commercial |
$10,744.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,535.57
|
| Rate for Payer: Health EOS Commercial |
$10,394.31
|
| Rate for Payer: HFN Commercial |
$10,744.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,759.25
|
| Rate for Payer: Multiplan Commercial |
$9,343.20
|
| Rate for Payer: NAPHCARE Commercial |
$7,007.40
|
| Rate for Payer: Preferred Network Access Commercial |
$10,744.68
|
| Rate for Payer: Quartz Beloit One Network |
$5,722.71
|
| Rate for Payer: Quartz Commercial |
$7,591.35
|
| Rate for Payer: Quartz Medicare Advantage |
$7,007.40
|
| Rate for Payer: The Alliance Commercial |
$46,716.00
|
| Rate for Payer: WEA Trust Commercial |
$6,423.45
|
| Rate for Payer: WPS Commercial |
$8,650.64
|
|
|
FEMORAL STEM ACTIS DUOFIX SZ 5 12/14 TAPER HIGH COLLAR 1010-12-050
|
Facility
|
IP
|
$11,679.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6170100
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,722.71 |
| Max. Negotiated Rate |
$10,744.68 |
| Rate for Payer: Aetna Commercial |
$10,511.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,043.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,189.87
|
| Rate for Payer: Cash Price |
$3,503.70
|
| Rate for Payer: Cigna Commercial |
$10,744.68
|
| Rate for Payer: Health EOS Commercial |
$10,394.31
|
| Rate for Payer: HFN Commercial |
$10,744.68
|
| Rate for Payer: Multiplan Commercial |
$9,343.20
|
| Rate for Payer: NAPHCARE Commercial |
$7,007.40
|
| Rate for Payer: Preferred Network Access Commercial |
$10,744.68
|
| Rate for Payer: Quartz Beloit One Network |
$5,722.71
|
| Rate for Payer: Quartz Commercial |
$7,007.40
|
| Rate for Payer: WEA Trust Commercial |
$6,423.45
|
| Rate for Payer: WPS Commercial |
$8,650.64
|
|
|
FEMORAL STEM ACTIS DUOFIX SZ 5 12/14 TAPER STD COLLAR 1010-11-050
|
Facility
|
IP
|
$11,679.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6141628
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,722.71 |
| Max. Negotiated Rate |
$10,744.68 |
| Rate for Payer: Aetna Commercial |
$10,511.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,043.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,189.87
|
| Rate for Payer: Cash Price |
$3,503.70
|
| Rate for Payer: Cigna Commercial |
$10,744.68
|
| Rate for Payer: Health EOS Commercial |
$10,394.31
|
| Rate for Payer: HFN Commercial |
$10,744.68
|
| Rate for Payer: Multiplan Commercial |
$9,343.20
|
| Rate for Payer: NAPHCARE Commercial |
$7,007.40
|
| Rate for Payer: Preferred Network Access Commercial |
$10,744.68
|
| Rate for Payer: Quartz Beloit One Network |
$5,722.71
|
| Rate for Payer: Quartz Commercial |
$7,007.40
|
| Rate for Payer: WEA Trust Commercial |
$6,423.45
|
| Rate for Payer: WPS Commercial |
$8,650.64
|
|
|
FEMORAL STEM ACTIS DUOFIX SZ 5 12/14 TAPER STD COLLAR 1010-11-050
|
Facility
|
OP
|
$11,679.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6141628
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,270.12 |
| Max. Negotiated Rate |
$46,716.00 |
| Rate for Payer: Aetna Commercial |
$10,511.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,043.94
|
| Rate for Payer: Aetna Managed Medicare |
$3,270.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,591.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,839.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,605.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,189.87
|
| Rate for Payer: Cash Price |
$3,503.70
|
| Rate for Payer: Cigna Commercial |
$10,744.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,535.57
|
| Rate for Payer: Health EOS Commercial |
$10,394.31
|
| Rate for Payer: HFN Commercial |
$10,744.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,759.25
|
| Rate for Payer: Multiplan Commercial |
$9,343.20
|
| Rate for Payer: NAPHCARE Commercial |
$7,007.40
|
| Rate for Payer: Preferred Network Access Commercial |
$10,744.68
|
| Rate for Payer: Quartz Beloit One Network |
$5,722.71
|
| Rate for Payer: Quartz Commercial |
$7,591.35
|
| Rate for Payer: Quartz Medicare Advantage |
$7,007.40
|
| Rate for Payer: The Alliance Commercial |
$46,716.00
|
| Rate for Payer: WEA Trust Commercial |
$6,423.45
|
| Rate for Payer: WPS Commercial |
$8,650.64
|
|
|
FEMORAL STEM ACTIS DUOFIX SZ 6 12/14 TAPER HIGH COLLAR 1010-12-060
|
Facility
|
OP
|
$11,679.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6170127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,270.12 |
| Max. Negotiated Rate |
$46,716.00 |
| Rate for Payer: Aetna Commercial |
$10,511.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,043.94
|
| Rate for Payer: Aetna Managed Medicare |
$3,270.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,591.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,839.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,605.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,189.87
|
| Rate for Payer: Cash Price |
$3,503.70
|
| Rate for Payer: Cigna Commercial |
$10,744.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,535.57
|
| Rate for Payer: Health EOS Commercial |
$10,394.31
|
| Rate for Payer: HFN Commercial |
$10,744.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,759.25
|
| Rate for Payer: Multiplan Commercial |
$9,343.20
|
| Rate for Payer: NAPHCARE Commercial |
$7,007.40
|
| Rate for Payer: Preferred Network Access Commercial |
$10,744.68
|
| Rate for Payer: Quartz Beloit One Network |
$5,722.71
|
| Rate for Payer: Quartz Commercial |
$7,591.35
|
| Rate for Payer: Quartz Medicare Advantage |
$7,007.40
|
| Rate for Payer: The Alliance Commercial |
$46,716.00
|
| Rate for Payer: WEA Trust Commercial |
$6,423.45
|
| Rate for Payer: WPS Commercial |
$8,650.64
|
|
|
FEMORAL STEM ACTIS DUOFIX SZ 6 12/14 TAPER HIGH COLLAR 1010-12-060
|
Facility
|
IP
|
$11,679.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6170127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,722.71 |
| Max. Negotiated Rate |
$10,744.68 |
| Rate for Payer: Aetna Commercial |
$10,511.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,043.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,189.87
|
| Rate for Payer: Cash Price |
$3,503.70
|
| Rate for Payer: Cigna Commercial |
$10,744.68
|
| Rate for Payer: Health EOS Commercial |
$10,394.31
|
| Rate for Payer: HFN Commercial |
$10,744.68
|
| Rate for Payer: Multiplan Commercial |
$9,343.20
|
| Rate for Payer: NAPHCARE Commercial |
$7,007.40
|
| Rate for Payer: Preferred Network Access Commercial |
$10,744.68
|
| Rate for Payer: Quartz Beloit One Network |
$5,722.71
|
| Rate for Payer: Quartz Commercial |
$7,007.40
|
| Rate for Payer: WEA Trust Commercial |
$6,423.45
|
| Rate for Payer: WPS Commercial |
$8,650.64
|
|
|
FEMORAL STEM ACTIS DUOFIX SZ 6 12/14 TAPER STD COLLAR 1010-11-060
|
Facility
|
OP
|
$11,679.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6037630
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,270.12 |
| Max. Negotiated Rate |
$46,716.00 |
| Rate for Payer: Aetna Commercial |
$10,511.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,043.94
|
| Rate for Payer: Aetna Managed Medicare |
$3,270.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,591.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,839.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,605.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,189.87
|
| Rate for Payer: Cash Price |
$3,503.70
|
| Rate for Payer: Cigna Commercial |
$10,744.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,535.57
|
| Rate for Payer: Health EOS Commercial |
$10,394.31
|
| Rate for Payer: HFN Commercial |
$10,744.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,759.25
|
| Rate for Payer: Multiplan Commercial |
$9,343.20
|
| Rate for Payer: NAPHCARE Commercial |
$7,007.40
|
| Rate for Payer: Preferred Network Access Commercial |
$10,744.68
|
| Rate for Payer: Quartz Beloit One Network |
$5,722.71
|
| Rate for Payer: Quartz Commercial |
$7,591.35
|
| Rate for Payer: Quartz Medicare Advantage |
$7,007.40
|
| Rate for Payer: The Alliance Commercial |
$46,716.00
|
| Rate for Payer: WEA Trust Commercial |
$6,423.45
|
| Rate for Payer: WPS Commercial |
$8,650.64
|
|
|
FEMORAL STEM ACTIS DUOFIX SZ 6 12/14 TAPER STD COLLAR 1010-11-060
|
Facility
|
IP
|
$11,679.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6037630
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,722.71 |
| Max. Negotiated Rate |
$10,744.68 |
| Rate for Payer: Aetna Commercial |
$10,511.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,043.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,189.87
|
| Rate for Payer: Cash Price |
$3,503.70
|
| Rate for Payer: Cigna Commercial |
$10,744.68
|
| Rate for Payer: Health EOS Commercial |
$10,394.31
|
| Rate for Payer: HFN Commercial |
$10,744.68
|
| Rate for Payer: Multiplan Commercial |
$9,343.20
|
| Rate for Payer: NAPHCARE Commercial |
$7,007.40
|
| Rate for Payer: Preferred Network Access Commercial |
$10,744.68
|
| Rate for Payer: Quartz Beloit One Network |
$5,722.71
|
| Rate for Payer: Quartz Commercial |
$7,007.40
|
| Rate for Payer: WEA Trust Commercial |
$6,423.45
|
| Rate for Payer: WPS Commercial |
$8,650.64
|
|
|
FEMORAL STEM ACTIS DUOFIX SZ 7 12/14 TAPER HIGH COLLAR 1010-12-070
|
Facility
|
IP
|
$11,230.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6179725
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,502.70 |
| Max. Negotiated Rate |
$10,331.60 |
| Rate for Payer: Aetna Commercial |
$10,107.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,657.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,951.90
|
| Rate for Payer: Cash Price |
$3,369.00
|
| Rate for Payer: Cigna Commercial |
$10,331.60
|
| Rate for Payer: Health EOS Commercial |
$9,994.70
|
| Rate for Payer: HFN Commercial |
$10,331.60
|
| Rate for Payer: Multiplan Commercial |
$8,984.00
|
| Rate for Payer: NAPHCARE Commercial |
$6,738.00
|
| Rate for Payer: Preferred Network Access Commercial |
$10,331.60
|
| Rate for Payer: Quartz Beloit One Network |
$5,502.70
|
| Rate for Payer: Quartz Commercial |
$6,738.00
|
| Rate for Payer: WEA Trust Commercial |
$6,176.50
|
| Rate for Payer: WPS Commercial |
$8,318.06
|
|
|
FEMORAL STEM ACTIS DUOFIX SZ 7 12/14 TAPER HIGH COLLAR 1010-12-070
|
Facility
|
OP
|
$11,230.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6179725
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,144.40 |
| Max. Negotiated Rate |
$44,920.00 |
| Rate for Payer: Aetna Commercial |
$10,107.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,657.80
|
| Rate for Payer: Aetna Managed Medicare |
$3,144.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,299.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,615.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,390.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,951.90
|
| Rate for Payer: Cash Price |
$3,369.00
|
| Rate for Payer: Cigna Commercial |
$10,331.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,284.31
|
| Rate for Payer: Health EOS Commercial |
$9,994.70
|
| Rate for Payer: HFN Commercial |
$10,331.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,422.50
|
| Rate for Payer: Multiplan Commercial |
$8,984.00
|
| Rate for Payer: NAPHCARE Commercial |
$6,738.00
|
| Rate for Payer: Preferred Network Access Commercial |
$10,331.60
|
| Rate for Payer: Quartz Beloit One Network |
$5,502.70
|
| Rate for Payer: Quartz Commercial |
$7,299.50
|
| Rate for Payer: Quartz Medicare Advantage |
$6,738.00
|
| Rate for Payer: The Alliance Commercial |
$44,920.00
|
| Rate for Payer: WEA Trust Commercial |
$6,176.50
|
| Rate for Payer: WPS Commercial |
$8,318.06
|
|
|
FEMORAL STEM ACTIS DUOFIX SZ 7 12/14 TAPER STD COLLAR 1010-11-070
|
Facility
|
IP
|
$11,679.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6111642
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,722.71 |
| Max. Negotiated Rate |
$10,744.68 |
| Rate for Payer: Aetna Commercial |
$10,511.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,043.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,189.87
|
| Rate for Payer: Cash Price |
$3,503.70
|
| Rate for Payer: Cigna Commercial |
$10,744.68
|
| Rate for Payer: Health EOS Commercial |
$10,394.31
|
| Rate for Payer: HFN Commercial |
$10,744.68
|
| Rate for Payer: Multiplan Commercial |
$9,343.20
|
| Rate for Payer: NAPHCARE Commercial |
$7,007.40
|
| Rate for Payer: Preferred Network Access Commercial |
$10,744.68
|
| Rate for Payer: Quartz Beloit One Network |
$5,722.71
|
| Rate for Payer: Quartz Commercial |
$7,007.40
|
| Rate for Payer: WEA Trust Commercial |
$6,423.45
|
| Rate for Payer: WPS Commercial |
$8,650.64
|
|
|
FEMORAL STEM ACTIS DUOFIX SZ 7 12/14 TAPER STD COLLAR 1010-11-070
|
Facility
|
OP
|
$11,679.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6111642
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,270.12 |
| Max. Negotiated Rate |
$46,716.00 |
| Rate for Payer: Aetna Commercial |
$10,511.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,043.94
|
| Rate for Payer: Aetna Managed Medicare |
$3,270.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,591.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,839.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,605.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,189.87
|
| Rate for Payer: Cash Price |
$3,503.70
|
| Rate for Payer: Cigna Commercial |
$10,744.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,535.57
|
| Rate for Payer: Health EOS Commercial |
$10,394.31
|
| Rate for Payer: HFN Commercial |
$10,744.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,759.25
|
| Rate for Payer: Multiplan Commercial |
$9,343.20
|
| Rate for Payer: NAPHCARE Commercial |
$7,007.40
|
| Rate for Payer: Preferred Network Access Commercial |
$10,744.68
|
| Rate for Payer: Quartz Beloit One Network |
$5,722.71
|
| Rate for Payer: Quartz Commercial |
$7,591.35
|
| Rate for Payer: Quartz Medicare Advantage |
$7,007.40
|
| Rate for Payer: The Alliance Commercial |
$46,716.00
|
| Rate for Payer: WEA Trust Commercial |
$6,423.45
|
| Rate for Payer: WPS Commercial |
$8,650.64
|
|
|
FEMORAL STEM ACTIS DUOFIX SZ 8 12/14 TAPER HIGH COLLAR 1010-12-080
|
Facility
|
OP
|
$11,679.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6169702
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,270.12 |
| Max. Negotiated Rate |
$46,716.00 |
| Rate for Payer: Aetna Commercial |
$10,511.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,043.94
|
| Rate for Payer: Aetna Managed Medicare |
$3,270.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,591.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,839.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,605.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,189.87
|
| Rate for Payer: Cash Price |
$3,503.70
|
| Rate for Payer: Cigna Commercial |
$10,744.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,535.57
|
| Rate for Payer: Health EOS Commercial |
$10,394.31
|
| Rate for Payer: HFN Commercial |
$10,744.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,759.25
|
| Rate for Payer: Multiplan Commercial |
$9,343.20
|
| Rate for Payer: NAPHCARE Commercial |
$7,007.40
|
| Rate for Payer: Preferred Network Access Commercial |
$10,744.68
|
| Rate for Payer: Quartz Beloit One Network |
$5,722.71
|
| Rate for Payer: Quartz Commercial |
$7,591.35
|
| Rate for Payer: Quartz Medicare Advantage |
$7,007.40
|
| Rate for Payer: The Alliance Commercial |
$46,716.00
|
| Rate for Payer: WEA Trust Commercial |
$6,423.45
|
| Rate for Payer: WPS Commercial |
$8,650.64
|
|
|
FEMORAL STEM ACTIS DUOFIX SZ 8 12/14 TAPER HIGH COLLAR 1010-12-080
|
Facility
|
IP
|
$11,679.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6169702
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,722.71 |
| Max. Negotiated Rate |
$10,744.68 |
| Rate for Payer: Aetna Commercial |
$10,511.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,043.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,189.87
|
| Rate for Payer: Cash Price |
$3,503.70
|
| Rate for Payer: Cigna Commercial |
$10,744.68
|
| Rate for Payer: Health EOS Commercial |
$10,394.31
|
| Rate for Payer: HFN Commercial |
$10,744.68
|
| Rate for Payer: Multiplan Commercial |
$9,343.20
|
| Rate for Payer: NAPHCARE Commercial |
$7,007.40
|
| Rate for Payer: Preferred Network Access Commercial |
$10,744.68
|
| Rate for Payer: Quartz Beloit One Network |
$5,722.71
|
| Rate for Payer: Quartz Commercial |
$7,007.40
|
| Rate for Payer: WEA Trust Commercial |
$6,423.45
|
| Rate for Payer: WPS Commercial |
$8,650.64
|
|
|
FEMORAL STEM ACTIS DUOFIX SZ 8 12/14 TAPER STD COLLAR 1010-11-080
|
Facility
|
OP
|
$11,679.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6174938
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,270.12 |
| Max. Negotiated Rate |
$46,716.00 |
| Rate for Payer: Aetna Commercial |
$10,511.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,043.94
|
| Rate for Payer: Aetna Managed Medicare |
$3,270.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,591.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,839.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,605.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,189.87
|
| Rate for Payer: Cash Price |
$3,503.70
|
| Rate for Payer: Cigna Commercial |
$10,744.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,535.57
|
| Rate for Payer: Health EOS Commercial |
$10,394.31
|
| Rate for Payer: HFN Commercial |
$10,744.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,759.25
|
| Rate for Payer: Multiplan Commercial |
$9,343.20
|
| Rate for Payer: NAPHCARE Commercial |
$7,007.40
|
| Rate for Payer: Preferred Network Access Commercial |
$10,744.68
|
| Rate for Payer: Quartz Beloit One Network |
$5,722.71
|
| Rate for Payer: Quartz Commercial |
$7,591.35
|
| Rate for Payer: Quartz Medicare Advantage |
$7,007.40
|
| Rate for Payer: The Alliance Commercial |
$46,716.00
|
| Rate for Payer: WEA Trust Commercial |
$6,423.45
|
| Rate for Payer: WPS Commercial |
$8,650.64
|
|
