|
FEMORAL STEM ACTIS DUOFIX SZ 8 12/14 TAPER STD COLLAR 1010-11-080
|
Facility
|
IP
|
$11,679.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6174938
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,722.71 |
| 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 9 12/14 TAPER STD COLLAR 1010-11-090
|
Facility
|
OP
|
$11,679.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6173255
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,270.12 |
| 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 9 12/14 TAPER STD COLLAR 1010-11-090
|
Facility
|
IP
|
$11,679.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6173255
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,722.71 |
| 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 ADVOCATE CMTD EXT 12 X 125 7850-12-20
|
Facility
|
OP
|
$13,780.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5286899
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,858.40 |
| Max. Negotiated Rate |
$55,120.00 |
| Rate for Payer: Aetna Commercial |
$12,402.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,850.80
|
| Rate for Payer: Aetna Managed Medicare |
$3,858.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,957.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,890.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,614.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,303.40
|
| Rate for Payer: Cash Price |
$4,134.00
|
| Rate for Payer: Cigna Commercial |
$12,677.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,711.29
|
| Rate for Payer: Health EOS Commercial |
$12,264.20
|
| Rate for Payer: HFN Commercial |
$12,677.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,335.00
|
| Rate for Payer: Multiplan Commercial |
$11,024.00
|
| Rate for Payer: NAPHCARE Commercial |
$8,268.00
|
| Rate for Payer: Preferred Network Access Commercial |
$12,677.60
|
| Rate for Payer: Quartz Beloit One Network |
$6,752.20
|
| Rate for Payer: Quartz Commercial |
$8,957.00
|
| Rate for Payer: Quartz Medicare Advantage |
$8,268.00
|
| Rate for Payer: The Alliance Commercial |
$55,120.00
|
| Rate for Payer: WEA Trust Commercial |
$7,579.00
|
| Rate for Payer: WPS Commercial |
$10,206.85
|
|
|
FEMORAL STEM ADVOCATE CMTD EXT 12 X 125 7850-12-20
|
Facility
|
IP
|
$13,780.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5286899
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,752.20 |
| Max. Negotiated Rate |
$12,677.60 |
| Rate for Payer: Aetna Commercial |
$12,402.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,850.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,303.40
|
| Rate for Payer: Cash Price |
$4,134.00
|
| Rate for Payer: Cigna Commercial |
$12,677.60
|
| Rate for Payer: Health EOS Commercial |
$12,264.20
|
| Rate for Payer: HFN Commercial |
$12,677.60
|
| Rate for Payer: Multiplan Commercial |
$11,024.00
|
| Rate for Payer: NAPHCARE Commercial |
$8,268.00
|
| Rate for Payer: Preferred Network Access Commercial |
$12,677.60
|
| Rate for Payer: Quartz Beloit One Network |
$6,752.20
|
| Rate for Payer: Quartz Commercial |
$8,268.00
|
| Rate for Payer: WEA Trust Commercial |
$7,579.00
|
| Rate for Payer: WPS Commercial |
$10,206.85
|
|
|
FEMORAL STEM ADVOCATE CMTD EXT 13 X 130 7850-13-20
|
Facility
|
IP
|
$13,780.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5286898
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,752.20 |
| Max. Negotiated Rate |
$12,677.60 |
| Rate for Payer: Aetna Commercial |
$12,402.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,850.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,303.40
|
| Rate for Payer: Cash Price |
$4,134.00
|
| Rate for Payer: Cigna Commercial |
$12,677.60
|
| Rate for Payer: Health EOS Commercial |
$12,264.20
|
| Rate for Payer: HFN Commercial |
$12,677.60
|
| Rate for Payer: Multiplan Commercial |
$11,024.00
|
| Rate for Payer: NAPHCARE Commercial |
$8,268.00
|
| Rate for Payer: Preferred Network Access Commercial |
$12,677.60
|
| Rate for Payer: Quartz Beloit One Network |
$6,752.20
|
| Rate for Payer: Quartz Commercial |
$8,268.00
|
| Rate for Payer: WEA Trust Commercial |
$7,579.00
|
| Rate for Payer: WPS Commercial |
$10,206.85
|
|
|
FEMORAL STEM ADVOCATE CMTD EXT 13 X 130 7850-13-20
|
Facility
|
OP
|
$13,780.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5286898
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,858.40 |
| Max. Negotiated Rate |
$55,120.00 |
| Rate for Payer: Aetna Commercial |
$12,402.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,850.80
|
| Rate for Payer: Aetna Managed Medicare |
$3,858.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,957.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,890.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,614.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,303.40
|
| Rate for Payer: Cash Price |
$4,134.00
|
| Rate for Payer: Cigna Commercial |
$12,677.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,711.29
|
| Rate for Payer: Health EOS Commercial |
$12,264.20
|
| Rate for Payer: HFN Commercial |
$12,677.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,335.00
|
| Rate for Payer: Multiplan Commercial |
$11,024.00
|
| Rate for Payer: NAPHCARE Commercial |
$8,268.00
|
| Rate for Payer: Preferred Network Access Commercial |
$12,677.60
|
| Rate for Payer: Quartz Beloit One Network |
$6,752.20
|
| Rate for Payer: Quartz Commercial |
$8,957.00
|
| Rate for Payer: Quartz Medicare Advantage |
$8,268.00
|
| Rate for Payer: The Alliance Commercial |
$55,120.00
|
| Rate for Payer: WEA Trust Commercial |
$7,579.00
|
| Rate for Payer: WPS Commercial |
$10,206.85
|
|
|
FEMORAL STEM ADVOCATE CMTD EXT 14 X 135 7850-14-20
|
Facility
|
OP
|
$13,780.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5286897
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,858.40 |
| Max. Negotiated Rate |
$55,120.00 |
| Rate for Payer: Aetna Commercial |
$12,402.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,850.80
|
| Rate for Payer: Aetna Managed Medicare |
$3,858.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,957.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,890.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,614.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,303.40
|
| Rate for Payer: Cash Price |
$4,134.00
|
| Rate for Payer: Cigna Commercial |
$12,677.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,711.29
|
| Rate for Payer: Health EOS Commercial |
$12,264.20
|
| Rate for Payer: HFN Commercial |
$12,677.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,335.00
|
| Rate for Payer: Multiplan Commercial |
$11,024.00
|
| Rate for Payer: NAPHCARE Commercial |
$8,268.00
|
| Rate for Payer: Preferred Network Access Commercial |
$12,677.60
|
| Rate for Payer: Quartz Beloit One Network |
$6,752.20
|
| Rate for Payer: Quartz Commercial |
$8,957.00
|
| Rate for Payer: Quartz Medicare Advantage |
$8,268.00
|
| Rate for Payer: The Alliance Commercial |
$55,120.00
|
| Rate for Payer: WEA Trust Commercial |
$7,579.00
|
| Rate for Payer: WPS Commercial |
$10,206.85
|
|
|
FEMORAL STEM ADVOCATE CMTD EXT 14 X 135 7850-14-20
|
Facility
|
IP
|
$13,780.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5286897
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,752.20 |
| Max. Negotiated Rate |
$12,677.60 |
| Rate for Payer: Aetna Commercial |
$12,402.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,850.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,303.40
|
| Rate for Payer: Cash Price |
$4,134.00
|
| Rate for Payer: Cigna Commercial |
$12,677.60
|
| Rate for Payer: Health EOS Commercial |
$12,264.20
|
| Rate for Payer: HFN Commercial |
$12,677.60
|
| Rate for Payer: Multiplan Commercial |
$11,024.00
|
| Rate for Payer: NAPHCARE Commercial |
$8,268.00
|
| Rate for Payer: Preferred Network Access Commercial |
$12,677.60
|
| Rate for Payer: Quartz Beloit One Network |
$6,752.20
|
| Rate for Payer: Quartz Commercial |
$8,268.00
|
| Rate for Payer: WEA Trust Commercial |
$7,579.00
|
| Rate for Payer: WPS Commercial |
$10,206.85
|
|
|
FEMORAL STEM ADVOCATE CMTD EXT 15 X 140 7850-15-20
|
Facility
|
IP
|
$13,780.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5286896
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,752.20 |
| Max. Negotiated Rate |
$12,677.60 |
| Rate for Payer: Aetna Commercial |
$12,402.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,850.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,303.40
|
| Rate for Payer: Cash Price |
$4,134.00
|
| Rate for Payer: Cigna Commercial |
$12,677.60
|
| Rate for Payer: Health EOS Commercial |
$12,264.20
|
| Rate for Payer: HFN Commercial |
$12,677.60
|
| Rate for Payer: Multiplan Commercial |
$11,024.00
|
| Rate for Payer: NAPHCARE Commercial |
$8,268.00
|
| Rate for Payer: Preferred Network Access Commercial |
$12,677.60
|
| Rate for Payer: Quartz Beloit One Network |
$6,752.20
|
| Rate for Payer: Quartz Commercial |
$8,268.00
|
| Rate for Payer: WEA Trust Commercial |
$7,579.00
|
| Rate for Payer: WPS Commercial |
$10,206.85
|
|
|
FEMORAL STEM ADVOCATE CMTD EXT 15 X 140 7850-15-20
|
Facility
|
OP
|
$13,780.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5286896
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,858.40 |
| Max. Negotiated Rate |
$55,120.00 |
| Rate for Payer: Aetna Commercial |
$12,402.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,850.80
|
| Rate for Payer: Aetna Managed Medicare |
$3,858.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,957.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,890.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,614.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,303.40
|
| Rate for Payer: Cash Price |
$4,134.00
|
| Rate for Payer: Cigna Commercial |
$12,677.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,711.29
|
| Rate for Payer: Health EOS Commercial |
$12,264.20
|
| Rate for Payer: HFN Commercial |
$12,677.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,335.00
|
| Rate for Payer: Multiplan Commercial |
$11,024.00
|
| Rate for Payer: NAPHCARE Commercial |
$8,268.00
|
| Rate for Payer: Preferred Network Access Commercial |
$12,677.60
|
| Rate for Payer: Quartz Beloit One Network |
$6,752.20
|
| Rate for Payer: Quartz Commercial |
$8,957.00
|
| Rate for Payer: Quartz Medicare Advantage |
$8,268.00
|
| Rate for Payer: The Alliance Commercial |
$55,120.00
|
| Rate for Payer: WEA Trust Commercial |
$7,579.00
|
| Rate for Payer: WPS Commercial |
$10,206.85
|
|
|
FEMORAL STEM ADVOCATE CMTD EXT 16 X 145 7850-16-20
|
Facility
|
OP
|
$13,780.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5286895
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,858.40 |
| Max. Negotiated Rate |
$55,120.00 |
| Rate for Payer: Aetna Commercial |
$12,402.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,850.80
|
| Rate for Payer: Aetna Managed Medicare |
$3,858.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,957.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,890.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,614.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,303.40
|
| Rate for Payer: Cash Price |
$4,134.00
|
| Rate for Payer: Cigna Commercial |
$12,677.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,711.29
|
| Rate for Payer: Health EOS Commercial |
$12,264.20
|
| Rate for Payer: HFN Commercial |
$12,677.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,335.00
|
| Rate for Payer: Multiplan Commercial |
$11,024.00
|
| Rate for Payer: NAPHCARE Commercial |
$8,268.00
|
| Rate for Payer: Preferred Network Access Commercial |
$12,677.60
|
| Rate for Payer: Quartz Beloit One Network |
$6,752.20
|
| Rate for Payer: Quartz Commercial |
$8,957.00
|
| Rate for Payer: Quartz Medicare Advantage |
$8,268.00
|
| Rate for Payer: The Alliance Commercial |
$55,120.00
|
| Rate for Payer: WEA Trust Commercial |
$7,579.00
|
| Rate for Payer: WPS Commercial |
$10,206.85
|
|
|
FEMORAL STEM ADVOCATE CMTD EXT 16 X 145 7850-16-20
|
Facility
|
IP
|
$13,780.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5286895
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,752.20 |
| Max. Negotiated Rate |
$12,677.60 |
| Rate for Payer: Aetna Commercial |
$12,402.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,850.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,303.40
|
| Rate for Payer: Cash Price |
$4,134.00
|
| Rate for Payer: Cigna Commercial |
$12,677.60
|
| Rate for Payer: Health EOS Commercial |
$12,264.20
|
| Rate for Payer: HFN Commercial |
$12,677.60
|
| Rate for Payer: Multiplan Commercial |
$11,024.00
|
| Rate for Payer: NAPHCARE Commercial |
$8,268.00
|
| Rate for Payer: Preferred Network Access Commercial |
$12,677.60
|
| Rate for Payer: Quartz Beloit One Network |
$6,752.20
|
| Rate for Payer: Quartz Commercial |
$8,268.00
|
| Rate for Payer: WEA Trust Commercial |
$7,579.00
|
| Rate for Payer: WPS Commercial |
$10,206.85
|
|
|
FEMORAL STEM ADVOCATE CMTD STD 11 X 120 7850-11
|
Facility
|
IP
|
$14,309.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5286889
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,011.41 |
| Max. Negotiated Rate |
$13,164.28 |
| Rate for Payer: Aetna Commercial |
$12,878.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,305.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,583.77
|
| Rate for Payer: Cash Price |
$4,292.70
|
| Rate for Payer: Cigna Commercial |
$13,164.28
|
| Rate for Payer: Health EOS Commercial |
$12,735.01
|
| Rate for Payer: HFN Commercial |
$13,164.28
|
| Rate for Payer: Multiplan Commercial |
$11,447.20
|
| Rate for Payer: NAPHCARE Commercial |
$8,585.40
|
| Rate for Payer: Preferred Network Access Commercial |
$13,164.28
|
| Rate for Payer: Quartz Beloit One Network |
$7,011.41
|
| Rate for Payer: Quartz Commercial |
$8,585.40
|
| Rate for Payer: WEA Trust Commercial |
$7,869.95
|
| Rate for Payer: WPS Commercial |
$10,598.68
|
|
|
FEMORAL STEM ADVOCATE CMTD STD 11 X 120 7850-11
|
Facility
|
OP
|
$14,309.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5286889
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,006.52 |
| Max. Negotiated Rate |
$57,236.00 |
| Rate for Payer: Aetna Commercial |
$12,878.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,305.74
|
| Rate for Payer: Aetna Managed Medicare |
$4,006.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,300.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,154.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,868.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,583.77
|
| Rate for Payer: Cash Price |
$4,292.70
|
| Rate for Payer: Cigna Commercial |
$13,164.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,007.32
|
| Rate for Payer: Health EOS Commercial |
$12,735.01
|
| Rate for Payer: HFN Commercial |
$13,164.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,731.75
|
| Rate for Payer: Multiplan Commercial |
$11,447.20
|
| Rate for Payer: NAPHCARE Commercial |
$8,585.40
|
| Rate for Payer: Preferred Network Access Commercial |
$13,164.28
|
| Rate for Payer: Quartz Beloit One Network |
$7,011.41
|
| Rate for Payer: Quartz Commercial |
$9,300.85
|
| Rate for Payer: Quartz Medicare Advantage |
$8,585.40
|
| Rate for Payer: The Alliance Commercial |
$57,236.00
|
| Rate for Payer: WEA Trust Commercial |
$7,869.95
|
| Rate for Payer: WPS Commercial |
$10,598.68
|
|
|
FEMORAL STEM ADVOCATE CMTD STD 12 X 125 7850-12
|
Facility
|
IP
|
$14,309.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5286890
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,011.41 |
| Max. Negotiated Rate |
$13,164.28 |
| Rate for Payer: Aetna Commercial |
$12,878.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,305.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,583.77
|
| Rate for Payer: Cash Price |
$4,292.70
|
| Rate for Payer: Cigna Commercial |
$13,164.28
|
| Rate for Payer: Health EOS Commercial |
$12,735.01
|
| Rate for Payer: HFN Commercial |
$13,164.28
|
| Rate for Payer: Multiplan Commercial |
$11,447.20
|
| Rate for Payer: NAPHCARE Commercial |
$8,585.40
|
| Rate for Payer: Preferred Network Access Commercial |
$13,164.28
|
| Rate for Payer: Quartz Beloit One Network |
$7,011.41
|
| Rate for Payer: Quartz Commercial |
$8,585.40
|
| Rate for Payer: WEA Trust Commercial |
$7,869.95
|
| Rate for Payer: WPS Commercial |
$10,598.68
|
|
|
FEMORAL STEM ADVOCATE CMTD STD 12 X 125 7850-12
|
Facility
|
OP
|
$14,309.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5286890
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,006.52 |
| Max. Negotiated Rate |
$57,236.00 |
| Rate for Payer: Aetna Commercial |
$12,878.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,305.74
|
| Rate for Payer: Aetna Managed Medicare |
$4,006.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,300.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,154.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,868.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,583.77
|
| Rate for Payer: Cash Price |
$4,292.70
|
| Rate for Payer: Cigna Commercial |
$13,164.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,007.32
|
| Rate for Payer: Health EOS Commercial |
$12,735.01
|
| Rate for Payer: HFN Commercial |
$13,164.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,731.75
|
| Rate for Payer: Multiplan Commercial |
$11,447.20
|
| Rate for Payer: NAPHCARE Commercial |
$8,585.40
|
| Rate for Payer: Preferred Network Access Commercial |
$13,164.28
|
| Rate for Payer: Quartz Beloit One Network |
$7,011.41
|
| Rate for Payer: Quartz Commercial |
$9,300.85
|
| Rate for Payer: Quartz Medicare Advantage |
$8,585.40
|
| Rate for Payer: The Alliance Commercial |
$57,236.00
|
| Rate for Payer: WEA Trust Commercial |
$7,869.95
|
| Rate for Payer: WPS Commercial |
$10,598.68
|
|
|
FEMORAL STEM ADVOCATE CMTD STD 13 X 130 7850-13
|
Facility
|
OP
|
$14,309.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4366038
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,006.52 |
| Max. Negotiated Rate |
$57,236.00 |
| Rate for Payer: Aetna Commercial |
$12,878.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,305.74
|
| Rate for Payer: Aetna Managed Medicare |
$4,006.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,300.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,154.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,868.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,583.77
|
| Rate for Payer: Cash Price |
$4,292.70
|
| Rate for Payer: Cigna Commercial |
$13,164.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,007.32
|
| Rate for Payer: Health EOS Commercial |
$12,735.01
|
| Rate for Payer: HFN Commercial |
$13,164.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,731.75
|
| Rate for Payer: Multiplan Commercial |
$11,447.20
|
| Rate for Payer: NAPHCARE Commercial |
$8,585.40
|
| Rate for Payer: Preferred Network Access Commercial |
$13,164.28
|
| Rate for Payer: Quartz Beloit One Network |
$7,011.41
|
| Rate for Payer: Quartz Commercial |
$9,300.85
|
| Rate for Payer: Quartz Medicare Advantage |
$8,585.40
|
| Rate for Payer: The Alliance Commercial |
$57,236.00
|
| Rate for Payer: WEA Trust Commercial |
$7,869.95
|
| Rate for Payer: WPS Commercial |
$10,598.68
|
|
|
FEMORAL STEM ADVOCATE CMTD STD 13 X 130 7850-13
|
Facility
|
IP
|
$14,309.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4366038
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,011.41 |
| Max. Negotiated Rate |
$13,164.28 |
| Rate for Payer: Aetna Commercial |
$12,878.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,305.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,583.77
|
| Rate for Payer: Cash Price |
$4,292.70
|
| Rate for Payer: Cigna Commercial |
$13,164.28
|
| Rate for Payer: Health EOS Commercial |
$12,735.01
|
| Rate for Payer: HFN Commercial |
$13,164.28
|
| Rate for Payer: Multiplan Commercial |
$11,447.20
|
| Rate for Payer: NAPHCARE Commercial |
$8,585.40
|
| Rate for Payer: Preferred Network Access Commercial |
$13,164.28
|
| Rate for Payer: Quartz Beloit One Network |
$7,011.41
|
| Rate for Payer: Quartz Commercial |
$8,585.40
|
| Rate for Payer: WEA Trust Commercial |
$7,869.95
|
| Rate for Payer: WPS Commercial |
$10,598.68
|
|
|
FEMORAL STEM ADVOCATE CMTD STD 14 X 135 7850-14
|
Facility
|
OP
|
$14,309.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5286891
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,006.52 |
| Max. Negotiated Rate |
$57,236.00 |
| Rate for Payer: Aetna Commercial |
$12,878.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,305.74
|
| Rate for Payer: Aetna Managed Medicare |
$4,006.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,300.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,154.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,868.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,583.77
|
| Rate for Payer: Cash Price |
$4,292.70
|
| Rate for Payer: Cigna Commercial |
$13,164.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,007.32
|
| Rate for Payer: Health EOS Commercial |
$12,735.01
|
| Rate for Payer: HFN Commercial |
$13,164.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,731.75
|
| Rate for Payer: Multiplan Commercial |
$11,447.20
|
| Rate for Payer: NAPHCARE Commercial |
$8,585.40
|
| Rate for Payer: Preferred Network Access Commercial |
$13,164.28
|
| Rate for Payer: Quartz Beloit One Network |
$7,011.41
|
| Rate for Payer: Quartz Commercial |
$9,300.85
|
| Rate for Payer: Quartz Medicare Advantage |
$8,585.40
|
| Rate for Payer: The Alliance Commercial |
$57,236.00
|
| Rate for Payer: WEA Trust Commercial |
$7,869.95
|
| Rate for Payer: WPS Commercial |
$10,598.68
|
|
|
FEMORAL STEM ADVOCATE CMTD STD 14 X 135 7850-14
|
Facility
|
IP
|
$14,309.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5286891
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,011.41 |
| Max. Negotiated Rate |
$13,164.28 |
| Rate for Payer: Aetna Commercial |
$12,878.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,305.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,583.77
|
| Rate for Payer: Cash Price |
$4,292.70
|
| Rate for Payer: Cigna Commercial |
$13,164.28
|
| Rate for Payer: Health EOS Commercial |
$12,735.01
|
| Rate for Payer: HFN Commercial |
$13,164.28
|
| Rate for Payer: Multiplan Commercial |
$11,447.20
|
| Rate for Payer: NAPHCARE Commercial |
$8,585.40
|
| Rate for Payer: Preferred Network Access Commercial |
$13,164.28
|
| Rate for Payer: Quartz Beloit One Network |
$7,011.41
|
| Rate for Payer: Quartz Commercial |
$8,585.40
|
| Rate for Payer: WEA Trust Commercial |
$7,869.95
|
| Rate for Payer: WPS Commercial |
$10,598.68
|
|
|
FEMORAL STEM ADVOCATE CMTD STD 15 X 140 7850-15
|
Facility
|
IP
|
$14,309.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5286892
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,011.41 |
| Max. Negotiated Rate |
$13,164.28 |
| Rate for Payer: Aetna Commercial |
$12,878.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,305.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,583.77
|
| Rate for Payer: Cash Price |
$4,292.70
|
| Rate for Payer: Cigna Commercial |
$13,164.28
|
| Rate for Payer: Health EOS Commercial |
$12,735.01
|
| Rate for Payer: HFN Commercial |
$13,164.28
|
| Rate for Payer: Multiplan Commercial |
$11,447.20
|
| Rate for Payer: NAPHCARE Commercial |
$8,585.40
|
| Rate for Payer: Preferred Network Access Commercial |
$13,164.28
|
| Rate for Payer: Quartz Beloit One Network |
$7,011.41
|
| Rate for Payer: Quartz Commercial |
$8,585.40
|
| Rate for Payer: WEA Trust Commercial |
$7,869.95
|
| Rate for Payer: WPS Commercial |
$10,598.68
|
|
|
FEMORAL STEM ADVOCATE CMTD STD 15 X 140 7850-15
|
Facility
|
OP
|
$14,309.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5286892
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,006.52 |
| Max. Negotiated Rate |
$57,236.00 |
| Rate for Payer: Aetna Commercial |
$12,878.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,305.74
|
| Rate for Payer: Aetna Managed Medicare |
$4,006.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,300.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,154.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,868.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,583.77
|
| Rate for Payer: Cash Price |
$4,292.70
|
| Rate for Payer: Cigna Commercial |
$13,164.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,007.32
|
| Rate for Payer: Health EOS Commercial |
$12,735.01
|
| Rate for Payer: HFN Commercial |
$13,164.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,731.75
|
| Rate for Payer: Multiplan Commercial |
$11,447.20
|
| Rate for Payer: NAPHCARE Commercial |
$8,585.40
|
| Rate for Payer: Preferred Network Access Commercial |
$13,164.28
|
| Rate for Payer: Quartz Beloit One Network |
$7,011.41
|
| Rate for Payer: Quartz Commercial |
$9,300.85
|
| Rate for Payer: Quartz Medicare Advantage |
$8,585.40
|
| Rate for Payer: The Alliance Commercial |
$57,236.00
|
| Rate for Payer: WEA Trust Commercial |
$7,869.95
|
| Rate for Payer: WPS Commercial |
$10,598.68
|
|
|
FEMORAL STEM ADVOCATE CMTD STD 16 X 145 7850-16
|
Facility
|
OP
|
$13,780.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5286893
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,858.40 |
| Max. Negotiated Rate |
$55,120.00 |
| Rate for Payer: Aetna Commercial |
$12,402.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,850.80
|
| Rate for Payer: Aetna Managed Medicare |
$3,858.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,957.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,890.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,614.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,303.40
|
| Rate for Payer: Cash Price |
$4,134.00
|
| Rate for Payer: Cigna Commercial |
$12,677.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,711.29
|
| Rate for Payer: Health EOS Commercial |
$12,264.20
|
| Rate for Payer: HFN Commercial |
$12,677.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,335.00
|
| Rate for Payer: Multiplan Commercial |
$11,024.00
|
| Rate for Payer: NAPHCARE Commercial |
$8,268.00
|
| Rate for Payer: Preferred Network Access Commercial |
$12,677.60
|
| Rate for Payer: Quartz Beloit One Network |
$6,752.20
|
| Rate for Payer: Quartz Commercial |
$8,957.00
|
| Rate for Payer: Quartz Medicare Advantage |
$8,268.00
|
| Rate for Payer: The Alliance Commercial |
$55,120.00
|
| Rate for Payer: WEA Trust Commercial |
$7,579.00
|
| Rate for Payer: WPS Commercial |
$10,206.85
|
|
|
FEMORAL STEM ADVOCATE CMTD STD 16 X 145 7850-16
|
Facility
|
IP
|
$13,780.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5286893
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,752.20 |
| Max. Negotiated Rate |
$12,677.60 |
| Rate for Payer: Aetna Commercial |
$12,402.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,850.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,303.40
|
| Rate for Payer: Cash Price |
$4,134.00
|
| Rate for Payer: Cigna Commercial |
$12,677.60
|
| Rate for Payer: Health EOS Commercial |
$12,264.20
|
| Rate for Payer: HFN Commercial |
$12,677.60
|
| Rate for Payer: Multiplan Commercial |
$11,024.00
|
| Rate for Payer: NAPHCARE Commercial |
$8,268.00
|
| Rate for Payer: Preferred Network Access Commercial |
$12,677.60
|
| Rate for Payer: Quartz Beloit One Network |
$6,752.20
|
| Rate for Payer: Quartz Commercial |
$8,268.00
|
| Rate for Payer: WEA Trust Commercial |
$7,579.00
|
| Rate for Payer: WPS Commercial |
$10,206.85
|
|
