|
FEMORAL STEM ADVOCATE CMTD STD 17 X 150 7850-17
|
Facility
|
OP
|
$13,780.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5286894
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$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 17 X 150 7850-17
|
Facility
|
IP
|
$13,780.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5286894
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$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 STD NECK OFFSET SZ 11 7850-11-05
|
Facility
|
IP
|
$12,495.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967865
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,122.55 |
| Max. Negotiated Rate |
$11,495.40 |
| Rate for Payer: Aetna Commercial |
$11,245.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,745.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,622.35
|
| Rate for Payer: Cash Price |
$3,748.50
|
| Rate for Payer: Cigna Commercial |
$11,495.40
|
| Rate for Payer: Health EOS Commercial |
$11,120.55
|
| Rate for Payer: HFN Commercial |
$11,495.40
|
| Rate for Payer: Multiplan Commercial |
$9,996.00
|
| Rate for Payer: NAPHCARE Commercial |
$7,497.00
|
| Rate for Payer: Preferred Network Access Commercial |
$11,495.40
|
| Rate for Payer: Quartz Beloit One Network |
$6,122.55
|
| Rate for Payer: Quartz Commercial |
$7,497.00
|
| Rate for Payer: WEA Trust Commercial |
$6,872.25
|
| Rate for Payer: WPS Commercial |
$9,255.05
|
|
|
FEMORAL STEM ADVOCATE STD NECK OFFSET SZ 11 7850-11-05
|
Facility
|
OP
|
$12,495.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967865
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,498.60 |
| Max. Negotiated Rate |
$49,980.00 |
| Rate for Payer: Aetna Commercial |
$11,245.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,745.70
|
| Rate for Payer: Aetna Managed Medicare |
$3,498.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,121.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,247.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,997.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,622.35
|
| Rate for Payer: Cash Price |
$3,748.50
|
| Rate for Payer: Cigna Commercial |
$11,495.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,992.20
|
| Rate for Payer: Health EOS Commercial |
$11,120.55
|
| Rate for Payer: HFN Commercial |
$11,495.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,371.25
|
| Rate for Payer: Multiplan Commercial |
$9,996.00
|
| Rate for Payer: NAPHCARE Commercial |
$7,497.00
|
| Rate for Payer: Preferred Network Access Commercial |
$11,495.40
|
| Rate for Payer: Quartz Beloit One Network |
$6,122.55
|
| Rate for Payer: Quartz Commercial |
$8,121.75
|
| Rate for Payer: Quartz Medicare Advantage |
$7,497.00
|
| Rate for Payer: The Alliance Commercial |
$49,980.00
|
| Rate for Payer: WEA Trust Commercial |
$6,872.25
|
| Rate for Payer: WPS Commercial |
$9,255.05
|
|
|
FEMORAL STEM AML 12/14 TAPER 12.0MM 6IN LG STATURE 160MM LENGTH 40MM OFFSET 1554-02-121
|
Facility
|
IP
|
$11,212.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6172811
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,493.88 |
| Max. Negotiated Rate |
$10,315.04 |
| Rate for Payer: Aetna Commercial |
$10,090.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,642.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,942.36
|
| Rate for Payer: Cash Price |
$3,363.60
|
| Rate for Payer: Cigna Commercial |
$10,315.04
|
| Rate for Payer: Health EOS Commercial |
$9,978.68
|
| Rate for Payer: HFN Commercial |
$10,315.04
|
| Rate for Payer: Multiplan Commercial |
$8,969.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,727.20
|
| Rate for Payer: Preferred Network Access Commercial |
$10,315.04
|
| Rate for Payer: Quartz Beloit One Network |
$5,493.88
|
| Rate for Payer: Quartz Commercial |
$6,727.20
|
| Rate for Payer: WEA Trust Commercial |
$6,166.60
|
| Rate for Payer: WPS Commercial |
$8,304.73
|
|
|
FEMORAL STEM AML 12/14 TAPER 12.0MM 6IN LG STATURE 160MM LENGTH 40MM OFFSET 1554-02-121
|
Facility
|
OP
|
$11,212.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6172811
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,139.36 |
| Max. Negotiated Rate |
$44,848.00 |
| Rate for Payer: Aetna Commercial |
$10,090.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,642.32
|
| Rate for Payer: Aetna Managed Medicare |
$3,139.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,287.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,606.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,381.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,942.36
|
| Rate for Payer: Cash Price |
$3,363.60
|
| Rate for Payer: Cigna Commercial |
$10,315.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,274.24
|
| Rate for Payer: Health EOS Commercial |
$9,978.68
|
| Rate for Payer: HFN Commercial |
$10,315.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,409.00
|
| Rate for Payer: Multiplan Commercial |
$8,969.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,727.20
|
| Rate for Payer: Preferred Network Access Commercial |
$10,315.04
|
| Rate for Payer: Quartz Beloit One Network |
$5,493.88
|
| Rate for Payer: Quartz Commercial |
$7,287.80
|
| Rate for Payer: Quartz Medicare Advantage |
$6,727.20
|
| Rate for Payer: The Alliance Commercial |
$44,848.00
|
| Rate for Payer: WEA Trust Commercial |
$6,166.60
|
| Rate for Payer: WPS Commercial |
$8,304.73
|
|
|
FEMORAL STEM AML 12/14 TAPER 13.5 SMALL STATURE 155MM LENGTH 43MM OFFSET 1554-01-135
|
Facility
|
OP
|
$11,212.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6165645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,139.36 |
| Max. Negotiated Rate |
$44,848.00 |
| Rate for Payer: Aetna Commercial |
$10,090.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,642.32
|
| Rate for Payer: Aetna Managed Medicare |
$3,139.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,287.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,606.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,381.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,942.36
|
| Rate for Payer: Cash Price |
$3,363.60
|
| Rate for Payer: Cigna Commercial |
$10,315.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,274.24
|
| Rate for Payer: Health EOS Commercial |
$9,978.68
|
| Rate for Payer: HFN Commercial |
$10,315.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,409.00
|
| Rate for Payer: Multiplan Commercial |
$8,969.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,727.20
|
| Rate for Payer: Preferred Network Access Commercial |
$10,315.04
|
| Rate for Payer: Quartz Beloit One Network |
$5,493.88
|
| Rate for Payer: Quartz Commercial |
$7,287.80
|
| Rate for Payer: Quartz Medicare Advantage |
$6,727.20
|
| Rate for Payer: The Alliance Commercial |
$44,848.00
|
| Rate for Payer: WEA Trust Commercial |
$6,166.60
|
| Rate for Payer: WPS Commercial |
$8,304.73
|
|
|
FEMORAL STEM AML 12/14 TAPER 13.5 SMALL STATURE 155MM LENGTH 43MM OFFSET 1554-01-135
|
Facility
|
IP
|
$11,212.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6165645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,493.88 |
| Max. Negotiated Rate |
$10,315.04 |
| Rate for Payer: Aetna Commercial |
$10,090.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,642.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,942.36
|
| Rate for Payer: Cash Price |
$3,363.60
|
| Rate for Payer: Cigna Commercial |
$10,315.04
|
| Rate for Payer: Health EOS Commercial |
$9,978.68
|
| Rate for Payer: HFN Commercial |
$10,315.04
|
| Rate for Payer: Multiplan Commercial |
$8,969.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,727.20
|
| Rate for Payer: Preferred Network Access Commercial |
$10,315.04
|
| Rate for Payer: Quartz Beloit One Network |
$5,493.88
|
| Rate for Payer: Quartz Commercial |
$6,727.20
|
| Rate for Payer: WEA Trust Commercial |
$6,166.60
|
| Rate for Payer: WPS Commercial |
$8,304.73
|
|
|
FEMORAL STEM AVENIR MULLER LATERAL SZ 2 01.06010.102
|
Facility
|
OP
|
$15,490.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5456725
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,337.20 |
| Max. Negotiated Rate |
$61,960.00 |
| Rate for Payer: Aetna Commercial |
$13,941.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,321.40
|
| Rate for Payer: Aetna Managed Medicare |
$4,337.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,068.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,745.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,435.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,209.70
|
| Rate for Payer: Cash Price |
$4,647.00
|
| Rate for Payer: Cigna Commercial |
$14,250.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,668.20
|
| Rate for Payer: Health EOS Commercial |
$13,786.10
|
| Rate for Payer: HFN Commercial |
$14,250.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,617.50
|
| Rate for Payer: Multiplan Commercial |
$12,392.00
|
| Rate for Payer: NAPHCARE Commercial |
$9,294.00
|
| Rate for Payer: Preferred Network Access Commercial |
$14,250.80
|
| Rate for Payer: Quartz Beloit One Network |
$7,590.10
|
| Rate for Payer: Quartz Commercial |
$10,068.50
|
| Rate for Payer: Quartz Medicare Advantage |
$9,294.00
|
| Rate for Payer: The Alliance Commercial |
$61,960.00
|
| Rate for Payer: WEA Trust Commercial |
$8,519.50
|
| Rate for Payer: WPS Commercial |
$11,473.44
|
|
|
FEMORAL STEM AVENIR MULLER LATERAL SZ 2 01.06010.102
|
Facility
|
IP
|
$15,490.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5456725
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,590.10 |
| Max. Negotiated Rate |
$14,250.80 |
| Rate for Payer: Aetna Commercial |
$13,941.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,321.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,209.70
|
| Rate for Payer: Cash Price |
$4,647.00
|
| Rate for Payer: Cigna Commercial |
$14,250.80
|
| Rate for Payer: Health EOS Commercial |
$13,786.10
|
| Rate for Payer: HFN Commercial |
$14,250.80
|
| Rate for Payer: Multiplan Commercial |
$12,392.00
|
| Rate for Payer: NAPHCARE Commercial |
$9,294.00
|
| Rate for Payer: Preferred Network Access Commercial |
$14,250.80
|
| Rate for Payer: Quartz Beloit One Network |
$7,590.10
|
| Rate for Payer: Quartz Commercial |
$9,294.00
|
| Rate for Payer: WEA Trust Commercial |
$8,519.50
|
| Rate for Payer: WPS Commercial |
$11,473.44
|
|
|
FEMORAL STEM AVENIR MULLER STD SZ 2 01.06010.002
|
Facility
|
IP
|
$12,244.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6220164
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,999.56 |
| Max. Negotiated Rate |
$11,264.48 |
| Rate for Payer: Aetna Commercial |
$11,019.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,529.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,489.32
|
| Rate for Payer: Cash Price |
$3,673.20
|
| Rate for Payer: Cigna Commercial |
$11,264.48
|
| Rate for Payer: Health EOS Commercial |
$10,897.16
|
| Rate for Payer: HFN Commercial |
$11,264.48
|
| Rate for Payer: Multiplan Commercial |
$9,795.20
|
| Rate for Payer: NAPHCARE Commercial |
$7,346.40
|
| Rate for Payer: Preferred Network Access Commercial |
$11,264.48
|
| Rate for Payer: Quartz Beloit One Network |
$5,999.56
|
| Rate for Payer: Quartz Commercial |
$7,346.40
|
| Rate for Payer: WEA Trust Commercial |
$6,734.20
|
| Rate for Payer: WPS Commercial |
$9,069.13
|
|
|
FEMORAL STEM AVENIR MULLER STD SZ 2 01.06010.002
|
Facility
|
OP
|
$12,244.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6220164
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,428.32 |
| Max. Negotiated Rate |
$48,976.00 |
| Rate for Payer: Aetna Commercial |
$11,019.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,529.84
|
| Rate for Payer: Aetna Managed Medicare |
$3,428.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,958.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,122.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,877.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,489.32
|
| Rate for Payer: Cash Price |
$3,673.20
|
| Rate for Payer: Cigna Commercial |
$11,264.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,851.74
|
| Rate for Payer: Health EOS Commercial |
$10,897.16
|
| Rate for Payer: HFN Commercial |
$11,264.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,183.00
|
| Rate for Payer: Multiplan Commercial |
$9,795.20
|
| Rate for Payer: NAPHCARE Commercial |
$7,346.40
|
| Rate for Payer: Preferred Network Access Commercial |
$11,264.48
|
| Rate for Payer: Quartz Beloit One Network |
$5,999.56
|
| Rate for Payer: Quartz Commercial |
$7,958.60
|
| Rate for Payer: Quartz Medicare Advantage |
$7,346.40
|
| Rate for Payer: The Alliance Commercial |
$48,976.00
|
| Rate for Payer: WEA Trust Commercial |
$6,734.20
|
| Rate for Payer: WPS Commercial |
$9,069.13
|
|
|
FEMORAL STEM AVENIR MULLER STD SZ 2 01.06010.202
|
Facility
|
OP
|
$15,490.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4858762
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,337.20 |
| Max. Negotiated Rate |
$61,960.00 |
| Rate for Payer: Aetna Commercial |
$13,941.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,321.40
|
| Rate for Payer: Aetna Managed Medicare |
$4,337.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,068.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,745.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,435.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,209.70
|
| Rate for Payer: Cash Price |
$4,647.00
|
| Rate for Payer: Cigna Commercial |
$14,250.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,668.20
|
| Rate for Payer: Health EOS Commercial |
$13,786.10
|
| Rate for Payer: HFN Commercial |
$14,250.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,617.50
|
| Rate for Payer: Multiplan Commercial |
$12,392.00
|
| Rate for Payer: NAPHCARE Commercial |
$9,294.00
|
| Rate for Payer: Preferred Network Access Commercial |
$14,250.80
|
| Rate for Payer: Quartz Beloit One Network |
$7,590.10
|
| Rate for Payer: Quartz Commercial |
$10,068.50
|
| Rate for Payer: Quartz Medicare Advantage |
$9,294.00
|
| Rate for Payer: The Alliance Commercial |
$61,960.00
|
| Rate for Payer: WEA Trust Commercial |
$8,519.50
|
| Rate for Payer: WPS Commercial |
$11,473.44
|
|
|
FEMORAL STEM AVENIR MULLER STD SZ 2 01.06010.202
|
Facility
|
IP
|
$15,490.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4858762
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,590.10 |
| Max. Negotiated Rate |
$14,250.80 |
| Rate for Payer: Aetna Commercial |
$13,941.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,321.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,209.70
|
| Rate for Payer: Cash Price |
$4,647.00
|
| Rate for Payer: Cigna Commercial |
$14,250.80
|
| Rate for Payer: Health EOS Commercial |
$13,786.10
|
| Rate for Payer: HFN Commercial |
$14,250.80
|
| Rate for Payer: Multiplan Commercial |
$12,392.00
|
| Rate for Payer: NAPHCARE Commercial |
$9,294.00
|
| Rate for Payer: Preferred Network Access Commercial |
$14,250.80
|
| Rate for Payer: Quartz Beloit One Network |
$7,590.10
|
| Rate for Payer: Quartz Commercial |
$9,294.00
|
| Rate for Payer: WEA Trust Commercial |
$8,519.50
|
| Rate for Payer: WPS Commercial |
$11,473.44
|
|
|
FEMORAL STEM AVENIR MULLER STD SZ 3 01.06010.003
|
Facility
|
IP
|
$16,085.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5307093
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,881.65 |
| Max. Negotiated Rate |
$14,798.20 |
| Rate for Payer: Aetna Commercial |
$14,476.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,833.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,525.05
|
| Rate for Payer: Cash Price |
$4,825.50
|
| Rate for Payer: Cigna Commercial |
$14,798.20
|
| Rate for Payer: Health EOS Commercial |
$14,315.65
|
| Rate for Payer: HFN Commercial |
$14,798.20
|
| Rate for Payer: Multiplan Commercial |
$12,868.00
|
| Rate for Payer: NAPHCARE Commercial |
$9,651.00
|
| Rate for Payer: Preferred Network Access Commercial |
$14,798.20
|
| Rate for Payer: Quartz Beloit One Network |
$7,881.65
|
| Rate for Payer: Quartz Commercial |
$9,651.00
|
| Rate for Payer: WEA Trust Commercial |
$8,846.75
|
| Rate for Payer: WPS Commercial |
$11,914.16
|
|
|
FEMORAL STEM AVENIR MULLER STD SZ 3 01.06010.003
|
Facility
|
OP
|
$16,085.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5307093
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,503.80 |
| Max. Negotiated Rate |
$64,340.00 |
| Rate for Payer: Aetna Commercial |
$14,476.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,833.10
|
| Rate for Payer: Aetna Managed Medicare |
$4,503.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,455.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,042.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,720.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,525.05
|
| Rate for Payer: Cash Price |
$4,825.50
|
| Rate for Payer: Cigna Commercial |
$14,798.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,001.17
|
| Rate for Payer: Health EOS Commercial |
$14,315.65
|
| Rate for Payer: HFN Commercial |
$14,798.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,063.75
|
| Rate for Payer: Multiplan Commercial |
$12,868.00
|
| Rate for Payer: NAPHCARE Commercial |
$9,651.00
|
| Rate for Payer: Preferred Network Access Commercial |
$14,798.20
|
| Rate for Payer: Quartz Beloit One Network |
$7,881.65
|
| Rate for Payer: Quartz Commercial |
$10,455.25
|
| Rate for Payer: Quartz Medicare Advantage |
$9,651.00
|
| Rate for Payer: The Alliance Commercial |
$64,340.00
|
| Rate for Payer: WEA Trust Commercial |
$8,846.75
|
| Rate for Payer: WPS Commercial |
$11,914.16
|
|
|
FEMORAL STEM AVENIR MULLER STD SZ 4 01.06010.004
|
Facility
|
OP
|
$16,085.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4640957
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,503.80 |
| Max. Negotiated Rate |
$64,340.00 |
| Rate for Payer: Aetna Commercial |
$14,476.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,833.10
|
| Rate for Payer: Aetna Managed Medicare |
$4,503.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,455.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,042.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,720.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,525.05
|
| Rate for Payer: Cash Price |
$4,825.50
|
| Rate for Payer: Cigna Commercial |
$14,798.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,001.17
|
| Rate for Payer: Health EOS Commercial |
$14,315.65
|
| Rate for Payer: HFN Commercial |
$14,798.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,063.75
|
| Rate for Payer: Multiplan Commercial |
$12,868.00
|
| Rate for Payer: NAPHCARE Commercial |
$9,651.00
|
| Rate for Payer: Preferred Network Access Commercial |
$14,798.20
|
| Rate for Payer: Quartz Beloit One Network |
$7,881.65
|
| Rate for Payer: Quartz Commercial |
$10,455.25
|
| Rate for Payer: Quartz Medicare Advantage |
$9,651.00
|
| Rate for Payer: The Alliance Commercial |
$64,340.00
|
| Rate for Payer: WEA Trust Commercial |
$8,846.75
|
| Rate for Payer: WPS Commercial |
$11,914.16
|
|
|
FEMORAL STEM AVENIR MULLER STD SZ 4 01.06010.004
|
Facility
|
IP
|
$16,085.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4640957
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,881.65 |
| Max. Negotiated Rate |
$14,798.20 |
| Rate for Payer: Aetna Commercial |
$14,476.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,833.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,525.05
|
| Rate for Payer: Cash Price |
$4,825.50
|
| Rate for Payer: Cigna Commercial |
$14,798.20
|
| Rate for Payer: Health EOS Commercial |
$14,315.65
|
| Rate for Payer: HFN Commercial |
$14,798.20
|
| Rate for Payer: Multiplan Commercial |
$12,868.00
|
| Rate for Payer: NAPHCARE Commercial |
$9,651.00
|
| Rate for Payer: Preferred Network Access Commercial |
$14,798.20
|
| Rate for Payer: Quartz Beloit One Network |
$7,881.65
|
| Rate for Payer: Quartz Commercial |
$9,651.00
|
| Rate for Payer: WEA Trust Commercial |
$8,846.75
|
| Rate for Payer: WPS Commercial |
$11,914.16
|
|
|
FEMORAL STEM AVENIR MULLER STD SZ 5 01.06010.005
|
Facility
|
IP
|
$12,192.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6220192
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,974.08 |
| Max. Negotiated Rate |
$11,216.64 |
| Rate for Payer: Aetna Commercial |
$10,972.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,485.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,461.76
|
| Rate for Payer: Cash Price |
$3,657.60
|
| Rate for Payer: Cigna Commercial |
$11,216.64
|
| Rate for Payer: Health EOS Commercial |
$10,850.88
|
| Rate for Payer: HFN Commercial |
$11,216.64
|
| Rate for Payer: Multiplan Commercial |
$9,753.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,315.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11,216.64
|
| Rate for Payer: Quartz Beloit One Network |
$5,974.08
|
| Rate for Payer: Quartz Commercial |
$7,315.20
|
| Rate for Payer: WEA Trust Commercial |
$6,705.60
|
| Rate for Payer: WPS Commercial |
$9,030.61
|
|
|
FEMORAL STEM AVENIR MULLER STD SZ 5 01.06010.005
|
Facility
|
OP
|
$12,192.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6220192
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,413.76 |
| Max. Negotiated Rate |
$48,768.00 |
| Rate for Payer: Aetna Commercial |
$10,972.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,485.12
|
| Rate for Payer: Aetna Managed Medicare |
$3,413.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,924.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,096.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,852.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,461.76
|
| Rate for Payer: Cash Price |
$3,657.60
|
| Rate for Payer: Cigna Commercial |
$11,216.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,822.64
|
| Rate for Payer: Health EOS Commercial |
$10,850.88
|
| Rate for Payer: HFN Commercial |
$11,216.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,144.00
|
| Rate for Payer: Multiplan Commercial |
$9,753.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,315.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11,216.64
|
| Rate for Payer: Quartz Beloit One Network |
$5,974.08
|
| Rate for Payer: Quartz Commercial |
$7,924.80
|
| Rate for Payer: Quartz Medicare Advantage |
$7,315.20
|
| Rate for Payer: The Alliance Commercial |
$48,768.00
|
| Rate for Payer: WEA Trust Commercial |
$6,705.60
|
| Rate for Payer: WPS Commercial |
$9,030.61
|
|
|
FEMORAL STEM AVENIR MULLER STD SZ 6 01.06010.006
|
Facility
|
OP
|
$16,085.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5456752
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,503.80 |
| Max. Negotiated Rate |
$64,340.00 |
| Rate for Payer: Aetna Commercial |
$14,476.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,833.10
|
| Rate for Payer: Aetna Managed Medicare |
$4,503.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,455.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,042.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,720.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,525.05
|
| Rate for Payer: Cash Price |
$4,825.50
|
| Rate for Payer: Cigna Commercial |
$14,798.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,001.17
|
| Rate for Payer: Health EOS Commercial |
$14,315.65
|
| Rate for Payer: HFN Commercial |
$14,798.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,063.75
|
| Rate for Payer: Multiplan Commercial |
$12,868.00
|
| Rate for Payer: NAPHCARE Commercial |
$9,651.00
|
| Rate for Payer: Preferred Network Access Commercial |
$14,798.20
|
| Rate for Payer: Quartz Beloit One Network |
$7,881.65
|
| Rate for Payer: Quartz Commercial |
$10,455.25
|
| Rate for Payer: Quartz Medicare Advantage |
$9,651.00
|
| Rate for Payer: The Alliance Commercial |
$64,340.00
|
| Rate for Payer: WEA Trust Commercial |
$8,846.75
|
| Rate for Payer: WPS Commercial |
$11,914.16
|
|
|
FEMORAL STEM AVENIR MULLER STD SZ 6 01.06010.006
|
Facility
|
IP
|
$16,085.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5456752
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,881.65 |
| Max. Negotiated Rate |
$14,798.20 |
| Rate for Payer: Aetna Commercial |
$14,476.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,833.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,525.05
|
| Rate for Payer: Cash Price |
$4,825.50
|
| Rate for Payer: Cigna Commercial |
$14,798.20
|
| Rate for Payer: Health EOS Commercial |
$14,315.65
|
| Rate for Payer: HFN Commercial |
$14,798.20
|
| Rate for Payer: Multiplan Commercial |
$12,868.00
|
| Rate for Payer: NAPHCARE Commercial |
$9,651.00
|
| Rate for Payer: Preferred Network Access Commercial |
$14,798.20
|
| Rate for Payer: Quartz Beloit One Network |
$7,881.65
|
| Rate for Payer: Quartz Commercial |
$9,651.00
|
| Rate for Payer: WEA Trust Commercial |
$8,846.75
|
| Rate for Payer: WPS Commercial |
$11,914.16
|
|
|
FEMORAL STEM AVENIR MULLER STD SZ 6 CEM 01.06010.206
|
Facility
|
OP
|
$9,810.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6246248
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,746.96 |
| Max. Negotiated Rate |
$39,242.32 |
| Rate for Payer: Aetna Commercial |
$8,829.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,437.10
|
| Rate for Payer: Aetna Managed Medicare |
$2,746.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,376.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,905.29
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,709.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,199.61
|
| Rate for Payer: Cash Price |
$2,943.17
|
| Rate for Payer: Cigna Commercial |
$9,025.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,490.00
|
| Rate for Payer: Health EOS Commercial |
$8,731.42
|
| Rate for Payer: HFN Commercial |
$9,025.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,357.94
|
| Rate for Payer: Multiplan Commercial |
$7,848.46
|
| Rate for Payer: NAPHCARE Commercial |
$5,886.35
|
| Rate for Payer: Preferred Network Access Commercial |
$9,025.73
|
| Rate for Payer: Quartz Beloit One Network |
$4,807.18
|
| Rate for Payer: Quartz Commercial |
$6,376.88
|
| Rate for Payer: Quartz Medicare Advantage |
$5,886.35
|
| Rate for Payer: The Alliance Commercial |
$39,242.32
|
| Rate for Payer: WEA Trust Commercial |
$5,395.82
|
| Rate for Payer: WPS Commercial |
$7,266.70
|
|
|
FEMORAL STEM AVENIR MULLER STD SZ 6 CEM 01.06010.206
|
Facility
|
IP
|
$9,810.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6246248
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,807.18 |
| Max. Negotiated Rate |
$9,025.73 |
| Rate for Payer: Aetna Commercial |
$8,829.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,437.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,199.61
|
| Rate for Payer: Cash Price |
$2,943.17
|
| Rate for Payer: Cigna Commercial |
$9,025.73
|
| Rate for Payer: Health EOS Commercial |
$8,731.42
|
| Rate for Payer: HFN Commercial |
$9,025.73
|
| Rate for Payer: Multiplan Commercial |
$7,848.46
|
| Rate for Payer: NAPHCARE Commercial |
$5,886.35
|
| Rate for Payer: Preferred Network Access Commercial |
$9,025.73
|
| Rate for Payer: Quartz Beloit One Network |
$4,807.18
|
| Rate for Payer: Quartz Commercial |
$5,886.35
|
| Rate for Payer: WEA Trust Commercial |
$5,395.82
|
| Rate for Payer: WPS Commercial |
$7,266.70
|
|
|
FEMORAL STEM AVENIR MULLER STD SZ 7 01.06010.007
|
Facility
|
OP
|
$15,490.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5458864
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,337.20 |
| Max. Negotiated Rate |
$61,960.00 |
| Rate for Payer: Aetna Commercial |
$13,941.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,321.40
|
| Rate for Payer: Aetna Managed Medicare |
$4,337.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,068.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,745.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,435.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,209.70
|
| Rate for Payer: Cash Price |
$4,647.00
|
| Rate for Payer: Cigna Commercial |
$14,250.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,668.20
|
| Rate for Payer: Health EOS Commercial |
$13,786.10
|
| Rate for Payer: HFN Commercial |
$14,250.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,617.50
|
| Rate for Payer: Multiplan Commercial |
$12,392.00
|
| Rate for Payer: NAPHCARE Commercial |
$9,294.00
|
| Rate for Payer: Preferred Network Access Commercial |
$14,250.80
|
| Rate for Payer: Quartz Beloit One Network |
$7,590.10
|
| Rate for Payer: Quartz Commercial |
$10,068.50
|
| Rate for Payer: Quartz Medicare Advantage |
$9,294.00
|
| Rate for Payer: The Alliance Commercial |
$61,960.00
|
| Rate for Payer: WEA Trust Commercial |
$8,519.50
|
| Rate for Payer: WPS Commercial |
$11,473.44
|
|
