|
FEMORAL STEM AVENIR MULLER STD SZ 7 01.06010.007
|
Facility
|
IP
|
$15,490.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5458864
|
|
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 CORAIL COATED REVISION 135 DEG STD COLLAR SZ 11 L98011
|
Facility
|
OP
|
$55,092.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563721
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15,425.76 |
| Max. Negotiated Rate |
$220,368.00 |
| Rate for Payer: Aetna Commercial |
$49,582.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47,379.12
|
| Rate for Payer: Aetna Managed Medicare |
$15,425.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$35,809.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27,546.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26,444.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29,198.76
|
| Rate for Payer: Cash Price |
$16,527.60
|
| Rate for Payer: Cigna Commercial |
$50,684.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30,829.48
|
| Rate for Payer: Health EOS Commercial |
$49,031.88
|
| Rate for Payer: HFN Commercial |
$50,684.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$41,319.00
|
| Rate for Payer: Multiplan Commercial |
$44,073.60
|
| Rate for Payer: NAPHCARE Commercial |
$33,055.20
|
| Rate for Payer: Preferred Network Access Commercial |
$50,684.64
|
| Rate for Payer: Quartz Beloit One Network |
$26,995.08
|
| Rate for Payer: Quartz Commercial |
$35,809.80
|
| Rate for Payer: Quartz Medicare Advantage |
$33,055.20
|
| Rate for Payer: The Alliance Commercial |
$220,368.00
|
| Rate for Payer: WEA Trust Commercial |
$30,300.60
|
| Rate for Payer: WPS Commercial |
$40,806.64
|
|
|
FEMORAL STEM CORAIL COATED REVISION 135 DEG STD COLLAR SZ 11 L98011
|
Facility
|
IP
|
$55,092.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563721
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$26,995.08 |
| Max. Negotiated Rate |
$50,684.64 |
| Rate for Payer: Aetna Commercial |
$49,582.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47,379.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29,198.76
|
| Rate for Payer: Cash Price |
$16,527.60
|
| Rate for Payer: Cigna Commercial |
$50,684.64
|
| Rate for Payer: Health EOS Commercial |
$49,031.88
|
| Rate for Payer: HFN Commercial |
$50,684.64
|
| Rate for Payer: Multiplan Commercial |
$44,073.60
|
| Rate for Payer: NAPHCARE Commercial |
$33,055.20
|
| Rate for Payer: Preferred Network Access Commercial |
$50,684.64
|
| Rate for Payer: Quartz Beloit One Network |
$26,995.08
|
| Rate for Payer: Quartz Commercial |
$33,055.20
|
| Rate for Payer: WEA Trust Commercial |
$30,300.60
|
| Rate for Payer: WPS Commercial |
$40,806.64
|
|
|
FEMORAL STEM SUMMIT SZ 12/14 TAPER 1570-13-090
|
Facility
|
IP
|
$9,016.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563690
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,417.84 |
| Max. Negotiated Rate |
$8,294.72 |
| Rate for Payer: Aetna Commercial |
$8,114.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,753.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,778.48
|
| Rate for Payer: Cash Price |
$2,704.80
|
| Rate for Payer: Cigna Commercial |
$8,294.72
|
| Rate for Payer: Health EOS Commercial |
$8,024.24
|
| Rate for Payer: HFN Commercial |
$8,294.72
|
| Rate for Payer: Multiplan Commercial |
$7,212.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,409.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,294.72
|
| Rate for Payer: Quartz Beloit One Network |
$4,417.84
|
| Rate for Payer: Quartz Commercial |
$5,409.60
|
| Rate for Payer: WEA Trust Commercial |
$4,958.80
|
| Rate for Payer: WPS Commercial |
$6,678.15
|
|
|
FEMORAL STEM SUMMIT SZ 12/14 TAPER 1570-13-090
|
Facility
|
OP
|
$9,016.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563690
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,524.48 |
| Max. Negotiated Rate |
$36,064.00 |
| Rate for Payer: Aetna Commercial |
$8,114.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,753.76
|
| Rate for Payer: Aetna Managed Medicare |
$2,524.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,860.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,508.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,327.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,778.48
|
| Rate for Payer: Cash Price |
$2,704.80
|
| Rate for Payer: Cigna Commercial |
$8,294.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,045.35
|
| Rate for Payer: Health EOS Commercial |
$8,024.24
|
| Rate for Payer: HFN Commercial |
$8,294.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,762.00
|
| Rate for Payer: Multiplan Commercial |
$7,212.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,409.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,294.72
|
| Rate for Payer: Quartz Beloit One Network |
$4,417.84
|
| Rate for Payer: Quartz Commercial |
$5,860.40
|
| Rate for Payer: Quartz Medicare Advantage |
$5,409.60
|
| Rate for Payer: The Alliance Commercial |
$36,064.00
|
| Rate for Payer: WEA Trust Commercial |
$4,958.80
|
| Rate for Payer: WPS Commercial |
$6,678.15
|
|
|
FEMORAL STEM SUMMIT SZ 2 STD CEMENTED 1570-03-080
|
Facility
|
OP
|
$9,573.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563459
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,680.44 |
| Max. Negotiated Rate |
$38,292.00 |
| Rate for Payer: Aetna Commercial |
$8,615.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,232.78
|
| Rate for Payer: Aetna Managed Medicare |
$2,680.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,222.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,786.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,595.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,073.69
|
| Rate for Payer: Cash Price |
$2,871.90
|
| Rate for Payer: Cigna Commercial |
$8,807.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,357.05
|
| Rate for Payer: Health EOS Commercial |
$8,519.97
|
| Rate for Payer: HFN Commercial |
$8,807.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,179.75
|
| Rate for Payer: Multiplan Commercial |
$7,658.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,743.80
|
| Rate for Payer: Preferred Network Access Commercial |
$8,807.16
|
| Rate for Payer: Quartz Beloit One Network |
$4,690.77
|
| Rate for Payer: Quartz Commercial |
$6,222.45
|
| Rate for Payer: Quartz Medicare Advantage |
$5,743.80
|
| Rate for Payer: The Alliance Commercial |
$38,292.00
|
| Rate for Payer: WEA Trust Commercial |
$5,265.15
|
| Rate for Payer: WPS Commercial |
$7,090.72
|
|
|
FEMORAL STEM SUMMIT SZ 2 STD CEMENTED 1570-03-080
|
Facility
|
IP
|
$9,573.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563459
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,690.77 |
| Max. Negotiated Rate |
$8,807.16 |
| Rate for Payer: Aetna Commercial |
$8,615.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,232.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,073.69
|
| Rate for Payer: Cash Price |
$2,871.90
|
| Rate for Payer: Cigna Commercial |
$8,807.16
|
| Rate for Payer: Health EOS Commercial |
$8,519.97
|
| Rate for Payer: HFN Commercial |
$8,807.16
|
| Rate for Payer: Multiplan Commercial |
$7,658.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,743.80
|
| Rate for Payer: Preferred Network Access Commercial |
$8,807.16
|
| Rate for Payer: Quartz Beloit One Network |
$4,690.77
|
| Rate for Payer: Quartz Commercial |
$5,743.80
|
| Rate for Payer: WEA Trust Commercial |
$5,265.15
|
| Rate for Payer: WPS Commercial |
$7,090.72
|
|
|
FEMORAL STEM SUMMIT SZ 3 12/14 TAPER 1570-01-090
|
Facility
|
OP
|
$16,595.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5459463
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,646.60 |
| Max. Negotiated Rate |
$66,380.00 |
| Rate for Payer: Aetna Commercial |
$14,935.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,271.70
|
| Rate for Payer: Aetna Managed Medicare |
$4,646.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,786.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,297.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,965.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,795.35
|
| Rate for Payer: Cash Price |
$4,978.50
|
| Rate for Payer: Cigna Commercial |
$15,267.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,286.56
|
| Rate for Payer: Health EOS Commercial |
$14,769.55
|
| Rate for Payer: HFN Commercial |
$15,267.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,446.25
|
| Rate for Payer: Multiplan Commercial |
$13,276.00
|
| Rate for Payer: NAPHCARE Commercial |
$9,957.00
|
| Rate for Payer: Preferred Network Access Commercial |
$15,267.40
|
| Rate for Payer: Quartz Beloit One Network |
$8,131.55
|
| Rate for Payer: Quartz Commercial |
$10,786.75
|
| Rate for Payer: Quartz Medicare Advantage |
$9,957.00
|
| Rate for Payer: The Alliance Commercial |
$66,380.00
|
| Rate for Payer: WEA Trust Commercial |
$9,127.25
|
| Rate for Payer: WPS Commercial |
$12,291.92
|
|
|
FEMORAL STEM SUMMIT SZ 3 12/14 TAPER 1570-01-090
|
Facility
|
IP
|
$16,595.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5459463
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,131.55 |
| Max. Negotiated Rate |
$15,267.40 |
| Rate for Payer: Aetna Commercial |
$14,935.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,271.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,795.35
|
| Rate for Payer: Cash Price |
$4,978.50
|
| Rate for Payer: Cigna Commercial |
$15,267.40
|
| Rate for Payer: Health EOS Commercial |
$14,769.55
|
| Rate for Payer: HFN Commercial |
$15,267.40
|
| Rate for Payer: Multiplan Commercial |
$13,276.00
|
| Rate for Payer: NAPHCARE Commercial |
$9,957.00
|
| Rate for Payer: Preferred Network Access Commercial |
$15,267.40
|
| Rate for Payer: Quartz Beloit One Network |
$8,131.55
|
| Rate for Payer: Quartz Commercial |
$9,957.00
|
| Rate for Payer: WEA Trust Commercial |
$9,127.25
|
| Rate for Payer: WPS Commercial |
$12,291.92
|
|
|
FEMORAL STEM SUMMIT SZ 3 12/14 TAPER 1570-11-090
|
Facility
|
OP
|
$17,234.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5459685
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,825.52 |
| Max. Negotiated Rate |
$68,936.00 |
| Rate for Payer: Aetna Commercial |
$15,510.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,821.24
|
| Rate for Payer: Aetna Managed Medicare |
$4,825.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,202.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,617.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,272.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,134.02
|
| Rate for Payer: Cash Price |
$5,170.20
|
| Rate for Payer: Cigna Commercial |
$15,855.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,644.15
|
| Rate for Payer: Health EOS Commercial |
$15,338.26
|
| Rate for Payer: HFN Commercial |
$15,855.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,925.50
|
| Rate for Payer: Multiplan Commercial |
$13,787.20
|
| Rate for Payer: NAPHCARE Commercial |
$10,340.40
|
| Rate for Payer: Preferred Network Access Commercial |
$15,855.28
|
| Rate for Payer: Quartz Beloit One Network |
$8,444.66
|
| Rate for Payer: Quartz Commercial |
$11,202.10
|
| Rate for Payer: Quartz Medicare Advantage |
$10,340.40
|
| Rate for Payer: The Alliance Commercial |
$68,936.00
|
| Rate for Payer: WEA Trust Commercial |
$9,478.70
|
| Rate for Payer: WPS Commercial |
$12,765.22
|
|
|
FEMORAL STEM SUMMIT SZ 3 12/14 TAPER 1570-11-090
|
Facility
|
IP
|
$17,234.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5459685
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,444.66 |
| Max. Negotiated Rate |
$15,855.28 |
| Rate for Payer: Aetna Commercial |
$15,510.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,821.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,134.02
|
| Rate for Payer: Cash Price |
$5,170.20
|
| Rate for Payer: Cigna Commercial |
$15,855.28
|
| Rate for Payer: Health EOS Commercial |
$15,338.26
|
| Rate for Payer: HFN Commercial |
$15,855.28
|
| Rate for Payer: Multiplan Commercial |
$13,787.20
|
| Rate for Payer: NAPHCARE Commercial |
$10,340.40
|
| Rate for Payer: Preferred Network Access Commercial |
$15,855.28
|
| Rate for Payer: Quartz Beloit One Network |
$8,444.66
|
| Rate for Payer: Quartz Commercial |
$10,340.40
|
| Rate for Payer: WEA Trust Commercial |
$9,478.70
|
| Rate for Payer: WPS Commercial |
$12,765.22
|
|
|
FEMORAL STEM SUMMIT SZ 3 STD CEMENTED 1570-03-090
|
Facility
|
OP
|
$9,956.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5490780
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,787.68 |
| Max. Negotiated Rate |
$39,824.00 |
| Rate for Payer: Aetna Commercial |
$8,960.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,562.16
|
| Rate for Payer: Aetna Managed Medicare |
$2,787.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,471.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,978.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,778.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,276.68
|
| Rate for Payer: Cash Price |
$2,986.80
|
| Rate for Payer: Cigna Commercial |
$9,159.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,571.38
|
| Rate for Payer: Health EOS Commercial |
$8,860.84
|
| Rate for Payer: HFN Commercial |
$9,159.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,467.00
|
| Rate for Payer: Multiplan Commercial |
$7,964.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,973.60
|
| Rate for Payer: Preferred Network Access Commercial |
$9,159.52
|
| Rate for Payer: Quartz Beloit One Network |
$4,878.44
|
| Rate for Payer: Quartz Commercial |
$6,471.40
|
| Rate for Payer: Quartz Medicare Advantage |
$5,973.60
|
| Rate for Payer: The Alliance Commercial |
$39,824.00
|
| Rate for Payer: WEA Trust Commercial |
$5,475.80
|
| Rate for Payer: WPS Commercial |
$7,374.41
|
|
|
FEMORAL STEM SUMMIT SZ 3 STD CEMENTED 1570-03-090
|
Facility
|
IP
|
$9,956.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5490780
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,878.44 |
| Max. Negotiated Rate |
$9,159.52 |
| Rate for Payer: Aetna Commercial |
$8,960.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,562.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,276.68
|
| Rate for Payer: Cash Price |
$2,986.80
|
| Rate for Payer: Cigna Commercial |
$9,159.52
|
| Rate for Payer: Health EOS Commercial |
$8,860.84
|
| Rate for Payer: HFN Commercial |
$9,159.52
|
| Rate for Payer: Multiplan Commercial |
$7,964.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,973.60
|
| Rate for Payer: Preferred Network Access Commercial |
$9,159.52
|
| Rate for Payer: Quartz Beloit One Network |
$4,878.44
|
| Rate for Payer: Quartz Commercial |
$5,973.60
|
| Rate for Payer: WEA Trust Commercial |
$5,475.80
|
| Rate for Payer: WPS Commercial |
$7,374.41
|
|
|
FEMORAL STEM SUMMIT SZ 4 12/14 TAPER 1570-11-100
|
Facility
|
OP
|
$12,126.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5591261
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,395.28 |
| Max. Negotiated Rate |
$48,504.00 |
| Rate for Payer: Aetna Commercial |
$10,913.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,428.36
|
| Rate for Payer: Aetna Managed Medicare |
$3,395.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,881.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,063.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,820.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,426.78
|
| Rate for Payer: Cash Price |
$3,637.80
|
| Rate for Payer: Cigna Commercial |
$11,155.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,785.71
|
| Rate for Payer: Health EOS Commercial |
$10,792.14
|
| Rate for Payer: HFN Commercial |
$11,155.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,094.50
|
| Rate for Payer: Multiplan Commercial |
$9,700.80
|
| Rate for Payer: NAPHCARE Commercial |
$7,275.60
|
| Rate for Payer: Preferred Network Access Commercial |
$11,155.92
|
| Rate for Payer: Quartz Beloit One Network |
$5,941.74
|
| Rate for Payer: Quartz Commercial |
$7,881.90
|
| Rate for Payer: Quartz Medicare Advantage |
$7,275.60
|
| Rate for Payer: The Alliance Commercial |
$48,504.00
|
| Rate for Payer: WEA Trust Commercial |
$6,669.30
|
| Rate for Payer: WPS Commercial |
$8,981.73
|
|
|
FEMORAL STEM SUMMIT SZ 4 12/14 TAPER 1570-11-100
|
Facility
|
IP
|
$12,126.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5591261
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,941.74 |
| Max. Negotiated Rate |
$11,155.92 |
| Rate for Payer: Aetna Commercial |
$10,913.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,428.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,426.78
|
| Rate for Payer: Cash Price |
$3,637.80
|
| Rate for Payer: Cigna Commercial |
$11,155.92
|
| Rate for Payer: Health EOS Commercial |
$10,792.14
|
| Rate for Payer: HFN Commercial |
$11,155.92
|
| Rate for Payer: Multiplan Commercial |
$9,700.80
|
| Rate for Payer: NAPHCARE Commercial |
$7,275.60
|
| Rate for Payer: Preferred Network Access Commercial |
$11,155.92
|
| Rate for Payer: Quartz Beloit One Network |
$5,941.74
|
| Rate for Payer: Quartz Commercial |
$7,275.60
|
| Rate for Payer: WEA Trust Commercial |
$6,669.30
|
| Rate for Payer: WPS Commercial |
$8,981.73
|
|
|
FEMORAL STEM SUMMIT SZ 4 STD 12/14 TAPER 1570-01-100
|
Facility
|
IP
|
$15,511.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5496705
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,600.39 |
| Max. Negotiated Rate |
$14,270.12 |
| Rate for Payer: Aetna Commercial |
$13,959.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,339.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,220.83
|
| Rate for Payer: Cash Price |
$4,653.30
|
| Rate for Payer: Cigna Commercial |
$14,270.12
|
| Rate for Payer: Health EOS Commercial |
$13,804.79
|
| Rate for Payer: HFN Commercial |
$14,270.12
|
| Rate for Payer: Multiplan Commercial |
$12,408.80
|
| Rate for Payer: NAPHCARE Commercial |
$9,306.60
|
| Rate for Payer: Preferred Network Access Commercial |
$14,270.12
|
| Rate for Payer: Quartz Beloit One Network |
$7,600.39
|
| Rate for Payer: Quartz Commercial |
$9,306.60
|
| Rate for Payer: WEA Trust Commercial |
$8,531.05
|
| Rate for Payer: WPS Commercial |
$11,489.00
|
|
|
FEMORAL STEM SUMMIT SZ 4 STD 12/14 TAPER 1570-01-100
|
Facility
|
OP
|
$15,511.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5496705
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,343.08 |
| Max. Negotiated Rate |
$62,044.00 |
| Rate for Payer: Aetna Commercial |
$13,959.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,339.46
|
| Rate for Payer: Aetna Managed Medicare |
$4,343.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,082.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,755.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,445.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,220.83
|
| Rate for Payer: Cash Price |
$4,653.30
|
| Rate for Payer: Cigna Commercial |
$14,270.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,679.96
|
| Rate for Payer: Health EOS Commercial |
$13,804.79
|
| Rate for Payer: HFN Commercial |
$14,270.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,633.25
|
| Rate for Payer: Multiplan Commercial |
$12,408.80
|
| Rate for Payer: NAPHCARE Commercial |
$9,306.60
|
| Rate for Payer: Preferred Network Access Commercial |
$14,270.12
|
| Rate for Payer: Quartz Beloit One Network |
$7,600.39
|
| Rate for Payer: Quartz Commercial |
$10,082.15
|
| Rate for Payer: Quartz Medicare Advantage |
$9,306.60
|
| Rate for Payer: The Alliance Commercial |
$62,044.00
|
| Rate for Payer: WEA Trust Commercial |
$8,531.05
|
| Rate for Payer: WPS Commercial |
$11,489.00
|
|
|
FEMORAL STEM SUMMIT SZ 4 STD CEMENTED 1570-03-100
|
Facility
|
IP
|
$9,573.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563324
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,690.77 |
| Max. Negotiated Rate |
$8,807.16 |
| Rate for Payer: Aetna Commercial |
$8,615.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,232.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,073.69
|
| Rate for Payer: Cash Price |
$2,871.90
|
| Rate for Payer: Cigna Commercial |
$8,807.16
|
| Rate for Payer: Health EOS Commercial |
$8,519.97
|
| Rate for Payer: HFN Commercial |
$8,807.16
|
| Rate for Payer: Multiplan Commercial |
$7,658.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,743.80
|
| Rate for Payer: Preferred Network Access Commercial |
$8,807.16
|
| Rate for Payer: Quartz Beloit One Network |
$4,690.77
|
| Rate for Payer: Quartz Commercial |
$5,743.80
|
| Rate for Payer: WEA Trust Commercial |
$5,265.15
|
| Rate for Payer: WPS Commercial |
$7,090.72
|
|
|
FEMORAL STEM SUMMIT SZ 4 STD CEMENTED 1570-03-100
|
Facility
|
OP
|
$9,573.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563324
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,680.44 |
| Max. Negotiated Rate |
$38,292.00 |
| Rate for Payer: Aetna Commercial |
$8,615.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,232.78
|
| Rate for Payer: Aetna Managed Medicare |
$2,680.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,222.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,786.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,595.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,073.69
|
| Rate for Payer: Cash Price |
$2,871.90
|
| Rate for Payer: Cigna Commercial |
$8,807.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,357.05
|
| Rate for Payer: Health EOS Commercial |
$8,519.97
|
| Rate for Payer: HFN Commercial |
$8,807.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,179.75
|
| Rate for Payer: Multiplan Commercial |
$7,658.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,743.80
|
| Rate for Payer: Preferred Network Access Commercial |
$8,807.16
|
| Rate for Payer: Quartz Beloit One Network |
$4,690.77
|
| Rate for Payer: Quartz Commercial |
$6,222.45
|
| Rate for Payer: Quartz Medicare Advantage |
$5,743.80
|
| Rate for Payer: The Alliance Commercial |
$38,292.00
|
| Rate for Payer: WEA Trust Commercial |
$5,265.15
|
| Rate for Payer: WPS Commercial |
$7,090.72
|
|
|
FEMORAL STEM SUMMIT SZ 5 12/14 TAPER 1570-11-110
|
Facility
|
OP
|
$14,935.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5496772
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,181.80 |
| Max. Negotiated Rate |
$59,740.00 |
| Rate for Payer: Aetna Commercial |
$13,441.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,844.10
|
| Rate for Payer: Aetna Managed Medicare |
$4,181.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,707.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,467.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,168.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,915.55
|
| Rate for Payer: Cash Price |
$4,480.50
|
| Rate for Payer: Cigna Commercial |
$13,740.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,357.63
|
| Rate for Payer: Health EOS Commercial |
$13,292.15
|
| Rate for Payer: HFN Commercial |
$13,740.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,201.25
|
| Rate for Payer: Multiplan Commercial |
$11,948.00
|
| Rate for Payer: NAPHCARE Commercial |
$8,961.00
|
| Rate for Payer: Preferred Network Access Commercial |
$13,740.20
|
| Rate for Payer: Quartz Beloit One Network |
$7,318.15
|
| Rate for Payer: Quartz Commercial |
$9,707.75
|
| Rate for Payer: Quartz Medicare Advantage |
$8,961.00
|
| Rate for Payer: The Alliance Commercial |
$59,740.00
|
| Rate for Payer: WEA Trust Commercial |
$8,214.25
|
| Rate for Payer: WPS Commercial |
$11,062.35
|
|
|
FEMORAL STEM SUMMIT SZ 5 12/14 TAPER 1570-11-110
|
Facility
|
IP
|
$14,935.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5496772
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,318.15 |
| Max. Negotiated Rate |
$13,740.20 |
| Rate for Payer: Aetna Commercial |
$13,441.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,844.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,915.55
|
| Rate for Payer: Cash Price |
$4,480.50
|
| Rate for Payer: Cigna Commercial |
$13,740.20
|
| Rate for Payer: Health EOS Commercial |
$13,292.15
|
| Rate for Payer: HFN Commercial |
$13,740.20
|
| Rate for Payer: Multiplan Commercial |
$11,948.00
|
| Rate for Payer: NAPHCARE Commercial |
$8,961.00
|
| Rate for Payer: Preferred Network Access Commercial |
$13,740.20
|
| Rate for Payer: Quartz Beloit One Network |
$7,318.15
|
| Rate for Payer: Quartz Commercial |
$8,961.00
|
| Rate for Payer: WEA Trust Commercial |
$8,214.25
|
| Rate for Payer: WPS Commercial |
$11,062.35
|
|
|
FEMORAL STEM SUMMIT SZ 5 12/14 TAPER 1570-13-110
|
Facility
|
IP
|
$9,956.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5547546
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,878.44 |
| Max. Negotiated Rate |
$9,159.52 |
| Rate for Payer: Aetna Commercial |
$8,960.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,562.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,276.68
|
| Rate for Payer: Cash Price |
$2,986.80
|
| Rate for Payer: Cigna Commercial |
$9,159.52
|
| Rate for Payer: Health EOS Commercial |
$8,860.84
|
| Rate for Payer: HFN Commercial |
$9,159.52
|
| Rate for Payer: Multiplan Commercial |
$7,964.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,973.60
|
| Rate for Payer: Preferred Network Access Commercial |
$9,159.52
|
| Rate for Payer: Quartz Beloit One Network |
$4,878.44
|
| Rate for Payer: Quartz Commercial |
$5,973.60
|
| Rate for Payer: WEA Trust Commercial |
$5,475.80
|
| Rate for Payer: WPS Commercial |
$7,374.41
|
|
|
FEMORAL STEM SUMMIT SZ 5 12/14 TAPER 1570-13-110
|
Facility
|
OP
|
$9,956.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5547546
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,787.68 |
| Max. Negotiated Rate |
$39,824.00 |
| Rate for Payer: Aetna Commercial |
$8,960.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,562.16
|
| Rate for Payer: Aetna Managed Medicare |
$2,787.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,471.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,978.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,778.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,276.68
|
| Rate for Payer: Cash Price |
$2,986.80
|
| Rate for Payer: Cigna Commercial |
$9,159.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,571.38
|
| Rate for Payer: Health EOS Commercial |
$8,860.84
|
| Rate for Payer: HFN Commercial |
$9,159.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,467.00
|
| Rate for Payer: Multiplan Commercial |
$7,964.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,973.60
|
| Rate for Payer: Preferred Network Access Commercial |
$9,159.52
|
| Rate for Payer: Quartz Beloit One Network |
$4,878.44
|
| Rate for Payer: Quartz Commercial |
$6,471.40
|
| Rate for Payer: Quartz Medicare Advantage |
$5,973.60
|
| Rate for Payer: The Alliance Commercial |
$39,824.00
|
| Rate for Payer: WEA Trust Commercial |
$5,475.80
|
| Rate for Payer: WPS Commercial |
$7,374.41
|
|
|
FEMORAL STEM SUMMIT SZ 5 STD 12/14 TAPER 1570-01-110
|
Facility
|
OP
|
$17,234.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5459768
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,825.52 |
| Max. Negotiated Rate |
$68,936.00 |
| Rate for Payer: Aetna Commercial |
$15,510.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,821.24
|
| Rate for Payer: Aetna Managed Medicare |
$4,825.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,202.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,617.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,272.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,134.02
|
| Rate for Payer: Cash Price |
$5,170.20
|
| Rate for Payer: Cigna Commercial |
$15,855.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,644.15
|
| Rate for Payer: Health EOS Commercial |
$15,338.26
|
| Rate for Payer: HFN Commercial |
$15,855.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,925.50
|
| Rate for Payer: Multiplan Commercial |
$13,787.20
|
| Rate for Payer: NAPHCARE Commercial |
$10,340.40
|
| Rate for Payer: Preferred Network Access Commercial |
$15,855.28
|
| Rate for Payer: Quartz Beloit One Network |
$8,444.66
|
| Rate for Payer: Quartz Commercial |
$11,202.10
|
| Rate for Payer: Quartz Medicare Advantage |
$10,340.40
|
| Rate for Payer: The Alliance Commercial |
$68,936.00
|
| Rate for Payer: WEA Trust Commercial |
$9,478.70
|
| Rate for Payer: WPS Commercial |
$12,765.22
|
|
|
FEMORAL STEM SUMMIT SZ 5 STD 12/14 TAPER 1570-01-110
|
Facility
|
IP
|
$17,234.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5459768
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,444.66 |
| Max. Negotiated Rate |
$15,855.28 |
| Rate for Payer: Aetna Commercial |
$15,510.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,821.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,134.02
|
| Rate for Payer: Cash Price |
$5,170.20
|
| Rate for Payer: Cigna Commercial |
$15,855.28
|
| Rate for Payer: Health EOS Commercial |
$15,338.26
|
| Rate for Payer: HFN Commercial |
$15,855.28
|
| Rate for Payer: Multiplan Commercial |
$13,787.20
|
| Rate for Payer: NAPHCARE Commercial |
$10,340.40
|
| Rate for Payer: Preferred Network Access Commercial |
$15,855.28
|
| Rate for Payer: Quartz Beloit One Network |
$8,444.66
|
| Rate for Payer: Quartz Commercial |
$10,340.40
|
| Rate for Payer: WEA Trust Commercial |
$9,478.70
|
| Rate for Payer: WPS Commercial |
$12,765.22
|
|
