|
FEMORAL STEM SUMMIT SZ 5 STD CEMENTED 1570-03-110
|
Facility
|
OP
|
$8,673.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5787623
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,428.44 |
| Max. Negotiated Rate |
$34,692.00 |
| Rate for Payer: Aetna Commercial |
$7,805.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,458.78
|
| Rate for Payer: Aetna Managed Medicare |
$2,428.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,637.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,336.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,163.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,596.69
|
| Rate for Payer: Cash Price |
$2,601.90
|
| Rate for Payer: Cigna Commercial |
$7,979.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,853.41
|
| Rate for Payer: Health EOS Commercial |
$7,718.97
|
| Rate for Payer: HFN Commercial |
$7,979.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,504.75
|
| Rate for Payer: Multiplan Commercial |
$6,938.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,203.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,979.16
|
| Rate for Payer: Quartz Beloit One Network |
$4,249.77
|
| Rate for Payer: Quartz Commercial |
$5,637.45
|
| Rate for Payer: Quartz Medicare Advantage |
$5,203.80
|
| Rate for Payer: The Alliance Commercial |
$34,692.00
|
| Rate for Payer: WEA Trust Commercial |
$4,770.15
|
| Rate for Payer: WPS Commercial |
$6,424.09
|
|
|
FEMORAL STEM SUMMIT SZ 5 STD CEMENTED 1570-03-110
|
Facility
|
IP
|
$8,673.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5787623
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,249.77 |
| Max. Negotiated Rate |
$7,979.16 |
| Rate for Payer: Aetna Commercial |
$7,805.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,458.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,596.69
|
| Rate for Payer: Cash Price |
$2,601.90
|
| Rate for Payer: Cigna Commercial |
$7,979.16
|
| Rate for Payer: Health EOS Commercial |
$7,718.97
|
| Rate for Payer: HFN Commercial |
$7,979.16
|
| Rate for Payer: Multiplan Commercial |
$6,938.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,203.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,979.16
|
| Rate for Payer: Quartz Beloit One Network |
$4,249.77
|
| Rate for Payer: Quartz Commercial |
$5,203.80
|
| Rate for Payer: WEA Trust Commercial |
$4,770.15
|
| Rate for Payer: WPS Commercial |
$6,424.09
|
|
|
FEMORAL STEM SUMMIT SZ 6 12/14 TAPER 1570-11-120
|
Facility
|
OP
|
$17,234.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5459307
|
|
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 6 12/14 TAPER 1570-11-120
|
Facility
|
IP
|
$17,234.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5459307
|
|
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 6 12/14 TAPER 1570-13-120
|
Facility
|
OP
|
$8,673.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5729684
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,428.44 |
| Max. Negotiated Rate |
$34,692.00 |
| Rate for Payer: Aetna Commercial |
$7,805.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,458.78
|
| Rate for Payer: Aetna Managed Medicare |
$2,428.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,637.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,336.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,163.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,596.69
|
| Rate for Payer: Cash Price |
$2,601.90
|
| Rate for Payer: Cigna Commercial |
$7,979.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,853.41
|
| Rate for Payer: Health EOS Commercial |
$7,718.97
|
| Rate for Payer: HFN Commercial |
$7,979.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,504.75
|
| Rate for Payer: Multiplan Commercial |
$6,938.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,203.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,979.16
|
| Rate for Payer: Quartz Beloit One Network |
$4,249.77
|
| Rate for Payer: Quartz Commercial |
$5,637.45
|
| Rate for Payer: Quartz Medicare Advantage |
$5,203.80
|
| Rate for Payer: The Alliance Commercial |
$34,692.00
|
| Rate for Payer: WEA Trust Commercial |
$4,770.15
|
| Rate for Payer: WPS Commercial |
$6,424.09
|
|
|
FEMORAL STEM SUMMIT SZ 6 12/14 TAPER 1570-13-120
|
Facility
|
IP
|
$8,673.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5729684
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,249.77 |
| Max. Negotiated Rate |
$7,979.16 |
| Rate for Payer: Aetna Commercial |
$7,805.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,458.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,596.69
|
| Rate for Payer: Cash Price |
$2,601.90
|
| Rate for Payer: Cigna Commercial |
$7,979.16
|
| Rate for Payer: Health EOS Commercial |
$7,718.97
|
| Rate for Payer: HFN Commercial |
$7,979.16
|
| Rate for Payer: Multiplan Commercial |
$6,938.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,203.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,979.16
|
| Rate for Payer: Quartz Beloit One Network |
$4,249.77
|
| Rate for Payer: Quartz Commercial |
$5,203.80
|
| Rate for Payer: WEA Trust Commercial |
$4,770.15
|
| Rate for Payer: WPS Commercial |
$6,424.09
|
|
|
FEMORAL STEM SUMMIT SZ 6 STD 12/14 TAPER 1570-01-120
|
Facility
|
OP
|
$12,126.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5547327
|
|
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 6 STD 12/14 TAPER 1570-01-120
|
Facility
|
IP
|
$12,126.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5547327
|
|
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 6 STD CEMENTED 1570-03-120
|
Facility
|
IP
|
$9,956.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5520919
|
|
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 6 STD CEMENTED 1570-03-120
|
Facility
|
OP
|
$9,956.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5520919
|
|
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 7 12/14 TAPER 1570-11-135
|
Facility
|
OP
|
$12,126.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5597545
|
|
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 7 12/14 TAPER 1570-11-135
|
Facility
|
IP
|
$12,126.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5597545
|
|
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 7 STD 12/14 TAPER 1570-01-135
|
Facility
|
IP
|
$15,511.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5497009
|
|
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 7 STD 12/14 TAPER 1570-01-135
|
Facility
|
OP
|
$15,511.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5497009
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,343.08 |
| 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 7 STD CEMENTED 1570-03-135
|
Facility
|
OP
|
$9,020.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5603614
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,525.60 |
| Max. Negotiated Rate |
$36,080.00 |
| Rate for Payer: Aetna Commercial |
$8,118.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,757.20
|
| Rate for Payer: Aetna Managed Medicare |
$2,525.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,863.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,510.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,329.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,780.60
|
| Rate for Payer: Cash Price |
$2,706.00
|
| Rate for Payer: Cigna Commercial |
$8,298.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,047.59
|
| Rate for Payer: Health EOS Commercial |
$8,027.80
|
| Rate for Payer: HFN Commercial |
$8,298.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,765.00
|
| Rate for Payer: Multiplan Commercial |
$7,216.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,412.00
|
| Rate for Payer: Preferred Network Access Commercial |
$8,298.40
|
| Rate for Payer: Quartz Beloit One Network |
$4,419.80
|
| Rate for Payer: Quartz Commercial |
$5,863.00
|
| Rate for Payer: Quartz Medicare Advantage |
$5,412.00
|
| Rate for Payer: The Alliance Commercial |
$36,080.00
|
| Rate for Payer: WEA Trust Commercial |
$4,961.00
|
| Rate for Payer: WPS Commercial |
$6,681.11
|
|
|
FEMORAL STEM SUMMIT SZ 7 STD CEMENTED 1570-03-135
|
Facility
|
IP
|
$9,020.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5603614
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,419.80 |
| Max. Negotiated Rate |
$8,298.40 |
| Rate for Payer: Aetna Commercial |
$8,118.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,757.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,780.60
|
| Rate for Payer: Cash Price |
$2,706.00
|
| Rate for Payer: Cigna Commercial |
$8,298.40
|
| Rate for Payer: Health EOS Commercial |
$8,027.80
|
| Rate for Payer: HFN Commercial |
$8,298.40
|
| Rate for Payer: Multiplan Commercial |
$7,216.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,412.00
|
| Rate for Payer: Preferred Network Access Commercial |
$8,298.40
|
| Rate for Payer: Quartz Beloit One Network |
$4,419.80
|
| Rate for Payer: Quartz Commercial |
$5,412.00
|
| Rate for Payer: WEA Trust Commercial |
$4,961.00
|
| Rate for Payer: WPS Commercial |
$6,681.11
|
|
|
FEMORAL STEM SUMMIT SZ 8 STD 12/14 TAPER 1570-01-150
|
Facility
|
OP
|
$14,935.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5496711
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,181.80 |
| 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 8 STD 12/14 TAPER 1570-01-150
|
Facility
|
IP
|
$14,935.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5496711
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,318.15 |
| 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 8 STD CEMENTED 1570-03-150
|
Facility
|
IP
|
$8,018.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6202963
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,928.82 |
| Max. Negotiated Rate |
$7,376.56 |
| Rate for Payer: Aetna Commercial |
$7,216.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,895.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,249.54
|
| Rate for Payer: Cash Price |
$2,405.40
|
| Rate for Payer: Cigna Commercial |
$7,376.56
|
| Rate for Payer: Health EOS Commercial |
$7,136.02
|
| Rate for Payer: HFN Commercial |
$7,376.56
|
| Rate for Payer: Multiplan Commercial |
$6,414.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,810.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,376.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,928.82
|
| Rate for Payer: Quartz Commercial |
$4,810.80
|
| Rate for Payer: WEA Trust Commercial |
$4,409.90
|
| Rate for Payer: WPS Commercial |
$5,938.93
|
|
|
FEMORAL STEM SUMMIT SZ 8 STD CEMENTED 1570-03-150
|
Facility
|
OP
|
$8,018.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6202963
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,245.04 |
| Max. Negotiated Rate |
$32,072.00 |
| Rate for Payer: Aetna Commercial |
$7,216.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,895.48
|
| Rate for Payer: Aetna Managed Medicare |
$2,245.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,211.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,009.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,848.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,249.54
|
| Rate for Payer: Cash Price |
$2,405.40
|
| Rate for Payer: Cigna Commercial |
$7,376.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,486.87
|
| Rate for Payer: Health EOS Commercial |
$7,136.02
|
| Rate for Payer: HFN Commercial |
$7,376.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,013.50
|
| Rate for Payer: Multiplan Commercial |
$6,414.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,810.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,376.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,928.82
|
| Rate for Payer: Quartz Commercial |
$5,211.70
|
| Rate for Payer: Quartz Medicare Advantage |
$4,810.80
|
| Rate for Payer: The Alliance Commercial |
$32,072.00
|
| Rate for Payer: WEA Trust Commercial |
$4,409.90
|
| Rate for Payer: WPS Commercial |
$5,938.93
|
|
|
FEMORAL STEM SUMMIT SZ 9 STD 12/14 TAPER 1570-01-165
|
Facility
|
IP
|
$11,660.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5659716
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,713.40 |
| Max. Negotiated Rate |
$10,727.20 |
| Rate for Payer: Aetna Commercial |
$10,494.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,027.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,179.80
|
| Rate for Payer: Cash Price |
$3,498.00
|
| Rate for Payer: Cigna Commercial |
$10,727.20
|
| Rate for Payer: Health EOS Commercial |
$10,377.40
|
| Rate for Payer: HFN Commercial |
$10,727.20
|
| Rate for Payer: Multiplan Commercial |
$9,328.00
|
| Rate for Payer: NAPHCARE Commercial |
$6,996.00
|
| Rate for Payer: Preferred Network Access Commercial |
$10,727.20
|
| Rate for Payer: Quartz Beloit One Network |
$5,713.40
|
| Rate for Payer: Quartz Commercial |
$6,996.00
|
| Rate for Payer: WEA Trust Commercial |
$6,413.00
|
| Rate for Payer: WPS Commercial |
$8,636.56
|
|
|
FEMORAL STEM SUMMIT SZ 9 STD 12/14 TAPER 1570-01-165
|
Facility
|
OP
|
$11,660.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5659716
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,264.80 |
| Max. Negotiated Rate |
$46,640.00 |
| Rate for Payer: Aetna Commercial |
$10,494.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,027.60
|
| Rate for Payer: Aetna Managed Medicare |
$3,264.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,579.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,830.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,596.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,179.80
|
| Rate for Payer: Cash Price |
$3,498.00
|
| Rate for Payer: Cigna Commercial |
$10,727.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,524.94
|
| Rate for Payer: Health EOS Commercial |
$10,377.40
|
| Rate for Payer: HFN Commercial |
$10,727.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,745.00
|
| Rate for Payer: Multiplan Commercial |
$9,328.00
|
| Rate for Payer: NAPHCARE Commercial |
$6,996.00
|
| Rate for Payer: Preferred Network Access Commercial |
$10,727.20
|
| Rate for Payer: Quartz Beloit One Network |
$5,713.40
|
| Rate for Payer: Quartz Commercial |
$7,579.00
|
| Rate for Payer: Quartz Medicare Advantage |
$6,996.00
|
| Rate for Payer: The Alliance Commercial |
$46,640.00
|
| Rate for Payer: WEA Trust Commercial |
$6,413.00
|
| Rate for Payer: WPS Commercial |
$8,636.56
|
|
|
FEMORAL STEM TAPERLOC PRIMARY STD OFFSET SZ 6 X 132MM 51-100060
|
Facility
|
OP
|
$12,612.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5861667
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,531.36 |
| Max. Negotiated Rate |
$50,448.00 |
| Rate for Payer: Aetna Commercial |
$11,350.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,846.32
|
| Rate for Payer: Aetna Managed Medicare |
$3,531.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,197.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,306.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,053.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,684.36
|
| Rate for Payer: Cash Price |
$3,783.60
|
| Rate for Payer: Cigna Commercial |
$11,603.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,057.68
|
| Rate for Payer: Health EOS Commercial |
$11,224.68
|
| Rate for Payer: HFN Commercial |
$11,603.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,459.00
|
| Rate for Payer: Multiplan Commercial |
$10,089.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,567.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11,603.04
|
| Rate for Payer: Quartz Beloit One Network |
$6,179.88
|
| Rate for Payer: Quartz Commercial |
$8,197.80
|
| Rate for Payer: Quartz Medicare Advantage |
$7,567.20
|
| Rate for Payer: The Alliance Commercial |
$50,448.00
|
| Rate for Payer: WEA Trust Commercial |
$6,936.60
|
| Rate for Payer: WPS Commercial |
$9,341.71
|
|
|
FEMORAL STEM TAPERLOC PRIMARY STD OFFSET SZ 6 X 132MM 51-100060
|
Facility
|
IP
|
$12,612.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5861667
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,179.88 |
| Max. Negotiated Rate |
$11,603.04 |
| Rate for Payer: Aetna Commercial |
$11,350.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,846.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,684.36
|
| Rate for Payer: Cash Price |
$3,783.60
|
| Rate for Payer: Cigna Commercial |
$11,603.04
|
| Rate for Payer: Health EOS Commercial |
$11,224.68
|
| Rate for Payer: HFN Commercial |
$11,603.04
|
| Rate for Payer: Multiplan Commercial |
$10,089.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,567.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11,603.04
|
| Rate for Payer: Quartz Beloit One Network |
$6,179.88
|
| Rate for Payer: Quartz Commercial |
$7,567.20
|
| Rate for Payer: WEA Trust Commercial |
$6,936.60
|
| Rate for Payer: WPS Commercial |
$9,341.71
|
|
|
FEMORAL STEM TAPERLOC STD OFFSET SZ 12 X 144MM 51-103120
|
Facility
|
OP
|
$12,612.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5685730
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,531.36 |
| Max. Negotiated Rate |
$50,448.00 |
| Rate for Payer: Aetna Commercial |
$11,350.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,846.32
|
| Rate for Payer: Aetna Managed Medicare |
$3,531.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,197.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,306.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,053.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,684.36
|
| Rate for Payer: Cash Price |
$3,783.60
|
| Rate for Payer: Cigna Commercial |
$11,603.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,057.68
|
| Rate for Payer: Health EOS Commercial |
$11,224.68
|
| Rate for Payer: HFN Commercial |
$11,603.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,459.00
|
| Rate for Payer: Multiplan Commercial |
$10,089.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,567.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11,603.04
|
| Rate for Payer: Quartz Beloit One Network |
$6,179.88
|
| Rate for Payer: Quartz Commercial |
$8,197.80
|
| Rate for Payer: Quartz Medicare Advantage |
$7,567.20
|
| Rate for Payer: The Alliance Commercial |
$50,448.00
|
| Rate for Payer: WEA Trust Commercial |
$6,936.60
|
| Rate for Payer: WPS Commercial |
$9,341.71
|
|
