|
AccuType IL28B - Molecular Diagnostics
|
Facility
|
IP
|
$79.00
|
|
| Hospital Charge Code |
1270800
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.71 |
| Max. Negotiated Rate |
$72.68 |
| Rate for Payer: Aetna Commercial |
$71.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.87
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cigna Commercial |
$72.68
|
| Rate for Payer: Health EOS Commercial |
$70.31
|
| Rate for Payer: HFN Commercial |
$72.68
|
| Rate for Payer: Multiplan Commercial |
$63.20
|
| Rate for Payer: NAPHCARE Commercial |
$47.40
|
| Rate for Payer: Preferred Network Access Commercial |
$72.68
|
| Rate for Payer: Quartz Beloit One Network |
$38.71
|
| Rate for Payer: Quartz Commercial |
$47.40
|
| Rate for Payer: WEA Trust Commercial |
$43.45
|
| Rate for Payer: WPS Commercial |
$58.52
|
|
|
AccuType IL28B - Molecular Diagnostics
|
Facility
|
OP
|
$79.00
|
|
| Hospital Charge Code |
1270800
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.12 |
| Max. Negotiated Rate |
$316.00 |
| Rate for Payer: Aetna Commercial |
$71.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.94
|
| Rate for Payer: Aetna Managed Medicare |
$22.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$51.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$39.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$37.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.87
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cigna Commercial |
$72.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.21
|
| Rate for Payer: Health EOS Commercial |
$70.31
|
| Rate for Payer: HFN Commercial |
$72.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.25
|
| Rate for Payer: Multiplan Commercial |
$63.20
|
| Rate for Payer: NAPHCARE Commercial |
$47.40
|
| Rate for Payer: Preferred Network Access Commercial |
$72.68
|
| Rate for Payer: Quartz Beloit One Network |
$38.71
|
| Rate for Payer: Quartz Commercial |
$51.35
|
| Rate for Payer: Quartz Medicare Advantage |
$47.40
|
| Rate for Payer: The Alliance Commercial |
$316.00
|
| Rate for Payer: United Healthcare PPO |
$59.25
|
| Rate for Payer: WEA Trust Commercial |
$43.45
|
| Rate for Payer: WPS Commercial |
$58.52
|
|
|
AccuType IL28B - Molecular Diagnostics
|
Professional
|
Both
|
$79.00
|
|
| Hospital Charge Code |
1270800
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.76 |
| Max. Negotiated Rate |
$75.05 |
| Rate for Payer: Aetna Commercial |
$75.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.94
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cigna Commercial |
$75.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$39.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.40
|
| Rate for Payer: Health EOS Commercial |
$71.89
|
| Rate for Payer: HFN Commercial |
$75.05
|
| Rate for Payer: Multiplan Commercial |
$63.20
|
| Rate for Payer: Preferred Network Access Commercial |
$75.05
|
| Rate for Payer: Quartz Beloit One Network |
$34.76
|
| Rate for Payer: Quartz Commercial |
$45.03
|
| Rate for Payer: The Alliance Commercial |
$39.50
|
| Rate for Payer: WEA Trust Commercial |
$43.45
|
| Rate for Payer: WPS Commercial |
$58.52
|
|
|
AccuType IL28B -Molecule Isolate Nucleic
|
Professional
|
Both
|
$79.00
|
|
| Hospital Charge Code |
1270799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.76 |
| Max. Negotiated Rate |
$75.05 |
| Rate for Payer: Aetna Commercial |
$75.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.94
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cigna Commercial |
$75.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$39.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.40
|
| Rate for Payer: Health EOS Commercial |
$71.89
|
| Rate for Payer: HFN Commercial |
$75.05
|
| Rate for Payer: Multiplan Commercial |
$63.20
|
| Rate for Payer: Preferred Network Access Commercial |
$75.05
|
| Rate for Payer: Quartz Beloit One Network |
$34.76
|
| Rate for Payer: Quartz Commercial |
$45.03
|
| Rate for Payer: The Alliance Commercial |
$39.50
|
| Rate for Payer: WEA Trust Commercial |
$43.45
|
| Rate for Payer: WPS Commercial |
$58.52
|
|
|
AccuType IL28B -Molecule Isolate Nucleic
|
Facility
|
OP
|
$79.00
|
|
| Hospital Charge Code |
1270799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.12 |
| Max. Negotiated Rate |
$316.00 |
| Rate for Payer: Aetna Commercial |
$71.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.94
|
| Rate for Payer: Aetna Managed Medicare |
$22.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$51.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$39.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$37.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.87
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cigna Commercial |
$72.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.21
|
| Rate for Payer: Health EOS Commercial |
$70.31
|
| Rate for Payer: HFN Commercial |
$72.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.25
|
| Rate for Payer: Multiplan Commercial |
$63.20
|
| Rate for Payer: NAPHCARE Commercial |
$47.40
|
| Rate for Payer: Preferred Network Access Commercial |
$72.68
|
| Rate for Payer: Quartz Beloit One Network |
$38.71
|
| Rate for Payer: Quartz Commercial |
$51.35
|
| Rate for Payer: Quartz Medicare Advantage |
$47.40
|
| Rate for Payer: The Alliance Commercial |
$316.00
|
| Rate for Payer: United Healthcare PPO |
$59.25
|
| Rate for Payer: WEA Trust Commercial |
$43.45
|
| Rate for Payer: WPS Commercial |
$58.52
|
|
|
AccuType IL28B -Molecule Isolate Nucleic
|
Facility
|
IP
|
$79.00
|
|
| Hospital Charge Code |
1270799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.71 |
| Max. Negotiated Rate |
$72.68 |
| Rate for Payer: Aetna Commercial |
$71.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.87
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cigna Commercial |
$72.68
|
| Rate for Payer: Health EOS Commercial |
$70.31
|
| Rate for Payer: HFN Commercial |
$72.68
|
| Rate for Payer: Multiplan Commercial |
$63.20
|
| Rate for Payer: NAPHCARE Commercial |
$47.40
|
| Rate for Payer: Preferred Network Access Commercial |
$72.68
|
| Rate for Payer: Quartz Beloit One Network |
$38.71
|
| Rate for Payer: Quartz Commercial |
$47.40
|
| Rate for Payer: WEA Trust Commercial |
$43.45
|
| Rate for Payer: WPS Commercial |
$58.52
|
|
|
AccuType IL28B - Molecule Nucleic Amplification
|
Facility
|
IP
|
$300.00
|
|
| Hospital Charge Code |
1270801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$147.00 |
| Max. Negotiated Rate |
$276.00 |
| Rate for Payer: Aetna Commercial |
$270.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$258.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$159.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$276.00
|
| Rate for Payer: Health EOS Commercial |
$267.00
|
| Rate for Payer: HFN Commercial |
$276.00
|
| Rate for Payer: Multiplan Commercial |
$240.00
|
| Rate for Payer: NAPHCARE Commercial |
$180.00
|
| Rate for Payer: Preferred Network Access Commercial |
$276.00
|
| Rate for Payer: Quartz Beloit One Network |
$147.00
|
| Rate for Payer: Quartz Commercial |
$180.00
|
| Rate for Payer: WEA Trust Commercial |
$165.00
|
| Rate for Payer: WPS Commercial |
$222.21
|
|
|
AccuType IL28B - Molecule Nucleic Amplification
|
Professional
|
Both
|
$300.00
|
|
| Hospital Charge Code |
1270801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$132.00 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Aetna Commercial |
$285.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$258.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$285.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$150.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$180.00
|
| Rate for Payer: Health EOS Commercial |
$273.00
|
| Rate for Payer: HFN Commercial |
$285.00
|
| Rate for Payer: Multiplan Commercial |
$240.00
|
| Rate for Payer: Preferred Network Access Commercial |
$285.00
|
| Rate for Payer: Quartz Beloit One Network |
$132.00
|
| Rate for Payer: Quartz Commercial |
$171.00
|
| Rate for Payer: The Alliance Commercial |
$150.00
|
| Rate for Payer: WEA Trust Commercial |
$165.00
|
| Rate for Payer: WPS Commercial |
$222.21
|
|
|
AccuType IL28B - Molecule Nucleic Amplification
|
Facility
|
OP
|
$300.00
|
|
| Hospital Charge Code |
1270801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$270.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$258.00
|
| Rate for Payer: Aetna Managed Medicare |
$84.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$195.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$150.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$144.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$159.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$276.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$167.88
|
| Rate for Payer: Health EOS Commercial |
$267.00
|
| Rate for Payer: HFN Commercial |
$276.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$225.00
|
| Rate for Payer: Multiplan Commercial |
$240.00
|
| Rate for Payer: NAPHCARE Commercial |
$180.00
|
| Rate for Payer: Preferred Network Access Commercial |
$276.00
|
| Rate for Payer: Quartz Beloit One Network |
$147.00
|
| Rate for Payer: Quartz Commercial |
$195.00
|
| Rate for Payer: Quartz Medicare Advantage |
$180.00
|
| Rate for Payer: The Alliance Commercial |
$1,200.00
|
| Rate for Payer: United Healthcare PPO |
$225.00
|
| Rate for Payer: WEA Trust Commercial |
$165.00
|
| Rate for Payer: WPS Commercial |
$222.21
|
|
|
ACETABULAR LINER DUAL MOBILITY VITACIT-E 28X40MM D 110031010
|
Facility
|
OP
|
$6,306.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5729657
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,765.68 |
| Max. Negotiated Rate |
$25,224.00 |
| Rate for Payer: Aetna Commercial |
$5,675.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,423.16
|
| Rate for Payer: Aetna Managed Medicare |
$1,765.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,098.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,153.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,026.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,342.18
|
| Rate for Payer: Cash Price |
$1,891.80
|
| Rate for Payer: Cigna Commercial |
$5,801.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,528.84
|
| Rate for Payer: Health EOS Commercial |
$5,612.34
|
| Rate for Payer: HFN Commercial |
$5,801.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,729.50
|
| Rate for Payer: Multiplan Commercial |
$5,044.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,783.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,801.52
|
| Rate for Payer: Quartz Beloit One Network |
$3,089.94
|
| Rate for Payer: Quartz Commercial |
$4,098.90
|
| Rate for Payer: Quartz Medicare Advantage |
$3,783.60
|
| Rate for Payer: The Alliance Commercial |
$25,224.00
|
| Rate for Payer: WEA Trust Commercial |
$3,468.30
|
| Rate for Payer: WPS Commercial |
$4,670.85
|
|
|
ACETABULAR LINER DUAL MOBILITY VITACIT-E 28X40MM D 110031010
|
Facility
|
IP
|
$6,306.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5729657
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,089.94 |
| Max. Negotiated Rate |
$5,801.52 |
| Rate for Payer: Aetna Commercial |
$5,675.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,423.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,342.18
|
| Rate for Payer: Cash Price |
$1,891.80
|
| Rate for Payer: Cigna Commercial |
$5,801.52
|
| Rate for Payer: Health EOS Commercial |
$5,612.34
|
| Rate for Payer: HFN Commercial |
$5,801.52
|
| Rate for Payer: Multiplan Commercial |
$5,044.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,783.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,801.52
|
| Rate for Payer: Quartz Beloit One Network |
$3,089.94
|
| Rate for Payer: Quartz Commercial |
$3,783.60
|
| Rate for Payer: WEA Trust Commercial |
$3,468.30
|
| Rate for Payer: WPS Commercial |
$4,670.85
|
|
|
ACETABULAR LINER DUAL MOBILITY VITACIT-E 28X42MM E 110031011
|
Facility
|
OP
|
$6,306.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5729661
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,765.68 |
| Max. Negotiated Rate |
$25,224.00 |
| Rate for Payer: Aetna Commercial |
$5,675.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,423.16
|
| Rate for Payer: Aetna Managed Medicare |
$1,765.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,098.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,153.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,026.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,342.18
|
| Rate for Payer: Cash Price |
$1,891.80
|
| Rate for Payer: Cigna Commercial |
$5,801.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,528.84
|
| Rate for Payer: Health EOS Commercial |
$5,612.34
|
| Rate for Payer: HFN Commercial |
$5,801.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,729.50
|
| Rate for Payer: Multiplan Commercial |
$5,044.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,783.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,801.52
|
| Rate for Payer: Quartz Beloit One Network |
$3,089.94
|
| Rate for Payer: Quartz Commercial |
$4,098.90
|
| Rate for Payer: Quartz Medicare Advantage |
$3,783.60
|
| Rate for Payer: The Alliance Commercial |
$25,224.00
|
| Rate for Payer: WEA Trust Commercial |
$3,468.30
|
| Rate for Payer: WPS Commercial |
$4,670.85
|
|
|
ACETABULAR LINER DUAL MOBILITY VITACIT-E 28X42MM E 110031011
|
Facility
|
IP
|
$6,306.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5729661
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,089.94 |
| Max. Negotiated Rate |
$5,801.52 |
| Rate for Payer: Aetna Commercial |
$5,675.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,423.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,342.18
|
| Rate for Payer: Cash Price |
$1,891.80
|
| Rate for Payer: Cigna Commercial |
$5,801.52
|
| Rate for Payer: Health EOS Commercial |
$5,612.34
|
| Rate for Payer: HFN Commercial |
$5,801.52
|
| Rate for Payer: Multiplan Commercial |
$5,044.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,783.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,801.52
|
| Rate for Payer: Quartz Beloit One Network |
$3,089.94
|
| Rate for Payer: Quartz Commercial |
$3,783.60
|
| Rate for Payer: WEA Trust Commercial |
$3,468.30
|
| Rate for Payer: WPS Commercial |
$4,670.85
|
|
|
ACETABULAR LINER DUAL MOBILITY VITACIT-E 28X44MM F 110031012
|
Facility
|
IP
|
$6,306.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5861669
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,089.94 |
| Max. Negotiated Rate |
$5,801.52 |
| Rate for Payer: Aetna Commercial |
$5,675.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,423.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,342.18
|
| Rate for Payer: Cash Price |
$1,891.80
|
| Rate for Payer: Cigna Commercial |
$5,801.52
|
| Rate for Payer: Health EOS Commercial |
$5,612.34
|
| Rate for Payer: HFN Commercial |
$5,801.52
|
| Rate for Payer: Multiplan Commercial |
$5,044.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,783.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,801.52
|
| Rate for Payer: Quartz Beloit One Network |
$3,089.94
|
| Rate for Payer: Quartz Commercial |
$3,783.60
|
| Rate for Payer: WEA Trust Commercial |
$3,468.30
|
| Rate for Payer: WPS Commercial |
$4,670.85
|
|
|
ACETABULAR LINER DUAL MOBILITY VITACIT-E 28X44MM F 110031012
|
Facility
|
OP
|
$6,306.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5861669
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,765.68 |
| Max. Negotiated Rate |
$25,224.00 |
| Rate for Payer: Aetna Commercial |
$5,675.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,423.16
|
| Rate for Payer: Aetna Managed Medicare |
$1,765.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,098.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,153.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,026.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,342.18
|
| Rate for Payer: Cash Price |
$1,891.80
|
| Rate for Payer: Cigna Commercial |
$5,801.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,528.84
|
| Rate for Payer: Health EOS Commercial |
$5,612.34
|
| Rate for Payer: HFN Commercial |
$5,801.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,729.50
|
| Rate for Payer: Multiplan Commercial |
$5,044.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,783.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,801.52
|
| Rate for Payer: Quartz Beloit One Network |
$3,089.94
|
| Rate for Payer: Quartz Commercial |
$4,098.90
|
| Rate for Payer: Quartz Medicare Advantage |
$3,783.60
|
| Rate for Payer: The Alliance Commercial |
$25,224.00
|
| Rate for Payer: WEA Trust Commercial |
$3,468.30
|
| Rate for Payer: WPS Commercial |
$4,670.85
|
|
|
ACETABULAR LINER G7 DUAL MOBILITY NEUTRAL 38MM C 110024461
|
Facility
|
OP
|
$7,006.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5685728
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,961.68 |
| Max. Negotiated Rate |
$28,024.00 |
| Rate for Payer: Aetna Commercial |
$6,305.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,025.16
|
| Rate for Payer: Aetna Managed Medicare |
$1,961.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,553.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,503.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,362.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,713.18
|
| Rate for Payer: Cash Price |
$2,101.80
|
| Rate for Payer: Cigna Commercial |
$6,445.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,920.56
|
| Rate for Payer: Health EOS Commercial |
$6,235.34
|
| Rate for Payer: HFN Commercial |
$6,445.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,254.50
|
| Rate for Payer: Multiplan Commercial |
$5,604.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,203.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,445.52
|
| Rate for Payer: Quartz Beloit One Network |
$3,432.94
|
| Rate for Payer: Quartz Commercial |
$4,553.90
|
| Rate for Payer: Quartz Medicare Advantage |
$4,203.60
|
| Rate for Payer: The Alliance Commercial |
$28,024.00
|
| Rate for Payer: WEA Trust Commercial |
$3,853.30
|
| Rate for Payer: WPS Commercial |
$5,189.34
|
|
|
ACETABULAR LINER G7 DUAL MOBILITY NEUTRAL 38MM C 110024461
|
Facility
|
IP
|
$7,006.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5685728
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,432.94 |
| Max. Negotiated Rate |
$6,445.52 |
| Rate for Payer: Aetna Commercial |
$6,305.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,025.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,713.18
|
| Rate for Payer: Cash Price |
$2,101.80
|
| Rate for Payer: Cigna Commercial |
$6,445.52
|
| Rate for Payer: Health EOS Commercial |
$6,235.34
|
| Rate for Payer: HFN Commercial |
$6,445.52
|
| Rate for Payer: Multiplan Commercial |
$5,604.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,203.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,445.52
|
| Rate for Payer: Quartz Beloit One Network |
$3,432.94
|
| Rate for Payer: Quartz Commercial |
$4,203.60
|
| Rate for Payer: WEA Trust Commercial |
$3,853.30
|
| Rate for Payer: WPS Commercial |
$5,189.34
|
|
|
ACETABULAR LINER G7 DUAL MOBILITY NEUTRAL 40MM D 110024462
|
Facility
|
OP
|
$7,006.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5729654
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,961.68 |
| Max. Negotiated Rate |
$28,024.00 |
| Rate for Payer: Aetna Commercial |
$6,305.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,025.16
|
| Rate for Payer: Aetna Managed Medicare |
$1,961.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,553.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,503.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,362.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,713.18
|
| Rate for Payer: Cash Price |
$2,101.80
|
| Rate for Payer: Cigna Commercial |
$6,445.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,920.56
|
| Rate for Payer: Health EOS Commercial |
$6,235.34
|
| Rate for Payer: HFN Commercial |
$6,445.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,254.50
|
| Rate for Payer: Multiplan Commercial |
$5,604.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,203.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,445.52
|
| Rate for Payer: Quartz Beloit One Network |
$3,432.94
|
| Rate for Payer: Quartz Commercial |
$4,553.90
|
| Rate for Payer: Quartz Medicare Advantage |
$4,203.60
|
| Rate for Payer: The Alliance Commercial |
$28,024.00
|
| Rate for Payer: WEA Trust Commercial |
$3,853.30
|
| Rate for Payer: WPS Commercial |
$5,189.34
|
|
|
ACETABULAR LINER G7 DUAL MOBILITY NEUTRAL 40MM D 110024462
|
Facility
|
IP
|
$7,006.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5729654
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,432.94 |
| Max. Negotiated Rate |
$6,445.52 |
| Rate for Payer: Aetna Commercial |
$6,305.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,025.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,713.18
|
| Rate for Payer: Cash Price |
$2,101.80
|
| Rate for Payer: Cigna Commercial |
$6,445.52
|
| Rate for Payer: Health EOS Commercial |
$6,235.34
|
| Rate for Payer: HFN Commercial |
$6,445.52
|
| Rate for Payer: Multiplan Commercial |
$5,604.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,203.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,445.52
|
| Rate for Payer: Quartz Beloit One Network |
$3,432.94
|
| Rate for Payer: Quartz Commercial |
$4,203.60
|
| Rate for Payer: WEA Trust Commercial |
$3,853.30
|
| Rate for Payer: WPS Commercial |
$5,189.34
|
|
|
ACETABULAR LINER G7 DUAL MOBILITY NEUTRAL 42MM E 110024463
|
Facility
|
IP
|
$7,006.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5729659
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,432.94 |
| Max. Negotiated Rate |
$6,445.52 |
| Rate for Payer: Aetna Commercial |
$6,305.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,025.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,713.18
|
| Rate for Payer: Cash Price |
$2,101.80
|
| Rate for Payer: Cigna Commercial |
$6,445.52
|
| Rate for Payer: Health EOS Commercial |
$6,235.34
|
| Rate for Payer: HFN Commercial |
$6,445.52
|
| Rate for Payer: Multiplan Commercial |
$5,604.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,203.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,445.52
|
| Rate for Payer: Quartz Beloit One Network |
$3,432.94
|
| Rate for Payer: Quartz Commercial |
$4,203.60
|
| Rate for Payer: WEA Trust Commercial |
$3,853.30
|
| Rate for Payer: WPS Commercial |
$5,189.34
|
|
|
ACETABULAR LINER G7 DUAL MOBILITY NEUTRAL 42MM E 110024463
|
Facility
|
OP
|
$7,006.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5729659
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,961.68 |
| Max. Negotiated Rate |
$28,024.00 |
| Rate for Payer: Aetna Commercial |
$6,305.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,025.16
|
| Rate for Payer: Aetna Managed Medicare |
$1,961.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,553.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,503.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,362.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,713.18
|
| Rate for Payer: Cash Price |
$2,101.80
|
| Rate for Payer: Cigna Commercial |
$6,445.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,920.56
|
| Rate for Payer: Health EOS Commercial |
$6,235.34
|
| Rate for Payer: HFN Commercial |
$6,445.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,254.50
|
| Rate for Payer: Multiplan Commercial |
$5,604.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,203.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,445.52
|
| Rate for Payer: Quartz Beloit One Network |
$3,432.94
|
| Rate for Payer: Quartz Commercial |
$4,553.90
|
| Rate for Payer: Quartz Medicare Advantage |
$4,203.60
|
| Rate for Payer: The Alliance Commercial |
$28,024.00
|
| Rate for Payer: WEA Trust Commercial |
$3,853.30
|
| Rate for Payer: WPS Commercial |
$5,189.34
|
|
|
ACETABULAR LINER G7 DUAL MOBILITY NEUTRAL 44MM F 110024464
|
Facility
|
OP
|
$7,006.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5861665
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,961.68 |
| Max. Negotiated Rate |
$28,024.00 |
| Rate for Payer: Aetna Commercial |
$6,305.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,025.16
|
| Rate for Payer: Aetna Managed Medicare |
$1,961.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,553.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,503.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,362.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,713.18
|
| Rate for Payer: Cash Price |
$2,101.80
|
| Rate for Payer: Cigna Commercial |
$6,445.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,920.56
|
| Rate for Payer: Health EOS Commercial |
$6,235.34
|
| Rate for Payer: HFN Commercial |
$6,445.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,254.50
|
| Rate for Payer: Multiplan Commercial |
$5,604.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,203.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,445.52
|
| Rate for Payer: Quartz Beloit One Network |
$3,432.94
|
| Rate for Payer: Quartz Commercial |
$4,553.90
|
| Rate for Payer: Quartz Medicare Advantage |
$4,203.60
|
| Rate for Payer: The Alliance Commercial |
$28,024.00
|
| Rate for Payer: WEA Trust Commercial |
$3,853.30
|
| Rate for Payer: WPS Commercial |
$5,189.34
|
|
|
ACETABULAR LINER G7 DUAL MOBILITY NEUTRAL 44MM F 110024464
|
Facility
|
IP
|
$7,006.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5861665
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,432.94 |
| Max. Negotiated Rate |
$6,445.52 |
| Rate for Payer: Aetna Commercial |
$6,305.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,025.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,713.18
|
| Rate for Payer: Cash Price |
$2,101.80
|
| Rate for Payer: Cigna Commercial |
$6,445.52
|
| Rate for Payer: Health EOS Commercial |
$6,235.34
|
| Rate for Payer: HFN Commercial |
$6,445.52
|
| Rate for Payer: Multiplan Commercial |
$5,604.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,203.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,445.52
|
| Rate for Payer: Quartz Beloit One Network |
$3,432.94
|
| Rate for Payer: Quartz Commercial |
$4,203.60
|
| Rate for Payer: WEA Trust Commercial |
$3,853.30
|
| Rate for Payer: WPS Commercial |
$5,189.34
|
|
|
ACETABULAR LINER G7 HIGH WALL 36MM F 30123606
|
Facility
|
IP
|
$6,063.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6065704
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$2,970.87 |
| Max. Negotiated Rate |
$5,577.96 |
| Rate for Payer: Aetna Commercial |
$5,456.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,214.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,213.39
|
| Rate for Payer: Cash Price |
$1,818.90
|
| Rate for Payer: Cigna Commercial |
$5,577.96
|
| Rate for Payer: Health EOS Commercial |
$5,396.07
|
| Rate for Payer: HFN Commercial |
$5,577.96
|
| Rate for Payer: Multiplan Commercial |
$4,850.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,637.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,577.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,970.87
|
| Rate for Payer: Quartz Commercial |
$3,637.80
|
| Rate for Payer: WEA Trust Commercial |
$3,334.65
|
| Rate for Payer: WPS Commercial |
$4,490.86
|
|
|
ACETABULAR LINER G7 HIGH WALL 36MM F 30123606
|
Facility
|
OP
|
$6,063.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6065704
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$1,697.64 |
| Max. Negotiated Rate |
$24,252.00 |
| Rate for Payer: Aetna Commercial |
$5,456.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,214.18
|
| Rate for Payer: Aetna Managed Medicare |
$1,697.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,940.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,031.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,910.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,213.39
|
| Rate for Payer: Cash Price |
$1,818.90
|
| Rate for Payer: Cigna Commercial |
$5,577.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,392.85
|
| Rate for Payer: Health EOS Commercial |
$5,396.07
|
| Rate for Payer: HFN Commercial |
$5,577.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,547.25
|
| Rate for Payer: Multiplan Commercial |
$4,850.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,637.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,577.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,970.87
|
| Rate for Payer: Quartz Commercial |
$3,940.95
|
| Rate for Payer: Quartz Medicare Advantage |
$3,637.80
|
| Rate for Payer: The Alliance Commercial |
$24,252.00
|
| Rate for Payer: WEA Trust Commercial |
$3,334.65
|
| Rate for Payer: WPS Commercial |
$4,490.86
|
|
