|
ACETABULAR LINER PINNACLE 32MM 50MM 1221-32-050
|
Facility
OP
|
$6,319.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5459306
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,769.32 |
| Max. Negotiated Rate |
$5,813.48 |
| Rate for Payer: Aetna Commercial |
$5,687.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,434.34
|
| Rate for Payer: Aetna Managed Medicare |
$1,769.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,107.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,159.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,033.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,349.07
|
| Rate for Payer: Cash Price |
$1,895.70
|
| Rate for Payer: Cigna Commercial |
$5,813.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,536.11
|
| Rate for Payer: Health EOS Commercial |
$5,623.91
|
| Rate for Payer: HFN Commercial |
$5,813.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,739.25
|
| Rate for Payer: Multiplan Commercial |
$5,055.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,791.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,813.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,096.31
|
| Rate for Payer: Quartz Commercial |
$4,107.35
|
| Rate for Payer: Quartz Medicare Advantage |
$3,791.40
|
| Rate for Payer: WEA Trust Commercial |
$3,475.45
|
| Rate for Payer: WPS Commercial |
$4,680.48
|
|
|
ACETABULAR LINER PINNACLE 32MM 50MM 1221-32-050
|
Facility
IP
|
$6,319.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5459306
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,096.31 |
| Max. Negotiated Rate |
$5,813.48 |
| Rate for Payer: Aetna Commercial |
$5,687.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,349.07
|
| Rate for Payer: Cash Price |
$1,895.70
|
| Rate for Payer: Cigna Commercial |
$5,813.48
|
| Rate for Payer: Health EOS Commercial |
$5,623.91
|
| Rate for Payer: HFN Commercial |
$5,813.48
|
| Rate for Payer: Multiplan Commercial |
$5,055.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,791.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,813.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,096.31
|
| Rate for Payer: Quartz Commercial |
$3,791.40
|
| Rate for Payer: WEA Trust Commercial |
$3,475.45
|
| Rate for Payer: WPS Commercial |
$4,680.48
|
|
|
ACETABULAR LINER PINNACLE 36MM 52MM 1221-36-052
|
Facility
IP
|
$6,319.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5459462
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,096.31 |
| Max. Negotiated Rate |
$5,813.48 |
| Rate for Payer: Aetna Commercial |
$5,687.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,349.07
|
| Rate for Payer: Cash Price |
$1,895.70
|
| Rate for Payer: Cigna Commercial |
$5,813.48
|
| Rate for Payer: Health EOS Commercial |
$5,623.91
|
| Rate for Payer: HFN Commercial |
$5,813.48
|
| Rate for Payer: Multiplan Commercial |
$5,055.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,791.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,813.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,096.31
|
| Rate for Payer: Quartz Commercial |
$3,791.40
|
| Rate for Payer: WEA Trust Commercial |
$3,475.45
|
| Rate for Payer: WPS Commercial |
$4,680.48
|
|
|
ACETABULAR LINER PINNACLE 36MM 52MM 1221-36-052
|
Facility
OP
|
$6,319.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5459462
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,769.32 |
| Max. Negotiated Rate |
$5,813.48 |
| Rate for Payer: Aetna Commercial |
$5,687.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,434.34
|
| Rate for Payer: Aetna Managed Medicare |
$1,769.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,107.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,159.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,033.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,349.07
|
| Rate for Payer: Cash Price |
$1,895.70
|
| Rate for Payer: Cigna Commercial |
$5,813.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,536.11
|
| Rate for Payer: Health EOS Commercial |
$5,623.91
|
| Rate for Payer: HFN Commercial |
$5,813.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,739.25
|
| Rate for Payer: Multiplan Commercial |
$5,055.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,791.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,813.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,096.31
|
| Rate for Payer: Quartz Commercial |
$4,107.35
|
| Rate for Payer: Quartz Medicare Advantage |
$3,791.40
|
| Rate for Payer: WEA Trust Commercial |
$3,475.45
|
| Rate for Payer: WPS Commercial |
$4,680.48
|
|
|
ACETABULAR LINER PINNACLE 36MM 52MM +4 NEUTRAL 1221-36-452
|
Facility
OP
|
$5,831.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5767772
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,632.68 |
| Max. Negotiated Rate |
$5,364.52 |
| Rate for Payer: Aetna Commercial |
$5,247.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,014.66
|
| Rate for Payer: Aetna Managed Medicare |
$1,632.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,790.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,915.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,798.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,090.43
|
| Rate for Payer: Cash Price |
$1,749.30
|
| Rate for Payer: Cigna Commercial |
$5,364.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,263.03
|
| Rate for Payer: Health EOS Commercial |
$5,189.59
|
| Rate for Payer: HFN Commercial |
$5,364.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,373.25
|
| Rate for Payer: Multiplan Commercial |
$4,664.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,498.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,364.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,857.19
|
| Rate for Payer: Quartz Commercial |
$3,790.15
|
| Rate for Payer: Quartz Medicare Advantage |
$3,498.60
|
| Rate for Payer: WEA Trust Commercial |
$3,207.05
|
| Rate for Payer: WPS Commercial |
$4,319.02
|
|
|
ACETABULAR LINER PINNACLE 36MM 52MM +4 NEUTRAL 1221-36-452
|
Facility
IP
|
$5,831.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5767772
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,857.19 |
| Max. Negotiated Rate |
$5,364.52 |
| Rate for Payer: Aetna Commercial |
$5,247.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,090.43
|
| Rate for Payer: Cash Price |
$1,749.30
|
| Rate for Payer: Cigna Commercial |
$5,364.52
|
| Rate for Payer: Health EOS Commercial |
$5,189.59
|
| Rate for Payer: HFN Commercial |
$5,364.52
|
| Rate for Payer: Multiplan Commercial |
$4,664.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,498.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,364.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,857.19
|
| Rate for Payer: Quartz Commercial |
$3,498.60
|
| Rate for Payer: WEA Trust Commercial |
$3,207.05
|
| Rate for Payer: WPS Commercial |
$4,319.02
|
|
|
ACETABULAR LINER PINNACLE 36MM 54MM 1221-36-054
|
Facility
OP
|
$6,319.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5496775
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,769.32 |
| Max. Negotiated Rate |
$5,813.48 |
| Rate for Payer: Aetna Commercial |
$5,687.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,434.34
|
| Rate for Payer: Aetna Managed Medicare |
$1,769.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,107.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,159.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,033.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,349.07
|
| Rate for Payer: Cash Price |
$1,895.70
|
| Rate for Payer: Cigna Commercial |
$5,813.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,536.11
|
| Rate for Payer: Health EOS Commercial |
$5,623.91
|
| Rate for Payer: HFN Commercial |
$5,813.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,739.25
|
| Rate for Payer: Multiplan Commercial |
$5,055.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,791.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,813.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,096.31
|
| Rate for Payer: Quartz Commercial |
$4,107.35
|
| Rate for Payer: Quartz Medicare Advantage |
$3,791.40
|
| Rate for Payer: WEA Trust Commercial |
$3,475.45
|
| Rate for Payer: WPS Commercial |
$4,680.48
|
|
|
ACETABULAR LINER PINNACLE 36MM 54MM 1221-36-054
|
Facility
IP
|
$6,319.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5496775
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,096.31 |
| Max. Negotiated Rate |
$5,813.48 |
| Rate for Payer: Aetna Commercial |
$5,687.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,349.07
|
| Rate for Payer: Cash Price |
$1,895.70
|
| Rate for Payer: Cigna Commercial |
$5,813.48
|
| Rate for Payer: Health EOS Commercial |
$5,623.91
|
| Rate for Payer: HFN Commercial |
$5,813.48
|
| Rate for Payer: Multiplan Commercial |
$5,055.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,791.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,813.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,096.31
|
| Rate for Payer: Quartz Commercial |
$3,791.40
|
| Rate for Payer: WEA Trust Commercial |
$3,475.45
|
| Rate for Payer: WPS Commercial |
$4,680.48
|
|
|
ACETABULAR LINER PINNACLE 36MM 54MM +4 NEUTRAL 1221-36-454
|
Facility
IP
|
$5,831.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5895663
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,857.19 |
| Max. Negotiated Rate |
$5,364.52 |
| Rate for Payer: Aetna Commercial |
$5,247.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,090.43
|
| Rate for Payer: Cash Price |
$1,749.30
|
| Rate for Payer: Cigna Commercial |
$5,364.52
|
| Rate for Payer: Health EOS Commercial |
$5,189.59
|
| Rate for Payer: HFN Commercial |
$5,364.52
|
| Rate for Payer: Multiplan Commercial |
$4,664.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,498.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,364.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,857.19
|
| Rate for Payer: Quartz Commercial |
$3,498.60
|
| Rate for Payer: WEA Trust Commercial |
$3,207.05
|
| Rate for Payer: WPS Commercial |
$4,319.02
|
|
|
ACETABULAR LINER PINNACLE 36MM 54MM +4 NEUTRAL 1221-36-454
|
Facility
OP
|
$5,831.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5895663
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,632.68 |
| Max. Negotiated Rate |
$5,364.52 |
| Rate for Payer: Aetna Commercial |
$5,247.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,014.66
|
| Rate for Payer: Aetna Managed Medicare |
$1,632.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,790.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,915.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,798.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,090.43
|
| Rate for Payer: Cash Price |
$1,749.30
|
| Rate for Payer: Cigna Commercial |
$5,364.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,263.03
|
| Rate for Payer: Health EOS Commercial |
$5,189.59
|
| Rate for Payer: HFN Commercial |
$5,364.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,373.25
|
| Rate for Payer: Multiplan Commercial |
$4,664.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,498.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,364.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,857.19
|
| Rate for Payer: Quartz Commercial |
$3,790.15
|
| Rate for Payer: Quartz Medicare Advantage |
$3,498.60
|
| Rate for Payer: WEA Trust Commercial |
$3,207.05
|
| Rate for Payer: WPS Commercial |
$4,319.02
|
|
|
ACETABULAR LINER PINNACLE 36MM 56MM 1221-36-056
|
Facility
IP
|
$6,319.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5459766
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,096.31 |
| Max. Negotiated Rate |
$5,813.48 |
| Rate for Payer: Aetna Commercial |
$5,687.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,349.07
|
| Rate for Payer: Cash Price |
$1,895.70
|
| Rate for Payer: Cigna Commercial |
$5,813.48
|
| Rate for Payer: Health EOS Commercial |
$5,623.91
|
| Rate for Payer: HFN Commercial |
$5,813.48
|
| Rate for Payer: Multiplan Commercial |
$5,055.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,791.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,813.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,096.31
|
| Rate for Payer: Quartz Commercial |
$3,791.40
|
| Rate for Payer: WEA Trust Commercial |
$3,475.45
|
| Rate for Payer: WPS Commercial |
$4,680.48
|
|
|
ACETABULAR LINER PINNACLE 36MM 56MM 1221-36-056
|
Facility
OP
|
$6,319.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5459766
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,769.32 |
| Max. Negotiated Rate |
$5,813.48 |
| Rate for Payer: Aetna Commercial |
$5,687.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,434.34
|
| Rate for Payer: Aetna Managed Medicare |
$1,769.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,107.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,159.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,033.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,349.07
|
| Rate for Payer: Cash Price |
$1,895.70
|
| Rate for Payer: Cigna Commercial |
$5,813.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,536.11
|
| Rate for Payer: Health EOS Commercial |
$5,623.91
|
| Rate for Payer: HFN Commercial |
$5,813.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,739.25
|
| Rate for Payer: Multiplan Commercial |
$5,055.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,791.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,813.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,096.31
|
| Rate for Payer: Quartz Commercial |
$4,107.35
|
| Rate for Payer: Quartz Medicare Advantage |
$3,791.40
|
| Rate for Payer: WEA Trust Commercial |
$3,475.45
|
| Rate for Payer: WPS Commercial |
$4,680.48
|
|
|
ACETABULAR LINER PINNACLE 36MM 56MM +4 NEUTRAL 1221-36-456
|
Facility
IP
|
$5,831.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5659699
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,857.19 |
| Max. Negotiated Rate |
$5,364.52 |
| Rate for Payer: Aetna Commercial |
$5,247.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,090.43
|
| Rate for Payer: Cash Price |
$1,749.30
|
| Rate for Payer: Cigna Commercial |
$5,364.52
|
| Rate for Payer: Health EOS Commercial |
$5,189.59
|
| Rate for Payer: HFN Commercial |
$5,364.52
|
| Rate for Payer: Multiplan Commercial |
$4,664.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,498.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,364.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,857.19
|
| Rate for Payer: Quartz Commercial |
$3,498.60
|
| Rate for Payer: WEA Trust Commercial |
$3,207.05
|
| Rate for Payer: WPS Commercial |
$4,319.02
|
|
|
ACETABULAR LINER PINNACLE 36MM 56MM +4 NEUTRAL 1221-36-456
|
Facility
OP
|
$5,831.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5659699
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,632.68 |
| Max. Negotiated Rate |
$5,364.52 |
| Rate for Payer: Aetna Commercial |
$5,247.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,014.66
|
| Rate for Payer: Aetna Managed Medicare |
$1,632.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,790.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,915.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,798.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,090.43
|
| Rate for Payer: Cash Price |
$1,749.30
|
| Rate for Payer: Cigna Commercial |
$5,364.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,263.03
|
| Rate for Payer: Health EOS Commercial |
$5,189.59
|
| Rate for Payer: HFN Commercial |
$5,364.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,373.25
|
| Rate for Payer: Multiplan Commercial |
$4,664.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,498.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,364.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,857.19
|
| Rate for Payer: Quartz Commercial |
$3,790.15
|
| Rate for Payer: Quartz Medicare Advantage |
$3,498.60
|
| Rate for Payer: WEA Trust Commercial |
$3,207.05
|
| Rate for Payer: WPS Commercial |
$4,319.02
|
|
|
ACETABULAR LINER PINNACLE 36MM 58MM 1221-36-058
|
Facility
OP
|
$6,319.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5496710
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,769.32 |
| Max. Negotiated Rate |
$5,813.48 |
| Rate for Payer: Aetna Commercial |
$5,687.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,434.34
|
| Rate for Payer: Aetna Managed Medicare |
$1,769.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,107.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,159.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,033.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,349.07
|
| Rate for Payer: Cash Price |
$1,895.70
|
| Rate for Payer: Cigna Commercial |
$5,813.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,536.11
|
| Rate for Payer: Health EOS Commercial |
$5,623.91
|
| Rate for Payer: HFN Commercial |
$5,813.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,739.25
|
| Rate for Payer: Multiplan Commercial |
$5,055.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,791.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,813.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,096.31
|
| Rate for Payer: Quartz Commercial |
$4,107.35
|
| Rate for Payer: Quartz Medicare Advantage |
$3,791.40
|
| Rate for Payer: WEA Trust Commercial |
$3,475.45
|
| Rate for Payer: WPS Commercial |
$4,680.48
|
|
|
ACETABULAR LINER PINNACLE 36MM 58MM 1221-36-058
|
Facility
IP
|
$6,319.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5496710
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,096.31 |
| Max. Negotiated Rate |
$5,813.48 |
| Rate for Payer: Aetna Commercial |
$5,687.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,349.07
|
| Rate for Payer: Cash Price |
$1,895.70
|
| Rate for Payer: Cigna Commercial |
$5,813.48
|
| Rate for Payer: Health EOS Commercial |
$5,623.91
|
| Rate for Payer: HFN Commercial |
$5,813.48
|
| Rate for Payer: Multiplan Commercial |
$5,055.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,791.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,813.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,096.31
|
| Rate for Payer: Quartz Commercial |
$3,791.40
|
| Rate for Payer: WEA Trust Commercial |
$3,475.45
|
| Rate for Payer: WPS Commercial |
$4,680.48
|
|
|
ACETABULAR LINER PINNACLE 36MM 58MM +4 NEUTRAL 1221-36-458
|
Facility
IP
|
$5,607.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6177635
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,747.43 |
| Max. Negotiated Rate |
$5,158.44 |
| Rate for Payer: Aetna Commercial |
$5,046.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,971.71
|
| Rate for Payer: Cash Price |
$1,682.10
|
| Rate for Payer: Cigna Commercial |
$5,158.44
|
| Rate for Payer: Health EOS Commercial |
$4,990.23
|
| Rate for Payer: HFN Commercial |
$5,158.44
|
| Rate for Payer: Multiplan Commercial |
$4,485.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,364.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,158.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,747.43
|
| Rate for Payer: Quartz Commercial |
$3,364.20
|
| Rate for Payer: WEA Trust Commercial |
$3,083.85
|
| Rate for Payer: WPS Commercial |
$4,153.10
|
|
|
ACETABULAR LINER PINNACLE 36MM 58MM +4 NEUTRAL 1221-36-458
|
Facility
OP
|
$5,607.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6177635
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,569.96 |
| Max. Negotiated Rate |
$5,158.44 |
| Rate for Payer: Aetna Commercial |
$5,046.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,822.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,569.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,644.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,803.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,691.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,971.71
|
| Rate for Payer: Cash Price |
$1,682.10
|
| Rate for Payer: Cigna Commercial |
$5,158.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,137.68
|
| Rate for Payer: Health EOS Commercial |
$4,990.23
|
| Rate for Payer: HFN Commercial |
$5,158.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,205.25
|
| Rate for Payer: Multiplan Commercial |
$4,485.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,364.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,158.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,747.43
|
| Rate for Payer: Quartz Commercial |
$3,644.55
|
| Rate for Payer: Quartz Medicare Advantage |
$3,364.20
|
| Rate for Payer: WEA Trust Commercial |
$3,083.85
|
| Rate for Payer: WPS Commercial |
$4,153.10
|
|
|
ACETABULAR LINER PINNACLE 36MM 60MM 1221-36-060
|
Facility
IP
|
$6,319.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5496876
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,096.31 |
| Max. Negotiated Rate |
$5,813.48 |
| Rate for Payer: Aetna Commercial |
$5,687.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,349.07
|
| Rate for Payer: Cash Price |
$1,895.70
|
| Rate for Payer: Cigna Commercial |
$5,813.48
|
| Rate for Payer: Health EOS Commercial |
$5,623.91
|
| Rate for Payer: HFN Commercial |
$5,813.48
|
| Rate for Payer: Multiplan Commercial |
$5,055.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,791.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,813.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,096.31
|
| Rate for Payer: Quartz Commercial |
$3,791.40
|
| Rate for Payer: WEA Trust Commercial |
$3,475.45
|
| Rate for Payer: WPS Commercial |
$4,680.48
|
|
|
ACETABULAR LINER PINNACLE 36MM 60MM 1221-36-060
|
Facility
OP
|
$6,319.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5496876
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,769.32 |
| Max. Negotiated Rate |
$5,813.48 |
| Rate for Payer: Aetna Commercial |
$5,687.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,434.34
|
| Rate for Payer: Aetna Managed Medicare |
$1,769.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,107.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,159.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,033.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,349.07
|
| Rate for Payer: Cash Price |
$1,895.70
|
| Rate for Payer: Cigna Commercial |
$5,813.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,536.11
|
| Rate for Payer: Health EOS Commercial |
$5,623.91
|
| Rate for Payer: HFN Commercial |
$5,813.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,739.25
|
| Rate for Payer: Multiplan Commercial |
$5,055.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,791.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,813.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,096.31
|
| Rate for Payer: Quartz Commercial |
$4,107.35
|
| Rate for Payer: Quartz Medicare Advantage |
$3,791.40
|
| Rate for Payer: WEA Trust Commercial |
$3,475.45
|
| Rate for Payer: WPS Commercial |
$4,680.48
|
|
|
ACETABULAR LINER PINNACLE 36MM 60MM +4 NEUTRAL 1221-36-460
|
Facility
IP
|
$5,819.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5787672
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,851.31 |
| Max. Negotiated Rate |
$5,353.48 |
| Rate for Payer: Aetna Commercial |
$5,237.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,084.07
|
| Rate for Payer: Cash Price |
$1,745.70
|
| Rate for Payer: Cigna Commercial |
$5,353.48
|
| Rate for Payer: Health EOS Commercial |
$5,178.91
|
| Rate for Payer: HFN Commercial |
$5,353.48
|
| Rate for Payer: Multiplan Commercial |
$4,655.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,491.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,353.48
|
| Rate for Payer: Quartz Beloit One Network |
$2,851.31
|
| Rate for Payer: Quartz Commercial |
$3,491.40
|
| Rate for Payer: WEA Trust Commercial |
$3,200.45
|
| Rate for Payer: WPS Commercial |
$4,310.13
|
|
|
ACETABULAR LINER PINNACLE 36MM 60MM +4 NEUTRAL 1221-36-460
|
Facility
OP
|
$5,819.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5787672
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,629.32 |
| Max. Negotiated Rate |
$5,353.48 |
| Rate for Payer: Aetna Commercial |
$5,237.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,004.34
|
| Rate for Payer: Aetna Managed Medicare |
$1,629.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,782.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,909.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,793.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,084.07
|
| Rate for Payer: Cash Price |
$1,745.70
|
| Rate for Payer: Cigna Commercial |
$5,353.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,256.31
|
| Rate for Payer: Health EOS Commercial |
$5,178.91
|
| Rate for Payer: HFN Commercial |
$5,353.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,364.25
|
| Rate for Payer: Multiplan Commercial |
$4,655.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,491.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,353.48
|
| Rate for Payer: Quartz Beloit One Network |
$2,851.31
|
| Rate for Payer: Quartz Commercial |
$3,782.35
|
| Rate for Payer: Quartz Medicare Advantage |
$3,491.40
|
| Rate for Payer: WEA Trust Commercial |
$3,200.45
|
| Rate for Payer: WPS Commercial |
$4,310.13
|
|
|
ACETABULAR LINER PINNACLE 36MM 62MM 1221-36-062
|
Facility
IP
|
$5,625.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5547326
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,756.25 |
| Max. Negotiated Rate |
$5,175.00 |
| Rate for Payer: Aetna Commercial |
$5,062.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,981.25
|
| Rate for Payer: Cash Price |
$1,687.50
|
| Rate for Payer: Cigna Commercial |
$5,175.00
|
| Rate for Payer: Health EOS Commercial |
$5,006.25
|
| Rate for Payer: HFN Commercial |
$5,175.00
|
| Rate for Payer: Multiplan Commercial |
$4,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,375.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,175.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,756.25
|
| Rate for Payer: Quartz Commercial |
$3,375.00
|
| Rate for Payer: WEA Trust Commercial |
$3,093.75
|
| Rate for Payer: WPS Commercial |
$4,166.44
|
|
|
ACETABULAR LINER PINNACLE 36MM 62MM 1221-36-062
|
Facility
OP
|
$5,625.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5547326
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,575.00 |
| Max. Negotiated Rate |
$5,175.00 |
| Rate for Payer: Aetna Commercial |
$5,062.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,837.50
|
| Rate for Payer: Aetna Managed Medicare |
$1,575.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,656.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,812.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,700.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,981.25
|
| Rate for Payer: Cash Price |
$1,687.50
|
| Rate for Payer: Cigna Commercial |
$5,175.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,147.75
|
| Rate for Payer: Health EOS Commercial |
$5,006.25
|
| Rate for Payer: HFN Commercial |
$5,175.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,218.75
|
| Rate for Payer: Multiplan Commercial |
$4,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,375.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,175.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,756.25
|
| Rate for Payer: Quartz Commercial |
$3,656.25
|
| Rate for Payer: Quartz Medicare Advantage |
$3,375.00
|
| Rate for Payer: WEA Trust Commercial |
$3,093.75
|
| Rate for Payer: WPS Commercial |
$4,166.44
|
|
|
ACETABULAR LINER PINNACLE 36MM 64MM 1221-36-064
|
Facility
IP
|
$5,391.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6182538
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,641.59 |
| Max. Negotiated Rate |
$4,959.72 |
| Rate for Payer: Aetna Commercial |
$4,851.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,857.23
|
| Rate for Payer: Cash Price |
$1,617.30
|
| Rate for Payer: Cigna Commercial |
$4,959.72
|
| Rate for Payer: Health EOS Commercial |
$4,797.99
|
| Rate for Payer: HFN Commercial |
$4,959.72
|
| Rate for Payer: Multiplan Commercial |
$4,312.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,234.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,959.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,641.59
|
| Rate for Payer: Quartz Commercial |
$3,234.60
|
| Rate for Payer: WEA Trust Commercial |
$2,965.05
|
| Rate for Payer: WPS Commercial |
$3,993.11
|
|
