|
AccuType IL28B - Molecule Nucleic Amplification
|
Professional
|
Both
|
$300.00
|
|
| Hospital Charge Code |
1270801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$137.28 |
| Max. Negotiated Rate |
$296.40 |
| Rate for Payer: Aetna Commercial |
$296.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$268.32
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$296.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$156.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$187.20
|
| Rate for Payer: Health EOS Commercial |
$283.92
|
| Rate for Payer: HFN Commercial |
$296.40
|
| Rate for Payer: Multiplan Commercial |
$249.60
|
| Rate for Payer: Preferred Network Access Commercial |
$296.40
|
| Rate for Payer: Quartz Beloit One Network |
$137.28
|
| Rate for Payer: Quartz Commercial |
$177.84
|
| Rate for Payer: The Alliance Commercial |
$156.00
|
| Rate for Payer: WEA Trust Commercial |
$171.60
|
| Rate for Payer: WPS Commercial |
$231.09
|
|
|
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 |
$3,213.54 |
| Max. Negotiated Rate |
$6,033.58 |
| Rate for Payer: Aetna Commercial |
$5,902.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,640.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,475.87
|
| Rate for Payer: Cash Price |
$1,891.80
|
| Rate for Payer: Cigna Commercial |
$6,033.58
|
| Rate for Payer: Health EOS Commercial |
$5,836.83
|
| Rate for Payer: HFN Commercial |
$6,033.58
|
| Rate for Payer: Multiplan Commercial |
$5,246.59
|
| Rate for Payer: Preferred Network Access Commercial |
$6,033.58
|
| Rate for Payer: Quartz Beloit One Network |
$3,213.54
|
| Rate for Payer: Quartz Commercial |
$3,934.94
|
| Rate for Payer: WEA Trust Commercial |
$3,607.03
|
| Rate for Payer: WPS Commercial |
$4,857.51
|
|
|
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 |
$1,836.31 |
| Max. Negotiated Rate |
$6,033.58 |
| Rate for Payer: Aetna Commercial |
$5,902.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,640.09
|
| Rate for Payer: Aetna Managed Medicare |
$1,836.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,262.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,279.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,147.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,475.87
|
| Rate for Payer: Cash Price |
$1,891.80
|
| Rate for Payer: Cigna Commercial |
$6,033.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,670.09
|
| Rate for Payer: Health EOS Commercial |
$5,836.83
|
| Rate for Payer: HFN Commercial |
$6,033.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,918.68
|
| Rate for Payer: Multiplan Commercial |
$5,246.59
|
| Rate for Payer: NAPHCARE Commercial |
$3,934.94
|
| Rate for Payer: Preferred Network Access Commercial |
$6,033.58
|
| Rate for Payer: Quartz Beloit One Network |
$3,213.54
|
| Rate for Payer: Quartz Commercial |
$4,262.86
|
| Rate for Payer: Quartz Medicare Advantage |
$3,934.94
|
| Rate for Payer: The Alliance Commercial |
$3,279.12
|
| Rate for Payer: WEA Trust Commercial |
$3,607.03
|
| Rate for Payer: WPS Commercial |
$4,857.51
|
|
|
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 |
$3,213.54 |
| Max. Negotiated Rate |
$6,033.58 |
| Rate for Payer: Aetna Commercial |
$5,902.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,640.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,475.87
|
| Rate for Payer: Cash Price |
$1,891.80
|
| Rate for Payer: Cigna Commercial |
$6,033.58
|
| Rate for Payer: Health EOS Commercial |
$5,836.83
|
| Rate for Payer: HFN Commercial |
$6,033.58
|
| Rate for Payer: Multiplan Commercial |
$5,246.59
|
| Rate for Payer: Preferred Network Access Commercial |
$6,033.58
|
| Rate for Payer: Quartz Beloit One Network |
$3,213.54
|
| Rate for Payer: Quartz Commercial |
$3,934.94
|
| Rate for Payer: WEA Trust Commercial |
$3,607.03
|
| Rate for Payer: WPS Commercial |
$4,857.51
|
|
|
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 |
$1,836.31 |
| Max. Negotiated Rate |
$6,033.58 |
| Rate for Payer: Aetna Commercial |
$5,902.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,640.09
|
| Rate for Payer: Aetna Managed Medicare |
$1,836.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,262.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,279.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,147.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,475.87
|
| Rate for Payer: Cash Price |
$1,891.80
|
| Rate for Payer: Cigna Commercial |
$6,033.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,670.09
|
| Rate for Payer: Health EOS Commercial |
$5,836.83
|
| Rate for Payer: HFN Commercial |
$6,033.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,918.68
|
| Rate for Payer: Multiplan Commercial |
$5,246.59
|
| Rate for Payer: NAPHCARE Commercial |
$3,934.94
|
| Rate for Payer: Preferred Network Access Commercial |
$6,033.58
|
| Rate for Payer: Quartz Beloit One Network |
$3,213.54
|
| Rate for Payer: Quartz Commercial |
$4,262.86
|
| Rate for Payer: Quartz Medicare Advantage |
$3,934.94
|
| Rate for Payer: The Alliance Commercial |
$3,279.12
|
| Rate for Payer: WEA Trust Commercial |
$3,607.03
|
| Rate for Payer: WPS Commercial |
$4,857.51
|
|
|
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 |
$3,213.54 |
| Max. Negotiated Rate |
$6,033.58 |
| Rate for Payer: Aetna Commercial |
$5,902.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,640.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,475.87
|
| Rate for Payer: Cash Price |
$1,891.80
|
| Rate for Payer: Cigna Commercial |
$6,033.58
|
| Rate for Payer: Health EOS Commercial |
$5,836.83
|
| Rate for Payer: HFN Commercial |
$6,033.58
|
| Rate for Payer: Multiplan Commercial |
$5,246.59
|
| Rate for Payer: Preferred Network Access Commercial |
$6,033.58
|
| Rate for Payer: Quartz Beloit One Network |
$3,213.54
|
| Rate for Payer: Quartz Commercial |
$3,934.94
|
| Rate for Payer: WEA Trust Commercial |
$3,607.03
|
| Rate for Payer: WPS Commercial |
$4,857.51
|
|
|
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 |
$1,836.31 |
| Max. Negotiated Rate |
$6,033.58 |
| Rate for Payer: Aetna Commercial |
$5,902.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,640.09
|
| Rate for Payer: Aetna Managed Medicare |
$1,836.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,262.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,279.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,147.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,475.87
|
| Rate for Payer: Cash Price |
$1,891.80
|
| Rate for Payer: Cigna Commercial |
$6,033.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,670.09
|
| Rate for Payer: Health EOS Commercial |
$5,836.83
|
| Rate for Payer: HFN Commercial |
$6,033.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,918.68
|
| Rate for Payer: Multiplan Commercial |
$5,246.59
|
| Rate for Payer: NAPHCARE Commercial |
$3,934.94
|
| Rate for Payer: Preferred Network Access Commercial |
$6,033.58
|
| Rate for Payer: Quartz Beloit One Network |
$3,213.54
|
| Rate for Payer: Quartz Commercial |
$4,262.86
|
| Rate for Payer: Quartz Medicare Advantage |
$3,934.94
|
| Rate for Payer: The Alliance Commercial |
$3,279.12
|
| Rate for Payer: WEA Trust Commercial |
$3,607.03
|
| Rate for Payer: WPS Commercial |
$4,857.51
|
|
|
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 |
$3,570.26 |
| Max. Negotiated Rate |
$6,703.34 |
| Rate for Payer: Aetna Commercial |
$6,557.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,266.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,861.71
|
| Rate for Payer: Cash Price |
$2,101.80
|
| Rate for Payer: Cigna Commercial |
$6,703.34
|
| Rate for Payer: Health EOS Commercial |
$6,484.75
|
| Rate for Payer: HFN Commercial |
$6,703.34
|
| Rate for Payer: Multiplan Commercial |
$5,828.99
|
| Rate for Payer: Preferred Network Access Commercial |
$6,703.34
|
| Rate for Payer: Quartz Beloit One Network |
$3,570.26
|
| Rate for Payer: Quartz Commercial |
$4,371.74
|
| Rate for Payer: WEA Trust Commercial |
$4,007.43
|
| Rate for Payer: WPS Commercial |
$5,396.72
|
|
|
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 |
$2,040.15 |
| Max. Negotiated Rate |
$6,703.34 |
| Rate for Payer: Aetna Commercial |
$6,557.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,266.17
|
| Rate for Payer: Aetna Managed Medicare |
$2,040.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,736.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,643.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,497.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,861.71
|
| Rate for Payer: Cash Price |
$2,101.80
|
| Rate for Payer: Cigna Commercial |
$6,703.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,077.49
|
| Rate for Payer: Health EOS Commercial |
$6,484.75
|
| Rate for Payer: HFN Commercial |
$6,703.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,464.68
|
| Rate for Payer: Multiplan Commercial |
$5,828.99
|
| Rate for Payer: NAPHCARE Commercial |
$4,371.74
|
| Rate for Payer: Preferred Network Access Commercial |
$6,703.34
|
| Rate for Payer: Quartz Beloit One Network |
$3,570.26
|
| Rate for Payer: Quartz Commercial |
$4,736.06
|
| Rate for Payer: Quartz Medicare Advantage |
$4,371.74
|
| Rate for Payer: The Alliance Commercial |
$3,643.12
|
| Rate for Payer: WEA Trust Commercial |
$4,007.43
|
| Rate for Payer: WPS Commercial |
$5,396.72
|
|
|
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 |
$2,040.15 |
| Max. Negotiated Rate |
$6,703.34 |
| Rate for Payer: Aetna Commercial |
$6,557.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,266.17
|
| Rate for Payer: Aetna Managed Medicare |
$2,040.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,736.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,643.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,497.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,861.71
|
| Rate for Payer: Cash Price |
$2,101.80
|
| Rate for Payer: Cigna Commercial |
$6,703.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,077.49
|
| Rate for Payer: Health EOS Commercial |
$6,484.75
|
| Rate for Payer: HFN Commercial |
$6,703.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,464.68
|
| Rate for Payer: Multiplan Commercial |
$5,828.99
|
| Rate for Payer: NAPHCARE Commercial |
$4,371.74
|
| Rate for Payer: Preferred Network Access Commercial |
$6,703.34
|
| Rate for Payer: Quartz Beloit One Network |
$3,570.26
|
| Rate for Payer: Quartz Commercial |
$4,736.06
|
| Rate for Payer: Quartz Medicare Advantage |
$4,371.74
|
| Rate for Payer: The Alliance Commercial |
$3,643.12
|
| Rate for Payer: WEA Trust Commercial |
$4,007.43
|
| Rate for Payer: WPS Commercial |
$5,396.72
|
|
|
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 |
$3,570.26 |
| Max. Negotiated Rate |
$6,703.34 |
| Rate for Payer: Aetna Commercial |
$6,557.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,266.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,861.71
|
| Rate for Payer: Cash Price |
$2,101.80
|
| Rate for Payer: Cigna Commercial |
$6,703.34
|
| Rate for Payer: Health EOS Commercial |
$6,484.75
|
| Rate for Payer: HFN Commercial |
$6,703.34
|
| Rate for Payer: Multiplan Commercial |
$5,828.99
|
| Rate for Payer: Preferred Network Access Commercial |
$6,703.34
|
| Rate for Payer: Quartz Beloit One Network |
$3,570.26
|
| Rate for Payer: Quartz Commercial |
$4,371.74
|
| Rate for Payer: WEA Trust Commercial |
$4,007.43
|
| Rate for Payer: WPS Commercial |
$5,396.72
|
|
|
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 |
$3,570.26 |
| Max. Negotiated Rate |
$6,703.34 |
| Rate for Payer: Aetna Commercial |
$6,557.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,266.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,861.71
|
| Rate for Payer: Cash Price |
$2,101.80
|
| Rate for Payer: Cigna Commercial |
$6,703.34
|
| Rate for Payer: Health EOS Commercial |
$6,484.75
|
| Rate for Payer: HFN Commercial |
$6,703.34
|
| Rate for Payer: Multiplan Commercial |
$5,828.99
|
| Rate for Payer: Preferred Network Access Commercial |
$6,703.34
|
| Rate for Payer: Quartz Beloit One Network |
$3,570.26
|
| Rate for Payer: Quartz Commercial |
$4,371.74
|
| Rate for Payer: WEA Trust Commercial |
$4,007.43
|
| Rate for Payer: WPS Commercial |
$5,396.72
|
|
|
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 |
$2,040.15 |
| Max. Negotiated Rate |
$6,703.34 |
| Rate for Payer: Aetna Commercial |
$6,557.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,266.17
|
| Rate for Payer: Aetna Managed Medicare |
$2,040.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,736.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,643.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,497.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,861.71
|
| Rate for Payer: Cash Price |
$2,101.80
|
| Rate for Payer: Cigna Commercial |
$6,703.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,077.49
|
| Rate for Payer: Health EOS Commercial |
$6,484.75
|
| Rate for Payer: HFN Commercial |
$6,703.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,464.68
|
| Rate for Payer: Multiplan Commercial |
$5,828.99
|
| Rate for Payer: NAPHCARE Commercial |
$4,371.74
|
| Rate for Payer: Preferred Network Access Commercial |
$6,703.34
|
| Rate for Payer: Quartz Beloit One Network |
$3,570.26
|
| Rate for Payer: Quartz Commercial |
$4,736.06
|
| Rate for Payer: Quartz Medicare Advantage |
$4,371.74
|
| Rate for Payer: The Alliance Commercial |
$3,643.12
|
| Rate for Payer: WEA Trust Commercial |
$4,007.43
|
| Rate for Payer: WPS Commercial |
$5,396.72
|
|
|
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 |
$2,040.15 |
| Max. Negotiated Rate |
$6,703.34 |
| Rate for Payer: Aetna Commercial |
$6,557.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,266.17
|
| Rate for Payer: Aetna Managed Medicare |
$2,040.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,736.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,643.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,497.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,861.71
|
| Rate for Payer: Cash Price |
$2,101.80
|
| Rate for Payer: Cigna Commercial |
$6,703.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,077.49
|
| Rate for Payer: Health EOS Commercial |
$6,484.75
|
| Rate for Payer: HFN Commercial |
$6,703.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,464.68
|
| Rate for Payer: Multiplan Commercial |
$5,828.99
|
| Rate for Payer: NAPHCARE Commercial |
$4,371.74
|
| Rate for Payer: Preferred Network Access Commercial |
$6,703.34
|
| Rate for Payer: Quartz Beloit One Network |
$3,570.26
|
| Rate for Payer: Quartz Commercial |
$4,736.06
|
| Rate for Payer: Quartz Medicare Advantage |
$4,371.74
|
| Rate for Payer: The Alliance Commercial |
$3,643.12
|
| Rate for Payer: WEA Trust Commercial |
$4,007.43
|
| Rate for Payer: WPS Commercial |
$5,396.72
|
|
|
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 |
$3,570.26 |
| Max. Negotiated Rate |
$6,703.34 |
| Rate for Payer: Aetna Commercial |
$6,557.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,266.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,861.71
|
| Rate for Payer: Cash Price |
$2,101.80
|
| Rate for Payer: Cigna Commercial |
$6,703.34
|
| Rate for Payer: Health EOS Commercial |
$6,484.75
|
| Rate for Payer: HFN Commercial |
$6,703.34
|
| Rate for Payer: Multiplan Commercial |
$5,828.99
|
| Rate for Payer: Preferred Network Access Commercial |
$6,703.34
|
| Rate for Payer: Quartz Beloit One Network |
$3,570.26
|
| Rate for Payer: Quartz Commercial |
$4,371.74
|
| Rate for Payer: WEA Trust Commercial |
$4,007.43
|
| Rate for Payer: WPS Commercial |
$5,396.72
|
|
|
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 |
$1,765.55 |
| Max. Negotiated Rate |
$5,801.08 |
| Rate for Payer: Aetna Commercial |
$5,674.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,422.75
|
| Rate for Payer: Aetna Managed Medicare |
$1,765.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,098.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,152.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,026.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,341.93
|
| Rate for Payer: Cash Price |
$1,818.90
|
| Rate for Payer: Cigna Commercial |
$5,801.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,528.67
|
| Rate for Payer: Health EOS Commercial |
$5,611.91
|
| Rate for Payer: HFN Commercial |
$5,801.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,729.14
|
| Rate for Payer: Multiplan Commercial |
$5,044.42
|
| Rate for Payer: NAPHCARE Commercial |
$3,783.31
|
| Rate for Payer: Preferred Network Access Commercial |
$5,801.08
|
| Rate for Payer: Quartz Beloit One Network |
$3,089.70
|
| Rate for Payer: Quartz Commercial |
$4,098.59
|
| Rate for Payer: Quartz Medicare Advantage |
$3,783.31
|
| Rate for Payer: The Alliance Commercial |
$3,152.76
|
| Rate for Payer: WEA Trust Commercial |
$3,468.04
|
| Rate for Payer: WPS Commercial |
$4,670.33
|
|
|
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 |
$3,089.70 |
| Max. Negotiated Rate |
$5,801.08 |
| Rate for Payer: Aetna Commercial |
$5,674.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,422.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,341.93
|
| Rate for Payer: Cash Price |
$1,818.90
|
| Rate for Payer: Cigna Commercial |
$5,801.08
|
| Rate for Payer: Health EOS Commercial |
$5,611.91
|
| Rate for Payer: HFN Commercial |
$5,801.08
|
| Rate for Payer: Multiplan Commercial |
$5,044.42
|
| Rate for Payer: Preferred Network Access Commercial |
$5,801.08
|
| Rate for Payer: Quartz Beloit One Network |
$3,089.70
|
| Rate for Payer: Quartz Commercial |
$3,783.31
|
| Rate for Payer: WEA Trust Commercial |
$3,468.04
|
| Rate for Payer: WPS Commercial |
$4,670.33
|
|
|
ACETABULAR LINER G7 OSSEO 3HOLE 52MM E 010000857
|
Facility
|
OP
|
$6,122.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6220161
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,782.73 |
| Max. Negotiated Rate |
$5,857.53 |
| Rate for Payer: Aetna Commercial |
$5,730.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,475.52
|
| Rate for Payer: Aetna Managed Medicare |
$1,782.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,138.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,183.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,056.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,374.45
|
| Rate for Payer: Cash Price |
$1,836.60
|
| Rate for Payer: Cigna Commercial |
$5,857.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,563.00
|
| Rate for Payer: Health EOS Commercial |
$5,666.52
|
| Rate for Payer: HFN Commercial |
$5,857.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,775.16
|
| Rate for Payer: Multiplan Commercial |
$5,093.50
|
| Rate for Payer: NAPHCARE Commercial |
$3,820.13
|
| Rate for Payer: Preferred Network Access Commercial |
$5,857.53
|
| Rate for Payer: Quartz Beloit One Network |
$3,119.77
|
| Rate for Payer: Quartz Commercial |
$4,138.47
|
| Rate for Payer: Quartz Medicare Advantage |
$3,820.13
|
| Rate for Payer: The Alliance Commercial |
$3,183.44
|
| Rate for Payer: WEA Trust Commercial |
$3,501.78
|
| Rate for Payer: WPS Commercial |
$4,715.78
|
|
|
ACETABULAR LINER G7 OSSEO 3HOLE 52MM E 010000857
|
Facility
|
IP
|
$6,122.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6220161
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,119.77 |
| Max. Negotiated Rate |
$5,857.53 |
| Rate for Payer: Aetna Commercial |
$5,730.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,475.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,374.45
|
| Rate for Payer: Cash Price |
$1,836.60
|
| Rate for Payer: Cigna Commercial |
$5,857.53
|
| Rate for Payer: Health EOS Commercial |
$5,666.52
|
| Rate for Payer: HFN Commercial |
$5,857.53
|
| Rate for Payer: Multiplan Commercial |
$5,093.50
|
| Rate for Payer: Preferred Network Access Commercial |
$5,857.53
|
| Rate for Payer: Quartz Beloit One Network |
$3,119.77
|
| Rate for Payer: Quartz Commercial |
$3,820.13
|
| Rate for Payer: WEA Trust Commercial |
$3,501.78
|
| Rate for Payer: WPS Commercial |
$4,715.78
|
|
|
ACETABULAR LINER G7 VIT E NEUTRAL 36MM E 30103605
|
Facility
|
OP
|
$1,346.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6220191
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$391.96 |
| Max. Negotiated Rate |
$1,287.85 |
| Rate for Payer: Aetna Commercial |
$1,259.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,203.86
|
| Rate for Payer: Aetna Managed Medicare |
$391.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$909.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$699.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$671.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$741.92
|
| Rate for Payer: Cash Price |
$403.80
|
| Rate for Payer: Cigna Commercial |
$1,287.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$783.37
|
| Rate for Payer: Health EOS Commercial |
$1,245.86
|
| Rate for Payer: HFN Commercial |
$1,287.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,049.88
|
| Rate for Payer: Multiplan Commercial |
$1,119.87
|
| Rate for Payer: NAPHCARE Commercial |
$839.90
|
| Rate for Payer: Preferred Network Access Commercial |
$1,287.85
|
| Rate for Payer: Quartz Beloit One Network |
$685.92
|
| Rate for Payer: Quartz Commercial |
$909.90
|
| Rate for Payer: Quartz Medicare Advantage |
$839.90
|
| Rate for Payer: The Alliance Commercial |
$699.92
|
| Rate for Payer: WEA Trust Commercial |
$769.91
|
| Rate for Payer: WPS Commercial |
$1,036.82
|
|
|
ACETABULAR LINER G7 VIT E NEUTRAL 36MM E 30103605
|
Facility
|
IP
|
$1,346.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6220191
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$685.92 |
| Max. Negotiated Rate |
$1,287.85 |
| Rate for Payer: Aetna Commercial |
$1,259.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,203.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$741.92
|
| Rate for Payer: Cash Price |
$403.80
|
| Rate for Payer: Cigna Commercial |
$1,287.85
|
| Rate for Payer: Health EOS Commercial |
$1,245.86
|
| Rate for Payer: HFN Commercial |
$1,287.85
|
| Rate for Payer: Multiplan Commercial |
$1,119.87
|
| Rate for Payer: Preferred Network Access Commercial |
$1,287.85
|
| Rate for Payer: Quartz Beloit One Network |
$685.92
|
| Rate for Payer: Quartz Commercial |
$839.90
|
| Rate for Payer: WEA Trust Commercial |
$769.91
|
| Rate for Payer: WPS Commercial |
$1,036.82
|
|
|
ACETABULAR LINER PINNACLE 32MM 48MM 1221-32-048
|
Facility
|
OP
|
$6,084.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5497003
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,771.66 |
| Max. Negotiated Rate |
$5,821.17 |
| Rate for Payer: Aetna Commercial |
$5,694.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,441.53
|
| Rate for Payer: Aetna Managed Medicare |
$1,771.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,112.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,163.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,037.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,353.50
|
| Rate for Payer: Cash Price |
$1,825.20
|
| Rate for Payer: Cigna Commercial |
$5,821.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,540.89
|
| Rate for Payer: Health EOS Commercial |
$5,631.35
|
| Rate for Payer: HFN Commercial |
$5,821.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,745.52
|
| Rate for Payer: Multiplan Commercial |
$5,061.89
|
| Rate for Payer: NAPHCARE Commercial |
$3,796.42
|
| Rate for Payer: Preferred Network Access Commercial |
$5,821.17
|
| Rate for Payer: Quartz Beloit One Network |
$3,100.41
|
| Rate for Payer: Quartz Commercial |
$4,112.78
|
| Rate for Payer: Quartz Medicare Advantage |
$3,796.42
|
| Rate for Payer: The Alliance Commercial |
$3,163.68
|
| Rate for Payer: WEA Trust Commercial |
$3,480.05
|
| Rate for Payer: WPS Commercial |
$4,686.51
|
|
|
ACETABULAR LINER PINNACLE 32MM 48MM 1221-32-048
|
Facility
|
IP
|
$6,084.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5497003
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,100.41 |
| Max. Negotiated Rate |
$5,821.17 |
| Rate for Payer: Aetna Commercial |
$5,694.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,441.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,353.50
|
| Rate for Payer: Cash Price |
$1,825.20
|
| Rate for Payer: Cigna Commercial |
$5,821.17
|
| Rate for Payer: Health EOS Commercial |
$5,631.35
|
| Rate for Payer: HFN Commercial |
$5,821.17
|
| Rate for Payer: Multiplan Commercial |
$5,061.89
|
| Rate for Payer: Preferred Network Access Commercial |
$5,821.17
|
| Rate for Payer: Quartz Beloit One Network |
$3,100.41
|
| Rate for Payer: Quartz Commercial |
$3,796.42
|
| Rate for Payer: WEA Trust Commercial |
$3,480.05
|
| Rate for Payer: WPS Commercial |
$4,686.51
|
|
|
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 |
$3,220.16 |
| Max. Negotiated Rate |
$6,046.02 |
| Rate for Payer: Aetna Commercial |
$5,914.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,651.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,483.03
|
| Rate for Payer: Cash Price |
$1,895.70
|
| Rate for Payer: Cigna Commercial |
$6,046.02
|
| Rate for Payer: Health EOS Commercial |
$5,848.87
|
| Rate for Payer: HFN Commercial |
$6,046.02
|
| Rate for Payer: Multiplan Commercial |
$5,257.41
|
| Rate for Payer: Preferred Network Access Commercial |
$6,046.02
|
| Rate for Payer: Quartz Beloit One Network |
$3,220.16
|
| Rate for Payer: Quartz Commercial |
$3,943.06
|
| Rate for Payer: WEA Trust Commercial |
$3,614.47
|
| Rate for Payer: WPS Commercial |
$4,867.53
|
|
|
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 |
$1,840.09 |
| Max. Negotiated Rate |
$6,046.02 |
| Rate for Payer: Aetna Commercial |
$5,914.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,651.71
|
| Rate for Payer: Aetna Managed Medicare |
$1,840.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,271.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,285.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,154.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,483.03
|
| Rate for Payer: Cash Price |
$1,895.70
|
| Rate for Payer: Cigna Commercial |
$6,046.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,677.66
|
| Rate for Payer: Health EOS Commercial |
$5,848.87
|
| Rate for Payer: HFN Commercial |
$6,046.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,928.82
|
| Rate for Payer: Multiplan Commercial |
$5,257.41
|
| Rate for Payer: NAPHCARE Commercial |
$3,943.06
|
| Rate for Payer: Preferred Network Access Commercial |
$6,046.02
|
| Rate for Payer: Quartz Beloit One Network |
$3,220.16
|
| Rate for Payer: Quartz Commercial |
$4,271.64
|
| Rate for Payer: Quartz Medicare Advantage |
$3,943.06
|
| Rate for Payer: The Alliance Commercial |
$3,285.88
|
| Rate for Payer: WEA Trust Commercial |
$3,614.47
|
| Rate for Payer: WPS Commercial |
$4,867.53
|
|
