|
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 |
$3,220.16 |
| 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 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 |
$1,840.09 |
| 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
|
|
|
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 |
$1,697.99 |
| Max. Negotiated Rate |
$5,579.10 |
| Rate for Payer: Aetna Commercial |
$5,457.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,215.25
|
| Rate for Payer: Aetna Managed Medicare |
$1,697.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,941.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,032.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,910.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,214.05
|
| Rate for Payer: Cash Price |
$1,749.30
|
| Rate for Payer: Cigna Commercial |
$5,579.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,393.64
|
| Rate for Payer: Health EOS Commercial |
$5,397.17
|
| Rate for Payer: HFN Commercial |
$5,579.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,548.18
|
| Rate for Payer: Multiplan Commercial |
$4,851.39
|
| Rate for Payer: NAPHCARE Commercial |
$3,638.54
|
| Rate for Payer: Preferred Network Access Commercial |
$5,579.10
|
| Rate for Payer: Quartz Beloit One Network |
$2,971.48
|
| Rate for Payer: Quartz Commercial |
$3,941.76
|
| Rate for Payer: Quartz Medicare Advantage |
$3,638.54
|
| Rate for Payer: The Alliance Commercial |
$3,032.12
|
| Rate for Payer: WEA Trust Commercial |
$3,335.33
|
| Rate for Payer: WPS Commercial |
$4,491.62
|
|
|
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 |
$2,971.48 |
| Max. Negotiated Rate |
$5,579.10 |
| Rate for Payer: Aetna Commercial |
$5,457.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,215.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,214.05
|
| Rate for Payer: Cash Price |
$1,749.30
|
| Rate for Payer: Cigna Commercial |
$5,579.10
|
| Rate for Payer: Health EOS Commercial |
$5,397.17
|
| Rate for Payer: HFN Commercial |
$5,579.10
|
| Rate for Payer: Multiplan Commercial |
$4,851.39
|
| Rate for Payer: Preferred Network Access Commercial |
$5,579.10
|
| Rate for Payer: Quartz Beloit One Network |
$2,971.48
|
| Rate for Payer: Quartz Commercial |
$3,638.54
|
| Rate for Payer: WEA Trust Commercial |
$3,335.33
|
| Rate for Payer: WPS Commercial |
$4,491.62
|
|
|
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 |
$1,840.09 |
| 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
|
|
|
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 |
$3,220.16 |
| 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 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 |
$1,697.99 |
| Max. Negotiated Rate |
$5,579.10 |
| Rate for Payer: Aetna Commercial |
$5,457.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,215.25
|
| Rate for Payer: Aetna Managed Medicare |
$1,697.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,941.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,032.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,910.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,214.05
|
| Rate for Payer: Cash Price |
$1,749.30
|
| Rate for Payer: Cigna Commercial |
$5,579.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,393.64
|
| Rate for Payer: Health EOS Commercial |
$5,397.17
|
| Rate for Payer: HFN Commercial |
$5,579.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,548.18
|
| Rate for Payer: Multiplan Commercial |
$4,851.39
|
| Rate for Payer: NAPHCARE Commercial |
$3,638.54
|
| Rate for Payer: Preferred Network Access Commercial |
$5,579.10
|
| Rate for Payer: Quartz Beloit One Network |
$2,971.48
|
| Rate for Payer: Quartz Commercial |
$3,941.76
|
| Rate for Payer: Quartz Medicare Advantage |
$3,638.54
|
| Rate for Payer: The Alliance Commercial |
$3,032.12
|
| Rate for Payer: WEA Trust Commercial |
$3,335.33
|
| Rate for Payer: WPS Commercial |
$4,491.62
|
|
|
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 |
$2,971.48 |
| Max. Negotiated Rate |
$5,579.10 |
| Rate for Payer: Aetna Commercial |
$5,457.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,215.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,214.05
|
| Rate for Payer: Cash Price |
$1,749.30
|
| Rate for Payer: Cigna Commercial |
$5,579.10
|
| Rate for Payer: Health EOS Commercial |
$5,397.17
|
| Rate for Payer: HFN Commercial |
$5,579.10
|
| Rate for Payer: Multiplan Commercial |
$4,851.39
|
| Rate for Payer: Preferred Network Access Commercial |
$5,579.10
|
| Rate for Payer: Quartz Beloit One Network |
$2,971.48
|
| Rate for Payer: Quartz Commercial |
$3,638.54
|
| Rate for Payer: WEA Trust Commercial |
$3,335.33
|
| Rate for Payer: WPS Commercial |
$4,491.62
|
|
|
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 |
$1,840.09 |
| 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
|
|
|
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 |
$3,220.16 |
| 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 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 |
$1,697.99 |
| Max. Negotiated Rate |
$5,579.10 |
| Rate for Payer: Aetna Commercial |
$5,457.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,215.25
|
| Rate for Payer: Aetna Managed Medicare |
$1,697.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,941.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,032.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,910.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,214.05
|
| Rate for Payer: Cash Price |
$1,749.30
|
| Rate for Payer: Cigna Commercial |
$5,579.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,393.64
|
| Rate for Payer: Health EOS Commercial |
$5,397.17
|
| Rate for Payer: HFN Commercial |
$5,579.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,548.18
|
| Rate for Payer: Multiplan Commercial |
$4,851.39
|
| Rate for Payer: NAPHCARE Commercial |
$3,638.54
|
| Rate for Payer: Preferred Network Access Commercial |
$5,579.10
|
| Rate for Payer: Quartz Beloit One Network |
$2,971.48
|
| Rate for Payer: Quartz Commercial |
$3,941.76
|
| Rate for Payer: Quartz Medicare Advantage |
$3,638.54
|
| Rate for Payer: The Alliance Commercial |
$3,032.12
|
| Rate for Payer: WEA Trust Commercial |
$3,335.33
|
| Rate for Payer: WPS Commercial |
$4,491.62
|
|
|
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 |
$2,971.48 |
| Max. Negotiated Rate |
$5,579.10 |
| Rate for Payer: Aetna Commercial |
$5,457.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,215.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,214.05
|
| Rate for Payer: Cash Price |
$1,749.30
|
| Rate for Payer: Cigna Commercial |
$5,579.10
|
| Rate for Payer: Health EOS Commercial |
$5,397.17
|
| Rate for Payer: HFN Commercial |
$5,579.10
|
| Rate for Payer: Multiplan Commercial |
$4,851.39
|
| Rate for Payer: Preferred Network Access Commercial |
$5,579.10
|
| Rate for Payer: Quartz Beloit One Network |
$2,971.48
|
| Rate for Payer: Quartz Commercial |
$3,638.54
|
| Rate for Payer: WEA Trust Commercial |
$3,335.33
|
| Rate for Payer: WPS Commercial |
$4,491.62
|
|
|
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 |
$3,220.16 |
| 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 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 |
$1,840.09 |
| 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
|
|
|
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 |
$1,632.76 |
| Max. Negotiated Rate |
$5,364.78 |
| Rate for Payer: Aetna Commercial |
$5,248.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,014.90
|
| Rate for Payer: Aetna Managed Medicare |
$1,632.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,790.33
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,915.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,799.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,090.58
|
| Rate for Payer: Cash Price |
$1,682.10
|
| Rate for Payer: Cigna Commercial |
$5,364.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,263.27
|
| Rate for Payer: Health EOS Commercial |
$5,189.84
|
| Rate for Payer: HFN Commercial |
$5,364.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,373.46
|
| Rate for Payer: Multiplan Commercial |
$4,665.02
|
| Rate for Payer: NAPHCARE Commercial |
$3,498.77
|
| Rate for Payer: Preferred Network Access Commercial |
$5,364.78
|
| Rate for Payer: Quartz Beloit One Network |
$2,857.33
|
| Rate for Payer: Quartz Commercial |
$3,790.33
|
| Rate for Payer: Quartz Medicare Advantage |
$3,498.77
|
| Rate for Payer: The Alliance Commercial |
$2,915.64
|
| Rate for Payer: WEA Trust Commercial |
$3,207.20
|
| Rate for Payer: WPS Commercial |
$4,319.07
|
|
|
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 |
$2,857.33 |
| Max. Negotiated Rate |
$5,364.78 |
| Rate for Payer: Aetna Commercial |
$5,248.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,014.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,090.58
|
| Rate for Payer: Cash Price |
$1,682.10
|
| Rate for Payer: Cigna Commercial |
$5,364.78
|
| Rate for Payer: Health EOS Commercial |
$5,189.84
|
| Rate for Payer: HFN Commercial |
$5,364.78
|
| Rate for Payer: Multiplan Commercial |
$4,665.02
|
| Rate for Payer: Preferred Network Access Commercial |
$5,364.78
|
| Rate for Payer: Quartz Beloit One Network |
$2,857.33
|
| Rate for Payer: Quartz Commercial |
$3,498.77
|
| Rate for Payer: WEA Trust Commercial |
$3,207.20
|
| Rate for Payer: WPS Commercial |
$4,319.07
|
|
|
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 |
$1,840.09 |
| 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
|
|
|
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 |
$3,220.16 |
| 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 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 |
$2,965.36 |
| Max. Negotiated Rate |
$5,567.62 |
| Rate for Payer: Aetna Commercial |
$5,446.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,204.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,207.43
|
| Rate for Payer: Cash Price |
$1,745.70
|
| Rate for Payer: Cigna Commercial |
$5,567.62
|
| Rate for Payer: Health EOS Commercial |
$5,386.07
|
| Rate for Payer: HFN Commercial |
$5,567.62
|
| Rate for Payer: Multiplan Commercial |
$4,841.41
|
| Rate for Payer: Preferred Network Access Commercial |
$5,567.62
|
| Rate for Payer: Quartz Beloit One Network |
$2,965.36
|
| Rate for Payer: Quartz Commercial |
$3,631.06
|
| Rate for Payer: WEA Trust Commercial |
$3,328.47
|
| Rate for Payer: WPS Commercial |
$4,482.38
|
|
|
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 |
$1,694.49 |
| Max. Negotiated Rate |
$5,567.62 |
| Rate for Payer: Aetna Commercial |
$5,446.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,204.51
|
| Rate for Payer: Aetna Managed Medicare |
$1,694.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,933.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,025.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,904.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,207.43
|
| Rate for Payer: Cash Price |
$1,745.70
|
| Rate for Payer: Cigna Commercial |
$5,567.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,386.66
|
| Rate for Payer: Health EOS Commercial |
$5,386.07
|
| Rate for Payer: HFN Commercial |
$5,567.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,538.82
|
| Rate for Payer: Multiplan Commercial |
$4,841.41
|
| Rate for Payer: NAPHCARE Commercial |
$3,631.06
|
| Rate for Payer: Preferred Network Access Commercial |
$5,567.62
|
| Rate for Payer: Quartz Beloit One Network |
$2,965.36
|
| Rate for Payer: Quartz Commercial |
$3,933.64
|
| Rate for Payer: Quartz Medicare Advantage |
$3,631.06
|
| Rate for Payer: The Alliance Commercial |
$3,025.88
|
| Rate for Payer: WEA Trust Commercial |
$3,328.47
|
| Rate for Payer: WPS Commercial |
$4,482.38
|
|
|
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 |
$2,866.50 |
| Max. Negotiated Rate |
$5,382.00 |
| Rate for Payer: Aetna Commercial |
$5,265.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,031.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,100.50
|
| Rate for Payer: Cash Price |
$1,687.50
|
| Rate for Payer: Cigna Commercial |
$5,382.00
|
| Rate for Payer: Health EOS Commercial |
$5,206.50
|
| Rate for Payer: HFN Commercial |
$5,382.00
|
| Rate for Payer: Multiplan Commercial |
$4,680.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,382.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,866.50
|
| Rate for Payer: Quartz Commercial |
$3,510.00
|
| Rate for Payer: WEA Trust Commercial |
$3,217.50
|
| Rate for Payer: WPS Commercial |
$4,332.94
|
|
|
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 |
$1,638.00 |
| Max. Negotiated Rate |
$5,382.00 |
| Rate for Payer: Aetna Commercial |
$5,265.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,031.00
|
| Rate for Payer: Aetna Managed Medicare |
$1,638.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,802.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,925.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,808.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,100.50
|
| Rate for Payer: Cash Price |
$1,687.50
|
| Rate for Payer: Cigna Commercial |
$5,382.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,273.75
|
| Rate for Payer: Health EOS Commercial |
$5,206.50
|
| Rate for Payer: HFN Commercial |
$5,382.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,387.50
|
| Rate for Payer: Multiplan Commercial |
$4,680.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,510.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,382.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,866.50
|
| Rate for Payer: Quartz Commercial |
$3,802.50
|
| Rate for Payer: Quartz Medicare Advantage |
$3,510.00
|
| Rate for Payer: The Alliance Commercial |
$2,925.00
|
| Rate for Payer: WEA Trust Commercial |
$3,217.50
|
| Rate for Payer: WPS Commercial |
$4,332.94
|
|
|
ACETABULAR LINER PINNACLE 36MM 64MM 1221-36-064
|
Facility
|
OP
|
$5,391.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6182538
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,569.86 |
| Max. Negotiated Rate |
$5,158.11 |
| Rate for Payer: Aetna Commercial |
$5,045.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,821.71
|
| Rate for Payer: Aetna Managed Medicare |
$1,569.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,644.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,803.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,691.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,971.52
|
| Rate for Payer: Cash Price |
$1,617.30
|
| Rate for Payer: Cigna Commercial |
$5,158.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,137.56
|
| Rate for Payer: Health EOS Commercial |
$4,989.91
|
| Rate for Payer: HFN Commercial |
$5,158.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,204.98
|
| Rate for Payer: Multiplan Commercial |
$4,485.31
|
| Rate for Payer: NAPHCARE Commercial |
$3,363.98
|
| Rate for Payer: Preferred Network Access Commercial |
$5,158.11
|
| Rate for Payer: Quartz Beloit One Network |
$2,747.25
|
| Rate for Payer: Quartz Commercial |
$3,644.32
|
| Rate for Payer: Quartz Medicare Advantage |
$3,363.98
|
| Rate for Payer: The Alliance Commercial |
$2,803.32
|
| Rate for Payer: WEA Trust Commercial |
$3,083.65
|
| Rate for Payer: WPS Commercial |
$4,152.69
|
|
|
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 |
$2,747.25 |
| Max. Negotiated Rate |
$5,158.11 |
| Rate for Payer: Aetna Commercial |
$5,045.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,821.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,971.52
|
| Rate for Payer: Cash Price |
$1,617.30
|
| Rate for Payer: Cigna Commercial |
$5,158.11
|
| Rate for Payer: Health EOS Commercial |
$4,989.91
|
| Rate for Payer: HFN Commercial |
$5,158.11
|
| Rate for Payer: Multiplan Commercial |
$4,485.31
|
| Rate for Payer: Preferred Network Access Commercial |
$5,158.11
|
| Rate for Payer: Quartz Beloit One Network |
$2,747.25
|
| Rate for Payer: Quartz Commercial |
$3,363.98
|
| Rate for Payer: WEA Trust Commercial |
$3,083.65
|
| Rate for Payer: WPS Commercial |
$4,152.69
|
|
|
ACETABULAR LINER PINNACLE 36MM 64MM +4 NEUTRAL 1221-36-464
|
Facility
|
OP
|
$191.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6181679
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$55.62 |
| Max. Negotiated Rate |
$182.75 |
| Rate for Payer: Aetna Commercial |
$178.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$170.83
|
| Rate for Payer: Aetna Managed Medicare |
$55.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$129.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$99.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$95.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$105.28
|
| Rate for Payer: Cash Price |
$57.30
|
| Rate for Payer: Cigna Commercial |
$182.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$111.16
|
| Rate for Payer: Health EOS Commercial |
$176.79
|
| Rate for Payer: HFN Commercial |
$182.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$148.98
|
| Rate for Payer: Multiplan Commercial |
$158.91
|
| Rate for Payer: NAPHCARE Commercial |
$119.18
|
| Rate for Payer: Preferred Network Access Commercial |
$182.75
|
| Rate for Payer: Quartz Beloit One Network |
$97.33
|
| Rate for Payer: Quartz Commercial |
$129.12
|
| Rate for Payer: Quartz Medicare Advantage |
$119.18
|
| Rate for Payer: The Alliance Commercial |
$99.32
|
| Rate for Payer: WEA Trust Commercial |
$109.25
|
| Rate for Payer: WPS Commercial |
$147.13
|
|
