|
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 |
$1,509.48 |
| Max. Negotiated Rate |
$4,959.72 |
| Rate for Payer: Aetna Commercial |
$4,851.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,636.26
|
| Rate for Payer: Aetna Managed Medicare |
$1,509.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,504.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,695.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,587.68
|
| 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: Dean Health DHI/DHP/ASO |
$3,016.80
|
| Rate for Payer: Health EOS Commercial |
$4,797.99
|
| Rate for Payer: HFN Commercial |
$4,959.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,043.25
|
| 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 |
$3,504.15
|
| Rate for Payer: Quartz Medicare Advantage |
$3,234.60
|
| Rate for Payer: WEA Trust Commercial |
$2,965.05
|
| Rate for Payer: WPS Commercial |
$3,993.11
|
|
|
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 |
$53.48 |
| Max. Negotiated Rate |
$175.72 |
| Rate for Payer: Aetna Commercial |
$171.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$164.26
|
| Rate for Payer: Aetna Managed Medicare |
$53.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$124.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$95.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$91.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$101.23
|
| Rate for Payer: Cash Price |
$57.30
|
| Rate for Payer: Cigna Commercial |
$175.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$106.88
|
| Rate for Payer: Health EOS Commercial |
$169.99
|
| Rate for Payer: HFN Commercial |
$175.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$143.25
|
| Rate for Payer: Multiplan Commercial |
$152.80
|
| Rate for Payer: NAPHCARE Commercial |
$114.60
|
| Rate for Payer: Preferred Network Access Commercial |
$175.72
|
| Rate for Payer: Quartz Beloit One Network |
$93.59
|
| Rate for Payer: Quartz Commercial |
$124.15
|
| Rate for Payer: Quartz Medicare Advantage |
$114.60
|
| Rate for Payer: WEA Trust Commercial |
$105.05
|
| Rate for Payer: WPS Commercial |
$141.47
|
|
|
ACETABULAR LINER PINNACLE 36MM 64MM +4 NEUTRAL 1221-36-464
|
Facility
IP
|
$191.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6181679
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$93.59 |
| Max. Negotiated Rate |
$175.72 |
| Rate for Payer: Aetna Commercial |
$171.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$101.23
|
| Rate for Payer: Cash Price |
$57.30
|
| Rate for Payer: Cigna Commercial |
$175.72
|
| Rate for Payer: Health EOS Commercial |
$169.99
|
| Rate for Payer: HFN Commercial |
$175.72
|
| Rate for Payer: Multiplan Commercial |
$152.80
|
| Rate for Payer: NAPHCARE Commercial |
$114.60
|
| Rate for Payer: Preferred Network Access Commercial |
$175.72
|
| Rate for Payer: Quartz Beloit One Network |
$93.59
|
| Rate for Payer: Quartz Commercial |
$114.60
|
| Rate for Payer: WEA Trust Commercial |
$105.05
|
| Rate for Payer: WPS Commercial |
$141.47
|
|
|
ACETABULAR LINER PINNACLE 40MM 56MM +4 10 DEG 1221-40-156
|
Facility
IP
|
$5,391.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6198969
|
|
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
|
|
|
ACETABULAR LINER PINNACLE 40MM 56MM +4 10 DEG 1221-40-156
|
Facility
OP
|
$5,391.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6198969
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,509.48 |
| Max. Negotiated Rate |
$4,959.72 |
| Rate for Payer: Aetna Commercial |
$4,851.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,636.26
|
| Rate for Payer: Aetna Managed Medicare |
$1,509.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,504.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,695.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,587.68
|
| 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: Dean Health DHI/DHP/ASO |
$3,016.80
|
| Rate for Payer: Health EOS Commercial |
$4,797.99
|
| Rate for Payer: HFN Commercial |
$4,959.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,043.25
|
| 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 |
$3,504.15
|
| Rate for Payer: Quartz Medicare Advantage |
$3,234.60
|
| Rate for Payer: WEA Trust Commercial |
$2,965.05
|
| Rate for Payer: WPS Commercial |
$3,993.11
|
|
|
ACETABULAR SHELL G7 OSSEO 3HOLE 48MM C 010000661
|
Facility
OP
|
$5,255.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5685726
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,471.40 |
| Max. Negotiated Rate |
$4,834.60 |
| Rate for Payer: Aetna Commercial |
$4,729.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,519.30
|
| Rate for Payer: Aetna Managed Medicare |
$1,471.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,415.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,627.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,522.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,785.15
|
| Rate for Payer: Cash Price |
$1,576.50
|
| Rate for Payer: Cigna Commercial |
$4,834.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,940.70
|
| Rate for Payer: Health EOS Commercial |
$4,676.95
|
| Rate for Payer: HFN Commercial |
$4,834.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,941.25
|
| Rate for Payer: Multiplan Commercial |
$4,204.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,153.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,834.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,574.95
|
| Rate for Payer: Quartz Commercial |
$3,415.75
|
| Rate for Payer: Quartz Medicare Advantage |
$3,153.00
|
| Rate for Payer: WEA Trust Commercial |
$2,890.25
|
| Rate for Payer: WPS Commercial |
$3,892.38
|
|
|
ACETABULAR SHELL G7 OSSEO 3HOLE 48MM C 010000661
|
Facility
IP
|
$5,255.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5685726
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,574.95 |
| Max. Negotiated Rate |
$4,834.60 |
| Rate for Payer: Aetna Commercial |
$4,729.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,785.15
|
| Rate for Payer: Cash Price |
$1,576.50
|
| Rate for Payer: Cigna Commercial |
$4,834.60
|
| Rate for Payer: Health EOS Commercial |
$4,676.95
|
| Rate for Payer: HFN Commercial |
$4,834.60
|
| Rate for Payer: Multiplan Commercial |
$4,204.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,153.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,834.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,574.95
|
| Rate for Payer: Quartz Commercial |
$3,153.00
|
| Rate for Payer: WEA Trust Commercial |
$2,890.25
|
| Rate for Payer: WPS Commercial |
$3,892.38
|
|
|
ACETABULAR SHELL G7 OSSEO 3HOLE 50MM D 110010243
|
Facility
IP
|
$15,695.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5729665
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,690.55 |
| Max. Negotiated Rate |
$14,439.40 |
| Rate for Payer: Aetna Commercial |
$14,125.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,318.35
|
| Rate for Payer: Cash Price |
$4,708.50
|
| Rate for Payer: Cigna Commercial |
$14,439.40
|
| Rate for Payer: Health EOS Commercial |
$13,968.55
|
| Rate for Payer: HFN Commercial |
$14,439.40
|
| Rate for Payer: Multiplan Commercial |
$12,556.00
|
| Rate for Payer: NAPHCARE Commercial |
$9,417.00
|
| Rate for Payer: Preferred Network Access Commercial |
$14,439.40
|
| Rate for Payer: Quartz Beloit One Network |
$7,690.55
|
| Rate for Payer: Quartz Commercial |
$9,417.00
|
| Rate for Payer: WEA Trust Commercial |
$8,632.25
|
| Rate for Payer: WPS Commercial |
$11,625.29
|
|
|
ACETABULAR SHELL G7 OSSEO 3HOLE 50MM D 110010243
|
Facility
OP
|
$15,695.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5729665
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,394.60 |
| Max. Negotiated Rate |
$14,439.40 |
| Rate for Payer: Aetna Commercial |
$14,125.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,497.70
|
| Rate for Payer: Aetna Managed Medicare |
$4,394.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,201.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,847.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,533.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,318.35
|
| Rate for Payer: Cash Price |
$4,708.50
|
| Rate for Payer: Cigna Commercial |
$14,439.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,782.92
|
| Rate for Payer: Health EOS Commercial |
$13,968.55
|
| Rate for Payer: HFN Commercial |
$14,439.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,771.25
|
| Rate for Payer: Multiplan Commercial |
$12,556.00
|
| Rate for Payer: NAPHCARE Commercial |
$9,417.00
|
| Rate for Payer: Preferred Network Access Commercial |
$14,439.40
|
| Rate for Payer: Quartz Beloit One Network |
$7,690.55
|
| Rate for Payer: Quartz Commercial |
$10,201.75
|
| Rate for Payer: Quartz Medicare Advantage |
$9,417.00
|
| Rate for Payer: WEA Trust Commercial |
$8,632.25
|
| Rate for Payer: WPS Commercial |
$11,625.29
|
|
|
ACETABULAR SHELL G7 OSSEO 3HOLE 52MM E 110010244
|
Facility
OP
|
$15,695.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5729663
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,394.60 |
| Max. Negotiated Rate |
$14,439.40 |
| Rate for Payer: Aetna Commercial |
$14,125.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,497.70
|
| Rate for Payer: Aetna Managed Medicare |
$4,394.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,201.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,847.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,533.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,318.35
|
| Rate for Payer: Cash Price |
$4,708.50
|
| Rate for Payer: Cigna Commercial |
$14,439.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,782.92
|
| Rate for Payer: Health EOS Commercial |
$13,968.55
|
| Rate for Payer: HFN Commercial |
$14,439.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,771.25
|
| Rate for Payer: Multiplan Commercial |
$12,556.00
|
| Rate for Payer: NAPHCARE Commercial |
$9,417.00
|
| Rate for Payer: Preferred Network Access Commercial |
$14,439.40
|
| Rate for Payer: Quartz Beloit One Network |
$7,690.55
|
| Rate for Payer: Quartz Commercial |
$10,201.75
|
| Rate for Payer: Quartz Medicare Advantage |
$9,417.00
|
| Rate for Payer: WEA Trust Commercial |
$8,632.25
|
| Rate for Payer: WPS Commercial |
$11,625.29
|
|
|
ACETABULAR SHELL G7 OSSEO 3HOLE 52MM E 110010244
|
Facility
IP
|
$15,695.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5729663
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,690.55 |
| Max. Negotiated Rate |
$14,439.40 |
| Rate for Payer: Aetna Commercial |
$14,125.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,318.35
|
| Rate for Payer: Cash Price |
$4,708.50
|
| Rate for Payer: Cigna Commercial |
$14,439.40
|
| Rate for Payer: Health EOS Commercial |
$13,968.55
|
| Rate for Payer: HFN Commercial |
$14,439.40
|
| Rate for Payer: Multiplan Commercial |
$12,556.00
|
| Rate for Payer: NAPHCARE Commercial |
$9,417.00
|
| Rate for Payer: Preferred Network Access Commercial |
$14,439.40
|
| Rate for Payer: Quartz Beloit One Network |
$7,690.55
|
| Rate for Payer: Quartz Commercial |
$9,417.00
|
| Rate for Payer: WEA Trust Commercial |
$8,632.25
|
| Rate for Payer: WPS Commercial |
$11,625.29
|
|
|
ACETABULAR SHELL G7 OSSEO TI 4HL 110010245
|
Facility
IP
|
$15,695.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5861663
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,690.55 |
| Max. Negotiated Rate |
$14,439.40 |
| Rate for Payer: Aetna Commercial |
$14,125.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,318.35
|
| Rate for Payer: Cash Price |
$4,708.50
|
| Rate for Payer: Cigna Commercial |
$14,439.40
|
| Rate for Payer: Health EOS Commercial |
$13,968.55
|
| Rate for Payer: HFN Commercial |
$14,439.40
|
| Rate for Payer: Multiplan Commercial |
$12,556.00
|
| Rate for Payer: NAPHCARE Commercial |
$9,417.00
|
| Rate for Payer: Preferred Network Access Commercial |
$14,439.40
|
| Rate for Payer: Quartz Beloit One Network |
$7,690.55
|
| Rate for Payer: Quartz Commercial |
$9,417.00
|
| Rate for Payer: WEA Trust Commercial |
$8,632.25
|
| Rate for Payer: WPS Commercial |
$11,625.29
|
|
|
ACETABULAR SHELL G7 OSSEO TI 4HL 110010245
|
Facility
OP
|
$15,695.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5861663
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,394.60 |
| Max. Negotiated Rate |
$14,439.40 |
| Rate for Payer: Aetna Commercial |
$14,125.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,497.70
|
| Rate for Payer: Aetna Managed Medicare |
$4,394.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,201.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,847.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,533.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,318.35
|
| Rate for Payer: Cash Price |
$4,708.50
|
| Rate for Payer: Cigna Commercial |
$14,439.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,782.92
|
| Rate for Payer: Health EOS Commercial |
$13,968.55
|
| Rate for Payer: HFN Commercial |
$14,439.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,771.25
|
| Rate for Payer: Multiplan Commercial |
$12,556.00
|
| Rate for Payer: NAPHCARE Commercial |
$9,417.00
|
| Rate for Payer: Preferred Network Access Commercial |
$14,439.40
|
| Rate for Payer: Quartz Beloit One Network |
$7,690.55
|
| Rate for Payer: Quartz Commercial |
$10,201.75
|
| Rate for Payer: Quartz Medicare Advantage |
$9,417.00
|
| Rate for Payer: WEA Trust Commercial |
$8,632.25
|
| Rate for Payer: WPS Commercial |
$11,625.29
|
|
|
ACETABULAR SHELL PINNACLE 22MM 48MM 1217-22-048
|
Facility
OP
|
$8,215.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5497001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,300.20 |
| Max. Negotiated Rate |
$7,557.80 |
| Rate for Payer: Aetna Commercial |
$7,393.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,064.90
|
| Rate for Payer: Aetna Managed Medicare |
$2,300.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,339.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,107.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,943.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,353.95
|
| Rate for Payer: Cash Price |
$2,464.50
|
| Rate for Payer: Cigna Commercial |
$7,557.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,597.11
|
| Rate for Payer: Health EOS Commercial |
$7,311.35
|
| Rate for Payer: HFN Commercial |
$7,557.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,161.25
|
| Rate for Payer: Multiplan Commercial |
$6,572.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,929.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,557.80
|
| Rate for Payer: Quartz Beloit One Network |
$4,025.35
|
| Rate for Payer: Quartz Commercial |
$5,339.75
|
| Rate for Payer: Quartz Medicare Advantage |
$4,929.00
|
| Rate for Payer: WEA Trust Commercial |
$4,518.25
|
| Rate for Payer: WPS Commercial |
$6,084.85
|
|
|
ACETABULAR SHELL PINNACLE 22MM 48MM 1217-22-048
|
Facility
IP
|
$8,215.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5497001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,025.35 |
| Max. Negotiated Rate |
$7,557.80 |
| Rate for Payer: Aetna Commercial |
$7,393.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,353.95
|
| Rate for Payer: Cash Price |
$2,464.50
|
| Rate for Payer: Cigna Commercial |
$7,557.80
|
| Rate for Payer: Health EOS Commercial |
$7,311.35
|
| Rate for Payer: HFN Commercial |
$7,557.80
|
| Rate for Payer: Multiplan Commercial |
$6,572.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,929.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,557.80
|
| Rate for Payer: Quartz Beloit One Network |
$4,025.35
|
| Rate for Payer: Quartz Commercial |
$4,929.00
|
| Rate for Payer: WEA Trust Commercial |
$4,518.25
|
| Rate for Payer: WPS Commercial |
$6,084.85
|
|
|
ACETABULAR SHELL PINNACLE 22MM 50MM 1217-22-050
|
Facility
IP
|
$8,530.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5459304
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,179.70 |
| Max. Negotiated Rate |
$7,847.60 |
| Rate for Payer: Aetna Commercial |
$7,677.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,520.90
|
| Rate for Payer: Cash Price |
$2,559.00
|
| Rate for Payer: Cigna Commercial |
$7,847.60
|
| Rate for Payer: Health EOS Commercial |
$7,591.70
|
| Rate for Payer: HFN Commercial |
$7,847.60
|
| Rate for Payer: Multiplan Commercial |
$6,824.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,118.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,847.60
|
| Rate for Payer: Quartz Beloit One Network |
$4,179.70
|
| Rate for Payer: Quartz Commercial |
$5,118.00
|
| Rate for Payer: WEA Trust Commercial |
$4,691.50
|
| Rate for Payer: WPS Commercial |
$6,318.17
|
|
|
ACETABULAR SHELL PINNACLE 22MM 50MM 1217-22-050
|
Facility
OP
|
$8,530.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5459304
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,388.40 |
| Max. Negotiated Rate |
$7,847.60 |
| Rate for Payer: Aetna Commercial |
$7,677.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,335.80
|
| Rate for Payer: Aetna Managed Medicare |
$2,388.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,544.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,265.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,094.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,520.90
|
| Rate for Payer: Cash Price |
$2,559.00
|
| Rate for Payer: Cigna Commercial |
$7,847.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,773.39
|
| Rate for Payer: Health EOS Commercial |
$7,591.70
|
| Rate for Payer: HFN Commercial |
$7,847.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,397.50
|
| Rate for Payer: Multiplan Commercial |
$6,824.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,118.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,847.60
|
| Rate for Payer: Quartz Beloit One Network |
$4,179.70
|
| Rate for Payer: Quartz Commercial |
$5,544.50
|
| Rate for Payer: Quartz Medicare Advantage |
$5,118.00
|
| Rate for Payer: WEA Trust Commercial |
$4,691.50
|
| Rate for Payer: WPS Commercial |
$6,318.17
|
|
|
ACETABULAR SHELL PINNACLE 22MM 52MM 1217-22-052
|
Facility
IP
|
$8,530.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5459683
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,179.70 |
| Max. Negotiated Rate |
$7,847.60 |
| Rate for Payer: Aetna Commercial |
$7,677.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,520.90
|
| Rate for Payer: Cash Price |
$2,559.00
|
| Rate for Payer: Cigna Commercial |
$7,847.60
|
| Rate for Payer: Health EOS Commercial |
$7,591.70
|
| Rate for Payer: HFN Commercial |
$7,847.60
|
| Rate for Payer: Multiplan Commercial |
$6,824.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,118.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,847.60
|
| Rate for Payer: Quartz Beloit One Network |
$4,179.70
|
| Rate for Payer: Quartz Commercial |
$5,118.00
|
| Rate for Payer: WEA Trust Commercial |
$4,691.50
|
| Rate for Payer: WPS Commercial |
$6,318.17
|
|
|
ACETABULAR SHELL PINNACLE 22MM 52MM 1217-22-052
|
Facility
OP
|
$8,530.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5459683
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,388.40 |
| Max. Negotiated Rate |
$7,847.60 |
| Rate for Payer: Aetna Commercial |
$7,677.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,335.80
|
| Rate for Payer: Aetna Managed Medicare |
$2,388.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,544.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,265.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,094.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,520.90
|
| Rate for Payer: Cash Price |
$2,559.00
|
| Rate for Payer: Cigna Commercial |
$7,847.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,773.39
|
| Rate for Payer: Health EOS Commercial |
$7,591.70
|
| Rate for Payer: HFN Commercial |
$7,847.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,397.50
|
| Rate for Payer: Multiplan Commercial |
$6,824.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,118.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,847.60
|
| Rate for Payer: Quartz Beloit One Network |
$4,179.70
|
| Rate for Payer: Quartz Commercial |
$5,544.50
|
| Rate for Payer: Quartz Medicare Advantage |
$5,118.00
|
| Rate for Payer: WEA Trust Commercial |
$4,691.50
|
| Rate for Payer: WPS Commercial |
$6,318.17
|
|
|
ACETABULAR SHELL PINNACLE 22MM 54MM 1217-22-054
|
Facility
IP
|
$8,530.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5496774
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,179.70 |
| Max. Negotiated Rate |
$7,847.60 |
| Rate for Payer: Aetna Commercial |
$7,677.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,520.90
|
| Rate for Payer: Cash Price |
$2,559.00
|
| Rate for Payer: Cigna Commercial |
$7,847.60
|
| Rate for Payer: Health EOS Commercial |
$7,591.70
|
| Rate for Payer: HFN Commercial |
$7,847.60
|
| Rate for Payer: Multiplan Commercial |
$6,824.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,118.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,847.60
|
| Rate for Payer: Quartz Beloit One Network |
$4,179.70
|
| Rate for Payer: Quartz Commercial |
$5,118.00
|
| Rate for Payer: WEA Trust Commercial |
$4,691.50
|
| Rate for Payer: WPS Commercial |
$6,318.17
|
|
|
ACETABULAR SHELL PINNACLE 22MM 54MM 1217-22-054
|
Facility
OP
|
$8,530.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5496774
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,388.40 |
| Max. Negotiated Rate |
$7,847.60 |
| Rate for Payer: Aetna Commercial |
$7,677.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,335.80
|
| Rate for Payer: Aetna Managed Medicare |
$2,388.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,544.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,265.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,094.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,520.90
|
| Rate for Payer: Cash Price |
$2,559.00
|
| Rate for Payer: Cigna Commercial |
$7,847.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,773.39
|
| Rate for Payer: Health EOS Commercial |
$7,591.70
|
| Rate for Payer: HFN Commercial |
$7,847.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,397.50
|
| Rate for Payer: Multiplan Commercial |
$6,824.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,118.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,847.60
|
| Rate for Payer: Quartz Beloit One Network |
$4,179.70
|
| Rate for Payer: Quartz Commercial |
$5,544.50
|
| Rate for Payer: Quartz Medicare Advantage |
$5,118.00
|
| Rate for Payer: WEA Trust Commercial |
$4,691.50
|
| Rate for Payer: WPS Commercial |
$6,318.17
|
|
|
ACETABULAR SHELL PINNACLE 22MM 56MM 1217-22-056
|
Facility
IP
|
$8,530.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5496771
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,179.70 |
| Max. Negotiated Rate |
$7,847.60 |
| Rate for Payer: Aetna Commercial |
$7,677.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,520.90
|
| Rate for Payer: Cash Price |
$2,559.00
|
| Rate for Payer: Cigna Commercial |
$7,847.60
|
| Rate for Payer: Health EOS Commercial |
$7,591.70
|
| Rate for Payer: HFN Commercial |
$7,847.60
|
| Rate for Payer: Multiplan Commercial |
$6,824.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,118.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,847.60
|
| Rate for Payer: Quartz Beloit One Network |
$4,179.70
|
| Rate for Payer: Quartz Commercial |
$5,118.00
|
| Rate for Payer: WEA Trust Commercial |
$4,691.50
|
| Rate for Payer: WPS Commercial |
$6,318.17
|
|
|
ACETABULAR SHELL PINNACLE 22MM 56MM 1217-22-056
|
Facility
OP
|
$8,530.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5496771
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,388.40 |
| Max. Negotiated Rate |
$7,847.60 |
| Rate for Payer: Aetna Commercial |
$7,677.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,335.80
|
| Rate for Payer: Aetna Managed Medicare |
$2,388.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,544.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,265.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,094.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,520.90
|
| Rate for Payer: Cash Price |
$2,559.00
|
| Rate for Payer: Cigna Commercial |
$7,847.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,773.39
|
| Rate for Payer: Health EOS Commercial |
$7,591.70
|
| Rate for Payer: HFN Commercial |
$7,847.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,397.50
|
| Rate for Payer: Multiplan Commercial |
$6,824.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,118.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,847.60
|
| Rate for Payer: Quartz Beloit One Network |
$4,179.70
|
| Rate for Payer: Quartz Commercial |
$5,544.50
|
| Rate for Payer: Quartz Medicare Advantage |
$5,118.00
|
| Rate for Payer: WEA Trust Commercial |
$4,691.50
|
| Rate for Payer: WPS Commercial |
$6,318.17
|
|
|
ACETABULAR SHELL PINNACLE 22MM 58MM 1217-22-058
|
Facility
OP
|
$8,215.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5496709
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,300.20 |
| Max. Negotiated Rate |
$7,557.80 |
| Rate for Payer: Aetna Commercial |
$7,393.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,064.90
|
| Rate for Payer: Aetna Managed Medicare |
$2,300.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,339.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,107.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,943.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,353.95
|
| Rate for Payer: Cash Price |
$2,464.50
|
| Rate for Payer: Cigna Commercial |
$7,557.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,597.11
|
| Rate for Payer: Health EOS Commercial |
$7,311.35
|
| Rate for Payer: HFN Commercial |
$7,557.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,161.25
|
| Rate for Payer: Multiplan Commercial |
$6,572.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,929.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,557.80
|
| Rate for Payer: Quartz Beloit One Network |
$4,025.35
|
| Rate for Payer: Quartz Commercial |
$5,339.75
|
| Rate for Payer: Quartz Medicare Advantage |
$4,929.00
|
| Rate for Payer: WEA Trust Commercial |
$4,518.25
|
| Rate for Payer: WPS Commercial |
$6,084.85
|
|
|
ACETABULAR SHELL PINNACLE 22MM 58MM 1217-22-058
|
Facility
IP
|
$8,215.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5496709
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,025.35 |
| Max. Negotiated Rate |
$7,557.80 |
| Rate for Payer: Aetna Commercial |
$7,393.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,353.95
|
| Rate for Payer: Cash Price |
$2,464.50
|
| Rate for Payer: Cigna Commercial |
$7,557.80
|
| Rate for Payer: Health EOS Commercial |
$7,311.35
|
| Rate for Payer: HFN Commercial |
$7,557.80
|
| Rate for Payer: Multiplan Commercial |
$6,572.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,929.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,557.80
|
| Rate for Payer: Quartz Beloit One Network |
$4,025.35
|
| Rate for Payer: Quartz Commercial |
$4,929.00
|
| Rate for Payer: WEA Trust Commercial |
$4,518.25
|
| Rate for Payer: WPS Commercial |
$6,084.85
|
|
