|
ACETABULAR SHELL PINNACLE 22MM 60MM 1217-22-060
|
Facility
IP
|
$8,530.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5497007
|
|
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 60MM 1217-22-060
|
Facility
OP
|
$8,530.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5497007
|
|
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 62MM 1217-22-062
|
Facility
IP
|
$8,215.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5547325
|
|
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 62MM 1217-22-062
|
Facility
OP
|
$8,215.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5547325
|
|
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 64MM 1217-22-064
|
Facility
OP
|
$6,064.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6181296
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,697.92 |
| Max. Negotiated Rate |
$5,578.88 |
| Rate for Payer: Aetna Commercial |
$5,457.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,215.04
|
| Rate for Payer: Aetna Managed Medicare |
$1,697.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,941.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,032.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,910.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,213.92
|
| Rate for Payer: Cash Price |
$1,819.20
|
| Rate for Payer: Cigna Commercial |
$5,578.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,393.41
|
| Rate for Payer: Health EOS Commercial |
$5,396.96
|
| Rate for Payer: HFN Commercial |
$5,578.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,548.00
|
| Rate for Payer: Multiplan Commercial |
$4,851.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,638.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,578.88
|
| Rate for Payer: Quartz Beloit One Network |
$2,971.36
|
| Rate for Payer: Quartz Commercial |
$3,941.60
|
| Rate for Payer: Quartz Medicare Advantage |
$3,638.40
|
| Rate for Payer: WEA Trust Commercial |
$3,335.20
|
| Rate for Payer: WPS Commercial |
$4,491.60
|
|
|
ACETABULAR SHELL PINNACLE 22MM 64MM 1217-22-064
|
Facility
IP
|
$6,064.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6181296
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,971.36 |
| Max. Negotiated Rate |
$5,578.88 |
| Rate for Payer: Aetna Commercial |
$5,457.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,213.92
|
| Rate for Payer: Cash Price |
$1,819.20
|
| Rate for Payer: Cigna Commercial |
$5,578.88
|
| Rate for Payer: Health EOS Commercial |
$5,396.96
|
| Rate for Payer: HFN Commercial |
$5,578.88
|
| Rate for Payer: Multiplan Commercial |
$4,851.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,638.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,578.88
|
| Rate for Payer: Quartz Beloit One Network |
$2,971.36
|
| Rate for Payer: Quartz Commercial |
$3,638.40
|
| Rate for Payer: WEA Trust Commercial |
$3,335.20
|
| Rate for Payer: WPS Commercial |
$4,491.60
|
|
|
ACETABULAR SHELL PINNACLE 32MM 48MM 1217-32-048
|
Facility
OP
|
$5,466.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5831739
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,530.48 |
| Max. Negotiated Rate |
$5,028.72 |
| Rate for Payer: Aetna Commercial |
$4,919.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,700.76
|
| Rate for Payer: Aetna Managed Medicare |
$1,530.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,552.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,733.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,623.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,896.98
|
| Rate for Payer: Cash Price |
$1,639.80
|
| Rate for Payer: Cigna Commercial |
$5,028.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,058.77
|
| Rate for Payer: Health EOS Commercial |
$4,864.74
|
| Rate for Payer: HFN Commercial |
$5,028.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,099.50
|
| Rate for Payer: Multiplan Commercial |
$4,372.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,279.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,028.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,678.34
|
| Rate for Payer: Quartz Commercial |
$3,552.90
|
| Rate for Payer: Quartz Medicare Advantage |
$3,279.60
|
| Rate for Payer: WEA Trust Commercial |
$3,006.30
|
| Rate for Payer: WPS Commercial |
$4,048.67
|
|
|
ACETABULAR SHELL PINNACLE 32MM 48MM 1217-32-048
|
Facility
IP
|
$5,466.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5831739
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,678.34 |
| Max. Negotiated Rate |
$5,028.72 |
| Rate for Payer: Aetna Commercial |
$4,919.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,896.98
|
| Rate for Payer: Cash Price |
$1,639.80
|
| Rate for Payer: Cigna Commercial |
$5,028.72
|
| Rate for Payer: Health EOS Commercial |
$4,864.74
|
| Rate for Payer: HFN Commercial |
$5,028.72
|
| Rate for Payer: Multiplan Commercial |
$4,372.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,279.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,028.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,678.34
|
| Rate for Payer: Quartz Commercial |
$3,279.60
|
| Rate for Payer: WEA Trust Commercial |
$3,006.30
|
| Rate for Payer: WPS Commercial |
$4,048.67
|
|
|
ACETABULAR SHELL PINNACLE 32MM 52MM 1217-32-052
|
Facility
OP
|
$8,215.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5459454
|
|
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 32MM 52MM 1217-32-052
|
Facility
IP
|
$8,215.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5459454
|
|
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 32MM 56MM 1217-32-056
|
Facility
IP
|
$8,215.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5459757
|
|
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 32MM 56MM 1217-32-056
|
Facility
OP
|
$8,215.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5459757
|
|
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 32MM 58MM 1217-32-058
|
Facility
OP
|
$5,850.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563222
|
|
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 |
$1,755.00
|
| Rate for Payer: Cigna Commercial |
$5,382.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,273.66
|
| 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: WEA Trust Commercial |
$3,217.50
|
| Rate for Payer: WPS Commercial |
$4,333.10
|
|
|
ACETABULAR SHELL PINNACLE 32MM 58MM 1217-32-058
|
Facility
IP
|
$5,850.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563222
|
|
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: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,100.50
|
| Rate for Payer: Cash Price |
$1,755.00
|
| 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: 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 |
$3,510.00
|
| Rate for Payer: WEA Trust Commercial |
$3,217.50
|
| Rate for Payer: WPS Commercial |
$4,333.10
|
|
|
ACETABULAR SHELL PINNACLE 32MM 60MM 1217-32-060
|
Facility
OP
|
$8,215.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5496874
|
|
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 32MM 60MM 1217-32-060
|
Facility
IP
|
$8,215.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5496874
|
|
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 32MM 62MM 1217-32-062
|
Facility
OP
|
$5,054.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6202962
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,415.12 |
| Max. Negotiated Rate |
$4,649.68 |
| Rate for Payer: Aetna Commercial |
$4,548.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,346.44
|
| Rate for Payer: Aetna Managed Medicare |
$1,415.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,285.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,527.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,425.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,678.62
|
| Rate for Payer: Cash Price |
$1,516.20
|
| Rate for Payer: Cigna Commercial |
$4,649.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,828.22
|
| Rate for Payer: Health EOS Commercial |
$4,498.06
|
| Rate for Payer: HFN Commercial |
$4,649.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,790.50
|
| Rate for Payer: Multiplan Commercial |
$4,043.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,032.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,649.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,476.46
|
| Rate for Payer: Quartz Commercial |
$3,285.10
|
| Rate for Payer: Quartz Medicare Advantage |
$3,032.40
|
| Rate for Payer: WEA Trust Commercial |
$2,779.70
|
| Rate for Payer: WPS Commercial |
$3,743.50
|
|
|
ACETABULAR SHELL PINNACLE 32MM 62MM 1217-32-062
|
Facility
IP
|
$5,054.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6202962
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,476.46 |
| Max. Negotiated Rate |
$4,649.68 |
| Rate for Payer: Aetna Commercial |
$4,548.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,678.62
|
| Rate for Payer: Cash Price |
$1,516.20
|
| Rate for Payer: Cigna Commercial |
$4,649.68
|
| Rate for Payer: Health EOS Commercial |
$4,498.06
|
| Rate for Payer: HFN Commercial |
$4,649.68
|
| Rate for Payer: Multiplan Commercial |
$4,043.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,032.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,649.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,476.46
|
| Rate for Payer: Quartz Commercial |
$3,032.40
|
| Rate for Payer: WEA Trust Commercial |
$2,779.70
|
| Rate for Payer: WPS Commercial |
$3,743.50
|
|
|
ACETABULAR SHELL PINNACLE 32MM 64MM 1217-32-064
|
Facility
IP
|
$5,054.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6182536
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,476.46 |
| Max. Negotiated Rate |
$4,649.68 |
| Rate for Payer: Aetna Commercial |
$4,548.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,678.62
|
| Rate for Payer: Cash Price |
$1,516.20
|
| Rate for Payer: Cigna Commercial |
$4,649.68
|
| Rate for Payer: Health EOS Commercial |
$4,498.06
|
| Rate for Payer: HFN Commercial |
$4,649.68
|
| Rate for Payer: Multiplan Commercial |
$4,043.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,032.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,649.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,476.46
|
| Rate for Payer: Quartz Commercial |
$3,032.40
|
| Rate for Payer: WEA Trust Commercial |
$2,779.70
|
| Rate for Payer: WPS Commercial |
$3,743.50
|
|
|
ACETABULAR SHELL PINNACLE 32MM 64MM 1217-32-064
|
Facility
OP
|
$5,054.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6182536
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,415.12 |
| Max. Negotiated Rate |
$4,649.68 |
| Rate for Payer: Aetna Commercial |
$4,548.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,346.44
|
| Rate for Payer: Aetna Managed Medicare |
$1,415.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,285.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,527.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,425.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,678.62
|
| Rate for Payer: Cash Price |
$1,516.20
|
| Rate for Payer: Cigna Commercial |
$4,649.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,828.22
|
| Rate for Payer: Health EOS Commercial |
$4,498.06
|
| Rate for Payer: HFN Commercial |
$4,649.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,790.50
|
| Rate for Payer: Multiplan Commercial |
$4,043.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,032.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,649.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,476.46
|
| Rate for Payer: Quartz Commercial |
$3,285.10
|
| Rate for Payer: Quartz Medicare Advantage |
$3,032.40
|
| Rate for Payer: WEA Trust Commercial |
$2,779.70
|
| Rate for Payer: WPS Commercial |
$3,743.50
|
|
|
ACETABULAR SHELL PINNACLE GRIPTION 48MM 1217-30-048
|
Facility
IP
|
$22,068.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5603542
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,813.32 |
| Max. Negotiated Rate |
$20,302.56 |
| Rate for Payer: Aetna Commercial |
$19,861.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,696.04
|
| Rate for Payer: Cash Price |
$6,620.40
|
| Rate for Payer: Cigna Commercial |
$20,302.56
|
| Rate for Payer: Health EOS Commercial |
$19,640.52
|
| Rate for Payer: HFN Commercial |
$20,302.56
|
| Rate for Payer: Multiplan Commercial |
$17,654.40
|
| Rate for Payer: NAPHCARE Commercial |
$13,240.80
|
| Rate for Payer: Preferred Network Access Commercial |
$20,302.56
|
| Rate for Payer: Quartz Beloit One Network |
$10,813.32
|
| Rate for Payer: Quartz Commercial |
$13,240.80
|
| Rate for Payer: WEA Trust Commercial |
$12,137.40
|
| Rate for Payer: WPS Commercial |
$16,345.77
|
|
|
ACETABULAR SHELL PINNACLE GRIPTION 48MM 1217-30-048
|
Facility
OP
|
$22,068.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5603542
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,179.04 |
| Max. Negotiated Rate |
$20,302.56 |
| Rate for Payer: Aetna Commercial |
$19,861.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,978.48
|
| Rate for Payer: Aetna Managed Medicare |
$6,179.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14,344.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,034.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,592.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,696.04
|
| Rate for Payer: Cash Price |
$6,620.40
|
| Rate for Payer: Cigna Commercial |
$20,302.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.25
|
| Rate for Payer: Health EOS Commercial |
$19,640.52
|
| Rate for Payer: HFN Commercial |
$20,302.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16,551.00
|
| Rate for Payer: Multiplan Commercial |
$17,654.40
|
| Rate for Payer: NAPHCARE Commercial |
$13,240.80
|
| Rate for Payer: Preferred Network Access Commercial |
$20,302.56
|
| Rate for Payer: Quartz Beloit One Network |
$10,813.32
|
| Rate for Payer: Quartz Commercial |
$14,344.20
|
| Rate for Payer: Quartz Medicare Advantage |
$13,240.80
|
| Rate for Payer: WEA Trust Commercial |
$12,137.40
|
| Rate for Payer: WPS Commercial |
$16,345.77
|
|
|
ACETABULAR SHELL PINNACLE GRIPTION 56MM 1217-30-056
|
Facility
OP
|
$19,618.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6181255
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,493.04 |
| Max. Negotiated Rate |
$18,048.56 |
| Rate for Payer: Aetna Commercial |
$17,656.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,871.48
|
| Rate for Payer: Aetna Managed Medicare |
$5,493.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,751.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,809.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,416.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,397.54
|
| Rate for Payer: Cash Price |
$5,885.40
|
| Rate for Payer: Cigna Commercial |
$18,048.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,978.23
|
| Rate for Payer: Health EOS Commercial |
$17,460.02
|
| Rate for Payer: HFN Commercial |
$18,048.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,713.50
|
| Rate for Payer: Multiplan Commercial |
$15,694.40
|
| Rate for Payer: NAPHCARE Commercial |
$11,770.80
|
| Rate for Payer: Preferred Network Access Commercial |
$18,048.56
|
| Rate for Payer: Quartz Beloit One Network |
$9,612.82
|
| Rate for Payer: Quartz Commercial |
$12,751.70
|
| Rate for Payer: Quartz Medicare Advantage |
$11,770.80
|
| Rate for Payer: WEA Trust Commercial |
$10,789.90
|
| Rate for Payer: WPS Commercial |
$14,531.05
|
|
|
ACETABULAR SHELL PINNACLE GRIPTION 56MM 1217-30-056
|
Facility
IP
|
$19,618.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6181255
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,612.82 |
| Max. Negotiated Rate |
$18,048.56 |
| Rate for Payer: Aetna Commercial |
$17,656.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,397.54
|
| Rate for Payer: Cash Price |
$5,885.40
|
| Rate for Payer: Cigna Commercial |
$18,048.56
|
| Rate for Payer: Health EOS Commercial |
$17,460.02
|
| Rate for Payer: HFN Commercial |
$18,048.56
|
| Rate for Payer: Multiplan Commercial |
$15,694.40
|
| Rate for Payer: NAPHCARE Commercial |
$11,770.80
|
| Rate for Payer: Preferred Network Access Commercial |
$18,048.56
|
| Rate for Payer: Quartz Beloit One Network |
$9,612.82
|
| Rate for Payer: Quartz Commercial |
$11,770.80
|
| Rate for Payer: WEA Trust Commercial |
$10,789.90
|
| Rate for Payer: WPS Commercial |
$14,531.05
|
|
|
ACETABULAR SHELL PINNACLE GRIPTION 58MM 1217-30-058
|
Facility
OP
|
$21,219.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5895655
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,941.32 |
| Max. Negotiated Rate |
$19,521.48 |
| Rate for Payer: Aetna Commercial |
$19,097.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,248.34
|
| Rate for Payer: Aetna Managed Medicare |
$5,941.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,792.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,609.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,185.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,246.07
|
| Rate for Payer: Cash Price |
$6,365.70
|
| Rate for Payer: Cigna Commercial |
$19,521.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.15
|
| Rate for Payer: Health EOS Commercial |
$18,884.91
|
| Rate for Payer: HFN Commercial |
$19,521.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,914.25
|
| Rate for Payer: Multiplan Commercial |
$16,975.20
|
| Rate for Payer: NAPHCARE Commercial |
$12,731.40
|
| Rate for Payer: Preferred Network Access Commercial |
$19,521.48
|
| Rate for Payer: Quartz Beloit One Network |
$10,397.31
|
| Rate for Payer: Quartz Commercial |
$13,792.35
|
| Rate for Payer: Quartz Medicare Advantage |
$12,731.40
|
| Rate for Payer: WEA Trust Commercial |
$11,670.45
|
| Rate for Payer: WPS Commercial |
$15,716.91
|
|
