|
FEMORAL HEAD BIOLOX DELTA CERAMIC 28MM +3MM 650-1157
|
Facility
|
OP
|
$5,255.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5861671
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,530.26 |
| Max. Negotiated Rate |
$5,027.98 |
| Rate for Payer: Aetna Commercial |
$4,918.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,700.07
|
| Rate for Payer: Aetna Managed Medicare |
$1,530.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,552.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,732.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,623.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,896.56
|
| Rate for Payer: Cash Price |
$1,576.50
|
| Rate for Payer: Cigna Commercial |
$5,027.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,058.41
|
| Rate for Payer: Health EOS Commercial |
$4,864.03
|
| Rate for Payer: HFN Commercial |
$5,027.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,098.90
|
| Rate for Payer: Multiplan Commercial |
$4,372.16
|
| Rate for Payer: NAPHCARE Commercial |
$3,279.12
|
| Rate for Payer: Preferred Network Access Commercial |
$5,027.98
|
| Rate for Payer: Quartz Beloit One Network |
$2,677.95
|
| Rate for Payer: Quartz Commercial |
$3,552.38
|
| Rate for Payer: Quartz Medicare Advantage |
$3,279.12
|
| Rate for Payer: The Alliance Commercial |
$2,732.60
|
| Rate for Payer: WEA Trust Commercial |
$3,005.86
|
| Rate for Payer: WPS Commercial |
$4,047.93
|
|
|
FEMORAL HEAD BIOLOX DELTA CERAMIC 32MM +0MM 00-8775-032-02
|
Facility
|
IP
|
$7,948.00
|
|
| Hospital Charge Code |
4230457
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,050.30 |
| Max. Negotiated Rate |
$7,604.65 |
| Rate for Payer: Aetna Commercial |
$7,439.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,108.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,380.94
|
| Rate for Payer: Cash Price |
$2,384.40
|
| Rate for Payer: Cigna Commercial |
$7,604.65
|
| Rate for Payer: Health EOS Commercial |
$7,356.67
|
| Rate for Payer: HFN Commercial |
$7,604.65
|
| Rate for Payer: Multiplan Commercial |
$6,612.74
|
| Rate for Payer: Preferred Network Access Commercial |
$7,604.65
|
| Rate for Payer: Quartz Beloit One Network |
$4,050.30
|
| Rate for Payer: Quartz Commercial |
$4,959.55
|
| Rate for Payer: WEA Trust Commercial |
$4,546.26
|
| Rate for Payer: WPS Commercial |
$6,122.34
|
|
|
FEMORAL HEAD BIOLOX DELTA CERAMIC 32MM +0MM 00-8775-032-02
|
Facility
|
OP
|
$7,948.00
|
|
| Hospital Charge Code |
4230457
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,314.46 |
| Max. Negotiated Rate |
$7,604.65 |
| Rate for Payer: Aetna Commercial |
$7,439.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,108.69
|
| Rate for Payer: Aetna Managed Medicare |
$2,314.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,372.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,132.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,967.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,380.94
|
| Rate for Payer: Cash Price |
$2,384.40
|
| Rate for Payer: Cigna Commercial |
$7,604.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,625.74
|
| Rate for Payer: Health EOS Commercial |
$7,356.67
|
| Rate for Payer: HFN Commercial |
$7,604.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,199.44
|
| Rate for Payer: Multiplan Commercial |
$6,612.74
|
| Rate for Payer: NAPHCARE Commercial |
$4,959.55
|
| Rate for Payer: Preferred Network Access Commercial |
$7,604.65
|
| Rate for Payer: Quartz Beloit One Network |
$4,050.30
|
| Rate for Payer: Quartz Commercial |
$5,372.85
|
| Rate for Payer: Quartz Medicare Advantage |
$4,959.55
|
| Rate for Payer: The Alliance Commercial |
$4,132.96
|
| Rate for Payer: WEA Trust Commercial |
$4,546.26
|
| Rate for Payer: WPS Commercial |
$6,122.34
|
|
|
FEMORAL HEAD BIOLOX DELTA CERAMIC 32MM -3.5MM 00-8775-032-01
|
Facility
|
IP
|
$8,296.00
|
|
| Hospital Charge Code |
2967478
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,227.64 |
| Max. Negotiated Rate |
$7,937.61 |
| Rate for Payer: Aetna Commercial |
$7,765.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,419.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,572.76
|
| Rate for Payer: Cash Price |
$2,488.80
|
| Rate for Payer: Cigna Commercial |
$7,937.61
|
| Rate for Payer: Health EOS Commercial |
$7,678.78
|
| Rate for Payer: HFN Commercial |
$7,937.61
|
| Rate for Payer: Multiplan Commercial |
$6,902.27
|
| Rate for Payer: Preferred Network Access Commercial |
$7,937.61
|
| Rate for Payer: Quartz Beloit One Network |
$4,227.64
|
| Rate for Payer: Quartz Commercial |
$5,176.70
|
| Rate for Payer: WEA Trust Commercial |
$4,745.31
|
| Rate for Payer: WPS Commercial |
$6,390.41
|
|
|
FEMORAL HEAD BIOLOX DELTA CERAMIC 32MM -3.5MM 00-8775-032-01
|
Facility
|
OP
|
$8,296.00
|
|
| Hospital Charge Code |
2967478
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,415.80 |
| Max. Negotiated Rate |
$7,937.61 |
| Rate for Payer: Aetna Commercial |
$7,765.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,419.94
|
| Rate for Payer: Aetna Managed Medicare |
$2,415.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,608.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,313.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,141.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,572.76
|
| Rate for Payer: Cash Price |
$2,488.80
|
| Rate for Payer: Cigna Commercial |
$7,937.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,828.27
|
| Rate for Payer: Health EOS Commercial |
$7,678.78
|
| Rate for Payer: HFN Commercial |
$7,937.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,470.88
|
| Rate for Payer: Multiplan Commercial |
$6,902.27
|
| Rate for Payer: NAPHCARE Commercial |
$5,176.70
|
| Rate for Payer: Preferred Network Access Commercial |
$7,937.61
|
| Rate for Payer: Quartz Beloit One Network |
$4,227.64
|
| Rate for Payer: Quartz Commercial |
$5,608.10
|
| Rate for Payer: Quartz Medicare Advantage |
$5,176.70
|
| Rate for Payer: The Alliance Commercial |
$4,313.92
|
| Rate for Payer: WEA Trust Commercial |
$4,745.31
|
| Rate for Payer: WPS Commercial |
$6,390.41
|
|
|
FEMORAL HEAD BIOLOX DELTA CERAMIC 32MM +3.5MM 00-8775-032-03
|
Facility
|
IP
|
$7,653.00
|
|
| Hospital Charge Code |
4230458
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,899.97 |
| Max. Negotiated Rate |
$7,322.39 |
| Rate for Payer: Aetna Commercial |
$7,163.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,844.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,218.33
|
| Rate for Payer: Cash Price |
$2,295.90
|
| Rate for Payer: Cigna Commercial |
$7,322.39
|
| Rate for Payer: Health EOS Commercial |
$7,083.62
|
| Rate for Payer: HFN Commercial |
$7,322.39
|
| Rate for Payer: Multiplan Commercial |
$6,367.30
|
| Rate for Payer: Preferred Network Access Commercial |
$7,322.39
|
| Rate for Payer: Quartz Beloit One Network |
$3,899.97
|
| Rate for Payer: Quartz Commercial |
$4,775.47
|
| Rate for Payer: WEA Trust Commercial |
$4,377.52
|
| Rate for Payer: WPS Commercial |
$5,895.11
|
|
|
FEMORAL HEAD BIOLOX DELTA CERAMIC 32MM +3.5MM 00-8775-032-03
|
Facility
|
OP
|
$7,653.00
|
|
| Hospital Charge Code |
4230458
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,228.55 |
| Max. Negotiated Rate |
$7,322.39 |
| Rate for Payer: Aetna Commercial |
$7,163.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,844.84
|
| Rate for Payer: Aetna Managed Medicare |
$2,228.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,173.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,979.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,820.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,218.33
|
| Rate for Payer: Cash Price |
$2,295.90
|
| Rate for Payer: Cigna Commercial |
$7,322.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,454.05
|
| Rate for Payer: Health EOS Commercial |
$7,083.62
|
| Rate for Payer: HFN Commercial |
$7,322.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,969.34
|
| Rate for Payer: Multiplan Commercial |
$6,367.30
|
| Rate for Payer: NAPHCARE Commercial |
$4,775.47
|
| Rate for Payer: Preferred Network Access Commercial |
$7,322.39
|
| Rate for Payer: Quartz Beloit One Network |
$3,899.97
|
| Rate for Payer: Quartz Commercial |
$5,173.43
|
| Rate for Payer: Quartz Medicare Advantage |
$4,775.47
|
| Rate for Payer: The Alliance Commercial |
$3,979.56
|
| Rate for Payer: WEA Trust Commercial |
$4,377.52
|
| Rate for Payer: WPS Commercial |
$5,895.11
|
|
|
FEMORAL HEAD BIOLOX DELTA CERAMIC 32MM +7MM 00-8775-032-04
|
Facility
|
OP
|
$7,653.00
|
|
| Hospital Charge Code |
4230459
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,228.55 |
| Max. Negotiated Rate |
$7,322.39 |
| Rate for Payer: Aetna Commercial |
$7,163.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,844.84
|
| Rate for Payer: Aetna Managed Medicare |
$2,228.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,173.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,979.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,820.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,218.33
|
| Rate for Payer: Cash Price |
$2,295.90
|
| Rate for Payer: Cigna Commercial |
$7,322.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,454.05
|
| Rate for Payer: Health EOS Commercial |
$7,083.62
|
| Rate for Payer: HFN Commercial |
$7,322.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,969.34
|
| Rate for Payer: Multiplan Commercial |
$6,367.30
|
| Rate for Payer: NAPHCARE Commercial |
$4,775.47
|
| Rate for Payer: Preferred Network Access Commercial |
$7,322.39
|
| Rate for Payer: Quartz Beloit One Network |
$3,899.97
|
| Rate for Payer: Quartz Commercial |
$5,173.43
|
| Rate for Payer: Quartz Medicare Advantage |
$4,775.47
|
| Rate for Payer: The Alliance Commercial |
$3,979.56
|
| Rate for Payer: WEA Trust Commercial |
$4,377.52
|
| Rate for Payer: WPS Commercial |
$5,895.11
|
|
|
FEMORAL HEAD BIOLOX DELTA CERAMIC 32MM +7MM 00-8775-032-04
|
Facility
|
IP
|
$7,653.00
|
|
| Hospital Charge Code |
4230459
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,899.97 |
| Max. Negotiated Rate |
$7,322.39 |
| Rate for Payer: Aetna Commercial |
$7,163.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,844.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,218.33
|
| Rate for Payer: Cash Price |
$2,295.90
|
| Rate for Payer: Cigna Commercial |
$7,322.39
|
| Rate for Payer: Health EOS Commercial |
$7,083.62
|
| Rate for Payer: HFN Commercial |
$7,322.39
|
| Rate for Payer: Multiplan Commercial |
$6,367.30
|
| Rate for Payer: Preferred Network Access Commercial |
$7,322.39
|
| Rate for Payer: Quartz Beloit One Network |
$3,899.97
|
| Rate for Payer: Quartz Commercial |
$4,775.47
|
| Rate for Payer: WEA Trust Commercial |
$4,377.52
|
| Rate for Payer: WPS Commercial |
$5,895.11
|
|
|
FEMORAL HEAD BIOLOX DELTA CERAMIC 36MM +0MM 00-8775-036-02
|
Facility
|
OP
|
$7,948.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3529520
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,314.46 |
| Max. Negotiated Rate |
$7,604.65 |
| Rate for Payer: Aetna Commercial |
$7,439.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,108.69
|
| Rate for Payer: Aetna Managed Medicare |
$2,314.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,372.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,132.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,967.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,380.94
|
| Rate for Payer: Cash Price |
$2,384.40
|
| Rate for Payer: Cigna Commercial |
$7,604.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,625.74
|
| Rate for Payer: Health EOS Commercial |
$7,356.67
|
| Rate for Payer: HFN Commercial |
$7,604.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,199.44
|
| Rate for Payer: Multiplan Commercial |
$6,612.74
|
| Rate for Payer: NAPHCARE Commercial |
$4,959.55
|
| Rate for Payer: Preferred Network Access Commercial |
$7,604.65
|
| Rate for Payer: Quartz Beloit One Network |
$4,050.30
|
| Rate for Payer: Quartz Commercial |
$5,372.85
|
| Rate for Payer: Quartz Medicare Advantage |
$4,959.55
|
| Rate for Payer: The Alliance Commercial |
$4,132.96
|
| Rate for Payer: WEA Trust Commercial |
$4,546.26
|
| Rate for Payer: WPS Commercial |
$6,122.34
|
|
|
FEMORAL HEAD BIOLOX DELTA CERAMIC 36MM +0MM 00-8775-036-02
|
Facility
|
IP
|
$7,948.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3529520
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,050.30 |
| Max. Negotiated Rate |
$7,604.65 |
| Rate for Payer: Aetna Commercial |
$7,439.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,108.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,380.94
|
| Rate for Payer: Cash Price |
$2,384.40
|
| Rate for Payer: Cigna Commercial |
$7,604.65
|
| Rate for Payer: Health EOS Commercial |
$7,356.67
|
| Rate for Payer: HFN Commercial |
$7,604.65
|
| Rate for Payer: Multiplan Commercial |
$6,612.74
|
| Rate for Payer: Preferred Network Access Commercial |
$7,604.65
|
| Rate for Payer: Quartz Beloit One Network |
$4,050.30
|
| Rate for Payer: Quartz Commercial |
$4,959.55
|
| Rate for Payer: WEA Trust Commercial |
$4,546.26
|
| Rate for Payer: WPS Commercial |
$6,122.34
|
|
|
FEMORAL HEAD BIOLOX DELTA CERAMIC 36MM +0MM 6570-0-136
|
Facility
|
OP
|
$6,967.00
|
|
| Hospital Charge Code |
3937337
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,028.79 |
| Max. Negotiated Rate |
$6,666.03 |
| Rate for Payer: Aetna Commercial |
$6,521.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,231.28
|
| Rate for Payer: Aetna Managed Medicare |
$2,028.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,709.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,622.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,477.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,840.21
|
| Rate for Payer: Cash Price |
$2,090.10
|
| Rate for Payer: Cigna Commercial |
$6,666.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,054.79
|
| Rate for Payer: Health EOS Commercial |
$6,448.66
|
| Rate for Payer: HFN Commercial |
$6,666.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,434.26
|
| Rate for Payer: Multiplan Commercial |
$5,796.54
|
| Rate for Payer: NAPHCARE Commercial |
$4,347.41
|
| Rate for Payer: Preferred Network Access Commercial |
$6,666.03
|
| Rate for Payer: Quartz Beloit One Network |
$3,550.38
|
| Rate for Payer: Quartz Commercial |
$4,709.69
|
| Rate for Payer: Quartz Medicare Advantage |
$4,347.41
|
| Rate for Payer: The Alliance Commercial |
$3,622.84
|
| Rate for Payer: WEA Trust Commercial |
$3,985.12
|
| Rate for Payer: WPS Commercial |
$5,366.68
|
|
|
FEMORAL HEAD BIOLOX DELTA CERAMIC 36MM +0MM 6570-0-136
|
Facility
|
IP
|
$6,967.00
|
|
| Hospital Charge Code |
3937337
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,550.38 |
| Max. Negotiated Rate |
$6,666.03 |
| Rate for Payer: Aetna Commercial |
$6,521.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,231.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,840.21
|
| Rate for Payer: Cash Price |
$2,090.10
|
| Rate for Payer: Cigna Commercial |
$6,666.03
|
| Rate for Payer: Health EOS Commercial |
$6,448.66
|
| Rate for Payer: HFN Commercial |
$6,666.03
|
| Rate for Payer: Multiplan Commercial |
$5,796.54
|
| Rate for Payer: Preferred Network Access Commercial |
$6,666.03
|
| Rate for Payer: Quartz Beloit One Network |
$3,550.38
|
| Rate for Payer: Quartz Commercial |
$4,347.41
|
| Rate for Payer: WEA Trust Commercial |
$3,985.12
|
| Rate for Payer: WPS Commercial |
$5,366.68
|
|
|
FEMORAL HEAD BIOLOX DELTA CERAMIC 36MM -2.5MM 6570-0-436
|
Facility
|
IP
|
$8,356.00
|
|
| Hospital Charge Code |
5179152
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,258.22 |
| Max. Negotiated Rate |
$7,995.02 |
| Rate for Payer: Aetna Commercial |
$7,821.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,473.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,605.83
|
| Rate for Payer: Cash Price |
$2,506.80
|
| Rate for Payer: Cigna Commercial |
$7,995.02
|
| Rate for Payer: Health EOS Commercial |
$7,734.31
|
| Rate for Payer: HFN Commercial |
$7,995.02
|
| Rate for Payer: Multiplan Commercial |
$6,952.19
|
| Rate for Payer: Preferred Network Access Commercial |
$7,995.02
|
| Rate for Payer: Quartz Beloit One Network |
$4,258.22
|
| Rate for Payer: Quartz Commercial |
$5,214.14
|
| Rate for Payer: WEA Trust Commercial |
$4,779.63
|
| Rate for Payer: WPS Commercial |
$6,436.63
|
|
|
FEMORAL HEAD BIOLOX DELTA CERAMIC 36MM -2.5MM 6570-0-436
|
Facility
|
OP
|
$8,356.00
|
|
| Hospital Charge Code |
5179152
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,433.27 |
| Max. Negotiated Rate |
$7,995.02 |
| Rate for Payer: Aetna Commercial |
$7,821.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,473.61
|
| Rate for Payer: Aetna Managed Medicare |
$2,433.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,648.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,345.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,171.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,605.83
|
| Rate for Payer: Cash Price |
$2,506.80
|
| Rate for Payer: Cigna Commercial |
$7,995.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,863.19
|
| Rate for Payer: Health EOS Commercial |
$7,734.31
|
| Rate for Payer: HFN Commercial |
$7,995.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,517.68
|
| Rate for Payer: Multiplan Commercial |
$6,952.19
|
| Rate for Payer: NAPHCARE Commercial |
$5,214.14
|
| Rate for Payer: Preferred Network Access Commercial |
$7,995.02
|
| Rate for Payer: Quartz Beloit One Network |
$4,258.22
|
| Rate for Payer: Quartz Commercial |
$5,648.66
|
| Rate for Payer: Quartz Medicare Advantage |
$5,214.14
|
| Rate for Payer: The Alliance Commercial |
$4,345.12
|
| Rate for Payer: WEA Trust Commercial |
$4,779.63
|
| Rate for Payer: WPS Commercial |
$6,436.63
|
|
|
FEMORAL HEAD BIOLOX DELTA CERAMIC 36MM +2.5MM 6570-0-536
|
Facility
|
OP
|
$6,968.00
|
|
| Hospital Charge Code |
4493961
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,029.08 |
| Max. Negotiated Rate |
$6,666.98 |
| Rate for Payer: Aetna Commercial |
$6,522.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,232.18
|
| Rate for Payer: Aetna Managed Medicare |
$2,029.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,710.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,623.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,478.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,840.76
|
| Rate for Payer: Cash Price |
$2,090.40
|
| Rate for Payer: Cigna Commercial |
$6,666.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,055.38
|
| Rate for Payer: Health EOS Commercial |
$6,449.58
|
| Rate for Payer: HFN Commercial |
$6,666.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,435.04
|
| Rate for Payer: Multiplan Commercial |
$5,797.38
|
| Rate for Payer: NAPHCARE Commercial |
$4,348.03
|
| Rate for Payer: Preferred Network Access Commercial |
$6,666.98
|
| Rate for Payer: Quartz Beloit One Network |
$3,550.89
|
| Rate for Payer: Quartz Commercial |
$4,710.37
|
| Rate for Payer: Quartz Medicare Advantage |
$4,348.03
|
| Rate for Payer: The Alliance Commercial |
$3,623.36
|
| Rate for Payer: WEA Trust Commercial |
$3,985.70
|
| Rate for Payer: WPS Commercial |
$5,367.45
|
|
|
FEMORAL HEAD BIOLOX DELTA CERAMIC 36MM +2.5MM 6570-0-536
|
Facility
|
IP
|
$6,968.00
|
|
| Hospital Charge Code |
4493961
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,550.89 |
| Max. Negotiated Rate |
$6,666.98 |
| Rate for Payer: Aetna Commercial |
$6,522.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,232.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,840.76
|
| Rate for Payer: Cash Price |
$2,090.40
|
| Rate for Payer: Cigna Commercial |
$6,666.98
|
| Rate for Payer: Health EOS Commercial |
$6,449.58
|
| Rate for Payer: HFN Commercial |
$6,666.98
|
| Rate for Payer: Multiplan Commercial |
$5,797.38
|
| Rate for Payer: Preferred Network Access Commercial |
$6,666.98
|
| Rate for Payer: Quartz Beloit One Network |
$3,550.89
|
| Rate for Payer: Quartz Commercial |
$4,348.03
|
| Rate for Payer: WEA Trust Commercial |
$3,985.70
|
| Rate for Payer: WPS Commercial |
$5,367.45
|
|
|
FEMORAL HEAD BIOLOX DELTA CERAMIC 36MM -3.5MM 00-8775-036-01
|
Facility
|
IP
|
$10,056.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967488
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,124.54 |
| Max. Negotiated Rate |
$9,621.58 |
| Rate for Payer: Aetna Commercial |
$9,412.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,994.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,542.87
|
| Rate for Payer: Cash Price |
$3,016.80
|
| Rate for Payer: Cigna Commercial |
$9,621.58
|
| Rate for Payer: Health EOS Commercial |
$9,307.83
|
| Rate for Payer: HFN Commercial |
$9,621.58
|
| Rate for Payer: Multiplan Commercial |
$8,366.59
|
| Rate for Payer: Preferred Network Access Commercial |
$9,621.58
|
| Rate for Payer: Quartz Beloit One Network |
$5,124.54
|
| Rate for Payer: Quartz Commercial |
$6,274.94
|
| Rate for Payer: WEA Trust Commercial |
$5,752.03
|
| Rate for Payer: WPS Commercial |
$7,746.14
|
|
|
FEMORAL HEAD BIOLOX DELTA CERAMIC 36MM -3.5MM 00-8775-036-01
|
Facility
|
OP
|
$10,056.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967488
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,928.31 |
| Max. Negotiated Rate |
$9,621.58 |
| Rate for Payer: Aetna Commercial |
$9,412.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,994.09
|
| Rate for Payer: Aetna Managed Medicare |
$2,928.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,797.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,229.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,019.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,542.87
|
| Rate for Payer: Cash Price |
$3,016.80
|
| Rate for Payer: Cigna Commercial |
$9,621.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,852.59
|
| Rate for Payer: Health EOS Commercial |
$9,307.83
|
| Rate for Payer: HFN Commercial |
$9,621.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,843.68
|
| Rate for Payer: Multiplan Commercial |
$8,366.59
|
| Rate for Payer: NAPHCARE Commercial |
$6,274.94
|
| Rate for Payer: Preferred Network Access Commercial |
$9,621.58
|
| Rate for Payer: Quartz Beloit One Network |
$5,124.54
|
| Rate for Payer: Quartz Commercial |
$6,797.86
|
| Rate for Payer: Quartz Medicare Advantage |
$6,274.94
|
| Rate for Payer: The Alliance Commercial |
$5,229.12
|
| Rate for Payer: WEA Trust Commercial |
$5,752.03
|
| Rate for Payer: WPS Commercial |
$7,746.14
|
|
|
FEMORAL HEAD BIOLOX DELTA CERAMIC 36MM +3.5MM 00-8775-036-03
|
Facility
|
OP
|
$7,948.00
|
|
| Hospital Charge Code |
4120803
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,314.46 |
| Max. Negotiated Rate |
$7,604.65 |
| Rate for Payer: Aetna Commercial |
$7,439.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,108.69
|
| Rate for Payer: Aetna Managed Medicare |
$2,314.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,372.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,132.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,967.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,380.94
|
| Rate for Payer: Cash Price |
$2,384.40
|
| Rate for Payer: Cigna Commercial |
$7,604.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,625.74
|
| Rate for Payer: Health EOS Commercial |
$7,356.67
|
| Rate for Payer: HFN Commercial |
$7,604.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,199.44
|
| Rate for Payer: Multiplan Commercial |
$6,612.74
|
| Rate for Payer: NAPHCARE Commercial |
$4,959.55
|
| Rate for Payer: Preferred Network Access Commercial |
$7,604.65
|
| Rate for Payer: Quartz Beloit One Network |
$4,050.30
|
| Rate for Payer: Quartz Commercial |
$5,372.85
|
| Rate for Payer: Quartz Medicare Advantage |
$4,959.55
|
| Rate for Payer: The Alliance Commercial |
$4,132.96
|
| Rate for Payer: WEA Trust Commercial |
$4,546.26
|
| Rate for Payer: WPS Commercial |
$6,122.34
|
|
|
FEMORAL HEAD BIOLOX DELTA CERAMIC 36MM +3.5MM 00-8775-036-03
|
Facility
|
IP
|
$7,948.00
|
|
| Hospital Charge Code |
4120803
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,050.30 |
| Max. Negotiated Rate |
$7,604.65 |
| Rate for Payer: Aetna Commercial |
$7,439.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,108.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,380.94
|
| Rate for Payer: Cash Price |
$2,384.40
|
| Rate for Payer: Cigna Commercial |
$7,604.65
|
| Rate for Payer: Health EOS Commercial |
$7,356.67
|
| Rate for Payer: HFN Commercial |
$7,604.65
|
| Rate for Payer: Multiplan Commercial |
$6,612.74
|
| Rate for Payer: Preferred Network Access Commercial |
$7,604.65
|
| Rate for Payer: Quartz Beloit One Network |
$4,050.30
|
| Rate for Payer: Quartz Commercial |
$4,959.55
|
| Rate for Payer: WEA Trust Commercial |
$4,546.26
|
| Rate for Payer: WPS Commercial |
$6,122.34
|
|
|
FEMORAL HEAD BIOLOX DELTA CERAMIC 36MM +5MM 6570-0-236
|
Facility
|
IP
|
$6,968.00
|
|
| Hospital Charge Code |
4220558
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,550.89 |
| Max. Negotiated Rate |
$6,666.98 |
| Rate for Payer: Aetna Commercial |
$6,522.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,232.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,840.76
|
| Rate for Payer: Cash Price |
$2,090.40
|
| Rate for Payer: Cigna Commercial |
$6,666.98
|
| Rate for Payer: Health EOS Commercial |
$6,449.58
|
| Rate for Payer: HFN Commercial |
$6,666.98
|
| Rate for Payer: Multiplan Commercial |
$5,797.38
|
| Rate for Payer: Preferred Network Access Commercial |
$6,666.98
|
| Rate for Payer: Quartz Beloit One Network |
$3,550.89
|
| Rate for Payer: Quartz Commercial |
$4,348.03
|
| Rate for Payer: WEA Trust Commercial |
$3,985.70
|
| Rate for Payer: WPS Commercial |
$5,367.45
|
|
|
FEMORAL HEAD BIOLOX DELTA CERAMIC 36MM +5MM 6570-0-236
|
Facility
|
OP
|
$6,968.00
|
|
| Hospital Charge Code |
4220558
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,029.08 |
| Max. Negotiated Rate |
$6,666.98 |
| Rate for Payer: Aetna Commercial |
$6,522.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,232.18
|
| Rate for Payer: Aetna Managed Medicare |
$2,029.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,710.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,623.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,478.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,840.76
|
| Rate for Payer: Cash Price |
$2,090.40
|
| Rate for Payer: Cigna Commercial |
$6,666.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,055.38
|
| Rate for Payer: Health EOS Commercial |
$6,449.58
|
| Rate for Payer: HFN Commercial |
$6,666.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,435.04
|
| Rate for Payer: Multiplan Commercial |
$5,797.38
|
| Rate for Payer: NAPHCARE Commercial |
$4,348.03
|
| Rate for Payer: Preferred Network Access Commercial |
$6,666.98
|
| Rate for Payer: Quartz Beloit One Network |
$3,550.89
|
| Rate for Payer: Quartz Commercial |
$4,710.37
|
| Rate for Payer: Quartz Medicare Advantage |
$4,348.03
|
| Rate for Payer: The Alliance Commercial |
$3,623.36
|
| Rate for Payer: WEA Trust Commercial |
$3,985.70
|
| Rate for Payer: WPS Commercial |
$5,367.45
|
|
|
FEMORAL HEAD BIOLOX DELTA CERAMIC 36MM +7.5MM 6570-0-736
|
Facility
|
IP
|
$6,708.00
|
|
| Hospital Charge Code |
4519933
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,418.40 |
| Max. Negotiated Rate |
$6,418.21 |
| Rate for Payer: Aetna Commercial |
$6,278.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,999.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,697.45
|
| Rate for Payer: Cash Price |
$2,012.40
|
| Rate for Payer: Cigna Commercial |
$6,418.21
|
| Rate for Payer: Health EOS Commercial |
$6,208.92
|
| Rate for Payer: HFN Commercial |
$6,418.21
|
| Rate for Payer: Multiplan Commercial |
$5,581.06
|
| Rate for Payer: Preferred Network Access Commercial |
$6,418.21
|
| Rate for Payer: Quartz Beloit One Network |
$3,418.40
|
| Rate for Payer: Quartz Commercial |
$4,185.79
|
| Rate for Payer: WEA Trust Commercial |
$3,836.98
|
| Rate for Payer: WPS Commercial |
$5,167.17
|
|
|
FEMORAL HEAD BIOLOX DELTA CERAMIC 36MM +7.5MM 6570-0-736
|
Facility
|
OP
|
$6,708.00
|
|
| Hospital Charge Code |
4519933
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,953.37 |
| Max. Negotiated Rate |
$6,418.21 |
| Rate for Payer: Aetna Commercial |
$6,278.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,999.64
|
| Rate for Payer: Aetna Managed Medicare |
$1,953.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,534.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,488.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,348.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,697.45
|
| Rate for Payer: Cash Price |
$2,012.40
|
| Rate for Payer: Cigna Commercial |
$6,418.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,904.06
|
| Rate for Payer: Health EOS Commercial |
$6,208.92
|
| Rate for Payer: HFN Commercial |
$6,418.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,232.24
|
| Rate for Payer: Multiplan Commercial |
$5,581.06
|
| Rate for Payer: NAPHCARE Commercial |
$4,185.79
|
| Rate for Payer: Preferred Network Access Commercial |
$6,418.21
|
| Rate for Payer: Quartz Beloit One Network |
$3,418.40
|
| Rate for Payer: Quartz Commercial |
$4,534.61
|
| Rate for Payer: Quartz Medicare Advantage |
$4,185.79
|
| Rate for Payer: The Alliance Commercial |
$3,488.16
|
| Rate for Payer: WEA Trust Commercial |
$3,836.98
|
| Rate for Payer: WPS Commercial |
$5,167.17
|
|
