|
FEMORAL HEAD VERSYS 40MM +7.0 8018-40-04
|
Facility
|
IP
|
$4,642.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5184691
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,365.56 |
| Max. Negotiated Rate |
$4,441.47 |
| Rate for Payer: Aetna Commercial |
$4,344.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,151.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,558.67
|
| Rate for Payer: Cash Price |
$1,392.60
|
| Rate for Payer: Cigna Commercial |
$4,441.47
|
| Rate for Payer: Health EOS Commercial |
$4,296.64
|
| Rate for Payer: HFN Commercial |
$4,441.47
|
| Rate for Payer: Multiplan Commercial |
$3,862.14
|
| Rate for Payer: Preferred Network Access Commercial |
$4,441.47
|
| Rate for Payer: Quartz Beloit One Network |
$2,365.56
|
| Rate for Payer: Quartz Commercial |
$2,896.61
|
| Rate for Payer: WEA Trust Commercial |
$2,655.22
|
| Rate for Payer: WPS Commercial |
$3,575.73
|
|
|
FEMORAL INTRAMEDULLARY RODDING
|
Facility
|
OP
|
$5,312.00
|
|
| Hospital Charge Code |
2960150
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,546.85 |
| Max. Negotiated Rate |
$5,082.52 |
| Rate for Payer: Aetna Commercial |
$4,972.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,751.05
|
| Rate for Payer: Aetna Managed Medicare |
$1,546.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,590.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,762.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,651.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,927.97
|
| Rate for Payer: Cash Price |
$1,593.60
|
| Rate for Payer: Cigna Commercial |
$5,082.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,091.58
|
| Rate for Payer: Health EOS Commercial |
$4,916.79
|
| Rate for Payer: HFN Commercial |
$5,082.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,143.36
|
| Rate for Payer: Multiplan Commercial |
$4,419.58
|
| Rate for Payer: NAPHCARE Commercial |
$3,314.69
|
| Rate for Payer: Preferred Network Access Commercial |
$5,082.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,707.00
|
| Rate for Payer: Quartz Commercial |
$3,590.91
|
| Rate for Payer: Quartz Medicare Advantage |
$3,314.69
|
| Rate for Payer: The Alliance Commercial |
$2,762.24
|
| Rate for Payer: WEA Trust Commercial |
$3,038.46
|
| Rate for Payer: WPS Commercial |
$4,091.83
|
|
|
FEMORAL INTRAMEDULLARY RODDING
|
Facility
|
IP
|
$5,312.00
|
|
| Hospital Charge Code |
2960150
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,707.00 |
| Max. Negotiated Rate |
$5,082.52 |
| Rate for Payer: Aetna Commercial |
$4,972.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,751.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,927.97
|
| Rate for Payer: Cash Price |
$1,593.60
|
| Rate for Payer: Cigna Commercial |
$5,082.52
|
| Rate for Payer: Health EOS Commercial |
$4,916.79
|
| Rate for Payer: HFN Commercial |
$5,082.52
|
| Rate for Payer: Multiplan Commercial |
$4,419.58
|
| Rate for Payer: Preferred Network Access Commercial |
$5,082.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,707.00
|
| Rate for Payer: Quartz Commercial |
$3,314.69
|
| Rate for Payer: WEA Trust Commercial |
$3,038.46
|
| Rate for Payer: WPS Commercial |
$4,091.83
|
|
|
FEMORAL NAIL 9MM FRN GT 400 LT 04.033.971S
|
Facility
|
OP
|
$9,845.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6182641
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,866.86 |
| Max. Negotiated Rate |
$9,419.70 |
| Rate for Payer: Aetna Commercial |
$9,214.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,805.37
|
| Rate for Payer: Aetna Managed Medicare |
$2,866.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,655.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,119.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,914.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,426.56
|
| Rate for Payer: Cash Price |
$2,953.50
|
| Rate for Payer: Cigna Commercial |
$9,419.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,729.79
|
| Rate for Payer: Health EOS Commercial |
$9,112.53
|
| Rate for Payer: HFN Commercial |
$9,419.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,679.10
|
| Rate for Payer: Multiplan Commercial |
$8,191.04
|
| Rate for Payer: NAPHCARE Commercial |
$6,143.28
|
| Rate for Payer: Preferred Network Access Commercial |
$9,419.70
|
| Rate for Payer: Quartz Beloit One Network |
$5,017.01
|
| Rate for Payer: Quartz Commercial |
$6,655.22
|
| Rate for Payer: Quartz Medicare Advantage |
$6,143.28
|
| Rate for Payer: The Alliance Commercial |
$5,119.40
|
| Rate for Payer: WEA Trust Commercial |
$5,631.34
|
| Rate for Payer: WPS Commercial |
$7,583.60
|
|
|
FEMORAL NAIL 9MM FRN GT 400 LT 04.033.971S
|
Facility
|
IP
|
$9,845.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6182641
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,017.01 |
| Max. Negotiated Rate |
$9,419.70 |
| Rate for Payer: Aetna Commercial |
$9,214.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,805.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,426.56
|
| Rate for Payer: Cash Price |
$2,953.50
|
| Rate for Payer: Cigna Commercial |
$9,419.70
|
| Rate for Payer: Health EOS Commercial |
$9,112.53
|
| Rate for Payer: HFN Commercial |
$9,419.70
|
| Rate for Payer: Multiplan Commercial |
$8,191.04
|
| Rate for Payer: Preferred Network Access Commercial |
$9,419.70
|
| Rate for Payer: Quartz Beloit One Network |
$5,017.01
|
| Rate for Payer: Quartz Commercial |
$6,143.28
|
| Rate for Payer: WEA Trust Commercial |
$5,631.34
|
| Rate for Payer: WPS Commercial |
$7,583.60
|
|
|
FEMORAL NAIL RFNA RETROGRADE 10MM X 340MM 10 DEG BEND 04.233.035S
|
Facility
|
IP
|
$11,872.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6202972
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,049.97 |
| Max. Negotiated Rate |
$11,359.13 |
| Rate for Payer: Aetna Commercial |
$11,112.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,618.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,543.85
|
| Rate for Payer: Cash Price |
$3,561.60
|
| Rate for Payer: Cigna Commercial |
$11,359.13
|
| Rate for Payer: Health EOS Commercial |
$10,988.72
|
| Rate for Payer: HFN Commercial |
$11,359.13
|
| Rate for Payer: Multiplan Commercial |
$9,877.50
|
| Rate for Payer: Preferred Network Access Commercial |
$11,359.13
|
| Rate for Payer: Quartz Beloit One Network |
$6,049.97
|
| Rate for Payer: Quartz Commercial |
$7,408.13
|
| Rate for Payer: WEA Trust Commercial |
$6,790.78
|
| Rate for Payer: WPS Commercial |
$9,145.00
|
|
|
FEMORAL NAIL RFNA RETROGRADE 10MM X 340MM 10 DEG BEND 04.233.035S
|
Facility
|
OP
|
$11,872.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6202972
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,457.13 |
| Max. Negotiated Rate |
$11,359.13 |
| Rate for Payer: Aetna Commercial |
$11,112.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,618.32
|
| Rate for Payer: Aetna Managed Medicare |
$3,457.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,025.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,173.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,926.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,543.85
|
| Rate for Payer: Cash Price |
$3,561.60
|
| Rate for Payer: Cigna Commercial |
$11,359.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,909.50
|
| Rate for Payer: Health EOS Commercial |
$10,988.72
|
| Rate for Payer: HFN Commercial |
$11,359.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,260.16
|
| Rate for Payer: Multiplan Commercial |
$9,877.50
|
| Rate for Payer: NAPHCARE Commercial |
$7,408.13
|
| Rate for Payer: Preferred Network Access Commercial |
$11,359.13
|
| Rate for Payer: Quartz Beloit One Network |
$6,049.97
|
| Rate for Payer: Quartz Commercial |
$8,025.47
|
| Rate for Payer: Quartz Medicare Advantage |
$7,408.13
|
| Rate for Payer: The Alliance Commercial |
$6,173.44
|
| Rate for Payer: WEA Trust Commercial |
$6,790.78
|
| Rate for Payer: WPS Commercial |
$9,145.00
|
|
|
FEMORAL NAIL RFNA RETROGRADE 12MM X 240MM STD BEND 04.233.224S
|
Facility
|
OP
|
$10,725.14
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6246184
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,123.16 |
| Max. Negotiated Rate |
$10,261.81 |
| Rate for Payer: Aetna Commercial |
$10,038.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,592.57
|
| Rate for Payer: Aetna Managed Medicare |
$3,123.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,250.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,577.07
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,353.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,911.70
|
| Rate for Payer: Cash Price |
$3,217.54
|
| Rate for Payer: Cigna Commercial |
$10,261.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,242.03
|
| Rate for Payer: Health EOS Commercial |
$9,927.19
|
| Rate for Payer: HFN Commercial |
$10,261.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,365.61
|
| Rate for Payer: Multiplan Commercial |
$8,923.32
|
| Rate for Payer: NAPHCARE Commercial |
$6,692.49
|
| Rate for Payer: Preferred Network Access Commercial |
$10,261.81
|
| Rate for Payer: Quartz Beloit One Network |
$5,465.53
|
| Rate for Payer: Quartz Commercial |
$7,250.19
|
| Rate for Payer: Quartz Medicare Advantage |
$6,692.49
|
| Rate for Payer: The Alliance Commercial |
$5,577.07
|
| Rate for Payer: WEA Trust Commercial |
$6,134.78
|
| Rate for Payer: WPS Commercial |
$8,261.58
|
|
|
FEMORAL NAIL RFNA RETROGRADE 12MM X 240MM STD BEND 04.233.224S
|
Facility
|
IP
|
$10,725.14
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6246184
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,465.53 |
| Max. Negotiated Rate |
$10,261.81 |
| Rate for Payer: Aetna Commercial |
$10,038.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,592.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,911.70
|
| Rate for Payer: Cash Price |
$3,217.54
|
| Rate for Payer: Cigna Commercial |
$10,261.81
|
| Rate for Payer: Health EOS Commercial |
$9,927.19
|
| Rate for Payer: HFN Commercial |
$10,261.81
|
| Rate for Payer: Multiplan Commercial |
$8,923.32
|
| Rate for Payer: Preferred Network Access Commercial |
$10,261.81
|
| Rate for Payer: Quartz Beloit One Network |
$5,465.53
|
| Rate for Payer: Quartz Commercial |
$6,692.49
|
| Rate for Payer: WEA Trust Commercial |
$6,134.78
|
| Rate for Payer: WPS Commercial |
$8,261.58
|
|
|
FEMORAL NAIL RFNA RETROGRADE 12MM X 380MM STD BEND 5DEG RT 04.233.238S
|
Facility
|
OP
|
$11,122.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6175472
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,238.73 |
| Max. Negotiated Rate |
$10,641.53 |
| Rate for Payer: Aetna Commercial |
$10,410.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,947.52
|
| Rate for Payer: Aetna Managed Medicare |
$3,238.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,518.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,783.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,552.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,130.45
|
| Rate for Payer: Cash Price |
$3,336.60
|
| Rate for Payer: Cigna Commercial |
$10,641.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,473.00
|
| Rate for Payer: Health EOS Commercial |
$10,294.52
|
| Rate for Payer: HFN Commercial |
$10,641.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,675.16
|
| Rate for Payer: Multiplan Commercial |
$9,253.50
|
| Rate for Payer: NAPHCARE Commercial |
$6,940.13
|
| Rate for Payer: Preferred Network Access Commercial |
$10,641.53
|
| Rate for Payer: Quartz Beloit One Network |
$5,667.77
|
| Rate for Payer: Quartz Commercial |
$7,518.47
|
| Rate for Payer: Quartz Medicare Advantage |
$6,940.13
|
| Rate for Payer: The Alliance Commercial |
$5,783.44
|
| Rate for Payer: WEA Trust Commercial |
$6,361.78
|
| Rate for Payer: WPS Commercial |
$8,567.28
|
|
|
FEMORAL NAIL RFNA RETROGRADE 12MM X 380MM STD BEND 5DEG RT 04.233.238S
|
Facility
|
IP
|
$11,122.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6175472
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,667.77 |
| Max. Negotiated Rate |
$10,641.53 |
| Rate for Payer: Aetna Commercial |
$10,410.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,947.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,130.45
|
| Rate for Payer: Cash Price |
$3,336.60
|
| Rate for Payer: Cigna Commercial |
$10,641.53
|
| Rate for Payer: Health EOS Commercial |
$10,294.52
|
| Rate for Payer: HFN Commercial |
$10,641.53
|
| Rate for Payer: Multiplan Commercial |
$9,253.50
|
| Rate for Payer: Preferred Network Access Commercial |
$10,641.53
|
| Rate for Payer: Quartz Beloit One Network |
$5,667.77
|
| Rate for Payer: Quartz Commercial |
$6,940.13
|
| Rate for Payer: WEA Trust Commercial |
$6,361.78
|
| Rate for Payer: WPS Commercial |
$8,567.28
|
|
|
FEMORAL POPLITEAL/TIBIAL/DISTAL BYPASS GRAFT
|
Facility
|
IP
|
$16,743.00
|
|
| Hospital Charge Code |
2960067
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,532.23 |
| Max. Negotiated Rate |
$16,019.70 |
| Rate for Payer: Aetna Commercial |
$15,671.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,974.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,228.74
|
| Rate for Payer: Cash Price |
$5,022.90
|
| Rate for Payer: Cigna Commercial |
$16,019.70
|
| Rate for Payer: Health EOS Commercial |
$15,497.32
|
| Rate for Payer: HFN Commercial |
$16,019.70
|
| Rate for Payer: Multiplan Commercial |
$13,930.18
|
| Rate for Payer: Preferred Network Access Commercial |
$16,019.70
|
| Rate for Payer: Quartz Beloit One Network |
$8,532.23
|
| Rate for Payer: Quartz Commercial |
$10,447.63
|
| Rate for Payer: WEA Trust Commercial |
$9,577.00
|
| Rate for Payer: WPS Commercial |
$12,897.13
|
|
|
FEMORAL POPLITEAL/TIBIAL/DISTAL BYPASS GRAFT
|
Facility
|
OP
|
$16,743.00
|
|
| Hospital Charge Code |
2960067
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,875.56 |
| Max. Negotiated Rate |
$16,019.70 |
| Rate for Payer: Aetna Commercial |
$15,671.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,974.94
|
| Rate for Payer: Aetna Managed Medicare |
$4,875.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,318.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,706.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,358.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,228.74
|
| Rate for Payer: Cash Price |
$5,022.90
|
| Rate for Payer: Cigna Commercial |
$16,019.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,744.43
|
| Rate for Payer: Health EOS Commercial |
$15,497.32
|
| Rate for Payer: HFN Commercial |
$16,019.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,059.54
|
| Rate for Payer: Multiplan Commercial |
$13,930.18
|
| Rate for Payer: NAPHCARE Commercial |
$10,447.63
|
| Rate for Payer: Preferred Network Access Commercial |
$16,019.70
|
| Rate for Payer: Quartz Beloit One Network |
$8,532.23
|
| Rate for Payer: Quartz Commercial |
$11,318.27
|
| Rate for Payer: Quartz Medicare Advantage |
$10,447.63
|
| Rate for Payer: The Alliance Commercial |
$8,706.36
|
| Rate for Payer: WEA Trust Commercial |
$9,577.00
|
| Rate for Payer: WPS Commercial |
$12,897.13
|
|
|
FEMORAL POSTERIOR STABILIZED ATTUNE SZ 10 RT CEMENTED 1504-10-210
|
Facility
|
OP
|
$7,413.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6166142
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,158.67 |
| Max. Negotiated Rate |
$7,092.76 |
| Rate for Payer: Aetna Commercial |
$6,938.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,630.19
|
| Rate for Payer: Aetna Managed Medicare |
$2,158.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,011.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,854.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,700.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,086.05
|
| Rate for Payer: Cash Price |
$2,223.90
|
| Rate for Payer: Cigna Commercial |
$7,092.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,314.37
|
| Rate for Payer: Health EOS Commercial |
$6,861.47
|
| Rate for Payer: HFN Commercial |
$7,092.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,782.14
|
| Rate for Payer: Multiplan Commercial |
$6,167.62
|
| Rate for Payer: NAPHCARE Commercial |
$4,625.71
|
| Rate for Payer: Preferred Network Access Commercial |
$7,092.76
|
| Rate for Payer: Quartz Beloit One Network |
$3,777.66
|
| Rate for Payer: Quartz Commercial |
$5,011.19
|
| Rate for Payer: Quartz Medicare Advantage |
$4,625.71
|
| Rate for Payer: The Alliance Commercial |
$3,854.76
|
| Rate for Payer: WEA Trust Commercial |
$4,240.24
|
| Rate for Payer: WPS Commercial |
$5,710.23
|
|
|
FEMORAL POSTERIOR STABILIZED ATTUNE SZ 10 RT CEMENTED 1504-10-210
|
Facility
|
IP
|
$7,413.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6166142
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,777.66 |
| Max. Negotiated Rate |
$7,092.76 |
| Rate for Payer: Aetna Commercial |
$6,938.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,630.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,086.05
|
| Rate for Payer: Cash Price |
$2,223.90
|
| Rate for Payer: Cigna Commercial |
$7,092.76
|
| Rate for Payer: Health EOS Commercial |
$6,861.47
|
| Rate for Payer: HFN Commercial |
$7,092.76
|
| Rate for Payer: Multiplan Commercial |
$6,167.62
|
| Rate for Payer: Preferred Network Access Commercial |
$7,092.76
|
| Rate for Payer: Quartz Beloit One Network |
$3,777.66
|
| Rate for Payer: Quartz Commercial |
$4,625.71
|
| Rate for Payer: WEA Trust Commercial |
$4,240.24
|
| Rate for Payer: WPS Commercial |
$5,710.23
|
|
|
FEMORAL POSTERIOR STABILIZED ATTUNE SZ 3 LT CEMENTED 1504-10-103
|
Facility
|
OP
|
$7,606.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5547476
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,214.87 |
| Max. Negotiated Rate |
$7,277.42 |
| Rate for Payer: Aetna Commercial |
$7,119.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,802.81
|
| Rate for Payer: Aetna Managed Medicare |
$2,214.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,141.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,955.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,796.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,192.43
|
| Rate for Payer: Cash Price |
$2,281.80
|
| Rate for Payer: Cigna Commercial |
$7,277.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,426.69
|
| Rate for Payer: Health EOS Commercial |
$7,040.11
|
| Rate for Payer: HFN Commercial |
$7,277.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,932.68
|
| Rate for Payer: Multiplan Commercial |
$6,328.19
|
| Rate for Payer: NAPHCARE Commercial |
$4,746.14
|
| Rate for Payer: Preferred Network Access Commercial |
$7,277.42
|
| Rate for Payer: Quartz Beloit One Network |
$3,876.02
|
| Rate for Payer: Quartz Commercial |
$5,141.66
|
| Rate for Payer: Quartz Medicare Advantage |
$4,746.14
|
| Rate for Payer: The Alliance Commercial |
$3,955.12
|
| Rate for Payer: WEA Trust Commercial |
$4,350.63
|
| Rate for Payer: WPS Commercial |
$5,858.90
|
|
|
FEMORAL POSTERIOR STABILIZED ATTUNE SZ 3 LT CEMENTED 1504-10-103
|
Facility
|
IP
|
$7,606.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5547476
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,876.02 |
| Max. Negotiated Rate |
$7,277.42 |
| Rate for Payer: Aetna Commercial |
$7,119.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,802.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,192.43
|
| Rate for Payer: Cash Price |
$2,281.80
|
| Rate for Payer: Cigna Commercial |
$7,277.42
|
| Rate for Payer: Health EOS Commercial |
$7,040.11
|
| Rate for Payer: HFN Commercial |
$7,277.42
|
| Rate for Payer: Multiplan Commercial |
$6,328.19
|
| Rate for Payer: Preferred Network Access Commercial |
$7,277.42
|
| Rate for Payer: Quartz Beloit One Network |
$3,876.02
|
| Rate for Payer: Quartz Commercial |
$4,746.14
|
| Rate for Payer: WEA Trust Commercial |
$4,350.63
|
| Rate for Payer: WPS Commercial |
$5,858.90
|
|
|
FEMORAL POSTERIOR STABILIZED ATTUNE SZ 3 RT CEMENTED 1504-10-203
|
Facility
|
OP
|
$7,606.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563331
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,214.87 |
| Max. Negotiated Rate |
$7,277.42 |
| Rate for Payer: Aetna Commercial |
$7,119.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,802.81
|
| Rate for Payer: Aetna Managed Medicare |
$2,214.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,141.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,955.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,796.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,192.43
|
| Rate for Payer: Cash Price |
$2,281.80
|
| Rate for Payer: Cigna Commercial |
$7,277.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,426.69
|
| Rate for Payer: Health EOS Commercial |
$7,040.11
|
| Rate for Payer: HFN Commercial |
$7,277.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,932.68
|
| Rate for Payer: Multiplan Commercial |
$6,328.19
|
| Rate for Payer: NAPHCARE Commercial |
$4,746.14
|
| Rate for Payer: Preferred Network Access Commercial |
$7,277.42
|
| Rate for Payer: Quartz Beloit One Network |
$3,876.02
|
| Rate for Payer: Quartz Commercial |
$5,141.66
|
| Rate for Payer: Quartz Medicare Advantage |
$4,746.14
|
| Rate for Payer: The Alliance Commercial |
$3,955.12
|
| Rate for Payer: WEA Trust Commercial |
$4,350.63
|
| Rate for Payer: WPS Commercial |
$5,858.90
|
|
|
FEMORAL POSTERIOR STABILIZED ATTUNE SZ 3 RT CEMENTED 1504-10-203
|
Facility
|
IP
|
$7,606.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563331
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,876.02 |
| Max. Negotiated Rate |
$7,277.42 |
| Rate for Payer: Aetna Commercial |
$7,119.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,802.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,192.43
|
| Rate for Payer: Cash Price |
$2,281.80
|
| Rate for Payer: Cigna Commercial |
$7,277.42
|
| Rate for Payer: Health EOS Commercial |
$7,040.11
|
| Rate for Payer: HFN Commercial |
$7,277.42
|
| Rate for Payer: Multiplan Commercial |
$6,328.19
|
| Rate for Payer: Preferred Network Access Commercial |
$7,277.42
|
| Rate for Payer: Quartz Beloit One Network |
$3,876.02
|
| Rate for Payer: Quartz Commercial |
$4,746.14
|
| Rate for Payer: WEA Trust Commercial |
$4,350.63
|
| Rate for Payer: WPS Commercial |
$5,858.90
|
|
|
FEMORAL POSTERIOR STABILIZED ATTUNE SZ 4 LT CEMENTED 1504-10-104
|
Facility
|
IP
|
$8,215.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5459754
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,186.36 |
| Max. Negotiated Rate |
$7,860.11 |
| Rate for Payer: Aetna Commercial |
$7,689.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,347.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,528.11
|
| Rate for Payer: Cash Price |
$2,464.50
|
| Rate for Payer: Cigna Commercial |
$7,860.11
|
| Rate for Payer: Health EOS Commercial |
$7,603.80
|
| Rate for Payer: HFN Commercial |
$7,860.11
|
| Rate for Payer: Multiplan Commercial |
$6,834.88
|
| Rate for Payer: Preferred Network Access Commercial |
$7,860.11
|
| Rate for Payer: Quartz Beloit One Network |
$4,186.36
|
| Rate for Payer: Quartz Commercial |
$5,126.16
|
| Rate for Payer: WEA Trust Commercial |
$4,698.98
|
| Rate for Payer: WPS Commercial |
$6,328.01
|
|
|
FEMORAL POSTERIOR STABILIZED ATTUNE SZ 4 LT CEMENTED 1504-10-104
|
Facility
|
OP
|
$8,215.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5459754
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,392.21 |
| Max. Negotiated Rate |
$7,860.11 |
| Rate for Payer: Aetna Commercial |
$7,689.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,347.50
|
| Rate for Payer: Aetna Managed Medicare |
$2,392.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,553.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,271.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,100.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,528.11
|
| Rate for Payer: Cash Price |
$2,464.50
|
| Rate for Payer: Cigna Commercial |
$7,860.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,781.13
|
| Rate for Payer: Health EOS Commercial |
$7,603.80
|
| Rate for Payer: HFN Commercial |
$7,860.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,407.70
|
| Rate for Payer: Multiplan Commercial |
$6,834.88
|
| Rate for Payer: NAPHCARE Commercial |
$5,126.16
|
| Rate for Payer: Preferred Network Access Commercial |
$7,860.11
|
| Rate for Payer: Quartz Beloit One Network |
$4,186.36
|
| Rate for Payer: Quartz Commercial |
$5,553.34
|
| Rate for Payer: Quartz Medicare Advantage |
$5,126.16
|
| Rate for Payer: The Alliance Commercial |
$4,271.80
|
| Rate for Payer: WEA Trust Commercial |
$4,698.98
|
| Rate for Payer: WPS Commercial |
$6,328.01
|
|
|
FEMORAL POSTERIOR STABILIZED ATTUNE SZ 4N LT CEMENTED NARROW 1504-10-124
|
Facility
|
OP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5520880
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,303.39 |
| Max. Negotiated Rate |
$7,568.29 |
| Rate for Payer: Aetna Commercial |
$7,403.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,074.70
|
| Rate for Payer: Aetna Managed Medicare |
$2,303.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,347.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,113.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,948.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,359.99
|
| Rate for Payer: Cash Price |
$2,373.00
|
| Rate for Payer: Cigna Commercial |
$7,568.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,603.62
|
| Rate for Payer: Health EOS Commercial |
$7,321.50
|
| Rate for Payer: HFN Commercial |
$7,568.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,169.80
|
| Rate for Payer: Multiplan Commercial |
$6,581.12
|
| Rate for Payer: NAPHCARE Commercial |
$4,935.84
|
| Rate for Payer: Preferred Network Access Commercial |
$7,568.29
|
| Rate for Payer: Quartz Beloit One Network |
$4,030.94
|
| Rate for Payer: Quartz Commercial |
$5,347.16
|
| Rate for Payer: Quartz Medicare Advantage |
$4,935.84
|
| Rate for Payer: The Alliance Commercial |
$4,113.20
|
| Rate for Payer: WEA Trust Commercial |
$4,524.52
|
| Rate for Payer: WPS Commercial |
$6,093.07
|
|
|
FEMORAL POSTERIOR STABILIZED ATTUNE SZ 4N LT CEMENTED NARROW 1504-10-124
|
Facility
|
IP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5520880
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,030.94 |
| Max. Negotiated Rate |
$7,568.29 |
| Rate for Payer: Aetna Commercial |
$7,403.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,074.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,359.99
|
| Rate for Payer: Cash Price |
$2,373.00
|
| Rate for Payer: Cigna Commercial |
$7,568.29
|
| Rate for Payer: Health EOS Commercial |
$7,321.50
|
| Rate for Payer: HFN Commercial |
$7,568.29
|
| Rate for Payer: Multiplan Commercial |
$6,581.12
|
| Rate for Payer: Preferred Network Access Commercial |
$7,568.29
|
| Rate for Payer: Quartz Beloit One Network |
$4,030.94
|
| Rate for Payer: Quartz Commercial |
$4,935.84
|
| Rate for Payer: WEA Trust Commercial |
$4,524.52
|
| Rate for Payer: WPS Commercial |
$6,093.07
|
|
|
FEMORAL POSTERIOR STABILIZED ATTUNE SZ 4N RT CEMENTED NARROW 1504-10-224
|
Facility
|
IP
|
$7,413.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5799856
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,777.66 |
| Max. Negotiated Rate |
$7,092.76 |
| Rate for Payer: Aetna Commercial |
$6,938.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,630.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,086.05
|
| Rate for Payer: Cash Price |
$2,223.90
|
| Rate for Payer: Cigna Commercial |
$7,092.76
|
| Rate for Payer: Health EOS Commercial |
$6,861.47
|
| Rate for Payer: HFN Commercial |
$7,092.76
|
| Rate for Payer: Multiplan Commercial |
$6,167.62
|
| Rate for Payer: Preferred Network Access Commercial |
$7,092.76
|
| Rate for Payer: Quartz Beloit One Network |
$3,777.66
|
| Rate for Payer: Quartz Commercial |
$4,625.71
|
| Rate for Payer: WEA Trust Commercial |
$4,240.24
|
| Rate for Payer: WPS Commercial |
$5,710.23
|
|
|
FEMORAL POSTERIOR STABILIZED ATTUNE SZ 4N RT CEMENTED NARROW 1504-10-224
|
Facility
|
OP
|
$7,413.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5799856
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,158.67 |
| Max. Negotiated Rate |
$7,092.76 |
| Rate for Payer: Aetna Commercial |
$6,938.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,630.19
|
| Rate for Payer: Aetna Managed Medicare |
$2,158.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,011.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,854.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,700.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,086.05
|
| Rate for Payer: Cash Price |
$2,223.90
|
| Rate for Payer: Cigna Commercial |
$7,092.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,314.37
|
| Rate for Payer: Health EOS Commercial |
$6,861.47
|
| Rate for Payer: HFN Commercial |
$7,092.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,782.14
|
| Rate for Payer: Multiplan Commercial |
$6,167.62
|
| Rate for Payer: NAPHCARE Commercial |
$4,625.71
|
| Rate for Payer: Preferred Network Access Commercial |
$7,092.76
|
| Rate for Payer: Quartz Beloit One Network |
$3,777.66
|
| Rate for Payer: Quartz Commercial |
$5,011.19
|
| Rate for Payer: Quartz Medicare Advantage |
$4,625.71
|
| Rate for Payer: The Alliance Commercial |
$3,854.76
|
| Rate for Payer: WEA Trust Commercial |
$4,240.24
|
| Rate for Payer: WPS Commercial |
$5,710.23
|
|
