|
FEMORAL POSTERIOR STABILIZED ATTUNE SZ 4 RT CEMENTED 1504-10-204
|
Facility
|
IP
|
$8,215.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5520735
|
|
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 RT CEMENTED 1504-10-204
|
Facility
|
OP
|
$8,215.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5520735
|
|
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 5 LT CEMENTED 1504-10-105
|
Facility
|
OP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5520754
|
|
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 5 LT CEMENTED 1504-10-105
|
Facility
|
IP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5520754
|
|
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 5N LT CEMENTED NARROW 1504-10-125
|
Facility
|
IP
|
$8,215.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5520886
|
|
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 5N LT CEMENTED NARROW 1504-10-125
|
Facility
|
OP
|
$8,215.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5520886
|
|
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 5N RT CEMENTED NARROW 1504-10-225
|
Facility
|
IP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5547252
|
|
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 5N RT CEMENTED NARROW 1504-10-225
|
Facility
|
OP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5547252
|
|
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 5 RT CEMENTED 1504-10-205
|
Facility
|
OP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5520797
|
|
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 5 RT CEMENTED 1504-10-205
|
Facility
|
IP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5520797
|
|
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 6 LT CEMENTED 1504-10-106
|
Facility
|
IP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5459819
|
|
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 6 LT CEMENTED 1504-10-106
|
Facility
|
OP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5459819
|
|
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 6N LT CEMENTED NARROW 1504-10-126
|
Facility
|
OP
|
$8,215.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5490755
|
|
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 6N LT CEMENTED NARROW 1504-10-126
|
Facility
|
IP
|
$8,215.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5490755
|
|
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 6N RT CEMENTED NARROW 1504-10-226
|
Facility
|
IP
|
$8,215.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5521118
|
|
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 6N RT CEMENTED NARROW 1504-10-226
|
Facility
|
OP
|
$8,215.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5521118
|
|
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 6 RT CEMENTED 1504-10-206
|
Facility
|
OP
|
$8,215.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5459758
|
|
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 6 RT CEMENTED 1504-10-206
|
Facility
|
IP
|
$8,215.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5459758
|
|
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 7 LT CEMENTED 1504-10-107
|
Facility
|
IP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5496832
|
|
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 7 LT CEMENTED 1504-10-107
|
Facility
|
OP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5496832
|
|
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 7 RT CEMENTED 1504-10-207
|
Facility
|
IP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5520973
|
|
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 7 RT CEMENTED 1504-10-207
|
Facility
|
OP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5520973
|
|
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 8 LT CEMENTED 1504-10-108
|
Facility
|
IP
|
$8,215.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5544762
|
|
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 8 LT CEMENTED 1504-10-108
|
Facility
|
OP
|
$8,215.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5544762
|
|
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 8 RT CEMENTED 1504-10-208
|
Facility
|
IP
|
$8,215.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5496863
|
|
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
|
|
