|
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 |
$1,950.76 |
| Max. Negotiated Rate |
$27,868.00 |
| Rate for Payer: Aetna Commercial |
$6,270.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,991.62
|
| Rate for Payer: Aetna Managed Medicare |
$1,950.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,528.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,483.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,344.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,692.51
|
| Rate for Payer: Cash Price |
$2,090.10
|
| Rate for Payer: Cigna Commercial |
$6,409.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,898.73
|
| Rate for Payer: Health EOS Commercial |
$6,200.63
|
| Rate for Payer: HFN Commercial |
$6,409.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,225.25
|
| Rate for Payer: Multiplan Commercial |
$5,573.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,180.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,409.64
|
| Rate for Payer: Quartz Beloit One Network |
$3,413.83
|
| Rate for Payer: Quartz Commercial |
$4,528.55
|
| Rate for Payer: Quartz Medicare Advantage |
$4,180.20
|
| Rate for Payer: The Alliance Commercial |
$27,868.00
|
| Rate for Payer: WEA Trust Commercial |
$3,831.85
|
| Rate for Payer: WPS Commercial |
$5,160.46
|
|
|
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 |
$4,094.44 |
| Max. Negotiated Rate |
$7,687.52 |
| Rate for Payer: Aetna Commercial |
$7,520.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,186.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,428.68
|
| Rate for Payer: Cash Price |
$2,506.80
|
| Rate for Payer: Cigna Commercial |
$7,687.52
|
| Rate for Payer: Health EOS Commercial |
$7,436.84
|
| Rate for Payer: HFN Commercial |
$7,687.52
|
| Rate for Payer: Multiplan Commercial |
$6,684.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,013.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,687.52
|
| Rate for Payer: Quartz Beloit One Network |
$4,094.44
|
| Rate for Payer: Quartz Commercial |
$5,013.60
|
| Rate for Payer: WEA Trust Commercial |
$4,595.80
|
| Rate for Payer: WPS Commercial |
$6,189.29
|
|
|
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 |
$2,339.68 |
| Max. Negotiated Rate |
$33,424.00 |
| Rate for Payer: Aetna Commercial |
$7,520.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,186.16
|
| Rate for Payer: Aetna Managed Medicare |
$2,339.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,431.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,178.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,010.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,428.68
|
| Rate for Payer: Cash Price |
$2,506.80
|
| Rate for Payer: Cigna Commercial |
$7,687.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,676.02
|
| Rate for Payer: Health EOS Commercial |
$7,436.84
|
| Rate for Payer: HFN Commercial |
$7,687.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,267.00
|
| Rate for Payer: Multiplan Commercial |
$6,684.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,013.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,687.52
|
| Rate for Payer: Quartz Beloit One Network |
$4,094.44
|
| Rate for Payer: Quartz Commercial |
$5,431.40
|
| Rate for Payer: Quartz Medicare Advantage |
$5,013.60
|
| Rate for Payer: The Alliance Commercial |
$33,424.00
|
| Rate for Payer: WEA Trust Commercial |
$4,595.80
|
| Rate for Payer: WPS Commercial |
$6,189.29
|
|
|
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 |
$3,414.32 |
| Max. Negotiated Rate |
$6,410.56 |
| Rate for Payer: Aetna Commercial |
$6,271.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,992.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,693.04
|
| Rate for Payer: Cash Price |
$2,090.40
|
| Rate for Payer: Cigna Commercial |
$6,410.56
|
| Rate for Payer: Health EOS Commercial |
$6,201.52
|
| Rate for Payer: HFN Commercial |
$6,410.56
|
| Rate for Payer: Multiplan Commercial |
$5,574.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,180.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,410.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,414.32
|
| Rate for Payer: Quartz Commercial |
$4,180.80
|
| Rate for Payer: WEA Trust Commercial |
$3,832.40
|
| Rate for Payer: WPS Commercial |
$5,161.20
|
|
|
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 |
$1,951.04 |
| Max. Negotiated Rate |
$27,872.00 |
| Rate for Payer: Aetna Commercial |
$6,271.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,992.48
|
| Rate for Payer: Aetna Managed Medicare |
$1,951.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,529.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,484.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,344.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,693.04
|
| Rate for Payer: Cash Price |
$2,090.40
|
| Rate for Payer: Cigna Commercial |
$6,410.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,899.29
|
| Rate for Payer: Health EOS Commercial |
$6,201.52
|
| Rate for Payer: HFN Commercial |
$6,410.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,226.00
|
| Rate for Payer: Multiplan Commercial |
$5,574.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,180.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,410.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,414.32
|
| Rate for Payer: Quartz Commercial |
$4,529.20
|
| Rate for Payer: Quartz Medicare Advantage |
$4,180.80
|
| Rate for Payer: The Alliance Commercial |
$27,872.00
|
| Rate for Payer: WEA Trust Commercial |
$3,832.40
|
| Rate for Payer: WPS Commercial |
$5,161.20
|
|
|
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 |
$2,815.68 |
| Max. Negotiated Rate |
$40,224.00 |
| Rate for Payer: Aetna Commercial |
$9,050.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,648.16
|
| Rate for Payer: Aetna Managed Medicare |
$2,815.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,536.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,028.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,826.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,329.68
|
| Rate for Payer: Cash Price |
$3,016.80
|
| Rate for Payer: Cigna Commercial |
$9,251.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,627.34
|
| Rate for Payer: Health EOS Commercial |
$8,949.84
|
| Rate for Payer: HFN Commercial |
$9,251.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,542.00
|
| Rate for Payer: Multiplan Commercial |
$8,044.80
|
| Rate for Payer: NAPHCARE Commercial |
$6,033.60
|
| Rate for Payer: Preferred Network Access Commercial |
$9,251.52
|
| Rate for Payer: Quartz Beloit One Network |
$4,927.44
|
| Rate for Payer: Quartz Commercial |
$6,536.40
|
| Rate for Payer: Quartz Medicare Advantage |
$6,033.60
|
| Rate for Payer: The Alliance Commercial |
$40,224.00
|
| Rate for Payer: WEA Trust Commercial |
$5,530.80
|
| Rate for Payer: WPS Commercial |
$7,448.48
|
|
|
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 |
$4,927.44 |
| Max. Negotiated Rate |
$9,251.52 |
| Rate for Payer: Aetna Commercial |
$9,050.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,648.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,329.68
|
| Rate for Payer: Cash Price |
$3,016.80
|
| Rate for Payer: Cigna Commercial |
$9,251.52
|
| Rate for Payer: Health EOS Commercial |
$8,949.84
|
| Rate for Payer: HFN Commercial |
$9,251.52
|
| Rate for Payer: Multiplan Commercial |
$8,044.80
|
| Rate for Payer: NAPHCARE Commercial |
$6,033.60
|
| Rate for Payer: Preferred Network Access Commercial |
$9,251.52
|
| Rate for Payer: Quartz Beloit One Network |
$4,927.44
|
| Rate for Payer: Quartz Commercial |
$6,033.60
|
| Rate for Payer: WEA Trust Commercial |
$5,530.80
|
| Rate for Payer: WPS Commercial |
$7,448.48
|
|
|
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 |
$2,225.44 |
| Max. Negotiated Rate |
$31,792.00 |
| Rate for Payer: Aetna Commercial |
$7,153.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,835.28
|
| Rate for Payer: Aetna Managed Medicare |
$2,225.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,166.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,974.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,815.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,212.44
|
| Rate for Payer: Cash Price |
$2,384.40
|
| Rate for Payer: Cigna Commercial |
$7,312.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,447.70
|
| Rate for Payer: Health EOS Commercial |
$7,073.72
|
| Rate for Payer: HFN Commercial |
$7,312.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,961.00
|
| Rate for Payer: Multiplan Commercial |
$6,358.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,768.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,312.16
|
| Rate for Payer: Quartz Beloit One Network |
$3,894.52
|
| Rate for Payer: Quartz Commercial |
$5,166.20
|
| Rate for Payer: Quartz Medicare Advantage |
$4,768.80
|
| Rate for Payer: The Alliance Commercial |
$31,792.00
|
| Rate for Payer: WEA Trust Commercial |
$4,371.40
|
| Rate for Payer: WPS Commercial |
$5,887.08
|
|
|
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 |
$3,894.52 |
| Max. Negotiated Rate |
$7,312.16 |
| Rate for Payer: Aetna Commercial |
$7,153.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,835.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,212.44
|
| Rate for Payer: Cash Price |
$2,384.40
|
| Rate for Payer: Cigna Commercial |
$7,312.16
|
| Rate for Payer: Health EOS Commercial |
$7,073.72
|
| Rate for Payer: HFN Commercial |
$7,312.16
|
| Rate for Payer: Multiplan Commercial |
$6,358.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,768.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,312.16
|
| Rate for Payer: Quartz Beloit One Network |
$3,894.52
|
| Rate for Payer: Quartz Commercial |
$4,768.80
|
| Rate for Payer: WEA Trust Commercial |
$4,371.40
|
| Rate for Payer: WPS Commercial |
$5,887.08
|
|
|
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 |
$1,951.04 |
| Max. Negotiated Rate |
$27,872.00 |
| Rate for Payer: Aetna Commercial |
$6,271.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,992.48
|
| Rate for Payer: Aetna Managed Medicare |
$1,951.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,529.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,484.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,344.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,693.04
|
| Rate for Payer: Cash Price |
$2,090.40
|
| Rate for Payer: Cigna Commercial |
$6,410.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,899.29
|
| Rate for Payer: Health EOS Commercial |
$6,201.52
|
| Rate for Payer: HFN Commercial |
$6,410.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,226.00
|
| Rate for Payer: Multiplan Commercial |
$5,574.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,180.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,410.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,414.32
|
| Rate for Payer: Quartz Commercial |
$4,529.20
|
| Rate for Payer: Quartz Medicare Advantage |
$4,180.80
|
| Rate for Payer: The Alliance Commercial |
$27,872.00
|
| Rate for Payer: WEA Trust Commercial |
$3,832.40
|
| Rate for Payer: WPS Commercial |
$5,161.20
|
|
|
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 |
$3,414.32 |
| Max. Negotiated Rate |
$6,410.56 |
| Rate for Payer: Aetna Commercial |
$6,271.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,992.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,693.04
|
| Rate for Payer: Cash Price |
$2,090.40
|
| Rate for Payer: Cigna Commercial |
$6,410.56
|
| Rate for Payer: Health EOS Commercial |
$6,201.52
|
| Rate for Payer: HFN Commercial |
$6,410.56
|
| Rate for Payer: Multiplan Commercial |
$5,574.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,180.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,410.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,414.32
|
| Rate for Payer: Quartz Commercial |
$4,180.80
|
| Rate for Payer: WEA Trust Commercial |
$3,832.40
|
| Rate for Payer: WPS Commercial |
$5,161.20
|
|
|
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 |
$1,878.24 |
| Max. Negotiated Rate |
$26,832.00 |
| Rate for Payer: Aetna Commercial |
$6,037.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,768.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,878.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,360.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,354.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,219.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,555.24
|
| Rate for Payer: Cash Price |
$2,012.40
|
| Rate for Payer: Cigna Commercial |
$6,171.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,753.80
|
| Rate for Payer: Health EOS Commercial |
$5,970.12
|
| Rate for Payer: HFN Commercial |
$6,171.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,031.00
|
| Rate for Payer: Multiplan Commercial |
$5,366.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,024.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,171.36
|
| Rate for Payer: Quartz Beloit One Network |
$3,286.92
|
| Rate for Payer: Quartz Commercial |
$4,360.20
|
| Rate for Payer: Quartz Medicare Advantage |
$4,024.80
|
| Rate for Payer: The Alliance Commercial |
$26,832.00
|
| Rate for Payer: WEA Trust Commercial |
$3,689.40
|
| Rate for Payer: WPS Commercial |
$4,968.62
|
|
|
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 |
$3,286.92 |
| Max. Negotiated Rate |
$6,171.36 |
| Rate for Payer: Aetna Commercial |
$6,037.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,768.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,555.24
|
| Rate for Payer: Cash Price |
$2,012.40
|
| Rate for Payer: Cigna Commercial |
$6,171.36
|
| Rate for Payer: Health EOS Commercial |
$5,970.12
|
| Rate for Payer: HFN Commercial |
$6,171.36
|
| Rate for Payer: Multiplan Commercial |
$5,366.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,024.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,171.36
|
| Rate for Payer: Quartz Beloit One Network |
$3,286.92
|
| Rate for Payer: Quartz Commercial |
$4,024.80
|
| Rate for Payer: WEA Trust Commercial |
$3,689.40
|
| Rate for Payer: WPS Commercial |
$4,968.62
|
|
|
FEMORAL HEAD BIOLOX DELTA CERAMIC 36MM +7MM 00-8775-036-04
|
Facility
|
IP
|
$7,948.00
|
|
| Hospital Charge Code |
4230460
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,894.52 |
| Max. Negotiated Rate |
$7,312.16 |
| Rate for Payer: Aetna Commercial |
$7,153.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,835.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,212.44
|
| Rate for Payer: Cash Price |
$2,384.40
|
| Rate for Payer: Cigna Commercial |
$7,312.16
|
| Rate for Payer: Health EOS Commercial |
$7,073.72
|
| Rate for Payer: HFN Commercial |
$7,312.16
|
| Rate for Payer: Multiplan Commercial |
$6,358.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,768.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,312.16
|
| Rate for Payer: Quartz Beloit One Network |
$3,894.52
|
| Rate for Payer: Quartz Commercial |
$4,768.80
|
| Rate for Payer: WEA Trust Commercial |
$4,371.40
|
| Rate for Payer: WPS Commercial |
$5,887.08
|
|
|
FEMORAL HEAD BIOLOX DELTA CERAMIC 36MM +7MM 00-8775-036-04
|
Facility
|
OP
|
$7,948.00
|
|
| Hospital Charge Code |
4230460
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,225.44 |
| Max. Negotiated Rate |
$31,792.00 |
| Rate for Payer: Aetna Commercial |
$7,153.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,835.28
|
| Rate for Payer: Aetna Managed Medicare |
$2,225.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,166.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,974.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,815.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,212.44
|
| Rate for Payer: Cash Price |
$2,384.40
|
| Rate for Payer: Cigna Commercial |
$7,312.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,447.70
|
| Rate for Payer: Health EOS Commercial |
$7,073.72
|
| Rate for Payer: HFN Commercial |
$7,312.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,961.00
|
| Rate for Payer: Multiplan Commercial |
$6,358.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,768.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,312.16
|
| Rate for Payer: Quartz Beloit One Network |
$3,894.52
|
| Rate for Payer: Quartz Commercial |
$5,166.20
|
| Rate for Payer: Quartz Medicare Advantage |
$4,768.80
|
| Rate for Payer: The Alliance Commercial |
$31,792.00
|
| Rate for Payer: WEA Trust Commercial |
$4,371.40
|
| Rate for Payer: WPS Commercial |
$5,887.08
|
|
|
FEMORAL HEAD BIOLOX DELTA CERAMIC FOR TAPER SLEEVE 28MM 650-1055
|
Facility
|
IP
|
$8,184.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5685734
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,010.16 |
| Max. Negotiated Rate |
$7,529.28 |
| Rate for Payer: Aetna Commercial |
$7,365.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,038.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,337.52
|
| Rate for Payer: Cash Price |
$2,455.20
|
| Rate for Payer: Cigna Commercial |
$7,529.28
|
| Rate for Payer: Health EOS Commercial |
$7,283.76
|
| Rate for Payer: HFN Commercial |
$7,529.28
|
| Rate for Payer: Multiplan Commercial |
$6,547.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,910.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,529.28
|
| Rate for Payer: Quartz Beloit One Network |
$4,010.16
|
| Rate for Payer: Quartz Commercial |
$4,910.40
|
| Rate for Payer: WEA Trust Commercial |
$4,501.20
|
| Rate for Payer: WPS Commercial |
$6,061.89
|
|
|
FEMORAL HEAD BIOLOX DELTA CERAMIC FOR TAPER SLEEVE 28MM 650-1055
|
Facility
|
OP
|
$8,184.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5685734
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,291.52 |
| Max. Negotiated Rate |
$32,736.00 |
| Rate for Payer: Aetna Commercial |
$7,365.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,038.24
|
| Rate for Payer: Aetna Managed Medicare |
$2,291.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,319.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,092.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,928.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,337.52
|
| Rate for Payer: Cash Price |
$2,455.20
|
| Rate for Payer: Cigna Commercial |
$7,529.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,579.77
|
| Rate for Payer: Health EOS Commercial |
$7,283.76
|
| Rate for Payer: HFN Commercial |
$7,529.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,138.00
|
| Rate for Payer: Multiplan Commercial |
$6,547.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,910.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,529.28
|
| Rate for Payer: Quartz Beloit One Network |
$4,010.16
|
| Rate for Payer: Quartz Commercial |
$5,319.60
|
| Rate for Payer: Quartz Medicare Advantage |
$4,910.40
|
| Rate for Payer: The Alliance Commercial |
$32,736.00
|
| Rate for Payer: WEA Trust Commercial |
$4,501.20
|
| Rate for Payer: WPS Commercial |
$6,061.89
|
|
|
FEMORAL HEAD BIOLOX DELTA MODULAR CERAMIC 36MM/-3MM STD 650-0660
|
Facility
|
OP
|
$4,859.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6179801
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,360.52 |
| Max. Negotiated Rate |
$19,436.00 |
| Rate for Payer: Aetna Commercial |
$4,373.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,178.74
|
| Rate for Payer: Aetna Managed Medicare |
$1,360.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,158.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,429.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,332.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,575.27
|
| Rate for Payer: Cash Price |
$1,457.70
|
| Rate for Payer: Cigna Commercial |
$4,470.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,719.10
|
| Rate for Payer: Health EOS Commercial |
$4,324.51
|
| Rate for Payer: HFN Commercial |
$4,470.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,644.25
|
| Rate for Payer: Multiplan Commercial |
$3,887.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,915.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,470.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,380.91
|
| Rate for Payer: Quartz Commercial |
$3,158.35
|
| Rate for Payer: Quartz Medicare Advantage |
$2,915.40
|
| Rate for Payer: The Alliance Commercial |
$19,436.00
|
| Rate for Payer: WEA Trust Commercial |
$2,672.45
|
| Rate for Payer: WPS Commercial |
$3,599.06
|
|
|
FEMORAL HEAD BIOLOX DELTA MODULAR CERAMIC 36MM/-3MM STD 650-0660
|
Facility
|
IP
|
$4,859.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6179801
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,380.91 |
| Max. Negotiated Rate |
$4,470.28 |
| Rate for Payer: Aetna Commercial |
$4,373.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,178.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,575.27
|
| Rate for Payer: Cash Price |
$1,457.70
|
| Rate for Payer: Cigna Commercial |
$4,470.28
|
| Rate for Payer: Health EOS Commercial |
$4,324.51
|
| Rate for Payer: HFN Commercial |
$4,470.28
|
| Rate for Payer: Multiplan Commercial |
$3,887.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,915.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,470.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,380.91
|
| Rate for Payer: Quartz Commercial |
$2,915.40
|
| Rate for Payer: WEA Trust Commercial |
$2,672.45
|
| Rate for Payer: WPS Commercial |
$3,599.06
|
|
|
FEMORAL HEAD BIOLOX DELTA MODULAR CERAMIC 36MM STD 12-115121
|
Facility
|
OP
|
$6,117.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563438
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,712.76 |
| Max. Negotiated Rate |
$24,468.00 |
| Rate for Payer: Aetna Commercial |
$5,505.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,260.62
|
| Rate for Payer: Aetna Managed Medicare |
$1,712.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,976.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,058.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,936.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,242.01
|
| Rate for Payer: Cash Price |
$1,835.10
|
| Rate for Payer: Cigna Commercial |
$5,627.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,423.07
|
| Rate for Payer: Health EOS Commercial |
$5,444.13
|
| Rate for Payer: HFN Commercial |
$5,627.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,587.75
|
| Rate for Payer: Multiplan Commercial |
$4,893.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,670.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,627.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,997.33
|
| Rate for Payer: Quartz Commercial |
$3,976.05
|
| Rate for Payer: Quartz Medicare Advantage |
$3,670.20
|
| Rate for Payer: The Alliance Commercial |
$24,468.00
|
| Rate for Payer: WEA Trust Commercial |
$3,364.35
|
| Rate for Payer: WPS Commercial |
$4,530.86
|
|
|
FEMORAL HEAD BIOLOX DELTA MODULAR CERAMIC 36MM STD 12-115121
|
Facility
|
IP
|
$6,117.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563438
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,997.33 |
| Max. Negotiated Rate |
$5,627.64 |
| Rate for Payer: Aetna Commercial |
$5,505.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,260.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,242.01
|
| Rate for Payer: Cash Price |
$1,835.10
|
| Rate for Payer: Cigna Commercial |
$5,627.64
|
| Rate for Payer: Health EOS Commercial |
$5,444.13
|
| Rate for Payer: HFN Commercial |
$5,627.64
|
| Rate for Payer: Multiplan Commercial |
$4,893.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,670.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,627.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,997.33
|
| Rate for Payer: Quartz Commercial |
$3,670.20
|
| Rate for Payer: WEA Trust Commercial |
$3,364.35
|
| Rate for Payer: WPS Commercial |
$4,530.86
|
|
|
FEMORAL HEAD BIOLOX DELTA MODULAR CERAMIC 36MM STD 650-0661
|
Facility
|
IP
|
$5,053.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6065702
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,475.97 |
| Max. Negotiated Rate |
$4,648.76 |
| Rate for Payer: Aetna Commercial |
$4,547.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,345.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,678.09
|
| Rate for Payer: Cash Price |
$1,515.90
|
| Rate for Payer: Cigna Commercial |
$4,648.76
|
| Rate for Payer: Health EOS Commercial |
$4,497.17
|
| Rate for Payer: HFN Commercial |
$4,648.76
|
| Rate for Payer: Multiplan Commercial |
$4,042.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,031.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,648.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,475.97
|
| Rate for Payer: Quartz Commercial |
$3,031.80
|
| Rate for Payer: WEA Trust Commercial |
$2,779.15
|
| Rate for Payer: WPS Commercial |
$3,742.76
|
|
|
FEMORAL HEAD BIOLOX DELTA MODULAR CERAMIC 36MM STD 650-0661
|
Facility
|
OP
|
$5,053.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6065702
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,414.84 |
| Max. Negotiated Rate |
$20,212.00 |
| Rate for Payer: Aetna Commercial |
$4,547.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,345.58
|
| Rate for Payer: Aetna Managed Medicare |
$1,414.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,284.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,526.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,425.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,678.09
|
| Rate for Payer: Cash Price |
$1,515.90
|
| Rate for Payer: Cigna Commercial |
$4,648.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,827.66
|
| Rate for Payer: Health EOS Commercial |
$4,497.17
|
| Rate for Payer: HFN Commercial |
$4,648.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,789.75
|
| Rate for Payer: Multiplan Commercial |
$4,042.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,031.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,648.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,475.97
|
| Rate for Payer: Quartz Commercial |
$3,284.45
|
| Rate for Payer: Quartz Medicare Advantage |
$3,031.80
|
| Rate for Payer: The Alliance Commercial |
$20,212.00
|
| Rate for Payer: WEA Trust Commercial |
$2,779.15
|
| Rate for Payer: WPS Commercial |
$3,742.76
|
|
|
FEMORAL HEAD CERAMIC 32MM -2.5 18-32-3
|
Facility
|
IP
|
$7,170.00
|
|
| Hospital Charge Code |
3072549
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,513.30 |
| Max. Negotiated Rate |
$6,596.40 |
| Rate for Payer: Aetna Commercial |
$6,453.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,166.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,800.10
|
| Rate for Payer: Cash Price |
$2,151.00
|
| Rate for Payer: Cigna Commercial |
$6,596.40
|
| Rate for Payer: Health EOS Commercial |
$6,381.30
|
| Rate for Payer: HFN Commercial |
$6,596.40
|
| Rate for Payer: Multiplan Commercial |
$5,736.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,302.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,596.40
|
| Rate for Payer: Quartz Beloit One Network |
$3,513.30
|
| Rate for Payer: Quartz Commercial |
$4,302.00
|
| Rate for Payer: WEA Trust Commercial |
$3,943.50
|
| Rate for Payer: WPS Commercial |
$5,310.82
|
|
|
FEMORAL HEAD CERAMIC 32MM -2.5 18-32-3
|
Facility
|
OP
|
$7,170.00
|
|
| Hospital Charge Code |
3072549
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,007.60 |
| Max. Negotiated Rate |
$28,680.00 |
| Rate for Payer: Aetna Commercial |
$6,453.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,166.20
|
| Rate for Payer: Aetna Managed Medicare |
$2,007.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,660.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,585.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,441.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,800.10
|
| Rate for Payer: Cash Price |
$2,151.00
|
| Rate for Payer: Cigna Commercial |
$6,596.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,012.33
|
| Rate for Payer: Health EOS Commercial |
$6,381.30
|
| Rate for Payer: HFN Commercial |
$6,596.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,377.50
|
| Rate for Payer: Multiplan Commercial |
$5,736.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,302.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,596.40
|
| Rate for Payer: Quartz Beloit One Network |
$3,513.30
|
| Rate for Payer: Quartz Commercial |
$4,660.50
|
| Rate for Payer: Quartz Medicare Advantage |
$4,302.00
|
| Rate for Payer: The Alliance Commercial |
$28,680.00
|
| Rate for Payer: WEA Trust Commercial |
$3,943.50
|
| Rate for Payer: WPS Commercial |
$5,310.82
|
|
