|
FEMORAL POPLITEAL/TIBIAL/DISTAL BYPASS GRAFT
|
Facility
|
IP
|
$16,743.00
|
|
| Hospital Charge Code |
2960067
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,204.07 |
| Max. Negotiated Rate |
$15,403.56 |
| Rate for Payer: Aetna Commercial |
$15,068.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,398.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,873.79
|
| Rate for Payer: Cash Price |
$5,022.90
|
| Rate for Payer: Cigna Commercial |
$15,403.56
|
| Rate for Payer: Health EOS Commercial |
$14,901.27
|
| Rate for Payer: HFN Commercial |
$15,403.56
|
| Rate for Payer: Multiplan Commercial |
$13,394.40
|
| Rate for Payer: NAPHCARE Commercial |
$10,045.80
|
| Rate for Payer: Preferred Network Access Commercial |
$15,403.56
|
| Rate for Payer: Quartz Beloit One Network |
$8,204.07
|
| Rate for Payer: Quartz Commercial |
$10,045.80
|
| Rate for Payer: WEA Trust Commercial |
$9,208.65
|
| Rate for Payer: WPS Commercial |
$12,401.54
|
|
|
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 |
$3,632.37 |
| Max. Negotiated Rate |
$6,819.96 |
| Rate for Payer: Aetna Commercial |
$6,671.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,375.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,928.89
|
| Rate for Payer: Cash Price |
$2,223.90
|
| Rate for Payer: Cigna Commercial |
$6,819.96
|
| Rate for Payer: Health EOS Commercial |
$6,597.57
|
| Rate for Payer: HFN Commercial |
$6,819.96
|
| Rate for Payer: Multiplan Commercial |
$5,930.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,447.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,819.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,632.37
|
| Rate for Payer: Quartz Commercial |
$4,447.80
|
| Rate for Payer: WEA Trust Commercial |
$4,077.15
|
| Rate for Payer: WPS Commercial |
$5,490.81
|
|
|
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 |
$2,075.64 |
| Max. Negotiated Rate |
$29,652.00 |
| Rate for Payer: Aetna Commercial |
$6,671.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,375.18
|
| Rate for Payer: Aetna Managed Medicare |
$2,075.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,818.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,706.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,558.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,928.89
|
| Rate for Payer: Cash Price |
$2,223.90
|
| Rate for Payer: Cigna Commercial |
$6,819.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,148.31
|
| Rate for Payer: Health EOS Commercial |
$6,597.57
|
| Rate for Payer: HFN Commercial |
$6,819.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,559.75
|
| Rate for Payer: Multiplan Commercial |
$5,930.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,447.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,819.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,632.37
|
| Rate for Payer: Quartz Commercial |
$4,818.45
|
| Rate for Payer: Quartz Medicare Advantage |
$4,447.80
|
| Rate for Payer: The Alliance Commercial |
$29,652.00
|
| Rate for Payer: WEA Trust Commercial |
$4,077.15
|
| Rate for Payer: WPS Commercial |
$5,490.81
|
|
|
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 |
$2,129.68 |
| Max. Negotiated Rate |
$30,424.00 |
| Rate for Payer: Aetna Commercial |
$6,845.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,541.16
|
| Rate for Payer: Aetna Managed Medicare |
$2,129.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,943.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,803.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,650.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,031.18
|
| Rate for Payer: Cash Price |
$2,281.80
|
| Rate for Payer: Cigna Commercial |
$6,997.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,256.32
|
| Rate for Payer: Health EOS Commercial |
$6,769.34
|
| Rate for Payer: HFN Commercial |
$6,997.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,704.50
|
| Rate for Payer: Multiplan Commercial |
$6,084.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,563.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,997.52
|
| Rate for Payer: Quartz Beloit One Network |
$3,726.94
|
| Rate for Payer: Quartz Commercial |
$4,943.90
|
| Rate for Payer: Quartz Medicare Advantage |
$4,563.60
|
| Rate for Payer: The Alliance Commercial |
$30,424.00
|
| Rate for Payer: WEA Trust Commercial |
$4,183.30
|
| Rate for Payer: WPS Commercial |
$5,633.76
|
|
|
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 |
$3,726.94 |
| Max. Negotiated Rate |
$6,997.52 |
| Rate for Payer: Aetna Commercial |
$6,845.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,541.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,031.18
|
| Rate for Payer: Cash Price |
$2,281.80
|
| Rate for Payer: Cigna Commercial |
$6,997.52
|
| Rate for Payer: Health EOS Commercial |
$6,769.34
|
| Rate for Payer: HFN Commercial |
$6,997.52
|
| Rate for Payer: Multiplan Commercial |
$6,084.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,563.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,997.52
|
| Rate for Payer: Quartz Beloit One Network |
$3,726.94
|
| Rate for Payer: Quartz Commercial |
$4,563.60
|
| Rate for Payer: WEA Trust Commercial |
$4,183.30
|
| Rate for Payer: WPS Commercial |
$5,633.76
|
|
|
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 |
$3,726.94 |
| Max. Negotiated Rate |
$6,997.52 |
| Rate for Payer: Aetna Commercial |
$6,845.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,541.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,031.18
|
| Rate for Payer: Cash Price |
$2,281.80
|
| Rate for Payer: Cigna Commercial |
$6,997.52
|
| Rate for Payer: Health EOS Commercial |
$6,769.34
|
| Rate for Payer: HFN Commercial |
$6,997.52
|
| Rate for Payer: Multiplan Commercial |
$6,084.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,563.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,997.52
|
| Rate for Payer: Quartz Beloit One Network |
$3,726.94
|
| Rate for Payer: Quartz Commercial |
$4,563.60
|
| Rate for Payer: WEA Trust Commercial |
$4,183.30
|
| Rate for Payer: WPS Commercial |
$5,633.76
|
|
|
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 |
$2,129.68 |
| Max. Negotiated Rate |
$30,424.00 |
| Rate for Payer: Aetna Commercial |
$6,845.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,541.16
|
| Rate for Payer: Aetna Managed Medicare |
$2,129.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,943.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,803.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,650.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,031.18
|
| Rate for Payer: Cash Price |
$2,281.80
|
| Rate for Payer: Cigna Commercial |
$6,997.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,256.32
|
| Rate for Payer: Health EOS Commercial |
$6,769.34
|
| Rate for Payer: HFN Commercial |
$6,997.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,704.50
|
| Rate for Payer: Multiplan Commercial |
$6,084.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,563.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,997.52
|
| Rate for Payer: Quartz Beloit One Network |
$3,726.94
|
| Rate for Payer: Quartz Commercial |
$4,943.90
|
| Rate for Payer: Quartz Medicare Advantage |
$4,563.60
|
| Rate for Payer: The Alliance Commercial |
$30,424.00
|
| Rate for Payer: WEA Trust Commercial |
$4,183.30
|
| Rate for Payer: WPS Commercial |
$5,633.76
|
|
|
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 |
$4,025.35 |
| Max. Negotiated Rate |
$7,557.80 |
| Rate for Payer: Aetna Commercial |
$7,393.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,064.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,353.95
|
| Rate for Payer: Cash Price |
$2,464.50
|
| Rate for Payer: Cigna Commercial |
$7,557.80
|
| Rate for Payer: Health EOS Commercial |
$7,311.35
|
| Rate for Payer: HFN Commercial |
$7,557.80
|
| Rate for Payer: Multiplan Commercial |
$6,572.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,929.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,557.80
|
| Rate for Payer: Quartz Beloit One Network |
$4,025.35
|
| Rate for Payer: Quartz Commercial |
$4,929.00
|
| Rate for Payer: WEA Trust Commercial |
$4,518.25
|
| Rate for Payer: WPS Commercial |
$6,084.85
|
|
|
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 |
$2,300.20 |
| Max. Negotiated Rate |
$32,860.00 |
| Rate for Payer: Aetna Commercial |
$7,393.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,064.90
|
| Rate for Payer: Aetna Managed Medicare |
$2,300.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,339.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,107.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,943.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,353.95
|
| Rate for Payer: Cash Price |
$2,464.50
|
| Rate for Payer: Cigna Commercial |
$7,557.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,597.11
|
| Rate for Payer: Health EOS Commercial |
$7,311.35
|
| Rate for Payer: HFN Commercial |
$7,557.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,161.25
|
| Rate for Payer: Multiplan Commercial |
$6,572.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,929.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,557.80
|
| Rate for Payer: Quartz Beloit One Network |
$4,025.35
|
| Rate for Payer: Quartz Commercial |
$5,339.75
|
| Rate for Payer: Quartz Medicare Advantage |
$4,929.00
|
| Rate for Payer: The Alliance Commercial |
$32,860.00
|
| Rate for Payer: WEA Trust Commercial |
$4,518.25
|
| Rate for Payer: WPS Commercial |
$6,084.85
|
|
|
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 |
$2,214.80 |
| Max. Negotiated Rate |
$31,640.00 |
| Rate for Payer: Aetna Commercial |
$7,119.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,802.60
|
| Rate for Payer: Aetna Managed Medicare |
$2,214.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,141.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,955.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,796.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,192.30
|
| Rate for Payer: Cash Price |
$2,373.00
|
| Rate for Payer: Cigna Commercial |
$7,277.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,426.44
|
| Rate for Payer: Health EOS Commercial |
$7,039.90
|
| Rate for Payer: HFN Commercial |
$7,277.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,932.50
|
| Rate for Payer: Multiplan Commercial |
$6,328.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,746.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,277.20
|
| Rate for Payer: Quartz Beloit One Network |
$3,875.90
|
| Rate for Payer: Quartz Commercial |
$5,141.50
|
| Rate for Payer: Quartz Medicare Advantage |
$4,746.00
|
| Rate for Payer: The Alliance Commercial |
$31,640.00
|
| Rate for Payer: WEA Trust Commercial |
$4,350.50
|
| Rate for Payer: WPS Commercial |
$5,858.94
|
|
|
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 |
$3,875.90 |
| Max. Negotiated Rate |
$7,277.20 |
| Rate for Payer: Aetna Commercial |
$7,119.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,802.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,192.30
|
| Rate for Payer: Cash Price |
$2,373.00
|
| Rate for Payer: Cigna Commercial |
$7,277.20
|
| Rate for Payer: Health EOS Commercial |
$7,039.90
|
| Rate for Payer: HFN Commercial |
$7,277.20
|
| Rate for Payer: Multiplan Commercial |
$6,328.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,746.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,277.20
|
| Rate for Payer: Quartz Beloit One Network |
$3,875.90
|
| Rate for Payer: Quartz Commercial |
$4,746.00
|
| Rate for Payer: WEA Trust Commercial |
$4,350.50
|
| Rate for Payer: WPS Commercial |
$5,858.94
|
|
|
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 |
$3,632.37 |
| Max. Negotiated Rate |
$6,819.96 |
| Rate for Payer: Aetna Commercial |
$6,671.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,375.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,928.89
|
| Rate for Payer: Cash Price |
$2,223.90
|
| Rate for Payer: Cigna Commercial |
$6,819.96
|
| Rate for Payer: Health EOS Commercial |
$6,597.57
|
| Rate for Payer: HFN Commercial |
$6,819.96
|
| Rate for Payer: Multiplan Commercial |
$5,930.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,447.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,819.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,632.37
|
| Rate for Payer: Quartz Commercial |
$4,447.80
|
| Rate for Payer: WEA Trust Commercial |
$4,077.15
|
| Rate for Payer: WPS Commercial |
$5,490.81
|
|
|
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 |
$2,075.64 |
| Max. Negotiated Rate |
$29,652.00 |
| Rate for Payer: Aetna Commercial |
$6,671.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,375.18
|
| Rate for Payer: Aetna Managed Medicare |
$2,075.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,818.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,706.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,558.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,928.89
|
| Rate for Payer: Cash Price |
$2,223.90
|
| Rate for Payer: Cigna Commercial |
$6,819.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,148.31
|
| Rate for Payer: Health EOS Commercial |
$6,597.57
|
| Rate for Payer: HFN Commercial |
$6,819.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,559.75
|
| Rate for Payer: Multiplan Commercial |
$5,930.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,447.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,819.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,632.37
|
| Rate for Payer: Quartz Commercial |
$4,818.45
|
| Rate for Payer: Quartz Medicare Advantage |
$4,447.80
|
| Rate for Payer: The Alliance Commercial |
$29,652.00
|
| Rate for Payer: WEA Trust Commercial |
$4,077.15
|
| Rate for Payer: WPS Commercial |
$5,490.81
|
|
|
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 |
$4,025.35 |
| Max. Negotiated Rate |
$7,557.80 |
| Rate for Payer: Aetna Commercial |
$7,393.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,064.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,353.95
|
| Rate for Payer: Cash Price |
$2,464.50
|
| Rate for Payer: Cigna Commercial |
$7,557.80
|
| Rate for Payer: Health EOS Commercial |
$7,311.35
|
| Rate for Payer: HFN Commercial |
$7,557.80
|
| Rate for Payer: Multiplan Commercial |
$6,572.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,929.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,557.80
|
| Rate for Payer: Quartz Beloit One Network |
$4,025.35
|
| Rate for Payer: Quartz Commercial |
$4,929.00
|
| Rate for Payer: WEA Trust Commercial |
$4,518.25
|
| Rate for Payer: WPS Commercial |
$6,084.85
|
|
|
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 |
$2,300.20 |
| Max. Negotiated Rate |
$32,860.00 |
| Rate for Payer: Aetna Commercial |
$7,393.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,064.90
|
| Rate for Payer: Aetna Managed Medicare |
$2,300.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,339.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,107.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,943.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,353.95
|
| Rate for Payer: Cash Price |
$2,464.50
|
| Rate for Payer: Cigna Commercial |
$7,557.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,597.11
|
| Rate for Payer: Health EOS Commercial |
$7,311.35
|
| Rate for Payer: HFN Commercial |
$7,557.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,161.25
|
| Rate for Payer: Multiplan Commercial |
$6,572.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,929.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,557.80
|
| Rate for Payer: Quartz Beloit One Network |
$4,025.35
|
| Rate for Payer: Quartz Commercial |
$5,339.75
|
| Rate for Payer: Quartz Medicare Advantage |
$4,929.00
|
| Rate for Payer: The Alliance Commercial |
$32,860.00
|
| Rate for Payer: WEA Trust Commercial |
$4,518.25
|
| Rate for Payer: WPS Commercial |
$6,084.85
|
|
|
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 |
$3,875.90 |
| Max. Negotiated Rate |
$7,277.20 |
| Rate for Payer: Aetna Commercial |
$7,119.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,802.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,192.30
|
| Rate for Payer: Cash Price |
$2,373.00
|
| Rate for Payer: Cigna Commercial |
$7,277.20
|
| Rate for Payer: Health EOS Commercial |
$7,039.90
|
| Rate for Payer: HFN Commercial |
$7,277.20
|
| Rate for Payer: Multiplan Commercial |
$6,328.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,746.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,277.20
|
| Rate for Payer: Quartz Beloit One Network |
$3,875.90
|
| Rate for Payer: Quartz Commercial |
$4,746.00
|
| Rate for Payer: WEA Trust Commercial |
$4,350.50
|
| Rate for Payer: WPS Commercial |
$5,858.94
|
|
|
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 |
$2,214.80 |
| Max. Negotiated Rate |
$31,640.00 |
| Rate for Payer: Aetna Commercial |
$7,119.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,802.60
|
| Rate for Payer: Aetna Managed Medicare |
$2,214.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,141.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,955.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,796.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,192.30
|
| Rate for Payer: Cash Price |
$2,373.00
|
| Rate for Payer: Cigna Commercial |
$7,277.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,426.44
|
| Rate for Payer: Health EOS Commercial |
$7,039.90
|
| Rate for Payer: HFN Commercial |
$7,277.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,932.50
|
| Rate for Payer: Multiplan Commercial |
$6,328.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,746.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,277.20
|
| Rate for Payer: Quartz Beloit One Network |
$3,875.90
|
| Rate for Payer: Quartz Commercial |
$5,141.50
|
| Rate for Payer: Quartz Medicare Advantage |
$4,746.00
|
| Rate for Payer: The Alliance Commercial |
$31,640.00
|
| Rate for Payer: WEA Trust Commercial |
$4,350.50
|
| Rate for Payer: WPS Commercial |
$5,858.94
|
|
|
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 |
$2,300.20 |
| Max. Negotiated Rate |
$32,860.00 |
| Rate for Payer: Aetna Commercial |
$7,393.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,064.90
|
| Rate for Payer: Aetna Managed Medicare |
$2,300.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,339.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,107.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,943.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,353.95
|
| Rate for Payer: Cash Price |
$2,464.50
|
| Rate for Payer: Cigna Commercial |
$7,557.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,597.11
|
| Rate for Payer: Health EOS Commercial |
$7,311.35
|
| Rate for Payer: HFN Commercial |
$7,557.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,161.25
|
| Rate for Payer: Multiplan Commercial |
$6,572.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,929.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,557.80
|
| Rate for Payer: Quartz Beloit One Network |
$4,025.35
|
| Rate for Payer: Quartz Commercial |
$5,339.75
|
| Rate for Payer: Quartz Medicare Advantage |
$4,929.00
|
| Rate for Payer: The Alliance Commercial |
$32,860.00
|
| Rate for Payer: WEA Trust Commercial |
$4,518.25
|
| Rate for Payer: WPS Commercial |
$6,084.85
|
|
|
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 |
$4,025.35 |
| Max. Negotiated Rate |
$7,557.80 |
| Rate for Payer: Aetna Commercial |
$7,393.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,064.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,353.95
|
| Rate for Payer: Cash Price |
$2,464.50
|
| Rate for Payer: Cigna Commercial |
$7,557.80
|
| Rate for Payer: Health EOS Commercial |
$7,311.35
|
| Rate for Payer: HFN Commercial |
$7,557.80
|
| Rate for Payer: Multiplan Commercial |
$6,572.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,929.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,557.80
|
| Rate for Payer: Quartz Beloit One Network |
$4,025.35
|
| Rate for Payer: Quartz Commercial |
$4,929.00
|
| Rate for Payer: WEA Trust Commercial |
$4,518.25
|
| Rate for Payer: WPS Commercial |
$6,084.85
|
|
|
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 |
$3,875.90 |
| Max. Negotiated Rate |
$7,277.20 |
| Rate for Payer: Aetna Commercial |
$7,119.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,802.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,192.30
|
| Rate for Payer: Cash Price |
$2,373.00
|
| Rate for Payer: Cigna Commercial |
$7,277.20
|
| Rate for Payer: Health EOS Commercial |
$7,039.90
|
| Rate for Payer: HFN Commercial |
$7,277.20
|
| Rate for Payer: Multiplan Commercial |
$6,328.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,746.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,277.20
|
| Rate for Payer: Quartz Beloit One Network |
$3,875.90
|
| Rate for Payer: Quartz Commercial |
$4,746.00
|
| Rate for Payer: WEA Trust Commercial |
$4,350.50
|
| Rate for Payer: WPS Commercial |
$5,858.94
|
|
|
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 |
$2,214.80 |
| Max. Negotiated Rate |
$31,640.00 |
| Rate for Payer: Aetna Commercial |
$7,119.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,802.60
|
| Rate for Payer: Aetna Managed Medicare |
$2,214.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,141.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,955.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,796.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,192.30
|
| Rate for Payer: Cash Price |
$2,373.00
|
| Rate for Payer: Cigna Commercial |
$7,277.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,426.44
|
| Rate for Payer: Health EOS Commercial |
$7,039.90
|
| Rate for Payer: HFN Commercial |
$7,277.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,932.50
|
| Rate for Payer: Multiplan Commercial |
$6,328.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,746.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,277.20
|
| Rate for Payer: Quartz Beloit One Network |
$3,875.90
|
| Rate for Payer: Quartz Commercial |
$5,141.50
|
| Rate for Payer: Quartz Medicare Advantage |
$4,746.00
|
| Rate for Payer: The Alliance Commercial |
$31,640.00
|
| Rate for Payer: WEA Trust Commercial |
$4,350.50
|
| Rate for Payer: WPS Commercial |
$5,858.94
|
|
|
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 |
$3,875.90 |
| Max. Negotiated Rate |
$7,277.20 |
| Rate for Payer: Aetna Commercial |
$7,119.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,802.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,192.30
|
| Rate for Payer: Cash Price |
$2,373.00
|
| Rate for Payer: Cigna Commercial |
$7,277.20
|
| Rate for Payer: Health EOS Commercial |
$7,039.90
|
| Rate for Payer: HFN Commercial |
$7,277.20
|
| Rate for Payer: Multiplan Commercial |
$6,328.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,746.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,277.20
|
| Rate for Payer: Quartz Beloit One Network |
$3,875.90
|
| Rate for Payer: Quartz Commercial |
$4,746.00
|
| Rate for Payer: WEA Trust Commercial |
$4,350.50
|
| Rate for Payer: WPS Commercial |
$5,858.94
|
|
|
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 |
$2,214.80 |
| Max. Negotiated Rate |
$31,640.00 |
| Rate for Payer: Aetna Commercial |
$7,119.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,802.60
|
| Rate for Payer: Aetna Managed Medicare |
$2,214.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,141.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,955.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,796.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,192.30
|
| Rate for Payer: Cash Price |
$2,373.00
|
| Rate for Payer: Cigna Commercial |
$7,277.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,426.44
|
| Rate for Payer: Health EOS Commercial |
$7,039.90
|
| Rate for Payer: HFN Commercial |
$7,277.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,932.50
|
| Rate for Payer: Multiplan Commercial |
$6,328.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,746.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,277.20
|
| Rate for Payer: Quartz Beloit One Network |
$3,875.90
|
| Rate for Payer: Quartz Commercial |
$5,141.50
|
| Rate for Payer: Quartz Medicare Advantage |
$4,746.00
|
| Rate for Payer: The Alliance Commercial |
$31,640.00
|
| Rate for Payer: WEA Trust Commercial |
$4,350.50
|
| Rate for Payer: WPS Commercial |
$5,858.94
|
|
|
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 |
$2,214.80 |
| Max. Negotiated Rate |
$31,640.00 |
| Rate for Payer: Aetna Commercial |
$7,119.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,802.60
|
| Rate for Payer: Aetna Managed Medicare |
$2,214.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,141.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,955.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,796.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,192.30
|
| Rate for Payer: Cash Price |
$2,373.00
|
| Rate for Payer: Cigna Commercial |
$7,277.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,426.44
|
| Rate for Payer: Health EOS Commercial |
$7,039.90
|
| Rate for Payer: HFN Commercial |
$7,277.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,932.50
|
| Rate for Payer: Multiplan Commercial |
$6,328.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,746.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,277.20
|
| Rate for Payer: Quartz Beloit One Network |
$3,875.90
|
| Rate for Payer: Quartz Commercial |
$5,141.50
|
| Rate for Payer: Quartz Medicare Advantage |
$4,746.00
|
| Rate for Payer: The Alliance Commercial |
$31,640.00
|
| Rate for Payer: WEA Trust Commercial |
$4,350.50
|
| Rate for Payer: WPS Commercial |
$5,858.94
|
|
|
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 |
$3,875.90 |
| Max. Negotiated Rate |
$7,277.20 |
| Rate for Payer: Aetna Commercial |
$7,119.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,802.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,192.30
|
| Rate for Payer: Cash Price |
$2,373.00
|
| Rate for Payer: Cigna Commercial |
$7,277.20
|
| Rate for Payer: Health EOS Commercial |
$7,039.90
|
| Rate for Payer: HFN Commercial |
$7,277.20
|
| Rate for Payer: Multiplan Commercial |
$6,328.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,746.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,277.20
|
| Rate for Payer: Quartz Beloit One Network |
$3,875.90
|
| Rate for Payer: Quartz Commercial |
$4,746.00
|
| Rate for Payer: WEA Trust Commercial |
$4,350.50
|
| Rate for Payer: WPS Commercial |
$5,858.94
|
|
