|
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 |
$4,025.35 |
| 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 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 |
$2,300.20 |
| 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 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 |
$4,025.35 |
| 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 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 |
$2,300.20 |
| 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 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 |
$4,025.35 |
| 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 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 |
$2,300.20 |
| 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 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 |
$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 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 |
$2,214.80 |
| 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 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 |
$2,214.80 |
| 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 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 |
$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 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 |
$4,025.35 |
| 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 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 |
$2,300.20 |
| 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 8 RT CEMENTED 1504-10-208
|
Facility
|
OP
|
$8,215.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5496863
|
|
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 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 |
$4,025.35 |
| 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 9 RT CEMENTED 1504-10-209
|
Facility
|
IP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5497056
|
|
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 9 RT CEMENTED 1504-10-209
|
Facility
|
OP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5497056
|
|
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 REVISION CRS ATTUNE SZ 3 RT CEMENTED 1504-40-203
|
Facility
|
IP
|
$47,672.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563333
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23,359.28 |
| Max. Negotiated Rate |
$43,858.24 |
| Rate for Payer: Aetna Commercial |
$42,904.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$40,997.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25,266.16
|
| Rate for Payer: Cash Price |
$14,301.60
|
| Rate for Payer: Cigna Commercial |
$43,858.24
|
| Rate for Payer: Health EOS Commercial |
$42,428.08
|
| Rate for Payer: HFN Commercial |
$43,858.24
|
| Rate for Payer: Multiplan Commercial |
$38,137.60
|
| Rate for Payer: NAPHCARE Commercial |
$28,603.20
|
| Rate for Payer: Preferred Network Access Commercial |
$43,858.24
|
| Rate for Payer: Quartz Beloit One Network |
$23,359.28
|
| Rate for Payer: Quartz Commercial |
$28,603.20
|
| Rate for Payer: WEA Trust Commercial |
$26,219.60
|
| Rate for Payer: WPS Commercial |
$35,310.65
|
|
|
FEMORAL REVISION CRS ATTUNE SZ 3 RT CEMENTED 1504-40-203
|
Facility
|
OP
|
$47,672.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563333
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13,348.16 |
| Max. Negotiated Rate |
$190,688.00 |
| Rate for Payer: Aetna Commercial |
$42,904.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$40,997.92
|
| Rate for Payer: Aetna Managed Medicare |
$13,348.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30,986.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23,836.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22,882.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25,266.16
|
| Rate for Payer: Cash Price |
$14,301.60
|
| Rate for Payer: Cigna Commercial |
$43,858.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26,677.25
|
| Rate for Payer: Health EOS Commercial |
$42,428.08
|
| Rate for Payer: HFN Commercial |
$43,858.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$35,754.00
|
| Rate for Payer: Multiplan Commercial |
$38,137.60
|
| Rate for Payer: NAPHCARE Commercial |
$28,603.20
|
| Rate for Payer: Preferred Network Access Commercial |
$43,858.24
|
| Rate for Payer: Quartz Beloit One Network |
$23,359.28
|
| Rate for Payer: Quartz Commercial |
$30,986.80
|
| Rate for Payer: Quartz Medicare Advantage |
$28,603.20
|
| Rate for Payer: The Alliance Commercial |
$190,688.00
|
| Rate for Payer: WEA Trust Commercial |
$26,219.60
|
| Rate for Payer: WPS Commercial |
$35,310.65
|
|
|
FEMORAL REVISION CRS ATTUNE SZ 4 LT CEMENTED 1504-40-104
|
Facility
|
OP
|
$31,940.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6177673
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,943.20 |
| Max. Negotiated Rate |
$127,760.00 |
| Rate for Payer: Aetna Commercial |
$28,746.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$27,468.40
|
| Rate for Payer: Aetna Managed Medicare |
$8,943.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20,761.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15,970.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,331.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16,928.20
|
| Rate for Payer: Cash Price |
$9,582.00
|
| Rate for Payer: Cigna Commercial |
$29,384.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17,873.62
|
| Rate for Payer: Health EOS Commercial |
$28,426.60
|
| Rate for Payer: HFN Commercial |
$29,384.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23,955.00
|
| Rate for Payer: Multiplan Commercial |
$25,552.00
|
| Rate for Payer: NAPHCARE Commercial |
$19,164.00
|
| Rate for Payer: Preferred Network Access Commercial |
$29,384.80
|
| Rate for Payer: Quartz Beloit One Network |
$15,650.60
|
| Rate for Payer: Quartz Commercial |
$20,761.00
|
| Rate for Payer: Quartz Medicare Advantage |
$19,164.00
|
| Rate for Payer: The Alliance Commercial |
$127,760.00
|
| Rate for Payer: WEA Trust Commercial |
$17,567.00
|
| Rate for Payer: WPS Commercial |
$23,657.96
|
|
|
FEMORAL REVISION CRS ATTUNE SZ 4 LT CEMENTED 1504-40-104
|
Facility
|
IP
|
$31,940.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6177673
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15,650.60 |
| Max. Negotiated Rate |
$29,384.80 |
| Rate for Payer: Aetna Commercial |
$28,746.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$27,468.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16,928.20
|
| Rate for Payer: Cash Price |
$9,582.00
|
| Rate for Payer: Cigna Commercial |
$29,384.80
|
| Rate for Payer: Health EOS Commercial |
$28,426.60
|
| Rate for Payer: HFN Commercial |
$29,384.80
|
| Rate for Payer: Multiplan Commercial |
$25,552.00
|
| Rate for Payer: NAPHCARE Commercial |
$19,164.00
|
| Rate for Payer: Preferred Network Access Commercial |
$29,384.80
|
| Rate for Payer: Quartz Beloit One Network |
$15,650.60
|
| Rate for Payer: Quartz Commercial |
$19,164.00
|
| Rate for Payer: WEA Trust Commercial |
$17,567.00
|
| Rate for Payer: WPS Commercial |
$23,657.96
|
|
|
FEMORAL REVISION CRS ATTUNE SZ 4 LT CEMENTED 1504-40-205
|
Facility
|
IP
|
$31,940.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6151662
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15,650.60 |
| Max. Negotiated Rate |
$29,384.80 |
| Rate for Payer: Aetna Commercial |
$28,746.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$27,468.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16,928.20
|
| Rate for Payer: Cash Price |
$9,582.00
|
| Rate for Payer: Cigna Commercial |
$29,384.80
|
| Rate for Payer: Health EOS Commercial |
$28,426.60
|
| Rate for Payer: HFN Commercial |
$29,384.80
|
| Rate for Payer: Multiplan Commercial |
$25,552.00
|
| Rate for Payer: NAPHCARE Commercial |
$19,164.00
|
| Rate for Payer: Preferred Network Access Commercial |
$29,384.80
|
| Rate for Payer: Quartz Beloit One Network |
$15,650.60
|
| Rate for Payer: Quartz Commercial |
$19,164.00
|
| Rate for Payer: WEA Trust Commercial |
$17,567.00
|
| Rate for Payer: WPS Commercial |
$23,657.96
|
|
|
FEMORAL REVISION CRS ATTUNE SZ 4 LT CEMENTED 1504-40-205
|
Facility
|
OP
|
$31,940.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6151662
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,943.20 |
| Max. Negotiated Rate |
$127,760.00 |
| Rate for Payer: Aetna Commercial |
$28,746.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$27,468.40
|
| Rate for Payer: Aetna Managed Medicare |
$8,943.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20,761.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15,970.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,331.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16,928.20
|
| Rate for Payer: Cash Price |
$9,582.00
|
| Rate for Payer: Cigna Commercial |
$29,384.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17,873.62
|
| Rate for Payer: Health EOS Commercial |
$28,426.60
|
| Rate for Payer: HFN Commercial |
$29,384.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23,955.00
|
| Rate for Payer: Multiplan Commercial |
$25,552.00
|
| Rate for Payer: NAPHCARE Commercial |
$19,164.00
|
| Rate for Payer: Preferred Network Access Commercial |
$29,384.80
|
| Rate for Payer: Quartz Beloit One Network |
$15,650.60
|
| Rate for Payer: Quartz Commercial |
$20,761.00
|
| Rate for Payer: Quartz Medicare Advantage |
$19,164.00
|
| Rate for Payer: The Alliance Commercial |
$127,760.00
|
| Rate for Payer: WEA Trust Commercial |
$17,567.00
|
| Rate for Payer: WPS Commercial |
$23,657.96
|
|
|
FEMORAL REVISION CRS ATTUNE SZ 4 RT CEMENTED 1504-40-204
|
Facility
|
OP
|
$49,378.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5528738
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13,825.84 |
| Max. Negotiated Rate |
$197,512.00 |
| Rate for Payer: Aetna Commercial |
$44,440.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42,465.08
|
| Rate for Payer: Aetna Managed Medicare |
$13,825.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32,095.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24,689.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23,701.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$26,170.34
|
| Rate for Payer: Cash Price |
$14,813.40
|
| Rate for Payer: Cigna Commercial |
$45,427.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27,631.93
|
| Rate for Payer: Health EOS Commercial |
$43,946.42
|
| Rate for Payer: HFN Commercial |
$45,427.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37,033.50
|
| Rate for Payer: Multiplan Commercial |
$39,502.40
|
| Rate for Payer: NAPHCARE Commercial |
$29,626.80
|
| Rate for Payer: Preferred Network Access Commercial |
$45,427.76
|
| Rate for Payer: Quartz Beloit One Network |
$24,195.22
|
| Rate for Payer: Quartz Commercial |
$32,095.70
|
| Rate for Payer: Quartz Medicare Advantage |
$29,626.80
|
| Rate for Payer: The Alliance Commercial |
$197,512.00
|
| Rate for Payer: WEA Trust Commercial |
$27,157.90
|
| Rate for Payer: WPS Commercial |
$36,574.28
|
|
|
FEMORAL REVISION CRS ATTUNE SZ 4 RT CEMENTED 1504-40-204
|
Facility
|
IP
|
$49,378.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5528738
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24,195.22 |
| Max. Negotiated Rate |
$45,427.76 |
| Rate for Payer: Aetna Commercial |
$44,440.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42,465.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$26,170.34
|
| Rate for Payer: Cash Price |
$14,813.40
|
| Rate for Payer: Cigna Commercial |
$45,427.76
|
| Rate for Payer: Health EOS Commercial |
$43,946.42
|
| Rate for Payer: HFN Commercial |
$45,427.76
|
| Rate for Payer: Multiplan Commercial |
$39,502.40
|
| Rate for Payer: NAPHCARE Commercial |
$29,626.80
|
| Rate for Payer: Preferred Network Access Commercial |
$45,427.76
|
| Rate for Payer: Quartz Beloit One Network |
$24,195.22
|
| Rate for Payer: Quartz Commercial |
$29,626.80
|
| Rate for Payer: WEA Trust Commercial |
$27,157.90
|
| Rate for Payer: WPS Commercial |
$36,574.28
|
|
|
FEMORAL REVISION CRS ATTUNE SZ 5 LT CEMENTED 1504-40-105
|
Facility
|
OP
|
$33,814.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6226145
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,467.92 |
| Max. Negotiated Rate |
$135,256.00 |
| Rate for Payer: Aetna Commercial |
$30,432.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$29,080.04
|
| Rate for Payer: Aetna Managed Medicare |
$9,467.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21,979.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,907.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16,230.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$17,921.42
|
| Rate for Payer: Cash Price |
$10,144.20
|
| Rate for Payer: Cigna Commercial |
$31,108.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18,922.31
|
| Rate for Payer: Health EOS Commercial |
$30,094.46
|
| Rate for Payer: HFN Commercial |
$31,108.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25,360.50
|
| Rate for Payer: Multiplan Commercial |
$27,051.20
|
| Rate for Payer: NAPHCARE Commercial |
$20,288.40
|
| Rate for Payer: Preferred Network Access Commercial |
$31,108.88
|
| Rate for Payer: Quartz Beloit One Network |
$16,568.86
|
| Rate for Payer: Quartz Commercial |
$21,979.10
|
| Rate for Payer: Quartz Medicare Advantage |
$20,288.40
|
| Rate for Payer: The Alliance Commercial |
$135,256.00
|
| Rate for Payer: WEA Trust Commercial |
$18,597.70
|
| Rate for Payer: WPS Commercial |
$25,046.03
|
|
