|
FEMUR BONE GRAFTING
|
Facility
|
IP
|
$4,170.00
|
|
| Hospital Charge Code |
2959858
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,125.03 |
| Max. Negotiated Rate |
$3,989.86 |
| Rate for Payer: Aetna Commercial |
$3,903.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,729.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,298.50
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cigna Commercial |
$3,989.86
|
| Rate for Payer: Health EOS Commercial |
$3,859.75
|
| Rate for Payer: HFN Commercial |
$3,989.86
|
| Rate for Payer: Multiplan Commercial |
$3,469.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,989.86
|
| Rate for Payer: Quartz Beloit One Network |
$2,125.03
|
| Rate for Payer: Quartz Commercial |
$2,602.08
|
| Rate for Payer: WEA Trust Commercial |
$2,385.24
|
| Rate for Payer: WPS Commercial |
$3,212.15
|
|
|
FEMUR, EPIPHYSIODESIS
|
Facility
|
OP
|
$5,314.00
|
|
| Hospital Charge Code |
2960015
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,547.44 |
| Max. Negotiated Rate |
$5,084.44 |
| Rate for Payer: Aetna Commercial |
$4,973.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,752.84
|
| Rate for Payer: Aetna Managed Medicare |
$1,547.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,592.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,763.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,652.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,929.08
|
| Rate for Payer: Cash Price |
$1,594.20
|
| Rate for Payer: Cigna Commercial |
$5,084.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,092.75
|
| Rate for Payer: Health EOS Commercial |
$4,918.64
|
| Rate for Payer: HFN Commercial |
$5,084.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,144.92
|
| Rate for Payer: Multiplan Commercial |
$4,421.25
|
| Rate for Payer: NAPHCARE Commercial |
$3,315.94
|
| Rate for Payer: Preferred Network Access Commercial |
$5,084.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,708.01
|
| Rate for Payer: Quartz Commercial |
$3,592.26
|
| Rate for Payer: Quartz Medicare Advantage |
$3,315.94
|
| Rate for Payer: The Alliance Commercial |
$2,763.28
|
| Rate for Payer: WEA Trust Commercial |
$3,039.61
|
| Rate for Payer: WPS Commercial |
$4,093.37
|
|
|
FEMUR, EPIPHYSIODESIS
|
Facility
|
IP
|
$5,314.00
|
|
| Hospital Charge Code |
2960015
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,708.01 |
| Max. Negotiated Rate |
$5,084.44 |
| Rate for Payer: Aetna Commercial |
$4,973.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,752.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,929.08
|
| Rate for Payer: Cash Price |
$1,594.20
|
| Rate for Payer: Cigna Commercial |
$5,084.44
|
| Rate for Payer: Health EOS Commercial |
$4,918.64
|
| Rate for Payer: HFN Commercial |
$5,084.44
|
| Rate for Payer: Multiplan Commercial |
$4,421.25
|
| Rate for Payer: Preferred Network Access Commercial |
$5,084.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,708.01
|
| Rate for Payer: Quartz Commercial |
$3,315.94
|
| Rate for Payer: WEA Trust Commercial |
$3,039.61
|
| Rate for Payer: WPS Commercial |
$4,093.37
|
|
|
FEMUR LPS-FLEX TIVANIUM SZ F LT 00-5968-016-51
|
Facility
|
IP
|
$21,849.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967471
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,134.25 |
| Max. Negotiated Rate |
$20,905.12 |
| Rate for Payer: Aetna Commercial |
$20,450.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19,541.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12,043.17
|
| Rate for Payer: Cash Price |
$6,554.70
|
| Rate for Payer: Cigna Commercial |
$20,905.12
|
| Rate for Payer: Health EOS Commercial |
$20,223.43
|
| Rate for Payer: HFN Commercial |
$20,905.12
|
| Rate for Payer: Multiplan Commercial |
$18,178.37
|
| Rate for Payer: Preferred Network Access Commercial |
$20,905.12
|
| Rate for Payer: Quartz Beloit One Network |
$11,134.25
|
| Rate for Payer: Quartz Commercial |
$13,633.78
|
| Rate for Payer: WEA Trust Commercial |
$12,497.63
|
| Rate for Payer: WPS Commercial |
$16,830.28
|
|
|
FEMUR LPS-FLEX TIVANIUM SZ F LT 00-5968-016-51
|
Facility
|
OP
|
$21,849.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967471
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,362.43 |
| Max. Negotiated Rate |
$20,905.12 |
| Rate for Payer: Aetna Commercial |
$20,450.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19,541.75
|
| Rate for Payer: Aetna Managed Medicare |
$6,362.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14,769.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,361.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,907.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12,043.17
|
| Rate for Payer: Cash Price |
$6,554.70
|
| Rate for Payer: Cigna Commercial |
$20,905.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,716.12
|
| Rate for Payer: Health EOS Commercial |
$20,223.43
|
| Rate for Payer: HFN Commercial |
$20,905.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17,042.22
|
| Rate for Payer: Multiplan Commercial |
$18,178.37
|
| Rate for Payer: NAPHCARE Commercial |
$13,633.78
|
| Rate for Payer: Preferred Network Access Commercial |
$20,905.12
|
| Rate for Payer: Quartz Beloit One Network |
$11,134.25
|
| Rate for Payer: Quartz Commercial |
$14,769.92
|
| Rate for Payer: Quartz Medicare Advantage |
$13,633.78
|
| Rate for Payer: The Alliance Commercial |
$11,361.48
|
| Rate for Payer: WEA Trust Commercial |
$12,497.63
|
| Rate for Payer: WPS Commercial |
$16,830.28
|
|
|
FEMUR NEXGEN POROUS CR-FLEX SZ E-LT 00-5952-015-01
|
Facility
|
OP
|
$14,382.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5415894
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,188.04 |
| Max. Negotiated Rate |
$13,760.70 |
| Rate for Payer: Aetna Commercial |
$13,461.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,863.26
|
| Rate for Payer: Aetna Managed Medicare |
$4,188.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,722.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,478.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,179.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,927.36
|
| Rate for Payer: Cash Price |
$4,314.60
|
| Rate for Payer: Cigna Commercial |
$13,760.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,370.32
|
| Rate for Payer: Health EOS Commercial |
$13,311.98
|
| Rate for Payer: HFN Commercial |
$13,760.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,217.96
|
| Rate for Payer: Multiplan Commercial |
$11,965.82
|
| Rate for Payer: NAPHCARE Commercial |
$8,974.37
|
| Rate for Payer: Preferred Network Access Commercial |
$13,760.70
|
| Rate for Payer: Quartz Beloit One Network |
$7,329.07
|
| Rate for Payer: Quartz Commercial |
$9,722.23
|
| Rate for Payer: Quartz Medicare Advantage |
$8,974.37
|
| Rate for Payer: The Alliance Commercial |
$7,478.64
|
| Rate for Payer: WEA Trust Commercial |
$8,226.50
|
| Rate for Payer: WPS Commercial |
$11,078.45
|
|
|
FEMUR NEXGEN POROUS CR-FLEX SZ E-LT 00-5952-015-01
|
Facility
|
IP
|
$14,382.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5415894
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,329.07 |
| Max. Negotiated Rate |
$13,760.70 |
| Rate for Payer: Aetna Commercial |
$13,461.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,863.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,927.36
|
| Rate for Payer: Cash Price |
$4,314.60
|
| Rate for Payer: Cigna Commercial |
$13,760.70
|
| Rate for Payer: Health EOS Commercial |
$13,311.98
|
| Rate for Payer: HFN Commercial |
$13,760.70
|
| Rate for Payer: Multiplan Commercial |
$11,965.82
|
| Rate for Payer: Preferred Network Access Commercial |
$13,760.70
|
| Rate for Payer: Quartz Beloit One Network |
$7,329.07
|
| Rate for Payer: Quartz Commercial |
$8,974.37
|
| Rate for Payer: WEA Trust Commercial |
$8,226.50
|
| Rate for Payer: WPS Commercial |
$11,078.45
|
|
|
FEMUR NEXGEN POROUS CR-FLEX SZ G-LT 00-5952-017-01
|
Facility
|
IP
|
$14,382.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5456754
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,329.07 |
| Max. Negotiated Rate |
$13,760.70 |
| Rate for Payer: Aetna Commercial |
$13,461.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,863.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,927.36
|
| Rate for Payer: Cash Price |
$4,314.60
|
| Rate for Payer: Cigna Commercial |
$13,760.70
|
| Rate for Payer: Health EOS Commercial |
$13,311.98
|
| Rate for Payer: HFN Commercial |
$13,760.70
|
| Rate for Payer: Multiplan Commercial |
$11,965.82
|
| Rate for Payer: Preferred Network Access Commercial |
$13,760.70
|
| Rate for Payer: Quartz Beloit One Network |
$7,329.07
|
| Rate for Payer: Quartz Commercial |
$8,974.37
|
| Rate for Payer: WEA Trust Commercial |
$8,226.50
|
| Rate for Payer: WPS Commercial |
$11,078.45
|
|
|
FEMUR NEXGEN POROUS CR-FLEX SZ G-LT 00-5952-017-01
|
Facility
|
OP
|
$14,382.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5456754
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,188.04 |
| Max. Negotiated Rate |
$13,760.70 |
| Rate for Payer: Aetna Commercial |
$13,461.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,863.26
|
| Rate for Payer: Aetna Managed Medicare |
$4,188.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,722.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,478.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,179.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,927.36
|
| Rate for Payer: Cash Price |
$4,314.60
|
| Rate for Payer: Cigna Commercial |
$13,760.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,370.32
|
| Rate for Payer: Health EOS Commercial |
$13,311.98
|
| Rate for Payer: HFN Commercial |
$13,760.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,217.96
|
| Rate for Payer: Multiplan Commercial |
$11,965.82
|
| Rate for Payer: NAPHCARE Commercial |
$8,974.37
|
| Rate for Payer: Preferred Network Access Commercial |
$13,760.70
|
| Rate for Payer: Quartz Beloit One Network |
$7,329.07
|
| Rate for Payer: Quartz Commercial |
$9,722.23
|
| Rate for Payer: Quartz Medicare Advantage |
$8,974.37
|
| Rate for Payer: The Alliance Commercial |
$7,478.64
|
| Rate for Payer: WEA Trust Commercial |
$8,226.50
|
| Rate for Payer: WPS Commercial |
$11,078.45
|
|
|
FEMUR NEXGEN TIVANIUM LPS-FLEX SZ E RT 00-5968-015-52
|
Facility
|
IP
|
$14,382.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4242992
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,329.07 |
| Max. Negotiated Rate |
$13,760.70 |
| Rate for Payer: Aetna Commercial |
$13,461.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,863.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,927.36
|
| Rate for Payer: Cash Price |
$4,314.60
|
| Rate for Payer: Cigna Commercial |
$13,760.70
|
| Rate for Payer: Health EOS Commercial |
$13,311.98
|
| Rate for Payer: HFN Commercial |
$13,760.70
|
| Rate for Payer: Multiplan Commercial |
$11,965.82
|
| Rate for Payer: Preferred Network Access Commercial |
$13,760.70
|
| Rate for Payer: Quartz Beloit One Network |
$7,329.07
|
| Rate for Payer: Quartz Commercial |
$8,974.37
|
| Rate for Payer: WEA Trust Commercial |
$8,226.50
|
| Rate for Payer: WPS Commercial |
$11,078.45
|
|
|
FEMUR NEXGEN TIVANIUM LPS-FLEX SZ E RT 00-5968-015-52
|
Facility
|
OP
|
$14,382.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4242992
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,188.04 |
| Max. Negotiated Rate |
$13,760.70 |
| Rate for Payer: Aetna Commercial |
$13,461.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,863.26
|
| Rate for Payer: Aetna Managed Medicare |
$4,188.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,722.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,478.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,179.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,927.36
|
| Rate for Payer: Cash Price |
$4,314.60
|
| Rate for Payer: Cigna Commercial |
$13,760.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,370.32
|
| Rate for Payer: Health EOS Commercial |
$13,311.98
|
| Rate for Payer: HFN Commercial |
$13,760.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,217.96
|
| Rate for Payer: Multiplan Commercial |
$11,965.82
|
| Rate for Payer: NAPHCARE Commercial |
$8,974.37
|
| Rate for Payer: Preferred Network Access Commercial |
$13,760.70
|
| Rate for Payer: Quartz Beloit One Network |
$7,329.07
|
| Rate for Payer: Quartz Commercial |
$9,722.23
|
| Rate for Payer: Quartz Medicare Advantage |
$8,974.37
|
| Rate for Payer: The Alliance Commercial |
$7,478.64
|
| Rate for Payer: WEA Trust Commercial |
$8,226.50
|
| Rate for Payer: WPS Commercial |
$11,078.45
|
|
|
FEMUR OXFORD TWIN PEG LARGE CEMENTED 161470
|
Facility
|
IP
|
$9,930.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4998680
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,060.33 |
| Max. Negotiated Rate |
$9,501.02 |
| Rate for Payer: Aetna Commercial |
$9,294.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,881.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,473.42
|
| Rate for Payer: Cash Price |
$2,979.00
|
| Rate for Payer: Cigna Commercial |
$9,501.02
|
| Rate for Payer: Health EOS Commercial |
$9,191.21
|
| Rate for Payer: HFN Commercial |
$9,501.02
|
| Rate for Payer: Multiplan Commercial |
$8,261.76
|
| Rate for Payer: Preferred Network Access Commercial |
$9,501.02
|
| Rate for Payer: Quartz Beloit One Network |
$5,060.33
|
| Rate for Payer: Quartz Commercial |
$6,196.32
|
| Rate for Payer: WEA Trust Commercial |
$5,679.96
|
| Rate for Payer: WPS Commercial |
$7,649.08
|
|
|
FEMUR OXFORD TWIN PEG LARGE CEMENTED 161470
|
Facility
|
OP
|
$9,930.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4998680
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,891.62 |
| Max. Negotiated Rate |
$9,501.02 |
| Rate for Payer: Aetna Commercial |
$9,294.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,881.39
|
| Rate for Payer: Aetna Managed Medicare |
$2,891.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,712.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,163.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,957.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,473.42
|
| Rate for Payer: Cash Price |
$2,979.00
|
| Rate for Payer: Cigna Commercial |
$9,501.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,779.26
|
| Rate for Payer: Health EOS Commercial |
$9,191.21
|
| Rate for Payer: HFN Commercial |
$9,501.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,745.40
|
| Rate for Payer: Multiplan Commercial |
$8,261.76
|
| Rate for Payer: NAPHCARE Commercial |
$6,196.32
|
| Rate for Payer: Preferred Network Access Commercial |
$9,501.02
|
| Rate for Payer: Quartz Beloit One Network |
$5,060.33
|
| Rate for Payer: Quartz Commercial |
$6,712.68
|
| Rate for Payer: Quartz Medicare Advantage |
$6,196.32
|
| Rate for Payer: The Alliance Commercial |
$5,163.60
|
| Rate for Payer: WEA Trust Commercial |
$5,679.96
|
| Rate for Payer: WPS Commercial |
$7,649.08
|
|
|
FEMUR OXFORD TWIN PEG MEDIUM CEMENTED 161469
|
Facility
|
IP
|
$11,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4998772
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,692.23 |
| Max. Negotiated Rate |
$10,687.46 |
| Rate for Payer: Aetna Commercial |
$10,455.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,990.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,156.90
|
| Rate for Payer: Cash Price |
$3,351.00
|
| Rate for Payer: Cigna Commercial |
$10,687.46
|
| Rate for Payer: Health EOS Commercial |
$10,338.95
|
| Rate for Payer: HFN Commercial |
$10,687.46
|
| Rate for Payer: Multiplan Commercial |
$9,293.44
|
| Rate for Payer: Preferred Network Access Commercial |
$10,687.46
|
| Rate for Payer: Quartz Beloit One Network |
$5,692.23
|
| Rate for Payer: Quartz Commercial |
$6,970.08
|
| Rate for Payer: WEA Trust Commercial |
$6,389.24
|
| Rate for Payer: WPS Commercial |
$8,604.25
|
|
|
FEMUR OXFORD TWIN PEG MEDIUM CEMENTED 161469
|
Facility
|
OP
|
$11,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4998772
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,252.70 |
| Max. Negotiated Rate |
$10,687.46 |
| Rate for Payer: Aetna Commercial |
$10,455.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,990.45
|
| Rate for Payer: Aetna Managed Medicare |
$3,252.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,550.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,808.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,576.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,156.90
|
| Rate for Payer: Cash Price |
$3,351.00
|
| Rate for Payer: Cigna Commercial |
$10,687.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,500.94
|
| Rate for Payer: Health EOS Commercial |
$10,338.95
|
| Rate for Payer: HFN Commercial |
$10,687.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,712.60
|
| Rate for Payer: Multiplan Commercial |
$9,293.44
|
| Rate for Payer: NAPHCARE Commercial |
$6,970.08
|
| Rate for Payer: Preferred Network Access Commercial |
$10,687.46
|
| Rate for Payer: Quartz Beloit One Network |
$5,692.23
|
| Rate for Payer: Quartz Commercial |
$7,550.92
|
| Rate for Payer: Quartz Medicare Advantage |
$6,970.08
|
| Rate for Payer: The Alliance Commercial |
$5,808.40
|
| Rate for Payer: WEA Trust Commercial |
$6,389.24
|
| Rate for Payer: WPS Commercial |
$8,604.25
|
|
|
FEMUR OXFORD TWIN PEG SMALL CEMENTED 161468
|
Facility
|
IP
|
$2,456.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5074878
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,251.58 |
| Max. Negotiated Rate |
$2,349.90 |
| Rate for Payer: Aetna Commercial |
$2,298.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,196.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,353.75
|
| Rate for Payer: Cash Price |
$736.80
|
| Rate for Payer: Cigna Commercial |
$2,349.90
|
| Rate for Payer: Health EOS Commercial |
$2,273.27
|
| Rate for Payer: HFN Commercial |
$2,349.90
|
| Rate for Payer: Multiplan Commercial |
$2,043.39
|
| Rate for Payer: Preferred Network Access Commercial |
$2,349.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,251.58
|
| Rate for Payer: Quartz Commercial |
$1,532.54
|
| Rate for Payer: WEA Trust Commercial |
$1,404.83
|
| Rate for Payer: WPS Commercial |
$1,891.86
|
|
|
FEMUR OXFORD TWIN PEG SMALL CEMENTED 161468
|
Facility
|
OP
|
$2,456.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5074878
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$715.19 |
| Max. Negotiated Rate |
$2,349.90 |
| Rate for Payer: Aetna Commercial |
$2,298.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,196.65
|
| Rate for Payer: Aetna Managed Medicare |
$715.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,660.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,277.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,226.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,353.75
|
| Rate for Payer: Cash Price |
$736.80
|
| Rate for Payer: Cigna Commercial |
$2,349.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,429.39
|
| Rate for Payer: Health EOS Commercial |
$2,273.27
|
| Rate for Payer: HFN Commercial |
$2,349.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,915.68
|
| Rate for Payer: Multiplan Commercial |
$2,043.39
|
| Rate for Payer: NAPHCARE Commercial |
$1,532.54
|
| Rate for Payer: Preferred Network Access Commercial |
$2,349.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,251.58
|
| Rate for Payer: Quartz Commercial |
$1,660.26
|
| Rate for Payer: Quartz Medicare Advantage |
$1,532.54
|
| Rate for Payer: The Alliance Commercial |
$1,277.12
|
| Rate for Payer: WEA Trust Commercial |
$1,404.83
|
| Rate for Payer: WPS Commercial |
$1,891.86
|
|
|
FEMUR OXINIUM LPS SZ6 LT 71421216
|
Facility
|
IP
|
$17,755.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3072511
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,047.95 |
| Max. Negotiated Rate |
$16,987.98 |
| Rate for Payer: Aetna Commercial |
$16,618.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,880.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,786.56
|
| Rate for Payer: Cash Price |
$5,326.50
|
| Rate for Payer: Cigna Commercial |
$16,987.98
|
| Rate for Payer: Health EOS Commercial |
$16,434.03
|
| Rate for Payer: HFN Commercial |
$16,987.98
|
| Rate for Payer: Multiplan Commercial |
$14,772.16
|
| Rate for Payer: Preferred Network Access Commercial |
$16,987.98
|
| Rate for Payer: Quartz Beloit One Network |
$9,047.95
|
| Rate for Payer: Quartz Commercial |
$11,079.12
|
| Rate for Payer: WEA Trust Commercial |
$10,155.86
|
| Rate for Payer: WPS Commercial |
$13,676.68
|
|
|
FEMUR OXINIUM LPS SZ6 LT 71421216
|
Facility
|
OP
|
$17,755.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3072511
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,170.26 |
| Max. Negotiated Rate |
$16,987.98 |
| Rate for Payer: Aetna Commercial |
$16,618.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,880.07
|
| Rate for Payer: Aetna Managed Medicare |
$5,170.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,002.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,232.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,863.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,786.56
|
| Rate for Payer: Cash Price |
$5,326.50
|
| Rate for Payer: Cigna Commercial |
$16,987.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,333.41
|
| Rate for Payer: Health EOS Commercial |
$16,434.03
|
| Rate for Payer: HFN Commercial |
$16,987.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,848.90
|
| Rate for Payer: Multiplan Commercial |
$14,772.16
|
| Rate for Payer: NAPHCARE Commercial |
$11,079.12
|
| Rate for Payer: Preferred Network Access Commercial |
$16,987.98
|
| Rate for Payer: Quartz Beloit One Network |
$9,047.95
|
| Rate for Payer: Quartz Commercial |
$12,002.38
|
| Rate for Payer: Quartz Medicare Advantage |
$11,079.12
|
| Rate for Payer: The Alliance Commercial |
$9,232.60
|
| Rate for Payer: WEA Trust Commercial |
$10,155.86
|
| Rate for Payer: WPS Commercial |
$13,676.68
|
|
|
FEMUR OXINIUM SZ 4 RT LPS 71421204
|
Facility
|
OP
|
$39,477.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3072431
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,495.70 |
| Max. Negotiated Rate |
$37,771.59 |
| Rate for Payer: Aetna Commercial |
$36,950.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$35,308.23
|
| Rate for Payer: Aetna Managed Medicare |
$11,495.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$26,686.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20,528.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19,706.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$21,759.72
|
| Rate for Payer: Cash Price |
$11,843.10
|
| Rate for Payer: Cigna Commercial |
$37,771.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22,975.61
|
| Rate for Payer: Health EOS Commercial |
$36,539.91
|
| Rate for Payer: HFN Commercial |
$37,771.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30,792.06
|
| Rate for Payer: Multiplan Commercial |
$32,844.86
|
| Rate for Payer: NAPHCARE Commercial |
$24,633.65
|
| Rate for Payer: Preferred Network Access Commercial |
$37,771.59
|
| Rate for Payer: Quartz Beloit One Network |
$20,117.48
|
| Rate for Payer: Quartz Commercial |
$26,686.45
|
| Rate for Payer: Quartz Medicare Advantage |
$24,633.65
|
| Rate for Payer: The Alliance Commercial |
$20,528.04
|
| Rate for Payer: WEA Trust Commercial |
$22,580.84
|
| Rate for Payer: WPS Commercial |
$30,409.13
|
|
|
FEMUR OXINIUM SZ 4 RT LPS 71421204
|
Facility
|
IP
|
$39,477.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3072431
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20,117.48 |
| Max. Negotiated Rate |
$37,771.59 |
| Rate for Payer: Aetna Commercial |
$36,950.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$35,308.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$21,759.72
|
| Rate for Payer: Cash Price |
$11,843.10
|
| Rate for Payer: Cigna Commercial |
$37,771.59
|
| Rate for Payer: Health EOS Commercial |
$36,539.91
|
| Rate for Payer: HFN Commercial |
$37,771.59
|
| Rate for Payer: Multiplan Commercial |
$32,844.86
|
| Rate for Payer: Preferred Network Access Commercial |
$37,771.59
|
| Rate for Payer: Quartz Beloit One Network |
$20,117.48
|
| Rate for Payer: Quartz Commercial |
$24,633.65
|
| Rate for Payer: WEA Trust Commercial |
$22,580.84
|
| Rate for Payer: WPS Commercial |
$30,409.13
|
|
|
FEMUR PERSONA CR CCR NARROW SZ 8 LT 42-5020-064-01
|
Facility
|
OP
|
$20,886.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4091153
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,082.00 |
| Max. Negotiated Rate |
$19,983.72 |
| Rate for Payer: Aetna Commercial |
$19,549.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,680.44
|
| Rate for Payer: Aetna Managed Medicare |
$6,082.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14,118.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,860.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,426.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,512.36
|
| Rate for Payer: Cash Price |
$6,265.80
|
| Rate for Payer: Cigna Commercial |
$19,983.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,155.65
|
| Rate for Payer: Health EOS Commercial |
$19,332.08
|
| Rate for Payer: HFN Commercial |
$19,983.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16,291.08
|
| Rate for Payer: Multiplan Commercial |
$17,377.15
|
| Rate for Payer: NAPHCARE Commercial |
$13,032.86
|
| Rate for Payer: Preferred Network Access Commercial |
$19,983.72
|
| Rate for Payer: Quartz Beloit One Network |
$10,643.51
|
| Rate for Payer: Quartz Commercial |
$14,118.94
|
| Rate for Payer: Quartz Medicare Advantage |
$13,032.86
|
| Rate for Payer: The Alliance Commercial |
$10,860.72
|
| Rate for Payer: WEA Trust Commercial |
$11,946.79
|
| Rate for Payer: WPS Commercial |
$16,088.49
|
|
|
FEMUR PERSONA CR CCR NARROW SZ 8 LT 42-5020-064-01
|
Facility
|
IP
|
$20,886.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4091153
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,643.51 |
| Max. Negotiated Rate |
$19,983.72 |
| Rate for Payer: Aetna Commercial |
$19,549.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,680.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,512.36
|
| Rate for Payer: Cash Price |
$6,265.80
|
| Rate for Payer: Cigna Commercial |
$19,983.72
|
| Rate for Payer: Health EOS Commercial |
$19,332.08
|
| Rate for Payer: HFN Commercial |
$19,983.72
|
| Rate for Payer: Multiplan Commercial |
$17,377.15
|
| Rate for Payer: Preferred Network Access Commercial |
$19,983.72
|
| Rate for Payer: Quartz Beloit One Network |
$10,643.51
|
| Rate for Payer: Quartz Commercial |
$13,032.86
|
| Rate for Payer: WEA Trust Commercial |
$11,946.79
|
| Rate for Payer: WPS Commercial |
$16,088.49
|
|
|
FEMUR PERSONA CR CCR STD SZ 11 LEFT 42-5026-070-01
|
Facility
|
IP
|
$20,886.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3697513
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,643.51 |
| Max. Negotiated Rate |
$19,983.72 |
| Rate for Payer: Aetna Commercial |
$19,549.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,680.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,512.36
|
| Rate for Payer: Cash Price |
$6,265.80
|
| Rate for Payer: Cigna Commercial |
$19,983.72
|
| Rate for Payer: Health EOS Commercial |
$19,332.08
|
| Rate for Payer: HFN Commercial |
$19,983.72
|
| Rate for Payer: Multiplan Commercial |
$17,377.15
|
| Rate for Payer: Preferred Network Access Commercial |
$19,983.72
|
| Rate for Payer: Quartz Beloit One Network |
$10,643.51
|
| Rate for Payer: Quartz Commercial |
$13,032.86
|
| Rate for Payer: WEA Trust Commercial |
$11,946.79
|
| Rate for Payer: WPS Commercial |
$16,088.49
|
|
|
FEMUR PERSONA CR CCR STD SZ 11 LEFT 42-5026-070-01
|
Facility
|
OP
|
$20,886.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3697513
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,082.00 |
| Max. Negotiated Rate |
$19,983.72 |
| Rate for Payer: Aetna Commercial |
$19,549.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,680.44
|
| Rate for Payer: Aetna Managed Medicare |
$6,082.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14,118.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,860.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,426.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,512.36
|
| Rate for Payer: Cash Price |
$6,265.80
|
| Rate for Payer: Cigna Commercial |
$19,983.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,155.65
|
| Rate for Payer: Health EOS Commercial |
$19,332.08
|
| Rate for Payer: HFN Commercial |
$19,983.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16,291.08
|
| Rate for Payer: Multiplan Commercial |
$17,377.15
|
| Rate for Payer: NAPHCARE Commercial |
$13,032.86
|
| Rate for Payer: Preferred Network Access Commercial |
$19,983.72
|
| Rate for Payer: Quartz Beloit One Network |
$10,643.51
|
| Rate for Payer: Quartz Commercial |
$14,118.94
|
| Rate for Payer: Quartz Medicare Advantage |
$13,032.86
|
| Rate for Payer: The Alliance Commercial |
$10,860.72
|
| Rate for Payer: WEA Trust Commercial |
$11,946.79
|
| Rate for Payer: WPS Commercial |
$16,088.49
|
|
