|
FEMUR PERSONA CR SZ 4 RT 42-5020-056-02
|
Facility
|
OP
|
$14,659.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4520383
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,268.70 |
| Max. Negotiated Rate |
$14,025.73 |
| Rate for Payer: Aetna Commercial |
$13,720.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,111.01
|
| Rate for Payer: Aetna Managed Medicare |
$4,268.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,909.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,622.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,317.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,080.04
|
| Rate for Payer: Cash Price |
$4,397.70
|
| Rate for Payer: Cigna Commercial |
$14,025.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,531.54
|
| Rate for Payer: Health EOS Commercial |
$13,568.37
|
| Rate for Payer: HFN Commercial |
$14,025.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,434.02
|
| Rate for Payer: Multiplan Commercial |
$12,196.29
|
| Rate for Payer: NAPHCARE Commercial |
$9,147.22
|
| Rate for Payer: Preferred Network Access Commercial |
$14,025.73
|
| Rate for Payer: Quartz Beloit One Network |
$7,470.23
|
| Rate for Payer: Quartz Commercial |
$9,909.48
|
| Rate for Payer: Quartz Medicare Advantage |
$9,147.22
|
| Rate for Payer: The Alliance Commercial |
$7,622.68
|
| Rate for Payer: WEA Trust Commercial |
$8,384.95
|
| Rate for Payer: WPS Commercial |
$11,291.83
|
|
|
FEMUR PERSONA CR SZ 4 RT 42-5020-056-02
|
Facility
|
IP
|
$14,659.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4520383
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,470.23 |
| Max. Negotiated Rate |
$14,025.73 |
| Rate for Payer: Aetna Commercial |
$13,720.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,111.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,080.04
|
| Rate for Payer: Cash Price |
$4,397.70
|
| Rate for Payer: Cigna Commercial |
$14,025.73
|
| Rate for Payer: Health EOS Commercial |
$13,568.37
|
| Rate for Payer: HFN Commercial |
$14,025.73
|
| Rate for Payer: Multiplan Commercial |
$12,196.29
|
| Rate for Payer: Preferred Network Access Commercial |
$14,025.73
|
| Rate for Payer: Quartz Beloit One Network |
$7,470.23
|
| Rate for Payer: Quartz Commercial |
$9,147.22
|
| Rate for Payer: WEA Trust Commercial |
$8,384.95
|
| Rate for Payer: WPS Commercial |
$11,291.83
|
|
|
FEMUR PERSONA CR SZ 7 RT 42-5020-062-02
|
Facility
|
IP
|
$21,689.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3491508
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,052.71 |
| Max. Negotiated Rate |
$20,752.04 |
| Rate for Payer: Aetna Commercial |
$20,300.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19,398.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,954.98
|
| Rate for Payer: Cash Price |
$6,506.70
|
| Rate for Payer: Cigna Commercial |
$20,752.04
|
| Rate for Payer: Health EOS Commercial |
$20,075.34
|
| Rate for Payer: HFN Commercial |
$20,752.04
|
| Rate for Payer: Multiplan Commercial |
$18,045.25
|
| Rate for Payer: Preferred Network Access Commercial |
$20,752.04
|
| Rate for Payer: Quartz Beloit One Network |
$11,052.71
|
| Rate for Payer: Quartz Commercial |
$13,533.94
|
| Rate for Payer: WEA Trust Commercial |
$12,406.11
|
| Rate for Payer: WPS Commercial |
$16,707.04
|
|
|
FEMUR PERSONA CR SZ 7 RT 42-5020-062-02
|
Facility
|
OP
|
$21,689.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3491508
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,315.84 |
| Max. Negotiated Rate |
$20,752.04 |
| Rate for Payer: Aetna Commercial |
$20,300.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19,398.64
|
| Rate for Payer: Aetna Managed Medicare |
$6,315.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14,661.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,278.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,827.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,954.98
|
| Rate for Payer: Cash Price |
$6,506.70
|
| Rate for Payer: Cigna Commercial |
$20,752.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,623.00
|
| Rate for Payer: Health EOS Commercial |
$20,075.34
|
| Rate for Payer: HFN Commercial |
$20,752.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16,917.42
|
| Rate for Payer: Multiplan Commercial |
$18,045.25
|
| Rate for Payer: NAPHCARE Commercial |
$13,533.94
|
| Rate for Payer: Preferred Network Access Commercial |
$20,752.04
|
| Rate for Payer: Quartz Beloit One Network |
$11,052.71
|
| Rate for Payer: Quartz Commercial |
$14,661.76
|
| Rate for Payer: Quartz Medicare Advantage |
$13,533.94
|
| Rate for Payer: The Alliance Commercial |
$11,278.28
|
| Rate for Payer: WEA Trust Commercial |
$12,406.11
|
| Rate for Payer: WPS Commercial |
$16,707.04
|
|
|
FEMUR PERSONA PS STD SZ 4 RT NITRIDED 42-5706-056-02
|
Facility
|
IP
|
$12,962.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5823635
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,605.44 |
| Max. Negotiated Rate |
$12,402.04 |
| Rate for Payer: Aetna Commercial |
$12,132.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,593.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,144.65
|
| Rate for Payer: Cash Price |
$3,888.60
|
| Rate for Payer: Cigna Commercial |
$12,402.04
|
| Rate for Payer: Health EOS Commercial |
$11,997.63
|
| Rate for Payer: HFN Commercial |
$12,402.04
|
| Rate for Payer: Multiplan Commercial |
$10,784.38
|
| Rate for Payer: Preferred Network Access Commercial |
$12,402.04
|
| Rate for Payer: Quartz Beloit One Network |
$6,605.44
|
| Rate for Payer: Quartz Commercial |
$8,088.29
|
| Rate for Payer: WEA Trust Commercial |
$7,414.26
|
| Rate for Payer: WPS Commercial |
$9,984.63
|
|
|
FEMUR PERSONA PS STD SZ 4 RT NITRIDED 42-5706-056-02
|
Facility
|
OP
|
$12,962.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5823635
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,774.53 |
| Max. Negotiated Rate |
$12,402.04 |
| Rate for Payer: Aetna Commercial |
$12,132.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,593.21
|
| Rate for Payer: Aetna Managed Medicare |
$3,774.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,762.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,740.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,470.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,144.65
|
| Rate for Payer: Cash Price |
$3,888.60
|
| Rate for Payer: Cigna Commercial |
$12,402.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,543.88
|
| Rate for Payer: Health EOS Commercial |
$11,997.63
|
| Rate for Payer: HFN Commercial |
$12,402.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,110.36
|
| Rate for Payer: Multiplan Commercial |
$10,784.38
|
| Rate for Payer: NAPHCARE Commercial |
$8,088.29
|
| Rate for Payer: Preferred Network Access Commercial |
$12,402.04
|
| Rate for Payer: Quartz Beloit One Network |
$6,605.44
|
| Rate for Payer: Quartz Commercial |
$8,762.31
|
| Rate for Payer: Quartz Medicare Advantage |
$8,088.29
|
| Rate for Payer: The Alliance Commercial |
$6,740.24
|
| Rate for Payer: WEA Trust Commercial |
$7,414.26
|
| Rate for Payer: WPS Commercial |
$9,984.63
|
|
|
FEMUR PERSONA PS STD SZ 5 LT NITRIDED 42-5706-058-01
|
Facility
|
OP
|
$12,584.00
|
|
| Hospital Charge Code |
6217103
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,664.46 |
| Max. Negotiated Rate |
$12,040.37 |
| Rate for Payer: Aetna Commercial |
$11,778.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,255.13
|
| Rate for Payer: Aetna Managed Medicare |
$3,664.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,506.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,543.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,281.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,936.30
|
| Rate for Payer: Cash Price |
$3,775.20
|
| Rate for Payer: Cigna Commercial |
$12,040.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,323.89
|
| Rate for Payer: Health EOS Commercial |
$11,647.75
|
| Rate for Payer: HFN Commercial |
$12,040.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,815.52
|
| Rate for Payer: Multiplan Commercial |
$10,469.89
|
| Rate for Payer: NAPHCARE Commercial |
$7,852.42
|
| Rate for Payer: Preferred Network Access Commercial |
$12,040.37
|
| Rate for Payer: Quartz Beloit One Network |
$6,412.81
|
| Rate for Payer: Quartz Commercial |
$8,506.78
|
| Rate for Payer: Quartz Medicare Advantage |
$7,852.42
|
| Rate for Payer: The Alliance Commercial |
$6,543.68
|
| Rate for Payer: WEA Trust Commercial |
$7,198.05
|
| Rate for Payer: WPS Commercial |
$9,693.46
|
|
|
FEMUR PERSONA PS STD SZ 5 LT NITRIDED 42-5706-058-01
|
Facility
|
IP
|
$12,584.00
|
|
| Hospital Charge Code |
6217103
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,412.81 |
| Max. Negotiated Rate |
$12,040.37 |
| Rate for Payer: Aetna Commercial |
$11,778.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,255.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,936.30
|
| Rate for Payer: Cash Price |
$3,775.20
|
| Rate for Payer: Cigna Commercial |
$12,040.37
|
| Rate for Payer: Health EOS Commercial |
$11,647.75
|
| Rate for Payer: HFN Commercial |
$12,040.37
|
| Rate for Payer: Multiplan Commercial |
$10,469.89
|
| Rate for Payer: Preferred Network Access Commercial |
$12,040.37
|
| Rate for Payer: Quartz Beloit One Network |
$6,412.81
|
| Rate for Payer: Quartz Commercial |
$7,852.42
|
| Rate for Payer: WEA Trust Commercial |
$7,198.05
|
| Rate for Payer: WPS Commercial |
$9,693.46
|
|
|
FEMUR PERSONA PS STD SZ 5 RT NITRIDED 42-5706-058-02
|
Facility
|
IP
|
$11,984.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6198978
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,107.05 |
| Max. Negotiated Rate |
$11,466.29 |
| Rate for Payer: Aetna Commercial |
$11,217.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,718.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,605.58
|
| Rate for Payer: Cash Price |
$3,595.20
|
| Rate for Payer: Cigna Commercial |
$11,466.29
|
| Rate for Payer: Health EOS Commercial |
$11,092.39
|
| Rate for Payer: HFN Commercial |
$11,466.29
|
| Rate for Payer: Multiplan Commercial |
$9,970.69
|
| Rate for Payer: Preferred Network Access Commercial |
$11,466.29
|
| Rate for Payer: Quartz Beloit One Network |
$6,107.05
|
| Rate for Payer: Quartz Commercial |
$7,478.02
|
| Rate for Payer: WEA Trust Commercial |
$6,854.85
|
| Rate for Payer: WPS Commercial |
$9,231.28
|
|
|
FEMUR PERSONA PS STD SZ 5 RT NITRIDED 42-5706-058-02
|
Facility
|
OP
|
$11,984.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6198978
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,489.74 |
| Max. Negotiated Rate |
$11,466.29 |
| Rate for Payer: Aetna Commercial |
$11,217.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,718.49
|
| Rate for Payer: Aetna Managed Medicare |
$3,489.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,101.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,231.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,982.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,605.58
|
| Rate for Payer: Cash Price |
$3,595.20
|
| Rate for Payer: Cigna Commercial |
$11,466.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,974.69
|
| Rate for Payer: Health EOS Commercial |
$11,092.39
|
| Rate for Payer: HFN Commercial |
$11,466.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,347.52
|
| Rate for Payer: Multiplan Commercial |
$9,970.69
|
| Rate for Payer: NAPHCARE Commercial |
$7,478.02
|
| Rate for Payer: Preferred Network Access Commercial |
$11,466.29
|
| Rate for Payer: Quartz Beloit One Network |
$6,107.05
|
| Rate for Payer: Quartz Commercial |
$8,101.18
|
| Rate for Payer: Quartz Medicare Advantage |
$7,478.02
|
| Rate for Payer: The Alliance Commercial |
$6,231.68
|
| Rate for Payer: WEA Trust Commercial |
$6,854.85
|
| Rate for Payer: WPS Commercial |
$9,231.28
|
|
|
FEMUR PERSONA PS STD SZ 8 LEFT NITRIDED 42-5706-064-01
|
Facility
|
OP
|
$13,480.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5603776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,925.38 |
| Max. Negotiated Rate |
$12,897.66 |
| Rate for Payer: Aetna Commercial |
$12,617.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,056.51
|
| Rate for Payer: Aetna Managed Medicare |
$3,925.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,112.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,009.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,729.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,430.18
|
| Rate for Payer: Cash Price |
$4,044.00
|
| Rate for Payer: Cigna Commercial |
$12,897.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,845.36
|
| Rate for Payer: Health EOS Commercial |
$12,477.09
|
| Rate for Payer: HFN Commercial |
$12,897.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,514.40
|
| Rate for Payer: Multiplan Commercial |
$11,215.36
|
| Rate for Payer: NAPHCARE Commercial |
$8,411.52
|
| Rate for Payer: Preferred Network Access Commercial |
$12,897.66
|
| Rate for Payer: Quartz Beloit One Network |
$6,869.41
|
| Rate for Payer: Quartz Commercial |
$9,112.48
|
| Rate for Payer: Quartz Medicare Advantage |
$8,411.52
|
| Rate for Payer: The Alliance Commercial |
$7,009.60
|
| Rate for Payer: WEA Trust Commercial |
$7,710.56
|
| Rate for Payer: WPS Commercial |
$10,383.64
|
|
|
FEMUR PERSONA PS STD SZ 8 LEFT NITRIDED 42-5706-064-01
|
Facility
|
IP
|
$13,480.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5603776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,869.41 |
| Max. Negotiated Rate |
$12,897.66 |
| Rate for Payer: Aetna Commercial |
$12,617.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,056.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,430.18
|
| Rate for Payer: Cash Price |
$4,044.00
|
| Rate for Payer: Cigna Commercial |
$12,897.66
|
| Rate for Payer: Health EOS Commercial |
$12,477.09
|
| Rate for Payer: HFN Commercial |
$12,897.66
|
| Rate for Payer: Multiplan Commercial |
$11,215.36
|
| Rate for Payer: Preferred Network Access Commercial |
$12,897.66
|
| Rate for Payer: Quartz Beloit One Network |
$6,869.41
|
| Rate for Payer: Quartz Commercial |
$8,411.52
|
| Rate for Payer: WEA Trust Commercial |
$7,710.56
|
| Rate for Payer: WPS Commercial |
$10,383.64
|
|
|
FEMUR PERSONA PS STD SZ 9 LT NITRIDED 42-5706-066-01
|
Facility
|
OP
|
$12,099.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6248130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,523.43 |
| Max. Negotiated Rate |
$11,576.98 |
| Rate for Payer: Aetna Commercial |
$11,325.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,821.96
|
| Rate for Payer: Aetna Managed Medicare |
$3,523.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,179.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,291.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,040.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,669.35
|
| Rate for Payer: Cash Price |
$3,629.91
|
| Rate for Payer: Cigna Commercial |
$11,576.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,042.02
|
| Rate for Payer: Health EOS Commercial |
$11,199.47
|
| Rate for Payer: HFN Commercial |
$11,576.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,437.76
|
| Rate for Payer: Multiplan Commercial |
$10,066.94
|
| Rate for Payer: NAPHCARE Commercial |
$7,550.21
|
| Rate for Payer: Preferred Network Access Commercial |
$11,576.98
|
| Rate for Payer: Quartz Beloit One Network |
$6,166.00
|
| Rate for Payer: Quartz Commercial |
$8,179.39
|
| Rate for Payer: Quartz Medicare Advantage |
$7,550.21
|
| Rate for Payer: The Alliance Commercial |
$6,291.84
|
| Rate for Payer: WEA Trust Commercial |
$6,921.02
|
| Rate for Payer: WPS Commercial |
$9,320.39
|
|
|
FEMUR PERSONA PS STD SZ 9 LT NITRIDED 42-5706-066-01
|
Facility
|
IP
|
$12,099.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6248130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,166.00 |
| Max. Negotiated Rate |
$11,576.98 |
| Rate for Payer: Aetna Commercial |
$11,325.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,821.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,669.35
|
| Rate for Payer: Cash Price |
$3,629.91
|
| Rate for Payer: Cigna Commercial |
$11,576.98
|
| Rate for Payer: Health EOS Commercial |
$11,199.47
|
| Rate for Payer: HFN Commercial |
$11,576.98
|
| Rate for Payer: Multiplan Commercial |
$10,066.94
|
| Rate for Payer: Preferred Network Access Commercial |
$11,576.98
|
| Rate for Payer: Quartz Beloit One Network |
$6,166.00
|
| Rate for Payer: Quartz Commercial |
$7,550.21
|
| Rate for Payer: WEA Trust Commercial |
$6,921.02
|
| Rate for Payer: WPS Commercial |
$9,320.39
|
|
|
FEMUR PERSONA PS STD SZ 9 RT NITRIDED 42-5706-066-02
|
Facility
|
IP
|
$11,984.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
6180294
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,107.05 |
| Max. Negotiated Rate |
$11,466.29 |
| Rate for Payer: Aetna Commercial |
$11,217.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,718.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,605.58
|
| Rate for Payer: Cash Price |
$3,595.20
|
| Rate for Payer: Cigna Commercial |
$11,466.29
|
| Rate for Payer: Health EOS Commercial |
$11,092.39
|
| Rate for Payer: HFN Commercial |
$11,466.29
|
| Rate for Payer: Multiplan Commercial |
$9,970.69
|
| Rate for Payer: Preferred Network Access Commercial |
$11,466.29
|
| Rate for Payer: Quartz Beloit One Network |
$6,107.05
|
| Rate for Payer: Quartz Commercial |
$7,478.02
|
| Rate for Payer: WEA Trust Commercial |
$6,854.85
|
| Rate for Payer: WPS Commercial |
$9,231.28
|
|
|
FEMUR PERSONA PS STD SZ 9 RT NITRIDED 42-5706-066-02
|
Facility
|
OP
|
$11,984.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
6180294
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,489.74 |
| Max. Negotiated Rate |
$11,466.29 |
| Rate for Payer: Aetna Commercial |
$11,217.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,718.49
|
| Rate for Payer: Aetna Managed Medicare |
$3,489.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,101.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,231.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,982.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,605.58
|
| Rate for Payer: Cash Price |
$3,595.20
|
| Rate for Payer: Cigna Commercial |
$11,466.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,974.69
|
| Rate for Payer: Health EOS Commercial |
$11,092.39
|
| Rate for Payer: HFN Commercial |
$11,466.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,347.52
|
| Rate for Payer: Multiplan Commercial |
$9,970.69
|
| Rate for Payer: NAPHCARE Commercial |
$7,478.02
|
| Rate for Payer: Preferred Network Access Commercial |
$11,466.29
|
| Rate for Payer: Quartz Beloit One Network |
$6,107.05
|
| Rate for Payer: Quartz Commercial |
$8,101.18
|
| Rate for Payer: Quartz Medicare Advantage |
$7,478.02
|
| Rate for Payer: The Alliance Commercial |
$6,231.68
|
| Rate for Payer: WEA Trust Commercial |
$6,854.85
|
| Rate for Payer: WPS Commercial |
$9,231.28
|
|
|
FEMUR PSN CR CMT CCR NRW RT SZ 8 42-5020-064-02
|
Facility
|
OP
|
$21,689.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3937331
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,315.84 |
| Max. Negotiated Rate |
$20,752.04 |
| Rate for Payer: Aetna Commercial |
$20,300.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19,398.64
|
| Rate for Payer: Aetna Managed Medicare |
$6,315.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14,661.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,278.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,827.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,954.98
|
| Rate for Payer: Cash Price |
$6,506.70
|
| Rate for Payer: Cigna Commercial |
$20,752.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,623.00
|
| Rate for Payer: Health EOS Commercial |
$20,075.34
|
| Rate for Payer: HFN Commercial |
$20,752.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16,917.42
|
| Rate for Payer: Multiplan Commercial |
$18,045.25
|
| Rate for Payer: NAPHCARE Commercial |
$13,533.94
|
| Rate for Payer: Preferred Network Access Commercial |
$20,752.04
|
| Rate for Payer: Quartz Beloit One Network |
$11,052.71
|
| Rate for Payer: Quartz Commercial |
$14,661.76
|
| Rate for Payer: Quartz Medicare Advantage |
$13,533.94
|
| Rate for Payer: The Alliance Commercial |
$11,278.28
|
| Rate for Payer: WEA Trust Commercial |
$12,406.11
|
| Rate for Payer: WPS Commercial |
$16,707.04
|
|
|
FEMUR PSN CR CMT CCR NRW RT SZ 8 42-5020-064-02
|
Facility
|
IP
|
$21,689.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3937331
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,052.71 |
| Max. Negotiated Rate |
$20,752.04 |
| Rate for Payer: Aetna Commercial |
$20,300.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19,398.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,954.98
|
| Rate for Payer: Cash Price |
$6,506.70
|
| Rate for Payer: Cigna Commercial |
$20,752.04
|
| Rate for Payer: Health EOS Commercial |
$20,075.34
|
| Rate for Payer: HFN Commercial |
$20,752.04
|
| Rate for Payer: Multiplan Commercial |
$18,045.25
|
| Rate for Payer: Preferred Network Access Commercial |
$20,752.04
|
| Rate for Payer: Quartz Beloit One Network |
$11,052.71
|
| Rate for Payer: Quartz Commercial |
$13,533.94
|
| Rate for Payer: WEA Trust Commercial |
$12,406.11
|
| Rate for Payer: WPS Commercial |
$16,707.04
|
|
|
FEMUR PSN CR CMT CCR STD RT SZ11 42-5026-070-02
|
Facility
|
OP
|
$20,886.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3937329
|
|
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 PSN CR CMT CCR STD RT SZ11 42-5026-070-02
|
Facility
|
IP
|
$20,886.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3937329
|
|
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 PSN CR CMT CCR STD SZ 7 LT 42-5026-062-01
|
Facility
|
OP
|
$21,689.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3739517
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,315.84 |
| Max. Negotiated Rate |
$20,752.04 |
| Rate for Payer: Aetna Commercial |
$20,300.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19,398.64
|
| Rate for Payer: Aetna Managed Medicare |
$6,315.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14,661.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,278.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,827.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,954.98
|
| Rate for Payer: Cash Price |
$6,506.70
|
| Rate for Payer: Cigna Commercial |
$20,752.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,623.00
|
| Rate for Payer: Health EOS Commercial |
$20,075.34
|
| Rate for Payer: HFN Commercial |
$20,752.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16,917.42
|
| Rate for Payer: Multiplan Commercial |
$18,045.25
|
| Rate for Payer: NAPHCARE Commercial |
$13,533.94
|
| Rate for Payer: Preferred Network Access Commercial |
$20,752.04
|
| Rate for Payer: Quartz Beloit One Network |
$11,052.71
|
| Rate for Payer: Quartz Commercial |
$14,661.76
|
| Rate for Payer: Quartz Medicare Advantage |
$13,533.94
|
| Rate for Payer: The Alliance Commercial |
$11,278.28
|
| Rate for Payer: WEA Trust Commercial |
$12,406.11
|
| Rate for Payer: WPS Commercial |
$16,707.04
|
|
|
FEMUR PSN CR CMT CCR STD SZ 7 LT 42-5026-062-01
|
Facility
|
IP
|
$21,689.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3739517
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,052.71 |
| Max. Negotiated Rate |
$20,752.04 |
| Rate for Payer: Aetna Commercial |
$20,300.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19,398.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,954.98
|
| Rate for Payer: Cash Price |
$6,506.70
|
| Rate for Payer: Cigna Commercial |
$20,752.04
|
| Rate for Payer: Health EOS Commercial |
$20,075.34
|
| Rate for Payer: HFN Commercial |
$20,752.04
|
| Rate for Payer: Multiplan Commercial |
$18,045.25
|
| Rate for Payer: Preferred Network Access Commercial |
$20,752.04
|
| Rate for Payer: Quartz Beloit One Network |
$11,052.71
|
| Rate for Payer: Quartz Commercial |
$13,533.94
|
| Rate for Payer: WEA Trust Commercial |
$12,406.11
|
| Rate for Payer: WPS Commercial |
$16,707.04
|
|
|
FEMUR PSN PS CMT CCR NRW LT SZ 10 42-5000-068-01
|
Facility
|
IP
|
$21,689.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3937327
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,052.71 |
| Max. Negotiated Rate |
$20,752.04 |
| Rate for Payer: Aetna Commercial |
$20,300.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19,398.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,954.98
|
| Rate for Payer: Cash Price |
$6,506.70
|
| Rate for Payer: Cigna Commercial |
$20,752.04
|
| Rate for Payer: Health EOS Commercial |
$20,075.34
|
| Rate for Payer: HFN Commercial |
$20,752.04
|
| Rate for Payer: Multiplan Commercial |
$18,045.25
|
| Rate for Payer: Preferred Network Access Commercial |
$20,752.04
|
| Rate for Payer: Quartz Beloit One Network |
$11,052.71
|
| Rate for Payer: Quartz Commercial |
$13,533.94
|
| Rate for Payer: WEA Trust Commercial |
$12,406.11
|
| Rate for Payer: WPS Commercial |
$16,707.04
|
|
|
FEMUR PSN PS CMT CCR NRW LT SZ 10 42-5000-068-01
|
Facility
|
OP
|
$21,689.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3937327
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,315.84 |
| Max. Negotiated Rate |
$20,752.04 |
| Rate for Payer: Aetna Commercial |
$20,300.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19,398.64
|
| Rate for Payer: Aetna Managed Medicare |
$6,315.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14,661.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,278.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,827.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,954.98
|
| Rate for Payer: Cash Price |
$6,506.70
|
| Rate for Payer: Cigna Commercial |
$20,752.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,623.00
|
| Rate for Payer: Health EOS Commercial |
$20,075.34
|
| Rate for Payer: HFN Commercial |
$20,752.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16,917.42
|
| Rate for Payer: Multiplan Commercial |
$18,045.25
|
| Rate for Payer: NAPHCARE Commercial |
$13,533.94
|
| Rate for Payer: Preferred Network Access Commercial |
$20,752.04
|
| Rate for Payer: Quartz Beloit One Network |
$11,052.71
|
| Rate for Payer: Quartz Commercial |
$14,661.76
|
| Rate for Payer: Quartz Medicare Advantage |
$13,533.94
|
| Rate for Payer: The Alliance Commercial |
$11,278.28
|
| Rate for Payer: WEA Trust Commercial |
$12,406.11
|
| Rate for Payer: WPS Commercial |
$16,707.04
|
|
|
FEMUR PSN PS CMT CCR NRW LT SZ 11 42-5000-070-01
|
Facility
|
OP
|
$20,886.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3781353
|
|
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
|
|
