|
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 |
$2,780.40 |
| Max. Negotiated Rate |
$39,720.00 |
| Rate for Payer: Aetna Commercial |
$8,937.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,539.80
|
| Rate for Payer: Aetna Managed Medicare |
$2,780.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,454.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,965.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,766.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,262.90
|
| Rate for Payer: Cash Price |
$2,979.00
|
| Rate for Payer: Cigna Commercial |
$9,135.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,556.83
|
| Rate for Payer: Health EOS Commercial |
$8,837.70
|
| Rate for Payer: HFN Commercial |
$9,135.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,447.50
|
| Rate for Payer: Multiplan Commercial |
$7,944.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,958.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9,135.60
|
| Rate for Payer: Quartz Beloit One Network |
$4,865.70
|
| Rate for Payer: Quartz Commercial |
$6,454.50
|
| Rate for Payer: Quartz Medicare Advantage |
$5,958.00
|
| Rate for Payer: The Alliance Commercial |
$39,720.00
|
| Rate for Payer: WEA Trust Commercial |
$5,461.50
|
| Rate for Payer: WPS Commercial |
$7,355.15
|
|
|
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 |
$3,127.60 |
| Max. Negotiated Rate |
$44,680.00 |
| Rate for Payer: Aetna Commercial |
$10,053.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,606.20
|
| Rate for Payer: Aetna Managed Medicare |
$3,127.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,260.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,585.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,361.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,920.10
|
| Rate for Payer: Cash Price |
$3,351.00
|
| Rate for Payer: Cigna Commercial |
$10,276.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,250.73
|
| Rate for Payer: Health EOS Commercial |
$9,941.30
|
| Rate for Payer: HFN Commercial |
$10,276.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,377.50
|
| Rate for Payer: Multiplan Commercial |
$8,936.00
|
| Rate for Payer: NAPHCARE Commercial |
$6,702.00
|
| Rate for Payer: Preferred Network Access Commercial |
$10,276.40
|
| Rate for Payer: Quartz Beloit One Network |
$5,473.30
|
| Rate for Payer: Quartz Commercial |
$7,260.50
|
| Rate for Payer: Quartz Medicare Advantage |
$6,702.00
|
| Rate for Payer: The Alliance Commercial |
$44,680.00
|
| Rate for Payer: WEA Trust Commercial |
$6,143.50
|
| Rate for Payer: WPS Commercial |
$8,273.62
|
|
|
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 |
$5,473.30 |
| Max. Negotiated Rate |
$10,276.40 |
| Rate for Payer: Aetna Commercial |
$10,053.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,606.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,920.10
|
| Rate for Payer: Cash Price |
$3,351.00
|
| Rate for Payer: Cigna Commercial |
$10,276.40
|
| Rate for Payer: Health EOS Commercial |
$9,941.30
|
| Rate for Payer: HFN Commercial |
$10,276.40
|
| Rate for Payer: Multiplan Commercial |
$8,936.00
|
| Rate for Payer: NAPHCARE Commercial |
$6,702.00
|
| Rate for Payer: Preferred Network Access Commercial |
$10,276.40
|
| Rate for Payer: Quartz Beloit One Network |
$5,473.30
|
| Rate for Payer: Quartz Commercial |
$6,702.00
|
| Rate for Payer: WEA Trust Commercial |
$6,143.50
|
| Rate for Payer: WPS Commercial |
$8,273.62
|
|
|
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 |
$687.68 |
| Max. Negotiated Rate |
$9,824.00 |
| Rate for Payer: Aetna Commercial |
$2,210.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,112.16
|
| Rate for Payer: Aetna Managed Medicare |
$687.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,596.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,228.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,178.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,301.68
|
| Rate for Payer: Cash Price |
$736.80
|
| Rate for Payer: Cigna Commercial |
$2,259.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,374.38
|
| Rate for Payer: Health EOS Commercial |
$2,185.84
|
| Rate for Payer: HFN Commercial |
$2,259.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,842.00
|
| Rate for Payer: Multiplan Commercial |
$1,964.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,473.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,259.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,203.44
|
| Rate for Payer: Quartz Commercial |
$1,596.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,473.60
|
| Rate for Payer: The Alliance Commercial |
$9,824.00
|
| Rate for Payer: WEA Trust Commercial |
$1,350.80
|
| Rate for Payer: WPS Commercial |
$1,819.16
|
|
|
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 |
$1,203.44 |
| Max. Negotiated Rate |
$2,259.52 |
| Rate for Payer: Aetna Commercial |
$2,210.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,112.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,301.68
|
| Rate for Payer: Cash Price |
$736.80
|
| Rate for Payer: Cigna Commercial |
$2,259.52
|
| Rate for Payer: Health EOS Commercial |
$2,185.84
|
| Rate for Payer: HFN Commercial |
$2,259.52
|
| Rate for Payer: Multiplan Commercial |
$1,964.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,473.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,259.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,203.44
|
| Rate for Payer: Quartz Commercial |
$1,473.60
|
| Rate for Payer: WEA Trust Commercial |
$1,350.80
|
| Rate for Payer: WPS Commercial |
$1,819.16
|
|
|
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 |
$4,971.40 |
| Max. Negotiated Rate |
$71,020.00 |
| Rate for Payer: Aetna Commercial |
$15,979.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,269.30
|
| Rate for Payer: Aetna Managed Medicare |
$4,971.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,540.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,877.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,522.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,410.15
|
| Rate for Payer: Cash Price |
$5,326.50
|
| Rate for Payer: Cigna Commercial |
$16,334.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,935.70
|
| Rate for Payer: Health EOS Commercial |
$15,801.95
|
| Rate for Payer: HFN Commercial |
$16,334.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,316.25
|
| Rate for Payer: Multiplan Commercial |
$14,204.00
|
| Rate for Payer: NAPHCARE Commercial |
$10,653.00
|
| Rate for Payer: Preferred Network Access Commercial |
$16,334.60
|
| Rate for Payer: Quartz Beloit One Network |
$8,699.95
|
| Rate for Payer: Quartz Commercial |
$11,540.75
|
| Rate for Payer: Quartz Medicare Advantage |
$10,653.00
|
| Rate for Payer: The Alliance Commercial |
$71,020.00
|
| Rate for Payer: WEA Trust Commercial |
$9,765.25
|
| Rate for Payer: WPS Commercial |
$13,151.13
|
|
|
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 |
$8,699.95 |
| Max. Negotiated Rate |
$16,334.60 |
| Rate for Payer: Aetna Commercial |
$15,979.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,269.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,410.15
|
| Rate for Payer: Cash Price |
$5,326.50
|
| Rate for Payer: Cigna Commercial |
$16,334.60
|
| Rate for Payer: Health EOS Commercial |
$15,801.95
|
| Rate for Payer: HFN Commercial |
$16,334.60
|
| Rate for Payer: Multiplan Commercial |
$14,204.00
|
| Rate for Payer: NAPHCARE Commercial |
$10,653.00
|
| Rate for Payer: Preferred Network Access Commercial |
$16,334.60
|
| Rate for Payer: Quartz Beloit One Network |
$8,699.95
|
| Rate for Payer: Quartz Commercial |
$10,653.00
|
| Rate for Payer: WEA Trust Commercial |
$9,765.25
|
| Rate for Payer: WPS Commercial |
$13,151.13
|
|
|
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 |
$19,343.73 |
| Max. Negotiated Rate |
$36,318.84 |
| Rate for Payer: Aetna Commercial |
$35,529.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$33,950.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$20,922.81
|
| Rate for Payer: Cash Price |
$11,843.10
|
| Rate for Payer: Cigna Commercial |
$36,318.84
|
| Rate for Payer: Health EOS Commercial |
$35,134.53
|
| Rate for Payer: HFN Commercial |
$36,318.84
|
| Rate for Payer: Multiplan Commercial |
$31,581.60
|
| Rate for Payer: NAPHCARE Commercial |
$23,686.20
|
| Rate for Payer: Preferred Network Access Commercial |
$36,318.84
|
| Rate for Payer: Quartz Beloit One Network |
$19,343.73
|
| Rate for Payer: Quartz Commercial |
$23,686.20
|
| Rate for Payer: WEA Trust Commercial |
$21,712.35
|
| Rate for Payer: WPS Commercial |
$29,240.61
|
|
|
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 |
$11,053.56 |
| Max. Negotiated Rate |
$157,908.00 |
| Rate for Payer: Aetna Commercial |
$35,529.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$33,950.22
|
| Rate for Payer: Aetna Managed Medicare |
$11,053.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25,660.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,738.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18,948.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$20,922.81
|
| Rate for Payer: Cash Price |
$11,843.10
|
| Rate for Payer: Cigna Commercial |
$36,318.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22,091.33
|
| Rate for Payer: Health EOS Commercial |
$35,134.53
|
| Rate for Payer: HFN Commercial |
$36,318.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29,607.75
|
| Rate for Payer: Multiplan Commercial |
$31,581.60
|
| Rate for Payer: NAPHCARE Commercial |
$23,686.20
|
| Rate for Payer: Preferred Network Access Commercial |
$36,318.84
|
| Rate for Payer: Quartz Beloit One Network |
$19,343.73
|
| Rate for Payer: Quartz Commercial |
$25,660.05
|
| Rate for Payer: Quartz Medicare Advantage |
$23,686.20
|
| Rate for Payer: The Alliance Commercial |
$157,908.00
|
| Rate for Payer: WEA Trust Commercial |
$21,712.35
|
| Rate for Payer: WPS Commercial |
$29,240.61
|
|
|
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 |
$10,234.14 |
| Max. Negotiated Rate |
$19,215.12 |
| Rate for Payer: Aetna Commercial |
$18,797.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,961.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,069.58
|
| Rate for Payer: Cash Price |
$6,265.80
|
| Rate for Payer: Cigna Commercial |
$19,215.12
|
| Rate for Payer: Health EOS Commercial |
$18,588.54
|
| Rate for Payer: HFN Commercial |
$19,215.12
|
| Rate for Payer: Multiplan Commercial |
$16,708.80
|
| Rate for Payer: NAPHCARE Commercial |
$12,531.60
|
| Rate for Payer: Preferred Network Access Commercial |
$19,215.12
|
| Rate for Payer: Quartz Beloit One Network |
$10,234.14
|
| Rate for Payer: Quartz Commercial |
$12,531.60
|
| Rate for Payer: WEA Trust Commercial |
$11,487.30
|
| Rate for Payer: WPS Commercial |
$15,470.26
|
|
|
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 |
$5,848.08 |
| Max. Negotiated Rate |
$83,544.00 |
| Rate for Payer: Aetna Commercial |
$18,797.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,961.96
|
| Rate for Payer: Aetna Managed Medicare |
$5,848.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,575.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,443.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,025.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,069.58
|
| Rate for Payer: Cash Price |
$6,265.80
|
| Rate for Payer: Cigna Commercial |
$19,215.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,687.81
|
| Rate for Payer: Health EOS Commercial |
$18,588.54
|
| Rate for Payer: HFN Commercial |
$19,215.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,664.50
|
| Rate for Payer: Multiplan Commercial |
$16,708.80
|
| Rate for Payer: NAPHCARE Commercial |
$12,531.60
|
| Rate for Payer: Preferred Network Access Commercial |
$19,215.12
|
| Rate for Payer: Quartz Beloit One Network |
$10,234.14
|
| Rate for Payer: Quartz Commercial |
$13,575.90
|
| Rate for Payer: Quartz Medicare Advantage |
$12,531.60
|
| Rate for Payer: The Alliance Commercial |
$83,544.00
|
| Rate for Payer: WEA Trust Commercial |
$11,487.30
|
| Rate for Payer: WPS Commercial |
$15,470.26
|
|
|
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 |
$5,848.08 |
| Max. Negotiated Rate |
$83,544.00 |
| Rate for Payer: Aetna Commercial |
$18,797.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,961.96
|
| Rate for Payer: Aetna Managed Medicare |
$5,848.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,575.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,443.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,025.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,069.58
|
| Rate for Payer: Cash Price |
$6,265.80
|
| Rate for Payer: Cigna Commercial |
$19,215.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,687.81
|
| Rate for Payer: Health EOS Commercial |
$18,588.54
|
| Rate for Payer: HFN Commercial |
$19,215.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,664.50
|
| Rate for Payer: Multiplan Commercial |
$16,708.80
|
| Rate for Payer: NAPHCARE Commercial |
$12,531.60
|
| Rate for Payer: Preferred Network Access Commercial |
$19,215.12
|
| Rate for Payer: Quartz Beloit One Network |
$10,234.14
|
| Rate for Payer: Quartz Commercial |
$13,575.90
|
| Rate for Payer: Quartz Medicare Advantage |
$12,531.60
|
| Rate for Payer: The Alliance Commercial |
$83,544.00
|
| Rate for Payer: WEA Trust Commercial |
$11,487.30
|
| Rate for Payer: WPS Commercial |
$15,470.26
|
|
|
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 |
$10,234.14 |
| Max. Negotiated Rate |
$19,215.12 |
| Rate for Payer: Aetna Commercial |
$18,797.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,961.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,069.58
|
| Rate for Payer: Cash Price |
$6,265.80
|
| Rate for Payer: Cigna Commercial |
$19,215.12
|
| Rate for Payer: Health EOS Commercial |
$18,588.54
|
| Rate for Payer: HFN Commercial |
$19,215.12
|
| Rate for Payer: Multiplan Commercial |
$16,708.80
|
| Rate for Payer: NAPHCARE Commercial |
$12,531.60
|
| Rate for Payer: Preferred Network Access Commercial |
$19,215.12
|
| Rate for Payer: Quartz Beloit One Network |
$10,234.14
|
| Rate for Payer: Quartz Commercial |
$12,531.60
|
| Rate for Payer: WEA Trust Commercial |
$11,487.30
|
| Rate for Payer: WPS Commercial |
$15,470.26
|
|
|
FEMUR PERSONA CR CCR STD SZ 7 RIGHT 42-5026-062-02
|
Facility
|
OP
|
$20,886.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3697510
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,848.08 |
| Max. Negotiated Rate |
$83,544.00 |
| Rate for Payer: Aetna Commercial |
$18,797.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,961.96
|
| Rate for Payer: Aetna Managed Medicare |
$5,848.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,575.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,443.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,025.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,069.58
|
| Rate for Payer: Cash Price |
$6,265.80
|
| Rate for Payer: Cigna Commercial |
$19,215.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,687.81
|
| Rate for Payer: Health EOS Commercial |
$18,588.54
|
| Rate for Payer: HFN Commercial |
$19,215.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,664.50
|
| Rate for Payer: Multiplan Commercial |
$16,708.80
|
| Rate for Payer: NAPHCARE Commercial |
$12,531.60
|
| Rate for Payer: Preferred Network Access Commercial |
$19,215.12
|
| Rate for Payer: Quartz Beloit One Network |
$10,234.14
|
| Rate for Payer: Quartz Commercial |
$13,575.90
|
| Rate for Payer: Quartz Medicare Advantage |
$12,531.60
|
| Rate for Payer: The Alliance Commercial |
$83,544.00
|
| Rate for Payer: WEA Trust Commercial |
$11,487.30
|
| Rate for Payer: WPS Commercial |
$15,470.26
|
|
|
FEMUR PERSONA CR CCR STD SZ 7 RIGHT 42-5026-062-02
|
Facility
|
IP
|
$20,886.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3697510
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,234.14 |
| Max. Negotiated Rate |
$19,215.12 |
| Rate for Payer: Aetna Commercial |
$18,797.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,961.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,069.58
|
| Rate for Payer: Cash Price |
$6,265.80
|
| Rate for Payer: Cigna Commercial |
$19,215.12
|
| Rate for Payer: Health EOS Commercial |
$18,588.54
|
| Rate for Payer: HFN Commercial |
$19,215.12
|
| Rate for Payer: Multiplan Commercial |
$16,708.80
|
| Rate for Payer: NAPHCARE Commercial |
$12,531.60
|
| Rate for Payer: Preferred Network Access Commercial |
$19,215.12
|
| Rate for Payer: Quartz Beloit One Network |
$10,234.14
|
| Rate for Payer: Quartz Commercial |
$12,531.60
|
| Rate for Payer: WEA Trust Commercial |
$11,487.30
|
| Rate for Payer: WPS Commercial |
$15,470.26
|
|
|
FEMUR PERSONA CR CMT CCR NRW SZ 10 LEFT 42-5020-068-01
|
Facility
|
IP
|
$20,886.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4520101
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,234.14 |
| Max. Negotiated Rate |
$19,215.12 |
| Rate for Payer: Aetna Commercial |
$18,797.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,961.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,069.58
|
| Rate for Payer: Cash Price |
$6,265.80
|
| Rate for Payer: Cigna Commercial |
$19,215.12
|
| Rate for Payer: Health EOS Commercial |
$18,588.54
|
| Rate for Payer: HFN Commercial |
$19,215.12
|
| Rate for Payer: Multiplan Commercial |
$16,708.80
|
| Rate for Payer: NAPHCARE Commercial |
$12,531.60
|
| Rate for Payer: Preferred Network Access Commercial |
$19,215.12
|
| Rate for Payer: Quartz Beloit One Network |
$10,234.14
|
| Rate for Payer: Quartz Commercial |
$12,531.60
|
| Rate for Payer: WEA Trust Commercial |
$11,487.30
|
| Rate for Payer: WPS Commercial |
$15,470.26
|
|
|
FEMUR PERSONA CR CMT CCR NRW SZ 10 LEFT 42-5020-068-01
|
Facility
|
OP
|
$20,886.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4520101
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,848.08 |
| Max. Negotiated Rate |
$83,544.00 |
| Rate for Payer: Aetna Commercial |
$18,797.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,961.96
|
| Rate for Payer: Aetna Managed Medicare |
$5,848.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,575.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,443.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,025.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,069.58
|
| Rate for Payer: Cash Price |
$6,265.80
|
| Rate for Payer: Cigna Commercial |
$19,215.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,687.81
|
| Rate for Payer: Health EOS Commercial |
$18,588.54
|
| Rate for Payer: HFN Commercial |
$19,215.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,664.50
|
| Rate for Payer: Multiplan Commercial |
$16,708.80
|
| Rate for Payer: NAPHCARE Commercial |
$12,531.60
|
| Rate for Payer: Preferred Network Access Commercial |
$19,215.12
|
| Rate for Payer: Quartz Beloit One Network |
$10,234.14
|
| Rate for Payer: Quartz Commercial |
$13,575.90
|
| Rate for Payer: Quartz Medicare Advantage |
$12,531.60
|
| Rate for Payer: The Alliance Commercial |
$83,544.00
|
| Rate for Payer: WEA Trust Commercial |
$11,487.30
|
| Rate for Payer: WPS Commercial |
$15,470.26
|
|
|
FEMUR PERSONA CR CMT CCR NRW SZ 10 RIGHT 42-5020-068-02
|
Facility
|
OP
|
$20,886.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4518801
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,848.08 |
| Max. Negotiated Rate |
$83,544.00 |
| Rate for Payer: Aetna Commercial |
$18,797.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,961.96
|
| Rate for Payer: Aetna Managed Medicare |
$5,848.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,575.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,443.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,025.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,069.58
|
| Rate for Payer: Cash Price |
$6,265.80
|
| Rate for Payer: Cigna Commercial |
$19,215.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,687.81
|
| Rate for Payer: Health EOS Commercial |
$18,588.54
|
| Rate for Payer: HFN Commercial |
$19,215.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,664.50
|
| Rate for Payer: Multiplan Commercial |
$16,708.80
|
| Rate for Payer: NAPHCARE Commercial |
$12,531.60
|
| Rate for Payer: Preferred Network Access Commercial |
$19,215.12
|
| Rate for Payer: Quartz Beloit One Network |
$10,234.14
|
| Rate for Payer: Quartz Commercial |
$13,575.90
|
| Rate for Payer: Quartz Medicare Advantage |
$12,531.60
|
| Rate for Payer: The Alliance Commercial |
$83,544.00
|
| Rate for Payer: WEA Trust Commercial |
$11,487.30
|
| Rate for Payer: WPS Commercial |
$15,470.26
|
|
|
FEMUR PERSONA CR CMT CCR NRW SZ 10 RIGHT 42-5020-068-02
|
Facility
|
IP
|
$20,886.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4518801
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,234.14 |
| Max. Negotiated Rate |
$19,215.12 |
| Rate for Payer: Aetna Commercial |
$18,797.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,961.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,069.58
|
| Rate for Payer: Cash Price |
$6,265.80
|
| Rate for Payer: Cigna Commercial |
$19,215.12
|
| Rate for Payer: Health EOS Commercial |
$18,588.54
|
| Rate for Payer: HFN Commercial |
$19,215.12
|
| Rate for Payer: Multiplan Commercial |
$16,708.80
|
| Rate for Payer: NAPHCARE Commercial |
$12,531.60
|
| Rate for Payer: Preferred Network Access Commercial |
$19,215.12
|
| Rate for Payer: Quartz Beloit One Network |
$10,234.14
|
| Rate for Payer: Quartz Commercial |
$12,531.60
|
| Rate for Payer: WEA Trust Commercial |
$11,487.30
|
| Rate for Payer: WPS Commercial |
$15,470.26
|
|
|
FEMUR PERSONA CR CMT CCR NRW SZ 6 LT 42-5020-060-01
|
Facility
|
OP
|
$20,886.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4391072
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,848.08 |
| Max. Negotiated Rate |
$83,544.00 |
| Rate for Payer: Aetna Commercial |
$18,797.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,961.96
|
| Rate for Payer: Aetna Managed Medicare |
$5,848.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,575.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,443.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,025.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,069.58
|
| Rate for Payer: Cash Price |
$6,265.80
|
| Rate for Payer: Cigna Commercial |
$19,215.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,687.81
|
| Rate for Payer: Health EOS Commercial |
$18,588.54
|
| Rate for Payer: HFN Commercial |
$19,215.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,664.50
|
| Rate for Payer: Multiplan Commercial |
$16,708.80
|
| Rate for Payer: NAPHCARE Commercial |
$12,531.60
|
| Rate for Payer: Preferred Network Access Commercial |
$19,215.12
|
| Rate for Payer: Quartz Beloit One Network |
$10,234.14
|
| Rate for Payer: Quartz Commercial |
$13,575.90
|
| Rate for Payer: Quartz Medicare Advantage |
$12,531.60
|
| Rate for Payer: The Alliance Commercial |
$83,544.00
|
| Rate for Payer: WEA Trust Commercial |
$11,487.30
|
| Rate for Payer: WPS Commercial |
$15,470.26
|
|
|
FEMUR PERSONA CR CMT CCR NRW SZ 6 LT 42-5020-060-01
|
Facility
|
IP
|
$20,886.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4391072
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,234.14 |
| Max. Negotiated Rate |
$19,215.12 |
| Rate for Payer: Aetna Commercial |
$18,797.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,961.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,069.58
|
| Rate for Payer: Cash Price |
$6,265.80
|
| Rate for Payer: Cigna Commercial |
$19,215.12
|
| Rate for Payer: Health EOS Commercial |
$18,588.54
|
| Rate for Payer: HFN Commercial |
$19,215.12
|
| Rate for Payer: Multiplan Commercial |
$16,708.80
|
| Rate for Payer: NAPHCARE Commercial |
$12,531.60
|
| Rate for Payer: Preferred Network Access Commercial |
$19,215.12
|
| Rate for Payer: Quartz Beloit One Network |
$10,234.14
|
| Rate for Payer: Quartz Commercial |
$12,531.60
|
| Rate for Payer: WEA Trust Commercial |
$11,487.30
|
| Rate for Payer: WPS Commercial |
$15,470.26
|
|
|
FEMUR PERSONA CR CMT CCR NRW SZ 6 RT 42-5020-060-02
|
Facility
|
OP
|
$20,886.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4006571
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,848.08 |
| Max. Negotiated Rate |
$83,544.00 |
| Rate for Payer: Aetna Commercial |
$18,797.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,961.96
|
| Rate for Payer: Aetna Managed Medicare |
$5,848.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,575.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,443.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,025.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,069.58
|
| Rate for Payer: Cash Price |
$6,265.80
|
| Rate for Payer: Cigna Commercial |
$19,215.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,687.81
|
| Rate for Payer: Health EOS Commercial |
$18,588.54
|
| Rate for Payer: HFN Commercial |
$19,215.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,664.50
|
| Rate for Payer: Multiplan Commercial |
$16,708.80
|
| Rate for Payer: NAPHCARE Commercial |
$12,531.60
|
| Rate for Payer: Preferred Network Access Commercial |
$19,215.12
|
| Rate for Payer: Quartz Beloit One Network |
$10,234.14
|
| Rate for Payer: Quartz Commercial |
$13,575.90
|
| Rate for Payer: Quartz Medicare Advantage |
$12,531.60
|
| Rate for Payer: The Alliance Commercial |
$83,544.00
|
| Rate for Payer: WEA Trust Commercial |
$11,487.30
|
| Rate for Payer: WPS Commercial |
$15,470.26
|
|
|
FEMUR PERSONA CR CMT CCR NRW SZ 6 RT 42-5020-060-02
|
Facility
|
IP
|
$20,886.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4006571
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,234.14 |
| Max. Negotiated Rate |
$19,215.12 |
| Rate for Payer: Aetna Commercial |
$18,797.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,961.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,069.58
|
| Rate for Payer: Cash Price |
$6,265.80
|
| Rate for Payer: Cigna Commercial |
$19,215.12
|
| Rate for Payer: Health EOS Commercial |
$18,588.54
|
| Rate for Payer: HFN Commercial |
$19,215.12
|
| Rate for Payer: Multiplan Commercial |
$16,708.80
|
| Rate for Payer: NAPHCARE Commercial |
$12,531.60
|
| Rate for Payer: Preferred Network Access Commercial |
$19,215.12
|
| Rate for Payer: Quartz Beloit One Network |
$10,234.14
|
| Rate for Payer: Quartz Commercial |
$12,531.60
|
| Rate for Payer: WEA Trust Commercial |
$11,487.30
|
| Rate for Payer: WPS Commercial |
$15,470.26
|
|
|
FEMUR PERSONA CR CMT CCR STD SZ 10 LT 42-5026-068-01
|
Facility
|
OP
|
$21,689.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4359457
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,072.92 |
| Max. Negotiated Rate |
$86,756.00 |
| Rate for Payer: Aetna Commercial |
$19,520.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,652.54
|
| Rate for Payer: Aetna Managed Medicare |
$6,072.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14,097.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,844.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,410.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,495.17
|
| Rate for Payer: Cash Price |
$6,506.70
|
| Rate for Payer: Cigna Commercial |
$19,953.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,137.16
|
| Rate for Payer: Health EOS Commercial |
$19,303.21
|
| Rate for Payer: HFN Commercial |
$19,953.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16,266.75
|
| Rate for Payer: Multiplan Commercial |
$17,351.20
|
| Rate for Payer: NAPHCARE Commercial |
$13,013.40
|
| Rate for Payer: Preferred Network Access Commercial |
$19,953.88
|
| Rate for Payer: Quartz Beloit One Network |
$10,627.61
|
| Rate for Payer: Quartz Commercial |
$14,097.85
|
| Rate for Payer: Quartz Medicare Advantage |
$13,013.40
|
| Rate for Payer: The Alliance Commercial |
$86,756.00
|
| Rate for Payer: WEA Trust Commercial |
$11,928.95
|
| Rate for Payer: WPS Commercial |
$16,065.04
|
|
|
FEMUR PERSONA CR CMT CCR STD SZ 10 LT 42-5026-068-01
|
Facility
|
IP
|
$21,689.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4359457
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,627.61 |
| Max. Negotiated Rate |
$19,953.88 |
| Rate for Payer: Aetna Commercial |
$19,520.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,652.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,495.17
|
| Rate for Payer: Cash Price |
$6,506.70
|
| Rate for Payer: Cigna Commercial |
$19,953.88
|
| Rate for Payer: Health EOS Commercial |
$19,303.21
|
| Rate for Payer: HFN Commercial |
$19,953.88
|
| Rate for Payer: Multiplan Commercial |
$17,351.20
|
| Rate for Payer: NAPHCARE Commercial |
$13,013.40
|
| Rate for Payer: Preferred Network Access Commercial |
$19,953.88
|
| Rate for Payer: Quartz Beloit One Network |
$10,627.61
|
| Rate for Payer: Quartz Commercial |
$13,013.40
|
| Rate for Payer: WEA Trust Commercial |
$11,928.95
|
| Rate for Payer: WPS Commercial |
$16,065.04
|
|
