|
FEMUR TRIATHLON CR SZ 3 RT 5510-F-302
|
Facility
|
IP
|
$11,586.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3177478
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,904.23 |
| Max. Negotiated Rate |
$11,085.48 |
| Rate for Payer: Aetna Commercial |
$10,844.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,362.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,386.20
|
| Rate for Payer: Cash Price |
$3,475.80
|
| Rate for Payer: Cigna Commercial |
$11,085.48
|
| Rate for Payer: Health EOS Commercial |
$10,724.00
|
| Rate for Payer: HFN Commercial |
$11,085.48
|
| Rate for Payer: Multiplan Commercial |
$9,639.55
|
| Rate for Payer: Preferred Network Access Commercial |
$11,085.48
|
| Rate for Payer: Quartz Beloit One Network |
$5,904.23
|
| Rate for Payer: Quartz Commercial |
$7,229.66
|
| Rate for Payer: WEA Trust Commercial |
$6,627.19
|
| Rate for Payer: WPS Commercial |
$8,924.70
|
|
|
FEMUR TRIATHLON CR SZ 3 RT 5510-F-302
|
Facility
|
OP
|
$11,586.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3177478
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,373.84 |
| Max. Negotiated Rate |
$11,085.48 |
| Rate for Payer: Aetna Commercial |
$10,844.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,362.52
|
| Rate for Payer: Aetna Managed Medicare |
$3,373.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,832.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,024.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,783.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,386.20
|
| Rate for Payer: Cash Price |
$3,475.80
|
| Rate for Payer: Cigna Commercial |
$11,085.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,743.05
|
| Rate for Payer: Health EOS Commercial |
$10,724.00
|
| Rate for Payer: HFN Commercial |
$11,085.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,037.08
|
| Rate for Payer: Multiplan Commercial |
$9,639.55
|
| Rate for Payer: NAPHCARE Commercial |
$7,229.66
|
| Rate for Payer: Preferred Network Access Commercial |
$11,085.48
|
| Rate for Payer: Quartz Beloit One Network |
$5,904.23
|
| Rate for Payer: Quartz Commercial |
$7,832.14
|
| Rate for Payer: Quartz Medicare Advantage |
$7,229.66
|
| Rate for Payer: The Alliance Commercial |
$6,024.72
|
| Rate for Payer: WEA Trust Commercial |
$6,627.19
|
| Rate for Payer: WPS Commercial |
$8,924.70
|
|
|
FEMUR TRIATHLON CR SZ 3 RT 5517-F-302
|
Facility
|
IP
|
$19,515.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4493838
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,944.84 |
| Max. Negotiated Rate |
$18,671.95 |
| Rate for Payer: Aetna Commercial |
$18,266.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,454.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,756.67
|
| Rate for Payer: Cash Price |
$5,854.50
|
| Rate for Payer: Cigna Commercial |
$18,671.95
|
| Rate for Payer: Health EOS Commercial |
$18,063.08
|
| Rate for Payer: HFN Commercial |
$18,671.95
|
| Rate for Payer: Multiplan Commercial |
$16,236.48
|
| Rate for Payer: Preferred Network Access Commercial |
$18,671.95
|
| Rate for Payer: Quartz Beloit One Network |
$9,944.84
|
| Rate for Payer: Quartz Commercial |
$12,177.36
|
| Rate for Payer: WEA Trust Commercial |
$11,162.58
|
| Rate for Payer: WPS Commercial |
$15,032.40
|
|
|
FEMUR TRIATHLON CR SZ 3 RT 5517-F-302
|
Facility
|
OP
|
$19,515.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4493838
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,682.77 |
| Max. Negotiated Rate |
$18,671.95 |
| Rate for Payer: Aetna Commercial |
$18,266.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,454.22
|
| Rate for Payer: Aetna Managed Medicare |
$5,682.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,192.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,147.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,741.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,756.67
|
| Rate for Payer: Cash Price |
$5,854.50
|
| Rate for Payer: Cigna Commercial |
$18,671.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,357.73
|
| Rate for Payer: Health EOS Commercial |
$18,063.08
|
| Rate for Payer: HFN Commercial |
$18,671.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,221.70
|
| Rate for Payer: Multiplan Commercial |
$16,236.48
|
| Rate for Payer: NAPHCARE Commercial |
$12,177.36
|
| Rate for Payer: Preferred Network Access Commercial |
$18,671.95
|
| Rate for Payer: Quartz Beloit One Network |
$9,944.84
|
| Rate for Payer: Quartz Commercial |
$13,192.14
|
| Rate for Payer: Quartz Medicare Advantage |
$12,177.36
|
| Rate for Payer: The Alliance Commercial |
$10,147.80
|
| Rate for Payer: WEA Trust Commercial |
$11,162.58
|
| Rate for Payer: WPS Commercial |
$15,032.40
|
|
|
FEMUR TRIATHLON CR SZ 4 LT 5510-F-401
|
Facility
|
OP
|
$11,586.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3128845
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,373.84 |
| Max. Negotiated Rate |
$11,085.48 |
| Rate for Payer: Aetna Commercial |
$10,844.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,362.52
|
| Rate for Payer: Aetna Managed Medicare |
$3,373.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,832.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,024.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,783.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,386.20
|
| Rate for Payer: Cash Price |
$3,475.80
|
| Rate for Payer: Cigna Commercial |
$11,085.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,743.05
|
| Rate for Payer: Health EOS Commercial |
$10,724.00
|
| Rate for Payer: HFN Commercial |
$11,085.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,037.08
|
| Rate for Payer: Multiplan Commercial |
$9,639.55
|
| Rate for Payer: NAPHCARE Commercial |
$7,229.66
|
| Rate for Payer: Preferred Network Access Commercial |
$11,085.48
|
| Rate for Payer: Quartz Beloit One Network |
$5,904.23
|
| Rate for Payer: Quartz Commercial |
$7,832.14
|
| Rate for Payer: Quartz Medicare Advantage |
$7,229.66
|
| Rate for Payer: The Alliance Commercial |
$6,024.72
|
| Rate for Payer: WEA Trust Commercial |
$6,627.19
|
| Rate for Payer: WPS Commercial |
$8,924.70
|
|
|
FEMUR TRIATHLON CR SZ 4 LT 5510-F-401
|
Facility
|
IP
|
$11,586.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3128845
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,904.23 |
| Max. Negotiated Rate |
$11,085.48 |
| Rate for Payer: Aetna Commercial |
$10,844.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,362.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,386.20
|
| Rate for Payer: Cash Price |
$3,475.80
|
| Rate for Payer: Cigna Commercial |
$11,085.48
|
| Rate for Payer: Health EOS Commercial |
$10,724.00
|
| Rate for Payer: HFN Commercial |
$11,085.48
|
| Rate for Payer: Multiplan Commercial |
$9,639.55
|
| Rate for Payer: Preferred Network Access Commercial |
$11,085.48
|
| Rate for Payer: Quartz Beloit One Network |
$5,904.23
|
| Rate for Payer: Quartz Commercial |
$7,229.66
|
| Rate for Payer: WEA Trust Commercial |
$6,627.19
|
| Rate for Payer: WPS Commercial |
$8,924.70
|
|
|
FEMUR TRIATHLON CR SZ 4 LT 5517-F-401
|
Facility
|
OP
|
$20,264.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3779517
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,900.88 |
| Max. Negotiated Rate |
$19,388.60 |
| Rate for Payer: Aetna Commercial |
$18,967.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,124.12
|
| Rate for Payer: Aetna Managed Medicare |
$5,900.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,698.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,537.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,115.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,169.52
|
| Rate for Payer: Cash Price |
$6,079.20
|
| Rate for Payer: Cigna Commercial |
$19,388.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,793.65
|
| Rate for Payer: Health EOS Commercial |
$18,756.36
|
| Rate for Payer: HFN Commercial |
$19,388.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,805.92
|
| Rate for Payer: Multiplan Commercial |
$16,859.65
|
| Rate for Payer: NAPHCARE Commercial |
$12,644.74
|
| Rate for Payer: Preferred Network Access Commercial |
$19,388.60
|
| Rate for Payer: Quartz Beloit One Network |
$10,326.53
|
| Rate for Payer: Quartz Commercial |
$13,698.46
|
| Rate for Payer: Quartz Medicare Advantage |
$12,644.74
|
| Rate for Payer: The Alliance Commercial |
$10,537.28
|
| Rate for Payer: WEA Trust Commercial |
$11,591.01
|
| Rate for Payer: WPS Commercial |
$15,609.36
|
|
|
FEMUR TRIATHLON CR SZ 4 LT 5517-F-401
|
Facility
|
IP
|
$20,264.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3779517
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,326.53 |
| Max. Negotiated Rate |
$19,388.60 |
| Rate for Payer: Aetna Commercial |
$18,967.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,124.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,169.52
|
| Rate for Payer: Cash Price |
$6,079.20
|
| Rate for Payer: Cigna Commercial |
$19,388.60
|
| Rate for Payer: Health EOS Commercial |
$18,756.36
|
| Rate for Payer: HFN Commercial |
$19,388.60
|
| Rate for Payer: Multiplan Commercial |
$16,859.65
|
| Rate for Payer: Preferred Network Access Commercial |
$19,388.60
|
| Rate for Payer: Quartz Beloit One Network |
$10,326.53
|
| Rate for Payer: Quartz Commercial |
$12,644.74
|
| Rate for Payer: WEA Trust Commercial |
$11,591.01
|
| Rate for Payer: WPS Commercial |
$15,609.36
|
|
|
FEMUR TRIATHLON CR SZ 4 RT 5510-F-402
|
Facility
|
IP
|
$11,586.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3263467
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,904.23 |
| Max. Negotiated Rate |
$11,085.48 |
| Rate for Payer: Aetna Commercial |
$10,844.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,362.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,386.20
|
| Rate for Payer: Cash Price |
$3,475.80
|
| Rate for Payer: Cigna Commercial |
$11,085.48
|
| Rate for Payer: Health EOS Commercial |
$10,724.00
|
| Rate for Payer: HFN Commercial |
$11,085.48
|
| Rate for Payer: Multiplan Commercial |
$9,639.55
|
| Rate for Payer: Preferred Network Access Commercial |
$11,085.48
|
| Rate for Payer: Quartz Beloit One Network |
$5,904.23
|
| Rate for Payer: Quartz Commercial |
$7,229.66
|
| Rate for Payer: WEA Trust Commercial |
$6,627.19
|
| Rate for Payer: WPS Commercial |
$8,924.70
|
|
|
FEMUR TRIATHLON CR SZ 4 RT 5510-F-402
|
Facility
|
OP
|
$11,586.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3263467
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,373.84 |
| Max. Negotiated Rate |
$11,085.48 |
| Rate for Payer: Aetna Commercial |
$10,844.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,362.52
|
| Rate for Payer: Aetna Managed Medicare |
$3,373.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,832.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,024.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,783.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,386.20
|
| Rate for Payer: Cash Price |
$3,475.80
|
| Rate for Payer: Cigna Commercial |
$11,085.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,743.05
|
| Rate for Payer: Health EOS Commercial |
$10,724.00
|
| Rate for Payer: HFN Commercial |
$11,085.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,037.08
|
| Rate for Payer: Multiplan Commercial |
$9,639.55
|
| Rate for Payer: NAPHCARE Commercial |
$7,229.66
|
| Rate for Payer: Preferred Network Access Commercial |
$11,085.48
|
| Rate for Payer: Quartz Beloit One Network |
$5,904.23
|
| Rate for Payer: Quartz Commercial |
$7,832.14
|
| Rate for Payer: Quartz Medicare Advantage |
$7,229.66
|
| Rate for Payer: The Alliance Commercial |
$6,024.72
|
| Rate for Payer: WEA Trust Commercial |
$6,627.19
|
| Rate for Payer: WPS Commercial |
$8,924.70
|
|
|
FEMUR TRIATHLON CR SZ 4 RT 5517-F-402
|
Facility
|
IP
|
$19,515.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4263464
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,944.84 |
| Max. Negotiated Rate |
$18,671.95 |
| Rate for Payer: Aetna Commercial |
$18,266.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,454.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,756.67
|
| Rate for Payer: Cash Price |
$5,854.50
|
| Rate for Payer: Cigna Commercial |
$18,671.95
|
| Rate for Payer: Health EOS Commercial |
$18,063.08
|
| Rate for Payer: HFN Commercial |
$18,671.95
|
| Rate for Payer: Multiplan Commercial |
$16,236.48
|
| Rate for Payer: Preferred Network Access Commercial |
$18,671.95
|
| Rate for Payer: Quartz Beloit One Network |
$9,944.84
|
| Rate for Payer: Quartz Commercial |
$12,177.36
|
| Rate for Payer: WEA Trust Commercial |
$11,162.58
|
| Rate for Payer: WPS Commercial |
$15,032.40
|
|
|
FEMUR TRIATHLON CR SZ 4 RT 5517-F-402
|
Facility
|
OP
|
$19,515.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4263464
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,682.77 |
| Max. Negotiated Rate |
$18,671.95 |
| Rate for Payer: Aetna Commercial |
$18,266.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,454.22
|
| Rate for Payer: Aetna Managed Medicare |
$5,682.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,192.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,147.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,741.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,756.67
|
| Rate for Payer: Cash Price |
$5,854.50
|
| Rate for Payer: Cigna Commercial |
$18,671.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,357.73
|
| Rate for Payer: Health EOS Commercial |
$18,063.08
|
| Rate for Payer: HFN Commercial |
$18,671.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,221.70
|
| Rate for Payer: Multiplan Commercial |
$16,236.48
|
| Rate for Payer: NAPHCARE Commercial |
$12,177.36
|
| Rate for Payer: Preferred Network Access Commercial |
$18,671.95
|
| Rate for Payer: Quartz Beloit One Network |
$9,944.84
|
| Rate for Payer: Quartz Commercial |
$13,192.14
|
| Rate for Payer: Quartz Medicare Advantage |
$12,177.36
|
| Rate for Payer: The Alliance Commercial |
$10,147.80
|
| Rate for Payer: WEA Trust Commercial |
$11,162.58
|
| Rate for Payer: WPS Commercial |
$15,032.40
|
|
|
FEMUR TRIATHLON CR SZ 5 LT 5510-F-501
|
Facility
|
IP
|
$11,586.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3127476
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,904.23 |
| Max. Negotiated Rate |
$11,085.48 |
| Rate for Payer: Aetna Commercial |
$10,844.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,362.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,386.20
|
| Rate for Payer: Cash Price |
$3,475.80
|
| Rate for Payer: Cigna Commercial |
$11,085.48
|
| Rate for Payer: Health EOS Commercial |
$10,724.00
|
| Rate for Payer: HFN Commercial |
$11,085.48
|
| Rate for Payer: Multiplan Commercial |
$9,639.55
|
| Rate for Payer: Preferred Network Access Commercial |
$11,085.48
|
| Rate for Payer: Quartz Beloit One Network |
$5,904.23
|
| Rate for Payer: Quartz Commercial |
$7,229.66
|
| Rate for Payer: WEA Trust Commercial |
$6,627.19
|
| Rate for Payer: WPS Commercial |
$8,924.70
|
|
|
FEMUR TRIATHLON CR SZ 5 LT 5510-F-501
|
Facility
|
OP
|
$11,586.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3127476
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,373.84 |
| Max. Negotiated Rate |
$11,085.48 |
| Rate for Payer: Aetna Commercial |
$10,844.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,362.52
|
| Rate for Payer: Aetna Managed Medicare |
$3,373.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,832.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,024.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,783.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,386.20
|
| Rate for Payer: Cash Price |
$3,475.80
|
| Rate for Payer: Cigna Commercial |
$11,085.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,743.05
|
| Rate for Payer: Health EOS Commercial |
$10,724.00
|
| Rate for Payer: HFN Commercial |
$11,085.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,037.08
|
| Rate for Payer: Multiplan Commercial |
$9,639.55
|
| Rate for Payer: NAPHCARE Commercial |
$7,229.66
|
| Rate for Payer: Preferred Network Access Commercial |
$11,085.48
|
| Rate for Payer: Quartz Beloit One Network |
$5,904.23
|
| Rate for Payer: Quartz Commercial |
$7,832.14
|
| Rate for Payer: Quartz Medicare Advantage |
$7,229.66
|
| Rate for Payer: The Alliance Commercial |
$6,024.72
|
| Rate for Payer: WEA Trust Commercial |
$6,627.19
|
| Rate for Payer: WPS Commercial |
$8,924.70
|
|
|
FEMUR TRIATHLON CR SZ 5 LT 5517-F-501
|
Facility
|
IP
|
$20,264.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4167704
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,326.53 |
| Max. Negotiated Rate |
$19,388.60 |
| Rate for Payer: Aetna Commercial |
$18,967.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,124.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,169.52
|
| Rate for Payer: Cash Price |
$6,079.20
|
| Rate for Payer: Cigna Commercial |
$19,388.60
|
| Rate for Payer: Health EOS Commercial |
$18,756.36
|
| Rate for Payer: HFN Commercial |
$19,388.60
|
| Rate for Payer: Multiplan Commercial |
$16,859.65
|
| Rate for Payer: Preferred Network Access Commercial |
$19,388.60
|
| Rate for Payer: Quartz Beloit One Network |
$10,326.53
|
| Rate for Payer: Quartz Commercial |
$12,644.74
|
| Rate for Payer: WEA Trust Commercial |
$11,591.01
|
| Rate for Payer: WPS Commercial |
$15,609.36
|
|
|
FEMUR TRIATHLON CR SZ 5 LT 5517-F-501
|
Facility
|
OP
|
$20,264.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4167704
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,900.88 |
| Max. Negotiated Rate |
$19,388.60 |
| Rate for Payer: Aetna Commercial |
$18,967.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,124.12
|
| Rate for Payer: Aetna Managed Medicare |
$5,900.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,698.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,537.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,115.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,169.52
|
| Rate for Payer: Cash Price |
$6,079.20
|
| Rate for Payer: Cigna Commercial |
$19,388.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,793.65
|
| Rate for Payer: Health EOS Commercial |
$18,756.36
|
| Rate for Payer: HFN Commercial |
$19,388.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,805.92
|
| Rate for Payer: Multiplan Commercial |
$16,859.65
|
| Rate for Payer: NAPHCARE Commercial |
$12,644.74
|
| Rate for Payer: Preferred Network Access Commercial |
$19,388.60
|
| Rate for Payer: Quartz Beloit One Network |
$10,326.53
|
| Rate for Payer: Quartz Commercial |
$13,698.46
|
| Rate for Payer: Quartz Medicare Advantage |
$12,644.74
|
| Rate for Payer: The Alliance Commercial |
$10,537.28
|
| Rate for Payer: WEA Trust Commercial |
$11,591.01
|
| Rate for Payer: WPS Commercial |
$15,609.36
|
|
|
FEMUR TRIATHLON CR SZ 5 RT 5510-F-502
|
Facility
|
IP
|
$12,032.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3779523
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,131.51 |
| Max. Negotiated Rate |
$11,512.22 |
| Rate for Payer: Aetna Commercial |
$11,261.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,761.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,632.04
|
| Rate for Payer: Cash Price |
$3,609.60
|
| Rate for Payer: Cigna Commercial |
$11,512.22
|
| Rate for Payer: Health EOS Commercial |
$11,136.82
|
| Rate for Payer: HFN Commercial |
$11,512.22
|
| Rate for Payer: Multiplan Commercial |
$10,010.62
|
| Rate for Payer: Preferred Network Access Commercial |
$11,512.22
|
| Rate for Payer: Quartz Beloit One Network |
$6,131.51
|
| Rate for Payer: Quartz Commercial |
$7,507.97
|
| Rate for Payer: WEA Trust Commercial |
$6,882.30
|
| Rate for Payer: WPS Commercial |
$9,268.25
|
|
|
FEMUR TRIATHLON CR SZ 5 RT 5510-F-502
|
Facility
|
OP
|
$12,032.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3779523
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,503.72 |
| Max. Negotiated Rate |
$11,512.22 |
| Rate for Payer: Aetna Commercial |
$11,261.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,761.42
|
| Rate for Payer: Aetna Managed Medicare |
$3,503.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,133.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,256.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,006.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,632.04
|
| Rate for Payer: Cash Price |
$3,609.60
|
| Rate for Payer: Cigna Commercial |
$11,512.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,002.62
|
| Rate for Payer: Health EOS Commercial |
$11,136.82
|
| Rate for Payer: HFN Commercial |
$11,512.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,384.96
|
| Rate for Payer: Multiplan Commercial |
$10,010.62
|
| Rate for Payer: NAPHCARE Commercial |
$7,507.97
|
| Rate for Payer: Preferred Network Access Commercial |
$11,512.22
|
| Rate for Payer: Quartz Beloit One Network |
$6,131.51
|
| Rate for Payer: Quartz Commercial |
$8,133.63
|
| Rate for Payer: Quartz Medicare Advantage |
$7,507.97
|
| Rate for Payer: The Alliance Commercial |
$6,256.64
|
| Rate for Payer: WEA Trust Commercial |
$6,882.30
|
| Rate for Payer: WPS Commercial |
$9,268.25
|
|
|
FEMUR TRIATHLON CR SZ 5 RT 5517-F-502
|
Facility
|
IP
|
$20,264.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4289889
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,326.53 |
| Max. Negotiated Rate |
$19,388.60 |
| Rate for Payer: Aetna Commercial |
$18,967.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,124.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,169.52
|
| Rate for Payer: Cash Price |
$6,079.20
|
| Rate for Payer: Cigna Commercial |
$19,388.60
|
| Rate for Payer: Health EOS Commercial |
$18,756.36
|
| Rate for Payer: HFN Commercial |
$19,388.60
|
| Rate for Payer: Multiplan Commercial |
$16,859.65
|
| Rate for Payer: Preferred Network Access Commercial |
$19,388.60
|
| Rate for Payer: Quartz Beloit One Network |
$10,326.53
|
| Rate for Payer: Quartz Commercial |
$12,644.74
|
| Rate for Payer: WEA Trust Commercial |
$11,591.01
|
| Rate for Payer: WPS Commercial |
$15,609.36
|
|
|
FEMUR TRIATHLON CR SZ 5 RT 5517-F-502
|
Facility
|
OP
|
$20,264.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4289889
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,900.88 |
| Max. Negotiated Rate |
$19,388.60 |
| Rate for Payer: Aetna Commercial |
$18,967.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,124.12
|
| Rate for Payer: Aetna Managed Medicare |
$5,900.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,698.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,537.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,115.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,169.52
|
| Rate for Payer: Cash Price |
$6,079.20
|
| Rate for Payer: Cigna Commercial |
$19,388.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,793.65
|
| Rate for Payer: Health EOS Commercial |
$18,756.36
|
| Rate for Payer: HFN Commercial |
$19,388.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,805.92
|
| Rate for Payer: Multiplan Commercial |
$16,859.65
|
| Rate for Payer: NAPHCARE Commercial |
$12,644.74
|
| Rate for Payer: Preferred Network Access Commercial |
$19,388.60
|
| Rate for Payer: Quartz Beloit One Network |
$10,326.53
|
| Rate for Payer: Quartz Commercial |
$13,698.46
|
| Rate for Payer: Quartz Medicare Advantage |
$12,644.74
|
| Rate for Payer: The Alliance Commercial |
$10,537.28
|
| Rate for Payer: WEA Trust Commercial |
$11,591.01
|
| Rate for Payer: WPS Commercial |
$15,609.36
|
|
|
FEMUR TRIATHLON CR SZ 6 LT 5510-F-601
|
Facility
|
OP
|
$11,586.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3935331
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,373.84 |
| Max. Negotiated Rate |
$11,085.48 |
| Rate for Payer: Aetna Commercial |
$10,844.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,362.52
|
| Rate for Payer: Aetna Managed Medicare |
$3,373.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,832.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,024.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,783.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,386.20
|
| Rate for Payer: Cash Price |
$3,475.80
|
| Rate for Payer: Cigna Commercial |
$11,085.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,743.05
|
| Rate for Payer: Health EOS Commercial |
$10,724.00
|
| Rate for Payer: HFN Commercial |
$11,085.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,037.08
|
| Rate for Payer: Multiplan Commercial |
$9,639.55
|
| Rate for Payer: NAPHCARE Commercial |
$7,229.66
|
| Rate for Payer: Preferred Network Access Commercial |
$11,085.48
|
| Rate for Payer: Quartz Beloit One Network |
$5,904.23
|
| Rate for Payer: Quartz Commercial |
$7,832.14
|
| Rate for Payer: Quartz Medicare Advantage |
$7,229.66
|
| Rate for Payer: The Alliance Commercial |
$6,024.72
|
| Rate for Payer: WEA Trust Commercial |
$6,627.19
|
| Rate for Payer: WPS Commercial |
$8,924.70
|
|
|
FEMUR TRIATHLON CR SZ 6 LT 5510-F-601
|
Facility
|
IP
|
$11,586.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3935331
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,904.23 |
| Max. Negotiated Rate |
$11,085.48 |
| Rate for Payer: Aetna Commercial |
$10,844.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,362.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,386.20
|
| Rate for Payer: Cash Price |
$3,475.80
|
| Rate for Payer: Cigna Commercial |
$11,085.48
|
| Rate for Payer: Health EOS Commercial |
$10,724.00
|
| Rate for Payer: HFN Commercial |
$11,085.48
|
| Rate for Payer: Multiplan Commercial |
$9,639.55
|
| Rate for Payer: Preferred Network Access Commercial |
$11,085.48
|
| Rate for Payer: Quartz Beloit One Network |
$5,904.23
|
| Rate for Payer: Quartz Commercial |
$7,229.66
|
| Rate for Payer: WEA Trust Commercial |
$6,627.19
|
| Rate for Payer: WPS Commercial |
$8,924.70
|
|
|
FEMUR TRIATHLON CR SZ 6 LT 5517-F-601
|
Facility
|
OP
|
$20,264.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4493881
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,900.88 |
| Max. Negotiated Rate |
$19,388.60 |
| Rate for Payer: Aetna Commercial |
$18,967.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,124.12
|
| Rate for Payer: Aetna Managed Medicare |
$5,900.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,698.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,537.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,115.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,169.52
|
| Rate for Payer: Cash Price |
$6,079.20
|
| Rate for Payer: Cigna Commercial |
$19,388.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,793.65
|
| Rate for Payer: Health EOS Commercial |
$18,756.36
|
| Rate for Payer: HFN Commercial |
$19,388.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,805.92
|
| Rate for Payer: Multiplan Commercial |
$16,859.65
|
| Rate for Payer: NAPHCARE Commercial |
$12,644.74
|
| Rate for Payer: Preferred Network Access Commercial |
$19,388.60
|
| Rate for Payer: Quartz Beloit One Network |
$10,326.53
|
| Rate for Payer: Quartz Commercial |
$13,698.46
|
| Rate for Payer: Quartz Medicare Advantage |
$12,644.74
|
| Rate for Payer: The Alliance Commercial |
$10,537.28
|
| Rate for Payer: WEA Trust Commercial |
$11,591.01
|
| Rate for Payer: WPS Commercial |
$15,609.36
|
|
|
FEMUR TRIATHLON CR SZ 6 LT 5517-F-601
|
Facility
|
IP
|
$20,264.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4493881
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,326.53 |
| Max. Negotiated Rate |
$19,388.60 |
| Rate for Payer: Aetna Commercial |
$18,967.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,124.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,169.52
|
| Rate for Payer: Cash Price |
$6,079.20
|
| Rate for Payer: Cigna Commercial |
$19,388.60
|
| Rate for Payer: Health EOS Commercial |
$18,756.36
|
| Rate for Payer: HFN Commercial |
$19,388.60
|
| Rate for Payer: Multiplan Commercial |
$16,859.65
|
| Rate for Payer: Preferred Network Access Commercial |
$19,388.60
|
| Rate for Payer: Quartz Beloit One Network |
$10,326.53
|
| Rate for Payer: Quartz Commercial |
$12,644.74
|
| Rate for Payer: WEA Trust Commercial |
$11,591.01
|
| Rate for Payer: WPS Commercial |
$15,609.36
|
|
|
FEMUR TRIATHLON CR SZ 6 RT 5510-F-602
|
Facility
|
OP
|
$11,586.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3072434
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,373.84 |
| Max. Negotiated Rate |
$11,085.48 |
| Rate for Payer: Aetna Commercial |
$10,844.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,362.52
|
| Rate for Payer: Aetna Managed Medicare |
$3,373.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,832.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,024.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,783.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,386.20
|
| Rate for Payer: Cash Price |
$3,475.80
|
| Rate for Payer: Cigna Commercial |
$11,085.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,743.05
|
| Rate for Payer: Health EOS Commercial |
$10,724.00
|
| Rate for Payer: HFN Commercial |
$11,085.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,037.08
|
| Rate for Payer: Multiplan Commercial |
$9,639.55
|
| Rate for Payer: NAPHCARE Commercial |
$7,229.66
|
| Rate for Payer: Preferred Network Access Commercial |
$11,085.48
|
| Rate for Payer: Quartz Beloit One Network |
$5,904.23
|
| Rate for Payer: Quartz Commercial |
$7,832.14
|
| Rate for Payer: Quartz Medicare Advantage |
$7,229.66
|
| Rate for Payer: The Alliance Commercial |
$6,024.72
|
| Rate for Payer: WEA Trust Commercial |
$6,627.19
|
| Rate for Payer: WPS Commercial |
$8,924.70
|
|
