|
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 |
$3,387.91 |
| Max. Negotiated Rate |
$48,398.76 |
| Rate for Payer: Aetna Commercial |
$10,889.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,405.73
|
| Rate for Payer: Aetna Managed Medicare |
$3,387.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,864.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,049.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,807.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,412.84
|
| Rate for Payer: Cash Price |
$3,629.91
|
| Rate for Payer: Cigna Commercial |
$11,131.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,770.99
|
| Rate for Payer: Health EOS Commercial |
$10,768.72
|
| Rate for Payer: HFN Commercial |
$11,131.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,074.77
|
| Rate for Payer: Multiplan Commercial |
$9,679.75
|
| Rate for Payer: NAPHCARE Commercial |
$7,259.81
|
| Rate for Payer: Preferred Network Access Commercial |
$11,131.71
|
| Rate for Payer: Quartz Beloit One Network |
$5,928.85
|
| Rate for Payer: Quartz Commercial |
$7,864.80
|
| Rate for Payer: Quartz Medicare Advantage |
$7,259.81
|
| Rate for Payer: The Alliance Commercial |
$48,398.76
|
| Rate for Payer: WEA Trust Commercial |
$6,654.83
|
| Rate for Payer: WPS Commercial |
$8,962.24
|
|
|
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 |
$5,928.85 |
| Max. Negotiated Rate |
$11,131.71 |
| Rate for Payer: Aetna Commercial |
$10,889.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,405.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,412.84
|
| Rate for Payer: Cash Price |
$3,629.91
|
| Rate for Payer: Cigna Commercial |
$11,131.71
|
| Rate for Payer: Health EOS Commercial |
$10,768.72
|
| Rate for Payer: HFN Commercial |
$11,131.71
|
| Rate for Payer: Multiplan Commercial |
$9,679.75
|
| Rate for Payer: NAPHCARE Commercial |
$7,259.81
|
| Rate for Payer: Preferred Network Access Commercial |
$11,131.71
|
| Rate for Payer: Quartz Beloit One Network |
$5,928.85
|
| Rate for Payer: Quartz Commercial |
$7,259.81
|
| Rate for Payer: WEA Trust Commercial |
$6,654.83
|
| Rate for Payer: WPS Commercial |
$8,962.24
|
|
|
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 |
$5,872.16 |
| Max. Negotiated Rate |
$11,025.28 |
| Rate for Payer: Aetna Commercial |
$10,785.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,306.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,351.52
|
| Rate for Payer: Cash Price |
$3,595.20
|
| Rate for Payer: Cigna Commercial |
$11,025.28
|
| Rate for Payer: Health EOS Commercial |
$10,665.76
|
| Rate for Payer: HFN Commercial |
$11,025.28
|
| Rate for Payer: Multiplan Commercial |
$9,587.20
|
| Rate for Payer: NAPHCARE Commercial |
$7,190.40
|
| Rate for Payer: Preferred Network Access Commercial |
$11,025.28
|
| Rate for Payer: Quartz Beloit One Network |
$5,872.16
|
| Rate for Payer: Quartz Commercial |
$7,190.40
|
| Rate for Payer: WEA Trust Commercial |
$6,591.20
|
| Rate for Payer: WPS Commercial |
$8,876.55
|
|
|
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 |
$3,355.52 |
| Max. Negotiated Rate |
$47,936.00 |
| Rate for Payer: Aetna Commercial |
$10,785.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,306.24
|
| Rate for Payer: Aetna Managed Medicare |
$3,355.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,789.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,992.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,752.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,351.52
|
| Rate for Payer: Cash Price |
$3,595.20
|
| Rate for Payer: Cigna Commercial |
$11,025.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,706.25
|
| Rate for Payer: Health EOS Commercial |
$10,665.76
|
| Rate for Payer: HFN Commercial |
$11,025.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,988.00
|
| Rate for Payer: Multiplan Commercial |
$9,587.20
|
| Rate for Payer: NAPHCARE Commercial |
$7,190.40
|
| Rate for Payer: Preferred Network Access Commercial |
$11,025.28
|
| Rate for Payer: Quartz Beloit One Network |
$5,872.16
|
| Rate for Payer: Quartz Commercial |
$7,789.60
|
| Rate for Payer: Quartz Medicare Advantage |
$7,190.40
|
| Rate for Payer: The Alliance Commercial |
$47,936.00
|
| Rate for Payer: WEA Trust Commercial |
$6,591.20
|
| Rate for Payer: WPS Commercial |
$8,876.55
|
|
|
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 |
$6,072.92 |
| 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 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 |
$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
|
|
|
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 |
$10,234.14 |
| 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 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 |
$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 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 |
$6,072.92 |
| 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 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 |
$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
|
|
|
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 |
$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
|
|
|
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 |
$6,072.92 |
| 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 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 |
$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 PSN PS CMT CCR NRW LT SZ 11 42-5000-070-01
|
Facility
|
IP
|
$20,886.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3781353
|
|
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 PSN PS CMT CCR NRW LT SZ 4 42-5000-056-01
|
Facility
|
IP
|
$20,886.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4493888
|
|
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 PSN PS CMT CCR NRW LT SZ 4 42-5000-056-01
|
Facility
|
OP
|
$20,886.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4493888
|
|
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 PSN PS CMT CCR NRW LT SZ 5 42-5000-058-01
|
Facility
|
OP
|
$21,689.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3950680
|
|
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 PSN PS CMT CCR NRW LT SZ 5 42-5000-058-01
|
Facility
|
IP
|
$21,689.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3950680
|
|
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
|
|
|
FEMUR PSN PS CMT CCR NRW LT SZ 6 42-5000-060-01
|
Facility
|
OP
|
$21,689.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3177473
|
|
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 PSN PS CMT CCR NRW LT SZ 6 42-5000-060-01
|
Facility
|
IP
|
$21,689.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3177473
|
|
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
|
|
|
FEMUR PSN PS CMT CCR NRW LT SZ 7 42-5000-062-01
|
Facility
|
IP
|
$21,689.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3950683
|
|
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
|
|
|
FEMUR PSN PS CMT CCR NRW LT SZ 7 42-5000-062-01
|
Facility
|
OP
|
$21,689.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3950683
|
|
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 PSN PS CMT CCR NRW LT SZ 8 42-5000-064-01
|
Facility
|
IP
|
$21,689.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3267496
|
|
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
|
|
|
FEMUR PSN PS CMT CCR NRW LT SZ 8 42-5000-064-01
|
Facility
|
OP
|
$21,689.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3267496
|
|
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 PSN PS CMT CCR NRW LT SZ 9 42-5000-066-01
|
Facility
|
OP
|
$21,689.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3583495
|
|
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
|
|
