|
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 |
$3,244.08 |
| Max. Negotiated Rate |
$46,344.00 |
| Rate for Payer: Aetna Commercial |
$10,427.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,963.96
|
| Rate for Payer: Aetna Managed Medicare |
$3,244.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,530.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,793.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,561.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,140.58
|
| Rate for Payer: Cash Price |
$3,475.80
|
| Rate for Payer: Cigna Commercial |
$10,659.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,483.53
|
| Rate for Payer: Health EOS Commercial |
$10,311.54
|
| Rate for Payer: HFN Commercial |
$10,659.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,689.50
|
| Rate for Payer: Multiplan Commercial |
$9,268.80
|
| Rate for Payer: NAPHCARE Commercial |
$6,951.60
|
| Rate for Payer: Preferred Network Access Commercial |
$10,659.12
|
| Rate for Payer: Quartz Beloit One Network |
$5,677.14
|
| Rate for Payer: Quartz Commercial |
$7,530.90
|
| Rate for Payer: Quartz Medicare Advantage |
$6,951.60
|
| Rate for Payer: The Alliance Commercial |
$46,344.00
|
| Rate for Payer: WEA Trust Commercial |
$6,372.30
|
| Rate for Payer: WPS Commercial |
$8,581.75
|
|
|
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 |
$5,677.14 |
| Max. Negotiated Rate |
$10,659.12 |
| Rate for Payer: Aetna Commercial |
$10,427.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,963.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,140.58
|
| Rate for Payer: Cash Price |
$3,475.80
|
| Rate for Payer: Cigna Commercial |
$10,659.12
|
| Rate for Payer: Health EOS Commercial |
$10,311.54
|
| Rate for Payer: HFN Commercial |
$10,659.12
|
| Rate for Payer: Multiplan Commercial |
$9,268.80
|
| Rate for Payer: NAPHCARE Commercial |
$6,951.60
|
| Rate for Payer: Preferred Network Access Commercial |
$10,659.12
|
| Rate for Payer: Quartz Beloit One Network |
$5,677.14
|
| Rate for Payer: Quartz Commercial |
$6,951.60
|
| Rate for Payer: WEA Trust Commercial |
$6,372.30
|
| Rate for Payer: WPS Commercial |
$8,581.75
|
|
|
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 |
$5,673.92 |
| Max. Negotiated Rate |
$81,056.00 |
| Rate for Payer: Aetna Commercial |
$18,237.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,427.04
|
| Rate for Payer: Aetna Managed Medicare |
$5,673.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,171.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,132.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,726.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,739.92
|
| Rate for Payer: Cash Price |
$6,079.20
|
| Rate for Payer: Cigna Commercial |
$18,642.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,339.73
|
| Rate for Payer: Health EOS Commercial |
$18,034.96
|
| Rate for Payer: HFN Commercial |
$18,642.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,198.00
|
| Rate for Payer: Multiplan Commercial |
$16,211.20
|
| Rate for Payer: NAPHCARE Commercial |
$12,158.40
|
| Rate for Payer: Preferred Network Access Commercial |
$18,642.88
|
| Rate for Payer: Quartz Beloit One Network |
$9,929.36
|
| Rate for Payer: Quartz Commercial |
$13,171.60
|
| Rate for Payer: Quartz Medicare Advantage |
$12,158.40
|
| Rate for Payer: The Alliance Commercial |
$81,056.00
|
| Rate for Payer: WEA Trust Commercial |
$11,145.20
|
| Rate for Payer: WPS Commercial |
$15,009.54
|
|
|
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 |
$9,929.36 |
| Max. Negotiated Rate |
$18,642.88 |
| Rate for Payer: Aetna Commercial |
$18,237.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,427.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,739.92
|
| Rate for Payer: Cash Price |
$6,079.20
|
| Rate for Payer: Cigna Commercial |
$18,642.88
|
| Rate for Payer: Health EOS Commercial |
$18,034.96
|
| Rate for Payer: HFN Commercial |
$18,642.88
|
| Rate for Payer: Multiplan Commercial |
$16,211.20
|
| Rate for Payer: NAPHCARE Commercial |
$12,158.40
|
| Rate for Payer: Preferred Network Access Commercial |
$18,642.88
|
| Rate for Payer: Quartz Beloit One Network |
$9,929.36
|
| Rate for Payer: Quartz Commercial |
$12,158.40
|
| Rate for Payer: WEA Trust Commercial |
$11,145.20
|
| Rate for Payer: WPS Commercial |
$15,009.54
|
|
|
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 |
$3,368.96 |
| Max. Negotiated Rate |
$48,128.00 |
| Rate for Payer: Aetna Commercial |
$10,828.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,347.52
|
| Rate for Payer: Aetna Managed Medicare |
$3,368.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,820.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,016.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,775.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,376.96
|
| Rate for Payer: Cash Price |
$3,609.60
|
| Rate for Payer: Cigna Commercial |
$11,069.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,733.11
|
| Rate for Payer: Health EOS Commercial |
$10,708.48
|
| Rate for Payer: HFN Commercial |
$11,069.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,024.00
|
| Rate for Payer: Multiplan Commercial |
$9,625.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,219.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11,069.44
|
| Rate for Payer: Quartz Beloit One Network |
$5,895.68
|
| Rate for Payer: Quartz Commercial |
$7,820.80
|
| Rate for Payer: Quartz Medicare Advantage |
$7,219.20
|
| Rate for Payer: The Alliance Commercial |
$48,128.00
|
| Rate for Payer: WEA Trust Commercial |
$6,617.60
|
| Rate for Payer: WPS Commercial |
$8,912.10
|
|
|
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 |
$5,895.68 |
| Max. Negotiated Rate |
$11,069.44 |
| Rate for Payer: Aetna Commercial |
$10,828.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,347.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,376.96
|
| Rate for Payer: Cash Price |
$3,609.60
|
| Rate for Payer: Cigna Commercial |
$11,069.44
|
| Rate for Payer: Health EOS Commercial |
$10,708.48
|
| Rate for Payer: HFN Commercial |
$11,069.44
|
| Rate for Payer: Multiplan Commercial |
$9,625.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,219.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11,069.44
|
| Rate for Payer: Quartz Beloit One Network |
$5,895.68
|
| Rate for Payer: Quartz Commercial |
$7,219.20
|
| Rate for Payer: WEA Trust Commercial |
$6,617.60
|
| Rate for Payer: WPS Commercial |
$8,912.10
|
|
|
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 |
$9,929.36 |
| Max. Negotiated Rate |
$18,642.88 |
| Rate for Payer: Aetna Commercial |
$18,237.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,427.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,739.92
|
| Rate for Payer: Cash Price |
$6,079.20
|
| Rate for Payer: Cigna Commercial |
$18,642.88
|
| Rate for Payer: Health EOS Commercial |
$18,034.96
|
| Rate for Payer: HFN Commercial |
$18,642.88
|
| Rate for Payer: Multiplan Commercial |
$16,211.20
|
| Rate for Payer: NAPHCARE Commercial |
$12,158.40
|
| Rate for Payer: Preferred Network Access Commercial |
$18,642.88
|
| Rate for Payer: Quartz Beloit One Network |
$9,929.36
|
| Rate for Payer: Quartz Commercial |
$12,158.40
|
| Rate for Payer: WEA Trust Commercial |
$11,145.20
|
| Rate for Payer: WPS Commercial |
$15,009.54
|
|
|
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 |
$5,673.92 |
| Max. Negotiated Rate |
$81,056.00 |
| Rate for Payer: Aetna Commercial |
$18,237.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,427.04
|
| Rate for Payer: Aetna Managed Medicare |
$5,673.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,171.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,132.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,726.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,739.92
|
| Rate for Payer: Cash Price |
$6,079.20
|
| Rate for Payer: Cigna Commercial |
$18,642.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,339.73
|
| Rate for Payer: Health EOS Commercial |
$18,034.96
|
| Rate for Payer: HFN Commercial |
$18,642.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,198.00
|
| Rate for Payer: Multiplan Commercial |
$16,211.20
|
| Rate for Payer: NAPHCARE Commercial |
$12,158.40
|
| Rate for Payer: Preferred Network Access Commercial |
$18,642.88
|
| Rate for Payer: Quartz Beloit One Network |
$9,929.36
|
| Rate for Payer: Quartz Commercial |
$13,171.60
|
| Rate for Payer: Quartz Medicare Advantage |
$12,158.40
|
| Rate for Payer: The Alliance Commercial |
$81,056.00
|
| Rate for Payer: WEA Trust Commercial |
$11,145.20
|
| Rate for Payer: WPS Commercial |
$15,009.54
|
|
|
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 |
$3,244.08 |
| Max. Negotiated Rate |
$46,344.00 |
| Rate for Payer: Aetna Commercial |
$10,427.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,963.96
|
| Rate for Payer: Aetna Managed Medicare |
$3,244.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,530.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,793.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,561.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,140.58
|
| Rate for Payer: Cash Price |
$3,475.80
|
| Rate for Payer: Cigna Commercial |
$10,659.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,483.53
|
| Rate for Payer: Health EOS Commercial |
$10,311.54
|
| Rate for Payer: HFN Commercial |
$10,659.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,689.50
|
| Rate for Payer: Multiplan Commercial |
$9,268.80
|
| Rate for Payer: NAPHCARE Commercial |
$6,951.60
|
| Rate for Payer: Preferred Network Access Commercial |
$10,659.12
|
| Rate for Payer: Quartz Beloit One Network |
$5,677.14
|
| Rate for Payer: Quartz Commercial |
$7,530.90
|
| Rate for Payer: Quartz Medicare Advantage |
$6,951.60
|
| Rate for Payer: The Alliance Commercial |
$46,344.00
|
| Rate for Payer: WEA Trust Commercial |
$6,372.30
|
| Rate for Payer: WPS Commercial |
$8,581.75
|
|
|
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 |
$5,677.14 |
| Max. Negotiated Rate |
$10,659.12 |
| Rate for Payer: Aetna Commercial |
$10,427.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,963.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,140.58
|
| Rate for Payer: Cash Price |
$3,475.80
|
| Rate for Payer: Cigna Commercial |
$10,659.12
|
| Rate for Payer: Health EOS Commercial |
$10,311.54
|
| Rate for Payer: HFN Commercial |
$10,659.12
|
| Rate for Payer: Multiplan Commercial |
$9,268.80
|
| Rate for Payer: NAPHCARE Commercial |
$6,951.60
|
| Rate for Payer: Preferred Network Access Commercial |
$10,659.12
|
| Rate for Payer: Quartz Beloit One Network |
$5,677.14
|
| Rate for Payer: Quartz Commercial |
$6,951.60
|
| Rate for Payer: WEA Trust Commercial |
$6,372.30
|
| Rate for Payer: WPS Commercial |
$8,581.75
|
|
|
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 |
$5,673.92 |
| Max. Negotiated Rate |
$81,056.00 |
| Rate for Payer: Aetna Commercial |
$18,237.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,427.04
|
| Rate for Payer: Aetna Managed Medicare |
$5,673.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,171.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,132.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,726.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,739.92
|
| Rate for Payer: Cash Price |
$6,079.20
|
| Rate for Payer: Cigna Commercial |
$18,642.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,339.73
|
| Rate for Payer: Health EOS Commercial |
$18,034.96
|
| Rate for Payer: HFN Commercial |
$18,642.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,198.00
|
| Rate for Payer: Multiplan Commercial |
$16,211.20
|
| Rate for Payer: NAPHCARE Commercial |
$12,158.40
|
| Rate for Payer: Preferred Network Access Commercial |
$18,642.88
|
| Rate for Payer: Quartz Beloit One Network |
$9,929.36
|
| Rate for Payer: Quartz Commercial |
$13,171.60
|
| Rate for Payer: Quartz Medicare Advantage |
$12,158.40
|
| Rate for Payer: The Alliance Commercial |
$81,056.00
|
| Rate for Payer: WEA Trust Commercial |
$11,145.20
|
| Rate for Payer: WPS Commercial |
$15,009.54
|
|
|
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 |
$9,929.36 |
| Max. Negotiated Rate |
$18,642.88 |
| Rate for Payer: Aetna Commercial |
$18,237.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,427.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,739.92
|
| Rate for Payer: Cash Price |
$6,079.20
|
| Rate for Payer: Cigna Commercial |
$18,642.88
|
| Rate for Payer: Health EOS Commercial |
$18,034.96
|
| Rate for Payer: HFN Commercial |
$18,642.88
|
| Rate for Payer: Multiplan Commercial |
$16,211.20
|
| Rate for Payer: NAPHCARE Commercial |
$12,158.40
|
| Rate for Payer: Preferred Network Access Commercial |
$18,642.88
|
| Rate for Payer: Quartz Beloit One Network |
$9,929.36
|
| Rate for Payer: Quartz Commercial |
$12,158.40
|
| Rate for Payer: WEA Trust Commercial |
$11,145.20
|
| Rate for Payer: WPS Commercial |
$15,009.54
|
|
|
FEMUR TRIATHLON CR SZ 6 RT 5510-F-602
|
Facility
|
IP
|
$11,586.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3072434
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,677.14 |
| Max. Negotiated Rate |
$10,659.12 |
| Rate for Payer: Aetna Commercial |
$10,427.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,963.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,140.58
|
| Rate for Payer: Cash Price |
$3,475.80
|
| Rate for Payer: Cigna Commercial |
$10,659.12
|
| Rate for Payer: Health EOS Commercial |
$10,311.54
|
| Rate for Payer: HFN Commercial |
$10,659.12
|
| Rate for Payer: Multiplan Commercial |
$9,268.80
|
| Rate for Payer: NAPHCARE Commercial |
$6,951.60
|
| Rate for Payer: Preferred Network Access Commercial |
$10,659.12
|
| Rate for Payer: Quartz Beloit One Network |
$5,677.14
|
| Rate for Payer: Quartz Commercial |
$6,951.60
|
| Rate for Payer: WEA Trust Commercial |
$6,372.30
|
| Rate for Payer: WPS Commercial |
$8,581.75
|
|
|
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 |
$3,244.08 |
| Max. Negotiated Rate |
$46,344.00 |
| Rate for Payer: Aetna Commercial |
$10,427.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,963.96
|
| Rate for Payer: Aetna Managed Medicare |
$3,244.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,530.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,793.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,561.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,140.58
|
| Rate for Payer: Cash Price |
$3,475.80
|
| Rate for Payer: Cigna Commercial |
$10,659.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,483.53
|
| Rate for Payer: Health EOS Commercial |
$10,311.54
|
| Rate for Payer: HFN Commercial |
$10,659.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,689.50
|
| Rate for Payer: Multiplan Commercial |
$9,268.80
|
| Rate for Payer: NAPHCARE Commercial |
$6,951.60
|
| Rate for Payer: Preferred Network Access Commercial |
$10,659.12
|
| Rate for Payer: Quartz Beloit One Network |
$5,677.14
|
| Rate for Payer: Quartz Commercial |
$7,530.90
|
| Rate for Payer: Quartz Medicare Advantage |
$6,951.60
|
| Rate for Payer: The Alliance Commercial |
$46,344.00
|
| Rate for Payer: WEA Trust Commercial |
$6,372.30
|
| Rate for Payer: WPS Commercial |
$8,581.75
|
|
|
FEMUR TRIATHLON CR SZ 6 RT 5517-F-602
|
Facility
|
OP
|
$19,515.00
|
|
| Hospital Charge Code |
4147199
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,464.20 |
| Max. Negotiated Rate |
$78,060.00 |
| Rate for Payer: Aetna Commercial |
$17,563.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,782.90
|
| Rate for Payer: Aetna Managed Medicare |
$5,464.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,684.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,757.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,367.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,342.95
|
| Rate for Payer: Cash Price |
$5,854.50
|
| Rate for Payer: Cigna Commercial |
$17,953.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,920.59
|
| Rate for Payer: Health EOS Commercial |
$17,368.35
|
| Rate for Payer: HFN Commercial |
$17,953.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,636.25
|
| Rate for Payer: Multiplan Commercial |
$15,612.00
|
| Rate for Payer: NAPHCARE Commercial |
$11,709.00
|
| Rate for Payer: Preferred Network Access Commercial |
$17,953.80
|
| Rate for Payer: Quartz Beloit One Network |
$9,562.35
|
| Rate for Payer: Quartz Commercial |
$12,684.75
|
| Rate for Payer: Quartz Medicare Advantage |
$11,709.00
|
| Rate for Payer: The Alliance Commercial |
$78,060.00
|
| Rate for Payer: WEA Trust Commercial |
$10,733.25
|
| Rate for Payer: WPS Commercial |
$14,454.76
|
|
|
FEMUR TRIATHLON CR SZ 6 RT 5517-F-602
|
Facility
|
IP
|
$19,515.00
|
|
| Hospital Charge Code |
4147199
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,562.35 |
| Max. Negotiated Rate |
$17,953.80 |
| Rate for Payer: Aetna Commercial |
$17,563.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,782.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,342.95
|
| Rate for Payer: Cash Price |
$5,854.50
|
| Rate for Payer: Cigna Commercial |
$17,953.80
|
| Rate for Payer: Health EOS Commercial |
$17,368.35
|
| Rate for Payer: HFN Commercial |
$17,953.80
|
| Rate for Payer: Multiplan Commercial |
$15,612.00
|
| Rate for Payer: NAPHCARE Commercial |
$11,709.00
|
| Rate for Payer: Preferred Network Access Commercial |
$17,953.80
|
| Rate for Payer: Quartz Beloit One Network |
$9,562.35
|
| Rate for Payer: Quartz Commercial |
$11,709.00
|
| Rate for Payer: WEA Trust Commercial |
$10,733.25
|
| Rate for Payer: WPS Commercial |
$14,454.76
|
|
|
FEMUR TRIATHLON CR SZ 7 LT 5510-F-701
|
Facility
|
IP
|
$11,586.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3468881
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,677.14 |
| Max. Negotiated Rate |
$10,659.12 |
| Rate for Payer: Aetna Commercial |
$10,427.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,963.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,140.58
|
| Rate for Payer: Cash Price |
$3,475.80
|
| Rate for Payer: Cigna Commercial |
$10,659.12
|
| Rate for Payer: Health EOS Commercial |
$10,311.54
|
| Rate for Payer: HFN Commercial |
$10,659.12
|
| Rate for Payer: Multiplan Commercial |
$9,268.80
|
| Rate for Payer: NAPHCARE Commercial |
$6,951.60
|
| Rate for Payer: Preferred Network Access Commercial |
$10,659.12
|
| Rate for Payer: Quartz Beloit One Network |
$5,677.14
|
| Rate for Payer: Quartz Commercial |
$6,951.60
|
| Rate for Payer: WEA Trust Commercial |
$6,372.30
|
| Rate for Payer: WPS Commercial |
$8,581.75
|
|
|
FEMUR TRIATHLON CR SZ 7 LT 5510-F-701
|
Facility
|
OP
|
$11,586.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3468881
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,244.08 |
| Max. Negotiated Rate |
$46,344.00 |
| Rate for Payer: Aetna Commercial |
$10,427.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,963.96
|
| Rate for Payer: Aetna Managed Medicare |
$3,244.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,530.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,793.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,561.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,140.58
|
| Rate for Payer: Cash Price |
$3,475.80
|
| Rate for Payer: Cigna Commercial |
$10,659.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,483.53
|
| Rate for Payer: Health EOS Commercial |
$10,311.54
|
| Rate for Payer: HFN Commercial |
$10,659.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,689.50
|
| Rate for Payer: Multiplan Commercial |
$9,268.80
|
| Rate for Payer: NAPHCARE Commercial |
$6,951.60
|
| Rate for Payer: Preferred Network Access Commercial |
$10,659.12
|
| Rate for Payer: Quartz Beloit One Network |
$5,677.14
|
| Rate for Payer: Quartz Commercial |
$7,530.90
|
| Rate for Payer: Quartz Medicare Advantage |
$6,951.60
|
| Rate for Payer: The Alliance Commercial |
$46,344.00
|
| Rate for Payer: WEA Trust Commercial |
$6,372.30
|
| Rate for Payer: WPS Commercial |
$8,581.75
|
|
|
FEMUR TRIATHLON CR SZ 7 LT 5517-F-701
|
Facility
|
IP
|
$20,264.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4493833
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,929.36 |
| Max. Negotiated Rate |
$18,642.88 |
| Rate for Payer: Aetna Commercial |
$18,237.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,427.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,739.92
|
| Rate for Payer: Cash Price |
$6,079.20
|
| Rate for Payer: Cigna Commercial |
$18,642.88
|
| Rate for Payer: Health EOS Commercial |
$18,034.96
|
| Rate for Payer: HFN Commercial |
$18,642.88
|
| Rate for Payer: Multiplan Commercial |
$16,211.20
|
| Rate for Payer: NAPHCARE Commercial |
$12,158.40
|
| Rate for Payer: Preferred Network Access Commercial |
$18,642.88
|
| Rate for Payer: Quartz Beloit One Network |
$9,929.36
|
| Rate for Payer: Quartz Commercial |
$12,158.40
|
| Rate for Payer: WEA Trust Commercial |
$11,145.20
|
| Rate for Payer: WPS Commercial |
$15,009.54
|
|
|
FEMUR TRIATHLON CR SZ 7 LT 5517-F-701
|
Facility
|
OP
|
$20,264.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4493833
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,673.92 |
| Max. Negotiated Rate |
$81,056.00 |
| Rate for Payer: Aetna Commercial |
$18,237.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,427.04
|
| Rate for Payer: Aetna Managed Medicare |
$5,673.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,171.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,132.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,726.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,739.92
|
| Rate for Payer: Cash Price |
$6,079.20
|
| Rate for Payer: Cigna Commercial |
$18,642.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,339.73
|
| Rate for Payer: Health EOS Commercial |
$18,034.96
|
| Rate for Payer: HFN Commercial |
$18,642.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,198.00
|
| Rate for Payer: Multiplan Commercial |
$16,211.20
|
| Rate for Payer: NAPHCARE Commercial |
$12,158.40
|
| Rate for Payer: Preferred Network Access Commercial |
$18,642.88
|
| Rate for Payer: Quartz Beloit One Network |
$9,929.36
|
| Rate for Payer: Quartz Commercial |
$13,171.60
|
| Rate for Payer: Quartz Medicare Advantage |
$12,158.40
|
| Rate for Payer: The Alliance Commercial |
$81,056.00
|
| Rate for Payer: WEA Trust Commercial |
$11,145.20
|
| Rate for Payer: WPS Commercial |
$15,009.54
|
|
|
FEMUR TRIATHLON CR SZ 7 RT 5510-F-702
|
Facility
|
OP
|
$11,586.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3219471
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,244.08 |
| Max. Negotiated Rate |
$46,344.00 |
| Rate for Payer: Aetna Commercial |
$10,427.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,963.96
|
| Rate for Payer: Aetna Managed Medicare |
$3,244.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,530.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,793.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,561.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,140.58
|
| Rate for Payer: Cash Price |
$3,475.80
|
| Rate for Payer: Cigna Commercial |
$10,659.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,483.53
|
| Rate for Payer: Health EOS Commercial |
$10,311.54
|
| Rate for Payer: HFN Commercial |
$10,659.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,689.50
|
| Rate for Payer: Multiplan Commercial |
$9,268.80
|
| Rate for Payer: NAPHCARE Commercial |
$6,951.60
|
| Rate for Payer: Preferred Network Access Commercial |
$10,659.12
|
| Rate for Payer: Quartz Beloit One Network |
$5,677.14
|
| Rate for Payer: Quartz Commercial |
$7,530.90
|
| Rate for Payer: Quartz Medicare Advantage |
$6,951.60
|
| Rate for Payer: The Alliance Commercial |
$46,344.00
|
| Rate for Payer: WEA Trust Commercial |
$6,372.30
|
| Rate for Payer: WPS Commercial |
$8,581.75
|
|
|
FEMUR TRIATHLON CR SZ 7 RT 5510-F-702
|
Facility
|
IP
|
$11,586.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3219471
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,677.14 |
| Max. Negotiated Rate |
$10,659.12 |
| Rate for Payer: Aetna Commercial |
$10,427.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,963.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,140.58
|
| Rate for Payer: Cash Price |
$3,475.80
|
| Rate for Payer: Cigna Commercial |
$10,659.12
|
| Rate for Payer: Health EOS Commercial |
$10,311.54
|
| Rate for Payer: HFN Commercial |
$10,659.12
|
| Rate for Payer: Multiplan Commercial |
$9,268.80
|
| Rate for Payer: NAPHCARE Commercial |
$6,951.60
|
| Rate for Payer: Preferred Network Access Commercial |
$10,659.12
|
| Rate for Payer: Quartz Beloit One Network |
$5,677.14
|
| Rate for Payer: Quartz Commercial |
$6,951.60
|
| Rate for Payer: WEA Trust Commercial |
$6,372.30
|
| Rate for Payer: WPS Commercial |
$8,581.75
|
|
|
FEMUR TRIATHLON CR SZ 7 RT 5517-F-702
|
Facility
|
IP
|
$20,264.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4493667
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,929.36 |
| Max. Negotiated Rate |
$18,642.88 |
| Rate for Payer: Aetna Commercial |
$18,237.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,427.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,739.92
|
| Rate for Payer: Cash Price |
$6,079.20
|
| Rate for Payer: Cigna Commercial |
$18,642.88
|
| Rate for Payer: Health EOS Commercial |
$18,034.96
|
| Rate for Payer: HFN Commercial |
$18,642.88
|
| Rate for Payer: Multiplan Commercial |
$16,211.20
|
| Rate for Payer: NAPHCARE Commercial |
$12,158.40
|
| Rate for Payer: Preferred Network Access Commercial |
$18,642.88
|
| Rate for Payer: Quartz Beloit One Network |
$9,929.36
|
| Rate for Payer: Quartz Commercial |
$12,158.40
|
| Rate for Payer: WEA Trust Commercial |
$11,145.20
|
| Rate for Payer: WPS Commercial |
$15,009.54
|
|
|
FEMUR TRIATHLON CR SZ 7 RT 5517-F-702
|
Facility
|
OP
|
$20,264.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4493667
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,673.92 |
| Max. Negotiated Rate |
$81,056.00 |
| Rate for Payer: Aetna Commercial |
$18,237.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,427.04
|
| Rate for Payer: Aetna Managed Medicare |
$5,673.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,171.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,132.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,726.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,739.92
|
| Rate for Payer: Cash Price |
$6,079.20
|
| Rate for Payer: Cigna Commercial |
$18,642.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,339.73
|
| Rate for Payer: Health EOS Commercial |
$18,034.96
|
| Rate for Payer: HFN Commercial |
$18,642.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,198.00
|
| Rate for Payer: Multiplan Commercial |
$16,211.20
|
| Rate for Payer: NAPHCARE Commercial |
$12,158.40
|
| Rate for Payer: Preferred Network Access Commercial |
$18,642.88
|
| Rate for Payer: Quartz Beloit One Network |
$9,929.36
|
| Rate for Payer: Quartz Commercial |
$13,171.60
|
| Rate for Payer: Quartz Medicare Advantage |
$12,158.40
|
| Rate for Payer: The Alliance Commercial |
$81,056.00
|
| Rate for Payer: WEA Trust Commercial |
$11,145.20
|
| Rate for Payer: WPS Commercial |
$15,009.54
|
|
|
FEMUR TRIATHLON CR SZ 8 LT 5510-F-801
|
Facility
|
IP
|
$11,586.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4493860
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,677.14 |
| Max. Negotiated Rate |
$10,659.12 |
| Rate for Payer: Aetna Commercial |
$10,427.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,963.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,140.58
|
| Rate for Payer: Cash Price |
$3,475.80
|
| Rate for Payer: Cigna Commercial |
$10,659.12
|
| Rate for Payer: Health EOS Commercial |
$10,311.54
|
| Rate for Payer: HFN Commercial |
$10,659.12
|
| Rate for Payer: Multiplan Commercial |
$9,268.80
|
| Rate for Payer: NAPHCARE Commercial |
$6,951.60
|
| Rate for Payer: Preferred Network Access Commercial |
$10,659.12
|
| Rate for Payer: Quartz Beloit One Network |
$5,677.14
|
| Rate for Payer: Quartz Commercial |
$6,951.60
|
| Rate for Payer: WEA Trust Commercial |
$6,372.30
|
| Rate for Payer: WPS Commercial |
$8,581.75
|
|
