4069402 (OTHER) — raw rate rows

OTHER · raw rates

4069402 — Acetabular 8757-054-02 Shell 54mm

Per-row negotiated rates, exactly as filed by each hospital. Aggregated views below summarize across hospitals; the bottom table shows the underlying rows.

View state-by-state → View hospital-by-hospital →

Typical negotiated price $6,738

Usually $6,683–$6,945 (25th–75th percentile) across 1 hospital · 5 payers.

“Negotiated” is the hospital’s negotiated facility rate for this OTHER 4069402 — the consumer-grade median across the country. It covers the facility charge only; the surgeon’s and anesthesiologist’s fees are billed separately.

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This estimate runs on the hospital’s facility charge only. The surgeon’s and anesthesiologist’s fees are billed separately and aren’t in this number — your EOB shows your complete total.

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Out-of-pocket max (assumed — typical plan) Coinsurance % (after deductible)

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Per-month price trends are temporarily unavailable while we rebuild them on quality-filtered rates. The medians, percentiles, and per-hospital rates on this page are the quality-filtered figures.

Hospital rates (per row)

Showing consumer-grade rates only. Flagged / outlier filings (excluded from the medians above) are hidden — tick “Show flagged / outlier rates” to include them.

Hospital	Payer	Plan	Negotiated rate	Gross	Cash	Observed	Source
POINTE COUPEE GENERAL HOSPITAL	Anthem Medicare Advantage	—	$3,489.59	$7,528.78	—	2026-07-31	MRF ↗
POINTE COUPEE GENERAL HOSPITAL	Anthem Medigap	—	$6,677.27	$7,528.78	—	2026-07-31	MRF ↗
POINTE COUPEE GENERAL HOSPITAL	Aetna	—	$6,700.61	$7,528.78	—	2026-07-31	MRF ↗
POINTE COUPEE GENERAL HOSPITAL	Self-Pay Rate	—	$6,775.90	$7,528.78	—	2026-07-31	MRF ↗
POINTE COUPEE GENERAL HOSPITAL	Cigna	—	$7,001.77	$7,528.78	—	2026-07-31	MRF ↗
POINTE COUPEE GENERAL HOSPITAL	Humana (Choicecare)	—	$7,152.34	$7,528.78	—	2026-07-31	MRF ↗