|
PATELLA ATTUNE MEDIALIZED ANATOMIC 38MM CEMENTED 1518-10-038
|
Facility
|
IP
|
$6,319.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5459821
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,096.31 |
| Max. Negotiated Rate |
$5,813.48 |
| Rate for Payer: Aetna Commercial |
$5,687.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,434.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,349.07
|
| Rate for Payer: Cash Price |
$1,895.70
|
| Rate for Payer: Cigna Commercial |
$5,813.48
|
| Rate for Payer: Health EOS Commercial |
$5,623.91
|
| Rate for Payer: HFN Commercial |
$5,813.48
|
| Rate for Payer: Multiplan Commercial |
$5,055.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,791.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,813.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,096.31
|
| Rate for Payer: Quartz Commercial |
$3,791.40
|
| Rate for Payer: WEA Trust Commercial |
$3,475.45
|
| Rate for Payer: WPS Commercial |
$4,680.48
|
|
|
PATELLA ATTUNE MEDIALIZED ANATOMIC 38MM CEMENTED 1518-10-038
|
Facility
|
OP
|
$6,319.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5459821
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,769.32 |
| Max. Negotiated Rate |
$25,276.00 |
| Rate for Payer: Aetna Commercial |
$5,687.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,434.34
|
| Rate for Payer: Aetna Managed Medicare |
$1,769.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,107.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,159.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,033.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,349.07
|
| Rate for Payer: Cash Price |
$1,895.70
|
| Rate for Payer: Cigna Commercial |
$5,813.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,536.11
|
| Rate for Payer: Health EOS Commercial |
$5,623.91
|
| Rate for Payer: HFN Commercial |
$5,813.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,739.25
|
| Rate for Payer: Multiplan Commercial |
$5,055.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,791.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,813.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,096.31
|
| Rate for Payer: Quartz Commercial |
$4,107.35
|
| Rate for Payer: Quartz Medicare Advantage |
$3,791.40
|
| Rate for Payer: The Alliance Commercial |
$25,276.00
|
| Rate for Payer: WEA Trust Commercial |
$3,475.45
|
| Rate for Payer: WPS Commercial |
$4,680.48
|
|
|
PATELLA ATTUNE MEDIALIZED ANATOMIC 41MM CEMENTED 1518-10-041
|
Facility
|
IP
|
$6,319.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5496834
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,096.31 |
| Max. Negotiated Rate |
$5,813.48 |
| Rate for Payer: Aetna Commercial |
$5,687.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,434.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,349.07
|
| Rate for Payer: Cash Price |
$1,895.70
|
| Rate for Payer: Cigna Commercial |
$5,813.48
|
| Rate for Payer: Health EOS Commercial |
$5,623.91
|
| Rate for Payer: HFN Commercial |
$5,813.48
|
| Rate for Payer: Multiplan Commercial |
$5,055.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,791.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,813.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,096.31
|
| Rate for Payer: Quartz Commercial |
$3,791.40
|
| Rate for Payer: WEA Trust Commercial |
$3,475.45
|
| Rate for Payer: WPS Commercial |
$4,680.48
|
|
|
PATELLA ATTUNE MEDIALIZED ANATOMIC 41MM CEMENTED 1518-10-041
|
Facility
|
OP
|
$6,319.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5496834
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,769.32 |
| Max. Negotiated Rate |
$25,276.00 |
| Rate for Payer: Aetna Commercial |
$5,687.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,434.34
|
| Rate for Payer: Aetna Managed Medicare |
$1,769.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,107.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,159.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,033.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,349.07
|
| Rate for Payer: Cash Price |
$1,895.70
|
| Rate for Payer: Cigna Commercial |
$5,813.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,536.11
|
| Rate for Payer: Health EOS Commercial |
$5,623.91
|
| Rate for Payer: HFN Commercial |
$5,813.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,739.25
|
| Rate for Payer: Multiplan Commercial |
$5,055.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,791.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,813.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,096.31
|
| Rate for Payer: Quartz Commercial |
$4,107.35
|
| Rate for Payer: Quartz Medicare Advantage |
$3,791.40
|
| Rate for Payer: The Alliance Commercial |
$25,276.00
|
| Rate for Payer: WEA Trust Commercial |
$3,475.45
|
| Rate for Payer: WPS Commercial |
$4,680.48
|
|
|
PATELLA BLADE 32MM 00-5979-095-32
|
Facility
|
OP
|
$2,912.00
|
|
| Hospital Charge Code |
2967770
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$815.36 |
| Max. Negotiated Rate |
$11,648.00 |
| Rate for Payer: Aetna Commercial |
$2,620.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,504.32
|
| Rate for Payer: Aetna Managed Medicare |
$815.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,892.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,456.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,397.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,543.36
|
| Rate for Payer: Cash Price |
$873.60
|
| Rate for Payer: Cigna Commercial |
$2,679.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,629.56
|
| Rate for Payer: Health EOS Commercial |
$2,591.68
|
| Rate for Payer: HFN Commercial |
$2,679.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,184.00
|
| Rate for Payer: Multiplan Commercial |
$2,329.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,747.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,679.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,426.88
|
| Rate for Payer: Quartz Commercial |
$1,892.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,747.20
|
| Rate for Payer: The Alliance Commercial |
$11,648.00
|
| Rate for Payer: WEA Trust Commercial |
$1,601.60
|
| Rate for Payer: WPS Commercial |
$2,156.92
|
|
|
PATELLA BLADE 32MM 00-5979-095-32
|
Facility
|
IP
|
$2,912.00
|
|
| Hospital Charge Code |
2967770
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,426.88 |
| Max. Negotiated Rate |
$2,679.04 |
| Rate for Payer: Aetna Commercial |
$2,620.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,504.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,543.36
|
| Rate for Payer: Cash Price |
$873.60
|
| Rate for Payer: Cigna Commercial |
$2,679.04
|
| Rate for Payer: Health EOS Commercial |
$2,591.68
|
| Rate for Payer: HFN Commercial |
$2,679.04
|
| Rate for Payer: Multiplan Commercial |
$2,329.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,747.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,679.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,426.88
|
| Rate for Payer: Quartz Commercial |
$1,747.20
|
| Rate for Payer: WEA Trust Commercial |
$1,601.60
|
| Rate for Payer: WPS Commercial |
$2,156.92
|
|
|
PATELLA BLADE 35MM 00-5979-095-35
|
Facility
|
OP
|
$2,912.00
|
|
| Hospital Charge Code |
2967771
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$815.36 |
| Max. Negotiated Rate |
$11,648.00 |
| Rate for Payer: Aetna Commercial |
$2,620.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,504.32
|
| Rate for Payer: Aetna Managed Medicare |
$815.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,892.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,456.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,397.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,543.36
|
| Rate for Payer: Cash Price |
$873.60
|
| Rate for Payer: Cigna Commercial |
$2,679.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,629.56
|
| Rate for Payer: Health EOS Commercial |
$2,591.68
|
| Rate for Payer: HFN Commercial |
$2,679.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,184.00
|
| Rate for Payer: Multiplan Commercial |
$2,329.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,747.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,679.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,426.88
|
| Rate for Payer: Quartz Commercial |
$1,892.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,747.20
|
| Rate for Payer: The Alliance Commercial |
$11,648.00
|
| Rate for Payer: WEA Trust Commercial |
$1,601.60
|
| Rate for Payer: WPS Commercial |
$2,156.92
|
|
|
PATELLA BLADE 35MM 00-5979-095-35
|
Facility
|
IP
|
$2,912.00
|
|
| Hospital Charge Code |
2967771
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,426.88 |
| Max. Negotiated Rate |
$2,679.04 |
| Rate for Payer: Aetna Commercial |
$2,620.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,504.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,543.36
|
| Rate for Payer: Cash Price |
$873.60
|
| Rate for Payer: Cigna Commercial |
$2,679.04
|
| Rate for Payer: Health EOS Commercial |
$2,591.68
|
| Rate for Payer: HFN Commercial |
$2,679.04
|
| Rate for Payer: Multiplan Commercial |
$2,329.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,747.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,679.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,426.88
|
| Rate for Payer: Quartz Commercial |
$1,747.20
|
| Rate for Payer: WEA Trust Commercial |
$1,601.60
|
| Rate for Payer: WPS Commercial |
$2,156.92
|
|
|
PATELLA BLADE 38MM 00-5979-095-38
|
Facility
|
OP
|
$3,022.00
|
|
| Hospital Charge Code |
2967772
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$846.16 |
| Max. Negotiated Rate |
$12,088.00 |
| Rate for Payer: Aetna Commercial |
$2,719.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,598.92
|
| Rate for Payer: Aetna Managed Medicare |
$846.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,964.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,511.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,450.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,601.66
|
| Rate for Payer: Cash Price |
$906.60
|
| Rate for Payer: Cigna Commercial |
$2,780.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,691.11
|
| Rate for Payer: Health EOS Commercial |
$2,689.58
|
| Rate for Payer: HFN Commercial |
$2,780.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,266.50
|
| Rate for Payer: Multiplan Commercial |
$2,417.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,813.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,780.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,480.78
|
| Rate for Payer: Quartz Commercial |
$1,964.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,813.20
|
| Rate for Payer: The Alliance Commercial |
$12,088.00
|
| Rate for Payer: WEA Trust Commercial |
$1,662.10
|
| Rate for Payer: WPS Commercial |
$2,238.40
|
|
|
PATELLA BLADE 38MM 00-5979-095-38
|
Facility
|
IP
|
$3,022.00
|
|
| Hospital Charge Code |
2967772
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,480.78 |
| Max. Negotiated Rate |
$2,780.24 |
| Rate for Payer: Aetna Commercial |
$2,719.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,598.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,601.66
|
| Rate for Payer: Cash Price |
$906.60
|
| Rate for Payer: Cigna Commercial |
$2,780.24
|
| Rate for Payer: Health EOS Commercial |
$2,689.58
|
| Rate for Payer: HFN Commercial |
$2,780.24
|
| Rate for Payer: Multiplan Commercial |
$2,417.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,813.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,780.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,480.78
|
| Rate for Payer: Quartz Commercial |
$1,813.20
|
| Rate for Payer: WEA Trust Commercial |
$1,662.10
|
| Rate for Payer: WPS Commercial |
$2,238.40
|
|
|
PATELLA BLADE 41MM 00-5979-095-41
|
Facility
|
OP
|
$3,022.00
|
|
| Hospital Charge Code |
2967773
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$846.16 |
| Max. Negotiated Rate |
$12,088.00 |
| Rate for Payer: Aetna Commercial |
$2,719.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,598.92
|
| Rate for Payer: Aetna Managed Medicare |
$846.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,964.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,511.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,450.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,601.66
|
| Rate for Payer: Cash Price |
$906.60
|
| Rate for Payer: Cigna Commercial |
$2,780.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,691.11
|
| Rate for Payer: Health EOS Commercial |
$2,689.58
|
| Rate for Payer: HFN Commercial |
$2,780.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,266.50
|
| Rate for Payer: Multiplan Commercial |
$2,417.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,813.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,780.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,480.78
|
| Rate for Payer: Quartz Commercial |
$1,964.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,813.20
|
| Rate for Payer: The Alliance Commercial |
$12,088.00
|
| Rate for Payer: WEA Trust Commercial |
$1,662.10
|
| Rate for Payer: WPS Commercial |
$2,238.40
|
|
|
PATELLA BLADE 41MM 00-5979-095-41
|
Facility
|
IP
|
$3,022.00
|
|
| Hospital Charge Code |
2967773
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,480.78 |
| Max. Negotiated Rate |
$2,780.24 |
| Rate for Payer: Aetna Commercial |
$2,719.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,598.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,601.66
|
| Rate for Payer: Cash Price |
$906.60
|
| Rate for Payer: Cigna Commercial |
$2,780.24
|
| Rate for Payer: Health EOS Commercial |
$2,689.58
|
| Rate for Payer: HFN Commercial |
$2,780.24
|
| Rate for Payer: Multiplan Commercial |
$2,417.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,813.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,780.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,480.78
|
| Rate for Payer: Quartz Commercial |
$1,813.20
|
| Rate for Payer: WEA Trust Commercial |
$1,662.10
|
| Rate for Payer: WPS Commercial |
$2,238.40
|
|
|
PATELLA BLADE 46MM 00-5979-095-46
|
Facility
|
OP
|
$3,022.00
|
|
| Hospital Charge Code |
2967774
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$846.16 |
| Max. Negotiated Rate |
$12,088.00 |
| Rate for Payer: Aetna Commercial |
$2,719.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,598.92
|
| Rate for Payer: Aetna Managed Medicare |
$846.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,964.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,511.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,450.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,601.66
|
| Rate for Payer: Cash Price |
$906.60
|
| Rate for Payer: Cigna Commercial |
$2,780.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,691.11
|
| Rate for Payer: Health EOS Commercial |
$2,689.58
|
| Rate for Payer: HFN Commercial |
$2,780.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,266.50
|
| Rate for Payer: Multiplan Commercial |
$2,417.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,813.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,780.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,480.78
|
| Rate for Payer: Quartz Commercial |
$1,964.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,813.20
|
| Rate for Payer: The Alliance Commercial |
$12,088.00
|
| Rate for Payer: WEA Trust Commercial |
$1,662.10
|
| Rate for Payer: WPS Commercial |
$2,238.40
|
|
|
PATELLA BLADE 46MM 00-5979-095-46
|
Facility
|
IP
|
$3,022.00
|
|
| Hospital Charge Code |
2967774
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,480.78 |
| Max. Negotiated Rate |
$2,780.24 |
| Rate for Payer: Aetna Commercial |
$2,719.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,598.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,601.66
|
| Rate for Payer: Cash Price |
$906.60
|
| Rate for Payer: Cigna Commercial |
$2,780.24
|
| Rate for Payer: Health EOS Commercial |
$2,689.58
|
| Rate for Payer: HFN Commercial |
$2,780.24
|
| Rate for Payer: Multiplan Commercial |
$2,417.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,813.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,780.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,480.78
|
| Rate for Payer: Quartz Commercial |
$1,813.20
|
| Rate for Payer: WEA Trust Commercial |
$1,662.10
|
| Rate for Payer: WPS Commercial |
$2,238.40
|
|
|
PATELLA BLADE 51MM 00-5979-095-51
|
Facility
|
IP
|
$3,022.00
|
|
| Hospital Charge Code |
2967775
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,480.78 |
| Max. Negotiated Rate |
$2,780.24 |
| Rate for Payer: Aetna Commercial |
$2,719.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,598.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,601.66
|
| Rate for Payer: Cash Price |
$906.60
|
| Rate for Payer: Cigna Commercial |
$2,780.24
|
| Rate for Payer: Health EOS Commercial |
$2,689.58
|
| Rate for Payer: HFN Commercial |
$2,780.24
|
| Rate for Payer: Multiplan Commercial |
$2,417.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,813.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,780.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,480.78
|
| Rate for Payer: Quartz Commercial |
$1,813.20
|
| Rate for Payer: WEA Trust Commercial |
$1,662.10
|
| Rate for Payer: WPS Commercial |
$2,238.40
|
|
|
PATELLA BLADE 51MM 00-5979-095-51
|
Facility
|
OP
|
$3,022.00
|
|
| Hospital Charge Code |
2967775
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$846.16 |
| Max. Negotiated Rate |
$12,088.00 |
| Rate for Payer: Aetna Commercial |
$2,719.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,598.92
|
| Rate for Payer: Aetna Managed Medicare |
$846.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,964.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,511.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,450.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,601.66
|
| Rate for Payer: Cash Price |
$906.60
|
| Rate for Payer: Cigna Commercial |
$2,780.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,691.11
|
| Rate for Payer: Health EOS Commercial |
$2,689.58
|
| Rate for Payer: HFN Commercial |
$2,780.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,266.50
|
| Rate for Payer: Multiplan Commercial |
$2,417.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,813.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,780.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,480.78
|
| Rate for Payer: Quartz Commercial |
$1,964.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,813.20
|
| Rate for Payer: The Alliance Commercial |
$12,088.00
|
| Rate for Payer: WEA Trust Commercial |
$1,662.10
|
| Rate for Payer: WPS Commercial |
$2,238.40
|
|
|
PATELLA FEMORAL JOINT ARTHROPLASTY
|
Facility
|
IP
|
$13,291.00
|
|
| Hospital Charge Code |
4494581
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,512.59 |
| Max. Negotiated Rate |
$12,227.72 |
| Rate for Payer: Aetna Commercial |
$11,961.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,430.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,044.23
|
| Rate for Payer: Cash Price |
$3,987.30
|
| Rate for Payer: Cigna Commercial |
$12,227.72
|
| Rate for Payer: Health EOS Commercial |
$11,828.99
|
| Rate for Payer: HFN Commercial |
$12,227.72
|
| Rate for Payer: Multiplan Commercial |
$10,632.80
|
| Rate for Payer: NAPHCARE Commercial |
$7,974.60
|
| Rate for Payer: Preferred Network Access Commercial |
$12,227.72
|
| Rate for Payer: Quartz Beloit One Network |
$6,512.59
|
| Rate for Payer: Quartz Commercial |
$7,974.60
|
| Rate for Payer: WEA Trust Commercial |
$7,310.05
|
| Rate for Payer: WPS Commercial |
$9,844.64
|
|
|
PATELLA FEMORAL JOINT ARTHROPLASTY
|
Facility
|
OP
|
$13,291.00
|
|
| Hospital Charge Code |
4494581
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,721.48 |
| Max. Negotiated Rate |
$53,164.00 |
| Rate for Payer: Aetna Commercial |
$11,961.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,430.26
|
| Rate for Payer: Aetna Managed Medicare |
$3,721.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,639.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,645.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,379.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,044.23
|
| Rate for Payer: Cash Price |
$3,987.30
|
| Rate for Payer: Cigna Commercial |
$12,227.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,437.64
|
| Rate for Payer: Health EOS Commercial |
$11,828.99
|
| Rate for Payer: HFN Commercial |
$12,227.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,968.25
|
| Rate for Payer: Multiplan Commercial |
$10,632.80
|
| Rate for Payer: NAPHCARE Commercial |
$7,974.60
|
| Rate for Payer: Preferred Network Access Commercial |
$12,227.72
|
| Rate for Payer: Quartz Beloit One Network |
$6,512.59
|
| Rate for Payer: Quartz Commercial |
$8,639.15
|
| Rate for Payer: Quartz Medicare Advantage |
$7,974.60
|
| Rate for Payer: The Alliance Commercial |
$53,164.00
|
| Rate for Payer: WEA Trust Commercial |
$7,310.05
|
| Rate for Payer: WPS Commercial |
$9,844.64
|
|
|
PATELLA PERSONA ALL POLY 29MM 42-5400-000-29
|
Facility
|
OP
|
$4,204.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3116528
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,177.12 |
| Max. Negotiated Rate |
$16,816.00 |
| Rate for Payer: Aetna Commercial |
$3,783.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,615.44
|
| Rate for Payer: Aetna Managed Medicare |
$1,177.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,732.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,102.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,017.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,228.12
|
| Rate for Payer: Cash Price |
$1,261.20
|
| Rate for Payer: Cigna Commercial |
$3,867.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,352.56
|
| Rate for Payer: Health EOS Commercial |
$3,741.56
|
| Rate for Payer: HFN Commercial |
$3,867.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,153.00
|
| Rate for Payer: Multiplan Commercial |
$3,363.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,522.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,867.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,059.96
|
| Rate for Payer: Quartz Commercial |
$2,732.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2,522.40
|
| Rate for Payer: The Alliance Commercial |
$16,816.00
|
| Rate for Payer: WEA Trust Commercial |
$2,312.20
|
| Rate for Payer: WPS Commercial |
$3,113.90
|
|
|
PATELLA PERSONA ALL POLY 29MM 42-5400-000-29
|
Facility
|
IP
|
$4,204.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3116528
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,059.96 |
| Max. Negotiated Rate |
$3,867.68 |
| Rate for Payer: Aetna Commercial |
$3,783.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,615.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,228.12
|
| Rate for Payer: Cash Price |
$1,261.20
|
| Rate for Payer: Cigna Commercial |
$3,867.68
|
| Rate for Payer: Health EOS Commercial |
$3,741.56
|
| Rate for Payer: HFN Commercial |
$3,867.68
|
| Rate for Payer: Multiplan Commercial |
$3,363.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,522.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,867.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,059.96
|
| Rate for Payer: Quartz Commercial |
$2,522.40
|
| Rate for Payer: WEA Trust Commercial |
$2,312.20
|
| Rate for Payer: WPS Commercial |
$3,113.90
|
|
|
PATELLA PERSONA ALL POLY 32MM 42-5400-000-32
|
Facility
|
IP
|
$4,357.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3221473
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,134.93 |
| Max. Negotiated Rate |
$4,008.44 |
| Rate for Payer: Aetna Commercial |
$3,921.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,747.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,309.21
|
| Rate for Payer: Cash Price |
$1,307.10
|
| Rate for Payer: Cigna Commercial |
$4,008.44
|
| Rate for Payer: Health EOS Commercial |
$3,877.73
|
| Rate for Payer: HFN Commercial |
$4,008.44
|
| Rate for Payer: Multiplan Commercial |
$3,485.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,614.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,008.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,134.93
|
| Rate for Payer: Quartz Commercial |
$2,614.20
|
| Rate for Payer: WEA Trust Commercial |
$2,396.35
|
| Rate for Payer: WPS Commercial |
$3,227.23
|
|
|
PATELLA PERSONA ALL POLY 32MM 42-5400-000-32
|
Facility
|
OP
|
$4,357.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3221473
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,219.96 |
| Max. Negotiated Rate |
$17,428.00 |
| Rate for Payer: Aetna Commercial |
$3,921.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,747.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,219.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,832.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,178.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,091.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,309.21
|
| Rate for Payer: Cash Price |
$1,307.10
|
| Rate for Payer: Cigna Commercial |
$4,008.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,438.18
|
| Rate for Payer: Health EOS Commercial |
$3,877.73
|
| Rate for Payer: HFN Commercial |
$4,008.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,267.75
|
| Rate for Payer: Multiplan Commercial |
$3,485.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,614.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,008.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,134.93
|
| Rate for Payer: Quartz Commercial |
$2,832.05
|
| Rate for Payer: Quartz Medicare Advantage |
$2,614.20
|
| Rate for Payer: The Alliance Commercial |
$17,428.00
|
| Rate for Payer: WEA Trust Commercial |
$2,396.35
|
| Rate for Payer: WPS Commercial |
$3,227.23
|
|
|
PATELLA PERSONA VE 29MM 42-5402-000-29
|
Facility
|
IP
|
$6,935.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3177476
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,398.15 |
| Max. Negotiated Rate |
$6,380.20 |
| Rate for Payer: Aetna Commercial |
$6,241.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,964.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,675.55
|
| Rate for Payer: Cash Price |
$2,080.50
|
| Rate for Payer: Cigna Commercial |
$6,380.20
|
| Rate for Payer: Health EOS Commercial |
$6,172.15
|
| Rate for Payer: HFN Commercial |
$6,380.20
|
| Rate for Payer: Multiplan Commercial |
$5,548.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,161.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,380.20
|
| Rate for Payer: Quartz Beloit One Network |
$3,398.15
|
| Rate for Payer: Quartz Commercial |
$4,161.00
|
| Rate for Payer: WEA Trust Commercial |
$3,814.25
|
| Rate for Payer: WPS Commercial |
$5,136.75
|
|
|
PATELLA PERSONA VE 29MM 42-5402-000-29
|
Facility
|
OP
|
$6,935.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3177476
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,941.80 |
| Max. Negotiated Rate |
$27,740.00 |
| Rate for Payer: Aetna Commercial |
$6,241.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,964.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,941.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,507.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,467.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,328.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,675.55
|
| Rate for Payer: Cash Price |
$2,080.50
|
| Rate for Payer: Cigna Commercial |
$6,380.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,880.83
|
| Rate for Payer: Health EOS Commercial |
$6,172.15
|
| Rate for Payer: HFN Commercial |
$6,380.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,201.25
|
| Rate for Payer: Multiplan Commercial |
$5,548.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,161.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,380.20
|
| Rate for Payer: Quartz Beloit One Network |
$3,398.15
|
| Rate for Payer: Quartz Commercial |
$4,507.75
|
| Rate for Payer: Quartz Medicare Advantage |
$4,161.00
|
| Rate for Payer: The Alliance Commercial |
$27,740.00
|
| Rate for Payer: WEA Trust Commercial |
$3,814.25
|
| Rate for Payer: WPS Commercial |
$5,136.75
|
|
|
PATELLA PERSONA VE 32MM 42-5402-000-32
|
Facility
|
OP
|
$6,935.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3177471
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,941.80 |
| Max. Negotiated Rate |
$27,740.00 |
| Rate for Payer: Aetna Commercial |
$6,241.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,964.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,941.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,507.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,467.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,328.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,675.55
|
| Rate for Payer: Cash Price |
$2,080.50
|
| Rate for Payer: Cigna Commercial |
$6,380.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,880.83
|
| Rate for Payer: Health EOS Commercial |
$6,172.15
|
| Rate for Payer: HFN Commercial |
$6,380.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,201.25
|
| Rate for Payer: Multiplan Commercial |
$5,548.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,161.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,380.20
|
| Rate for Payer: Quartz Beloit One Network |
$3,398.15
|
| Rate for Payer: Quartz Commercial |
$4,507.75
|
| Rate for Payer: Quartz Medicare Advantage |
$4,161.00
|
| Rate for Payer: The Alliance Commercial |
$27,740.00
|
| Rate for Payer: WEA Trust Commercial |
$3,814.25
|
| Rate for Payer: WPS Commercial |
$5,136.75
|
|
