|
PATELLA 32MM PROLONG 00-5972-066-32
|
Facility
|
OP
|
$7,508.00
|
|
| Hospital Charge Code |
2967766
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,186.33 |
| Max. Negotiated Rate |
$7,183.65 |
| Rate for Payer: Aetna Commercial |
$7,027.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,715.16
|
| Rate for Payer: Aetna Managed Medicare |
$2,186.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,075.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,904.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,747.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,138.41
|
| Rate for Payer: Cash Price |
$2,252.40
|
| Rate for Payer: Cigna Commercial |
$7,183.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,369.66
|
| Rate for Payer: Health EOS Commercial |
$6,949.40
|
| Rate for Payer: HFN Commercial |
$7,183.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,856.24
|
| Rate for Payer: Multiplan Commercial |
$6,246.66
|
| Rate for Payer: NAPHCARE Commercial |
$4,684.99
|
| Rate for Payer: Preferred Network Access Commercial |
$7,183.65
|
| Rate for Payer: Quartz Beloit One Network |
$3,826.08
|
| Rate for Payer: Quartz Commercial |
$5,075.41
|
| Rate for Payer: Quartz Medicare Advantage |
$4,684.99
|
| Rate for Payer: The Alliance Commercial |
$3,904.16
|
| Rate for Payer: WEA Trust Commercial |
$4,294.58
|
| Rate for Payer: WPS Commercial |
$5,783.41
|
|
|
PATELLA 35MM PROLONG 00-5972-066-35
|
Facility
|
IP
|
$7,508.00
|
|
| Hospital Charge Code |
2967767
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,826.08 |
| Max. Negotiated Rate |
$7,183.65 |
| Rate for Payer: Aetna Commercial |
$7,027.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,715.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,138.41
|
| Rate for Payer: Cash Price |
$2,252.40
|
| Rate for Payer: Cigna Commercial |
$7,183.65
|
| Rate for Payer: Health EOS Commercial |
$6,949.40
|
| Rate for Payer: HFN Commercial |
$7,183.65
|
| Rate for Payer: Multiplan Commercial |
$6,246.66
|
| Rate for Payer: Preferred Network Access Commercial |
$7,183.65
|
| Rate for Payer: Quartz Beloit One Network |
$3,826.08
|
| Rate for Payer: Quartz Commercial |
$4,684.99
|
| Rate for Payer: WEA Trust Commercial |
$4,294.58
|
| Rate for Payer: WPS Commercial |
$5,783.41
|
|
|
PATELLA 35MM PROLONG 00-5972-066-35
|
Facility
|
OP
|
$7,508.00
|
|
| Hospital Charge Code |
2967767
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,186.33 |
| Max. Negotiated Rate |
$7,183.65 |
| Rate for Payer: Aetna Commercial |
$7,027.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,715.16
|
| Rate for Payer: Aetna Managed Medicare |
$2,186.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,075.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,904.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,747.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,138.41
|
| Rate for Payer: Cash Price |
$2,252.40
|
| Rate for Payer: Cigna Commercial |
$7,183.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,369.66
|
| Rate for Payer: Health EOS Commercial |
$6,949.40
|
| Rate for Payer: HFN Commercial |
$7,183.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,856.24
|
| Rate for Payer: Multiplan Commercial |
$6,246.66
|
| Rate for Payer: NAPHCARE Commercial |
$4,684.99
|
| Rate for Payer: Preferred Network Access Commercial |
$7,183.65
|
| Rate for Payer: Quartz Beloit One Network |
$3,826.08
|
| Rate for Payer: Quartz Commercial |
$5,075.41
|
| Rate for Payer: Quartz Medicare Advantage |
$4,684.99
|
| Rate for Payer: The Alliance Commercial |
$3,904.16
|
| Rate for Payer: WEA Trust Commercial |
$4,294.58
|
| Rate for Payer: WPS Commercial |
$5,783.41
|
|
|
PATELLA 38MM PROLONG 00-5972-066-38
|
Facility
|
OP
|
$7,229.00
|
|
| Hospital Charge Code |
2967768
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,105.08 |
| Max. Negotiated Rate |
$6,916.71 |
| Rate for Payer: Aetna Commercial |
$6,766.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,465.62
|
| Rate for Payer: Aetna Managed Medicare |
$2,105.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,886.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,759.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,608.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,984.62
|
| Rate for Payer: Cash Price |
$2,168.70
|
| Rate for Payer: Cigna Commercial |
$6,916.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,207.28
|
| Rate for Payer: Health EOS Commercial |
$6,691.16
|
| Rate for Payer: HFN Commercial |
$6,916.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,638.62
|
| Rate for Payer: Multiplan Commercial |
$6,014.53
|
| Rate for Payer: NAPHCARE Commercial |
$4,510.90
|
| Rate for Payer: Preferred Network Access Commercial |
$6,916.71
|
| Rate for Payer: Quartz Beloit One Network |
$3,683.90
|
| Rate for Payer: Quartz Commercial |
$4,886.80
|
| Rate for Payer: Quartz Medicare Advantage |
$4,510.90
|
| Rate for Payer: The Alliance Commercial |
$3,759.08
|
| Rate for Payer: WEA Trust Commercial |
$4,134.99
|
| Rate for Payer: WPS Commercial |
$5,568.50
|
|
|
PATELLA 38MM PROLONG 00-5972-066-38
|
Facility
|
IP
|
$7,229.00
|
|
| Hospital Charge Code |
2967768
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,683.90 |
| Max. Negotiated Rate |
$6,916.71 |
| Rate for Payer: Aetna Commercial |
$6,766.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,465.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,984.62
|
| Rate for Payer: Cash Price |
$2,168.70
|
| Rate for Payer: Cigna Commercial |
$6,916.71
|
| Rate for Payer: Health EOS Commercial |
$6,691.16
|
| Rate for Payer: HFN Commercial |
$6,916.71
|
| Rate for Payer: Multiplan Commercial |
$6,014.53
|
| Rate for Payer: Preferred Network Access Commercial |
$6,916.71
|
| Rate for Payer: Quartz Beloit One Network |
$3,683.90
|
| Rate for Payer: Quartz Commercial |
$4,510.90
|
| Rate for Payer: WEA Trust Commercial |
$4,134.99
|
| Rate for Payer: WPS Commercial |
$5,568.50
|
|
|
PATELLA 3-PEG P3 NX043
|
Facility
|
OP
|
$4,918.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5659639
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,432.12 |
| Max. Negotiated Rate |
$4,705.54 |
| Rate for Payer: Aetna Commercial |
$4,603.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,398.66
|
| Rate for Payer: Aetna Managed Medicare |
$1,432.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,324.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,557.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,455.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,710.80
|
| Rate for Payer: Cash Price |
$1,475.40
|
| Rate for Payer: Cigna Commercial |
$4,705.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,862.28
|
| Rate for Payer: Health EOS Commercial |
$4,552.10
|
| Rate for Payer: HFN Commercial |
$4,705.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,836.04
|
| Rate for Payer: Multiplan Commercial |
$4,091.78
|
| Rate for Payer: NAPHCARE Commercial |
$3,068.83
|
| Rate for Payer: Preferred Network Access Commercial |
$4,705.54
|
| Rate for Payer: Quartz Beloit One Network |
$2,506.21
|
| Rate for Payer: Quartz Commercial |
$3,324.57
|
| Rate for Payer: Quartz Medicare Advantage |
$3,068.83
|
| Rate for Payer: The Alliance Commercial |
$2,557.36
|
| Rate for Payer: WEA Trust Commercial |
$2,813.10
|
| Rate for Payer: WPS Commercial |
$3,788.34
|
|
|
PATELLA 3-PEG P3 NX043
|
Facility
|
IP
|
$4,918.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5659639
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,506.21 |
| Max. Negotiated Rate |
$4,705.54 |
| Rate for Payer: Aetna Commercial |
$4,603.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,398.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,710.80
|
| Rate for Payer: Cash Price |
$1,475.40
|
| Rate for Payer: Cigna Commercial |
$4,705.54
|
| Rate for Payer: Health EOS Commercial |
$4,552.10
|
| Rate for Payer: HFN Commercial |
$4,705.54
|
| Rate for Payer: Multiplan Commercial |
$4,091.78
|
| Rate for Payer: Preferred Network Access Commercial |
$4,705.54
|
| Rate for Payer: Quartz Beloit One Network |
$2,506.21
|
| Rate for Payer: Quartz Commercial |
$3,068.83
|
| Rate for Payer: WEA Trust Commercial |
$2,813.10
|
| Rate for Payer: WPS Commercial |
$3,788.34
|
|
|
PATELLA 41MM PROLONG 00-5972-066-41
|
Facility
|
IP
|
$7,229.00
|
|
| Hospital Charge Code |
2967769
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,683.90 |
| Max. Negotiated Rate |
$6,916.71 |
| Rate for Payer: Aetna Commercial |
$6,766.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,465.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,984.62
|
| Rate for Payer: Cash Price |
$2,168.70
|
| Rate for Payer: Cigna Commercial |
$6,916.71
|
| Rate for Payer: Health EOS Commercial |
$6,691.16
|
| Rate for Payer: HFN Commercial |
$6,916.71
|
| Rate for Payer: Multiplan Commercial |
$6,014.53
|
| Rate for Payer: Preferred Network Access Commercial |
$6,916.71
|
| Rate for Payer: Quartz Beloit One Network |
$3,683.90
|
| Rate for Payer: Quartz Commercial |
$4,510.90
|
| Rate for Payer: WEA Trust Commercial |
$4,134.99
|
| Rate for Payer: WPS Commercial |
$5,568.50
|
|
|
PATELLA 41MM PROLONG 00-5972-066-41
|
Facility
|
OP
|
$7,229.00
|
|
| Hospital Charge Code |
2967769
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,105.08 |
| Max. Negotiated Rate |
$6,916.71 |
| Rate for Payer: Aetna Commercial |
$6,766.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,465.62
|
| Rate for Payer: Aetna Managed Medicare |
$2,105.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,886.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,759.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,608.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,984.62
|
| Rate for Payer: Cash Price |
$2,168.70
|
| Rate for Payer: Cigna Commercial |
$6,916.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,207.28
|
| Rate for Payer: Health EOS Commercial |
$6,691.16
|
| Rate for Payer: HFN Commercial |
$6,916.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,638.62
|
| Rate for Payer: Multiplan Commercial |
$6,014.53
|
| Rate for Payer: NAPHCARE Commercial |
$4,510.90
|
| Rate for Payer: Preferred Network Access Commercial |
$6,916.71
|
| Rate for Payer: Quartz Beloit One Network |
$3,683.90
|
| Rate for Payer: Quartz Commercial |
$4,886.80
|
| Rate for Payer: Quartz Medicare Advantage |
$4,510.90
|
| Rate for Payer: The Alliance Commercial |
$3,759.08
|
| Rate for Payer: WEA Trust Commercial |
$4,134.99
|
| Rate for Payer: WPS Commercial |
$5,568.50
|
|
|
PATELLA ATTUNE MEDIALIZED ANATOMIC 29MM CEMENTED 1518-10-029
|
Facility
|
IP
|
$4,610.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5611655
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,349.26 |
| Max. Negotiated Rate |
$4,410.85 |
| Rate for Payer: Aetna Commercial |
$4,314.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,123.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,541.03
|
| Rate for Payer: Cash Price |
$1,383.00
|
| Rate for Payer: Cigna Commercial |
$4,410.85
|
| Rate for Payer: Health EOS Commercial |
$4,267.02
|
| Rate for Payer: HFN Commercial |
$4,410.85
|
| Rate for Payer: Multiplan Commercial |
$3,835.52
|
| Rate for Payer: Preferred Network Access Commercial |
$4,410.85
|
| Rate for Payer: Quartz Beloit One Network |
$2,349.26
|
| Rate for Payer: Quartz Commercial |
$2,876.64
|
| Rate for Payer: WEA Trust Commercial |
$2,636.92
|
| Rate for Payer: WPS Commercial |
$3,551.08
|
|
|
PATELLA ATTUNE MEDIALIZED ANATOMIC 29MM CEMENTED 1518-10-029
|
Facility
|
OP
|
$4,610.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5611655
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,342.43 |
| Max. Negotiated Rate |
$4,410.85 |
| Rate for Payer: Aetna Commercial |
$4,314.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,123.18
|
| Rate for Payer: Aetna Managed Medicare |
$1,342.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,116.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,397.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,301.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,541.03
|
| Rate for Payer: Cash Price |
$1,383.00
|
| Rate for Payer: Cigna Commercial |
$4,410.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,683.02
|
| Rate for Payer: Health EOS Commercial |
$4,267.02
|
| Rate for Payer: HFN Commercial |
$4,410.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,595.80
|
| Rate for Payer: Multiplan Commercial |
$3,835.52
|
| Rate for Payer: NAPHCARE Commercial |
$2,876.64
|
| Rate for Payer: Preferred Network Access Commercial |
$4,410.85
|
| Rate for Payer: Quartz Beloit One Network |
$2,349.26
|
| Rate for Payer: Quartz Commercial |
$3,116.36
|
| Rate for Payer: Quartz Medicare Advantage |
$2,876.64
|
| Rate for Payer: The Alliance Commercial |
$2,397.20
|
| Rate for Payer: WEA Trust Commercial |
$2,636.92
|
| Rate for Payer: WPS Commercial |
$3,551.08
|
|
|
PATELLA ATTUNE MEDIALIZED ANATOMIC 32MM CEMENTED 1518-10-032
|
Facility
|
IP
|
$6,319.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5459755
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,220.16 |
| Max. Negotiated Rate |
$6,046.02 |
| Rate for Payer: Aetna Commercial |
$5,914.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,651.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,483.03
|
| Rate for Payer: Cash Price |
$1,895.70
|
| Rate for Payer: Cigna Commercial |
$6,046.02
|
| Rate for Payer: Health EOS Commercial |
$5,848.87
|
| Rate for Payer: HFN Commercial |
$6,046.02
|
| Rate for Payer: Multiplan Commercial |
$5,257.41
|
| Rate for Payer: Preferred Network Access Commercial |
$6,046.02
|
| Rate for Payer: Quartz Beloit One Network |
$3,220.16
|
| Rate for Payer: Quartz Commercial |
$3,943.06
|
| Rate for Payer: WEA Trust Commercial |
$3,614.47
|
| Rate for Payer: WPS Commercial |
$4,867.53
|
|
|
PATELLA ATTUNE MEDIALIZED ANATOMIC 32MM CEMENTED 1518-10-032
|
Facility
|
OP
|
$6,319.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5459755
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,840.09 |
| Max. Negotiated Rate |
$6,046.02 |
| Rate for Payer: Aetna Commercial |
$5,914.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,651.71
|
| Rate for Payer: Aetna Managed Medicare |
$1,840.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,271.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,285.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,154.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,483.03
|
| Rate for Payer: Cash Price |
$1,895.70
|
| Rate for Payer: Cigna Commercial |
$6,046.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,677.66
|
| Rate for Payer: Health EOS Commercial |
$5,848.87
|
| Rate for Payer: HFN Commercial |
$6,046.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,928.82
|
| Rate for Payer: Multiplan Commercial |
$5,257.41
|
| Rate for Payer: NAPHCARE Commercial |
$3,943.06
|
| Rate for Payer: Preferred Network Access Commercial |
$6,046.02
|
| Rate for Payer: Quartz Beloit One Network |
$3,220.16
|
| Rate for Payer: Quartz Commercial |
$4,271.64
|
| Rate for Payer: Quartz Medicare Advantage |
$3,943.06
|
| Rate for Payer: The Alliance Commercial |
$3,285.88
|
| Rate for Payer: WEA Trust Commercial |
$3,614.47
|
| Rate for Payer: WPS Commercial |
$4,867.53
|
|
|
PATELLA ATTUNE MEDIALIZED ANATOMIC 35MM CEMENTED 1518-10-035
|
Facility
|
OP
|
$6,319.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5459770
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,840.09 |
| Max. Negotiated Rate |
$6,046.02 |
| Rate for Payer: Aetna Commercial |
$5,914.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,651.71
|
| Rate for Payer: Aetna Managed Medicare |
$1,840.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,271.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,285.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,154.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,483.03
|
| Rate for Payer: Cash Price |
$1,895.70
|
| Rate for Payer: Cigna Commercial |
$6,046.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,677.66
|
| Rate for Payer: Health EOS Commercial |
$5,848.87
|
| Rate for Payer: HFN Commercial |
$6,046.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,928.82
|
| Rate for Payer: Multiplan Commercial |
$5,257.41
|
| Rate for Payer: NAPHCARE Commercial |
$3,943.06
|
| Rate for Payer: Preferred Network Access Commercial |
$6,046.02
|
| Rate for Payer: Quartz Beloit One Network |
$3,220.16
|
| Rate for Payer: Quartz Commercial |
$4,271.64
|
| Rate for Payer: Quartz Medicare Advantage |
$3,943.06
|
| Rate for Payer: The Alliance Commercial |
$3,285.88
|
| Rate for Payer: WEA Trust Commercial |
$3,614.47
|
| Rate for Payer: WPS Commercial |
$4,867.53
|
|
|
PATELLA ATTUNE MEDIALIZED ANATOMIC 35MM CEMENTED 1518-10-035
|
Facility
|
IP
|
$6,319.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5459770
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,220.16 |
| Max. Negotiated Rate |
$6,046.02 |
| Rate for Payer: Aetna Commercial |
$5,914.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,651.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,483.03
|
| Rate for Payer: Cash Price |
$1,895.70
|
| Rate for Payer: Cigna Commercial |
$6,046.02
|
| Rate for Payer: Health EOS Commercial |
$5,848.87
|
| Rate for Payer: HFN Commercial |
$6,046.02
|
| Rate for Payer: Multiplan Commercial |
$5,257.41
|
| Rate for Payer: Preferred Network Access Commercial |
$6,046.02
|
| Rate for Payer: Quartz Beloit One Network |
$3,220.16
|
| Rate for Payer: Quartz Commercial |
$3,943.06
|
| Rate for Payer: WEA Trust Commercial |
$3,614.47
|
| Rate for Payer: WPS Commercial |
$4,867.53
|
|
|
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 |
$3,220.16 |
| Max. Negotiated Rate |
$6,046.02 |
| Rate for Payer: Aetna Commercial |
$5,914.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,651.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,483.03
|
| Rate for Payer: Cash Price |
$1,895.70
|
| Rate for Payer: Cigna Commercial |
$6,046.02
|
| Rate for Payer: Health EOS Commercial |
$5,848.87
|
| Rate for Payer: HFN Commercial |
$6,046.02
|
| Rate for Payer: Multiplan Commercial |
$5,257.41
|
| Rate for Payer: Preferred Network Access Commercial |
$6,046.02
|
| Rate for Payer: Quartz Beloit One Network |
$3,220.16
|
| Rate for Payer: Quartz Commercial |
$3,943.06
|
| Rate for Payer: WEA Trust Commercial |
$3,614.47
|
| Rate for Payer: WPS Commercial |
$4,867.53
|
|
|
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 |
$1,840.09 |
| Max. Negotiated Rate |
$6,046.02 |
| Rate for Payer: Aetna Commercial |
$5,914.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,651.71
|
| Rate for Payer: Aetna Managed Medicare |
$1,840.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,271.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,285.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,154.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,483.03
|
| Rate for Payer: Cash Price |
$1,895.70
|
| Rate for Payer: Cigna Commercial |
$6,046.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,677.66
|
| Rate for Payer: Health EOS Commercial |
$5,848.87
|
| Rate for Payer: HFN Commercial |
$6,046.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,928.82
|
| Rate for Payer: Multiplan Commercial |
$5,257.41
|
| Rate for Payer: NAPHCARE Commercial |
$3,943.06
|
| Rate for Payer: Preferred Network Access Commercial |
$6,046.02
|
| Rate for Payer: Quartz Beloit One Network |
$3,220.16
|
| Rate for Payer: Quartz Commercial |
$4,271.64
|
| Rate for Payer: Quartz Medicare Advantage |
$3,943.06
|
| Rate for Payer: The Alliance Commercial |
$3,285.88
|
| Rate for Payer: WEA Trust Commercial |
$3,614.47
|
| Rate for Payer: WPS Commercial |
$4,867.53
|
|
|
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 |
$3,220.16 |
| Max. Negotiated Rate |
$6,046.02 |
| Rate for Payer: Aetna Commercial |
$5,914.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,651.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,483.03
|
| Rate for Payer: Cash Price |
$1,895.70
|
| Rate for Payer: Cigna Commercial |
$6,046.02
|
| Rate for Payer: Health EOS Commercial |
$5,848.87
|
| Rate for Payer: HFN Commercial |
$6,046.02
|
| Rate for Payer: Multiplan Commercial |
$5,257.41
|
| Rate for Payer: Preferred Network Access Commercial |
$6,046.02
|
| Rate for Payer: Quartz Beloit One Network |
$3,220.16
|
| Rate for Payer: Quartz Commercial |
$3,943.06
|
| Rate for Payer: WEA Trust Commercial |
$3,614.47
|
| Rate for Payer: WPS Commercial |
$4,867.53
|
|
|
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 |
$1,840.09 |
| Max. Negotiated Rate |
$6,046.02 |
| Rate for Payer: Aetna Commercial |
$5,914.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,651.71
|
| Rate for Payer: Aetna Managed Medicare |
$1,840.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,271.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,285.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,154.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,483.03
|
| Rate for Payer: Cash Price |
$1,895.70
|
| Rate for Payer: Cigna Commercial |
$6,046.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,677.66
|
| Rate for Payer: Health EOS Commercial |
$5,848.87
|
| Rate for Payer: HFN Commercial |
$6,046.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,928.82
|
| Rate for Payer: Multiplan Commercial |
$5,257.41
|
| Rate for Payer: NAPHCARE Commercial |
$3,943.06
|
| Rate for Payer: Preferred Network Access Commercial |
$6,046.02
|
| Rate for Payer: Quartz Beloit One Network |
$3,220.16
|
| Rate for Payer: Quartz Commercial |
$4,271.64
|
| Rate for Payer: Quartz Medicare Advantage |
$3,943.06
|
| Rate for Payer: The Alliance Commercial |
$3,285.88
|
| Rate for Payer: WEA Trust Commercial |
$3,614.47
|
| Rate for Payer: WPS Commercial |
$4,867.53
|
|
|
PATELLA BLADE 32MM 00-5979-095-32
|
Facility
|
IP
|
$2,912.00
|
|
| Hospital Charge Code |
2967770
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,483.96 |
| Max. Negotiated Rate |
$2,786.20 |
| Rate for Payer: Aetna Commercial |
$2,725.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,604.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,605.09
|
| Rate for Payer: Cash Price |
$873.60
|
| Rate for Payer: Cigna Commercial |
$2,786.20
|
| Rate for Payer: Health EOS Commercial |
$2,695.35
|
| Rate for Payer: HFN Commercial |
$2,786.20
|
| Rate for Payer: Multiplan Commercial |
$2,422.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,786.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,483.96
|
| Rate for Payer: Quartz Commercial |
$1,817.09
|
| Rate for Payer: WEA Trust Commercial |
$1,665.66
|
| Rate for Payer: WPS Commercial |
$2,243.11
|
|
|
PATELLA BLADE 32MM 00-5979-095-32
|
Facility
|
OP
|
$2,912.00
|
|
| Hospital Charge Code |
2967770
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$847.97 |
| Max. Negotiated Rate |
$2,786.20 |
| Rate for Payer: Aetna Commercial |
$2,725.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,604.49
|
| Rate for Payer: Aetna Managed Medicare |
$847.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,968.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,514.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,453.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,605.09
|
| Rate for Payer: Cash Price |
$873.60
|
| Rate for Payer: Cigna Commercial |
$2,786.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,694.78
|
| Rate for Payer: Health EOS Commercial |
$2,695.35
|
| Rate for Payer: HFN Commercial |
$2,786.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,271.36
|
| Rate for Payer: Multiplan Commercial |
$2,422.78
|
| Rate for Payer: NAPHCARE Commercial |
$1,817.09
|
| Rate for Payer: Preferred Network Access Commercial |
$2,786.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,483.96
|
| Rate for Payer: Quartz Commercial |
$1,968.51
|
| Rate for Payer: Quartz Medicare Advantage |
$1,817.09
|
| Rate for Payer: The Alliance Commercial |
$1,514.24
|
| Rate for Payer: WEA Trust Commercial |
$1,665.66
|
| Rate for Payer: WPS Commercial |
$2,243.11
|
|
|
PATELLA BLADE 35MM 00-5979-095-35
|
Facility
|
OP
|
$2,912.00
|
|
| Hospital Charge Code |
2967771
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$847.97 |
| Max. Negotiated Rate |
$2,786.20 |
| Rate for Payer: Aetna Commercial |
$2,725.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,604.49
|
| Rate for Payer: Aetna Managed Medicare |
$847.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,968.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,514.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,453.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,605.09
|
| Rate for Payer: Cash Price |
$873.60
|
| Rate for Payer: Cigna Commercial |
$2,786.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,694.78
|
| Rate for Payer: Health EOS Commercial |
$2,695.35
|
| Rate for Payer: HFN Commercial |
$2,786.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,271.36
|
| Rate for Payer: Multiplan Commercial |
$2,422.78
|
| Rate for Payer: NAPHCARE Commercial |
$1,817.09
|
| Rate for Payer: Preferred Network Access Commercial |
$2,786.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,483.96
|
| Rate for Payer: Quartz Commercial |
$1,968.51
|
| Rate for Payer: Quartz Medicare Advantage |
$1,817.09
|
| Rate for Payer: The Alliance Commercial |
$1,514.24
|
| Rate for Payer: WEA Trust Commercial |
$1,665.66
|
| Rate for Payer: WPS Commercial |
$2,243.11
|
|
|
PATELLA BLADE 35MM 00-5979-095-35
|
Facility
|
IP
|
$2,912.00
|
|
| Hospital Charge Code |
2967771
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,483.96 |
| Max. Negotiated Rate |
$2,786.20 |
| Rate for Payer: Aetna Commercial |
$2,725.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,604.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,605.09
|
| Rate for Payer: Cash Price |
$873.60
|
| Rate for Payer: Cigna Commercial |
$2,786.20
|
| Rate for Payer: Health EOS Commercial |
$2,695.35
|
| Rate for Payer: HFN Commercial |
$2,786.20
|
| Rate for Payer: Multiplan Commercial |
$2,422.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,786.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,483.96
|
| Rate for Payer: Quartz Commercial |
$1,817.09
|
| Rate for Payer: WEA Trust Commercial |
$1,665.66
|
| Rate for Payer: WPS Commercial |
$2,243.11
|
|
|
PATELLA BLADE 38MM 00-5979-095-38
|
Facility
|
IP
|
$3,022.00
|
|
| Hospital Charge Code |
2967772
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,540.01 |
| Max. Negotiated Rate |
$2,891.45 |
| Rate for Payer: Aetna Commercial |
$2,828.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,702.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,665.73
|
| Rate for Payer: Cash Price |
$906.60
|
| Rate for Payer: Cigna Commercial |
$2,891.45
|
| Rate for Payer: Health EOS Commercial |
$2,797.16
|
| Rate for Payer: HFN Commercial |
$2,891.45
|
| Rate for Payer: Multiplan Commercial |
$2,514.30
|
| Rate for Payer: Preferred Network Access Commercial |
$2,891.45
|
| Rate for Payer: Quartz Beloit One Network |
$1,540.01
|
| Rate for Payer: Quartz Commercial |
$1,885.73
|
| Rate for Payer: WEA Trust Commercial |
$1,728.58
|
| Rate for Payer: WPS Commercial |
$2,327.85
|
|
|
PATELLA BLADE 38MM 00-5979-095-38
|
Facility
|
OP
|
$3,022.00
|
|
| Hospital Charge Code |
2967772
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$880.01 |
| Max. Negotiated Rate |
$2,891.45 |
| Rate for Payer: Aetna Commercial |
$2,828.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,702.88
|
| Rate for Payer: Aetna Managed Medicare |
$880.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,042.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,571.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,508.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,665.73
|
| Rate for Payer: Cash Price |
$906.60
|
| Rate for Payer: Cigna Commercial |
$2,891.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,758.80
|
| Rate for Payer: Health EOS Commercial |
$2,797.16
|
| Rate for Payer: HFN Commercial |
$2,891.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,357.16
|
| Rate for Payer: Multiplan Commercial |
$2,514.30
|
| Rate for Payer: NAPHCARE Commercial |
$1,885.73
|
| Rate for Payer: Preferred Network Access Commercial |
$2,891.45
|
| Rate for Payer: Quartz Beloit One Network |
$1,540.01
|
| Rate for Payer: Quartz Commercial |
$2,042.87
|
| Rate for Payer: Quartz Medicare Advantage |
$1,885.73
|
| Rate for Payer: The Alliance Commercial |
$1,571.44
|
| Rate for Payer: WEA Trust Commercial |
$1,728.58
|
| Rate for Payer: WPS Commercial |
$2,327.85
|
|
