|
ARTICULAR INSERT 15MM GENESIS 71421511
|
Facility
|
OP
|
$11,422.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2965972
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,198.16 |
| Max. Negotiated Rate |
$45,688.00 |
| Rate for Payer: Aetna Commercial |
$10,279.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,822.92
|
| Rate for Payer: Aetna Managed Medicare |
$3,198.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,424.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,711.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,482.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,053.66
|
| Rate for Payer: Cash Price |
$3,426.60
|
| Rate for Payer: Cigna Commercial |
$10,508.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,391.75
|
| Rate for Payer: Health EOS Commercial |
$10,165.58
|
| Rate for Payer: HFN Commercial |
$10,508.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,566.50
|
| Rate for Payer: Multiplan Commercial |
$9,137.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,853.20
|
| Rate for Payer: Preferred Network Access Commercial |
$10,508.24
|
| Rate for Payer: Quartz Beloit One Network |
$5,596.78
|
| Rate for Payer: Quartz Commercial |
$7,424.30
|
| Rate for Payer: Quartz Medicare Advantage |
$6,853.20
|
| Rate for Payer: The Alliance Commercial |
$45,688.00
|
| Rate for Payer: WEA Trust Commercial |
$6,282.10
|
| Rate for Payer: WPS Commercial |
$8,460.28
|
|
|
ARTICULAR SURFACE BLUE G 10MM LCCK 5994-50-10
|
Facility
|
OP
|
$10,348.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2973990
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,897.44 |
| Max. Negotiated Rate |
$41,392.00 |
| Rate for Payer: Aetna Commercial |
$9,313.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,899.28
|
| Rate for Payer: Aetna Managed Medicare |
$2,897.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,726.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,174.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,967.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,484.44
|
| Rate for Payer: Cash Price |
$3,104.40
|
| Rate for Payer: Cigna Commercial |
$9,520.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,790.74
|
| Rate for Payer: Health EOS Commercial |
$9,209.72
|
| Rate for Payer: HFN Commercial |
$9,520.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,761.00
|
| Rate for Payer: Multiplan Commercial |
$8,278.40
|
| Rate for Payer: NAPHCARE Commercial |
$6,208.80
|
| Rate for Payer: Preferred Network Access Commercial |
$9,520.16
|
| Rate for Payer: Quartz Beloit One Network |
$5,070.52
|
| Rate for Payer: Quartz Commercial |
$6,726.20
|
| Rate for Payer: Quartz Medicare Advantage |
$6,208.80
|
| Rate for Payer: The Alliance Commercial |
$41,392.00
|
| Rate for Payer: WEA Trust Commercial |
$5,691.40
|
| Rate for Payer: WPS Commercial |
$7,664.76
|
|
|
ARTICULAR SURFACE BLUE G 10MM LCCK 5994-50-10
|
Facility
|
IP
|
$10,348.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2973990
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,070.52 |
| Max. Negotiated Rate |
$9,520.16 |
| Rate for Payer: Aetna Commercial |
$9,313.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,899.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,484.44
|
| Rate for Payer: Cash Price |
$3,104.40
|
| Rate for Payer: Cigna Commercial |
$9,520.16
|
| Rate for Payer: Health EOS Commercial |
$9,209.72
|
| Rate for Payer: HFN Commercial |
$9,520.16
|
| Rate for Payer: Multiplan Commercial |
$8,278.40
|
| Rate for Payer: NAPHCARE Commercial |
$6,208.80
|
| Rate for Payer: Preferred Network Access Commercial |
$9,520.16
|
| Rate for Payer: Quartz Beloit One Network |
$5,070.52
|
| Rate for Payer: Quartz Commercial |
$6,208.80
|
| Rate for Payer: WEA Trust Commercial |
$5,691.40
|
| Rate for Payer: WPS Commercial |
$7,664.76
|
|
|
ARTICULAR SURFACE BLUE G 12MM LCCK 5994-50-12
|
Facility
|
OP
|
$10,348.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2973991
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,897.44 |
| Max. Negotiated Rate |
$41,392.00 |
| Rate for Payer: Aetna Commercial |
$9,313.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,899.28
|
| Rate for Payer: Aetna Managed Medicare |
$2,897.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,726.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,174.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,967.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,484.44
|
| Rate for Payer: Cash Price |
$3,104.40
|
| Rate for Payer: Cigna Commercial |
$9,520.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,790.74
|
| Rate for Payer: Health EOS Commercial |
$9,209.72
|
| Rate for Payer: HFN Commercial |
$9,520.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,761.00
|
| Rate for Payer: Multiplan Commercial |
$8,278.40
|
| Rate for Payer: NAPHCARE Commercial |
$6,208.80
|
| Rate for Payer: Preferred Network Access Commercial |
$9,520.16
|
| Rate for Payer: Quartz Beloit One Network |
$5,070.52
|
| Rate for Payer: Quartz Commercial |
$6,726.20
|
| Rate for Payer: Quartz Medicare Advantage |
$6,208.80
|
| Rate for Payer: The Alliance Commercial |
$41,392.00
|
| Rate for Payer: WEA Trust Commercial |
$5,691.40
|
| Rate for Payer: WPS Commercial |
$7,664.76
|
|
|
ARTICULAR SURFACE BLUE G 12MM LCCK 5994-50-12
|
Facility
|
IP
|
$10,348.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2973991
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,070.52 |
| Max. Negotiated Rate |
$9,520.16 |
| Rate for Payer: Aetna Commercial |
$9,313.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,899.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,484.44
|
| Rate for Payer: Cash Price |
$3,104.40
|
| Rate for Payer: Cigna Commercial |
$9,520.16
|
| Rate for Payer: Health EOS Commercial |
$9,209.72
|
| Rate for Payer: HFN Commercial |
$9,520.16
|
| Rate for Payer: Multiplan Commercial |
$8,278.40
|
| Rate for Payer: NAPHCARE Commercial |
$6,208.80
|
| Rate for Payer: Preferred Network Access Commercial |
$9,520.16
|
| Rate for Payer: Quartz Beloit One Network |
$5,070.52
|
| Rate for Payer: Quartz Commercial |
$6,208.80
|
| Rate for Payer: WEA Trust Commercial |
$5,691.40
|
| Rate for Payer: WPS Commercial |
$7,664.76
|
|
|
ARTICULAR SURFACE BLUE G 14MM LCCK 5994-50-14
|
Facility
|
OP
|
$10,348.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2973992
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,897.44 |
| Max. Negotiated Rate |
$41,392.00 |
| Rate for Payer: Aetna Commercial |
$9,313.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,899.28
|
| Rate for Payer: Aetna Managed Medicare |
$2,897.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,726.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,174.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,967.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,484.44
|
| Rate for Payer: Cash Price |
$3,104.40
|
| Rate for Payer: Cigna Commercial |
$9,520.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,790.74
|
| Rate for Payer: Health EOS Commercial |
$9,209.72
|
| Rate for Payer: HFN Commercial |
$9,520.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,761.00
|
| Rate for Payer: Multiplan Commercial |
$8,278.40
|
| Rate for Payer: NAPHCARE Commercial |
$6,208.80
|
| Rate for Payer: Preferred Network Access Commercial |
$9,520.16
|
| Rate for Payer: Quartz Beloit One Network |
$5,070.52
|
| Rate for Payer: Quartz Commercial |
$6,726.20
|
| Rate for Payer: Quartz Medicare Advantage |
$6,208.80
|
| Rate for Payer: The Alliance Commercial |
$41,392.00
|
| Rate for Payer: WEA Trust Commercial |
$5,691.40
|
| Rate for Payer: WPS Commercial |
$7,664.76
|
|
|
ARTICULAR SURFACE BLUE G 14MM LCCK 5994-50-14
|
Facility
|
IP
|
$10,348.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2973992
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,070.52 |
| Max. Negotiated Rate |
$9,520.16 |
| Rate for Payer: Aetna Commercial |
$9,313.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,899.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,484.44
|
| Rate for Payer: Cash Price |
$3,104.40
|
| Rate for Payer: Cigna Commercial |
$9,520.16
|
| Rate for Payer: Health EOS Commercial |
$9,209.72
|
| Rate for Payer: HFN Commercial |
$9,520.16
|
| Rate for Payer: Multiplan Commercial |
$8,278.40
|
| Rate for Payer: NAPHCARE Commercial |
$6,208.80
|
| Rate for Payer: Preferred Network Access Commercial |
$9,520.16
|
| Rate for Payer: Quartz Beloit One Network |
$5,070.52
|
| Rate for Payer: Quartz Commercial |
$6,208.80
|
| Rate for Payer: WEA Trust Commercial |
$5,691.40
|
| Rate for Payer: WPS Commercial |
$7,664.76
|
|
|
ARTICULAR SURFACE BLUE G 17MM LCCK 5994-50-17
|
Facility
|
IP
|
$10,348.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2973993
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,070.52 |
| Max. Negotiated Rate |
$9,520.16 |
| Rate for Payer: Aetna Commercial |
$9,313.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,899.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,484.44
|
| Rate for Payer: Cash Price |
$3,104.40
|
| Rate for Payer: Cigna Commercial |
$9,520.16
|
| Rate for Payer: Health EOS Commercial |
$9,209.72
|
| Rate for Payer: HFN Commercial |
$9,520.16
|
| Rate for Payer: Multiplan Commercial |
$8,278.40
|
| Rate for Payer: NAPHCARE Commercial |
$6,208.80
|
| Rate for Payer: Preferred Network Access Commercial |
$9,520.16
|
| Rate for Payer: Quartz Beloit One Network |
$5,070.52
|
| Rate for Payer: Quartz Commercial |
$6,208.80
|
| Rate for Payer: WEA Trust Commercial |
$5,691.40
|
| Rate for Payer: WPS Commercial |
$7,664.76
|
|
|
ARTICULAR SURFACE BLUE G 17MM LCCK 5994-50-17
|
Facility
|
OP
|
$10,348.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2973993
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,897.44 |
| Max. Negotiated Rate |
$41,392.00 |
| Rate for Payer: Aetna Commercial |
$9,313.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,899.28
|
| Rate for Payer: Aetna Managed Medicare |
$2,897.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,726.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,174.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,967.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,484.44
|
| Rate for Payer: Cash Price |
$3,104.40
|
| Rate for Payer: Cigna Commercial |
$9,520.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,790.74
|
| Rate for Payer: Health EOS Commercial |
$9,209.72
|
| Rate for Payer: HFN Commercial |
$9,520.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,761.00
|
| Rate for Payer: Multiplan Commercial |
$8,278.40
|
| Rate for Payer: NAPHCARE Commercial |
$6,208.80
|
| Rate for Payer: Preferred Network Access Commercial |
$9,520.16
|
| Rate for Payer: Quartz Beloit One Network |
$5,070.52
|
| Rate for Payer: Quartz Commercial |
$6,726.20
|
| Rate for Payer: Quartz Medicare Advantage |
$6,208.80
|
| Rate for Payer: The Alliance Commercial |
$41,392.00
|
| Rate for Payer: WEA Trust Commercial |
$5,691.40
|
| Rate for Payer: WPS Commercial |
$7,664.76
|
|
|
ARTICULAR SURFACE CD 1-2 10MM 5964-22-10
|
Facility
|
OP
|
$9,011.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967442
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,523.08 |
| Max. Negotiated Rate |
$36,044.00 |
| Rate for Payer: Aetna Commercial |
$8,109.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,749.46
|
| Rate for Payer: Aetna Managed Medicare |
$2,523.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,857.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,505.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,325.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,775.83
|
| Rate for Payer: Cash Price |
$2,703.30
|
| Rate for Payer: Cigna Commercial |
$8,290.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,042.56
|
| Rate for Payer: Health EOS Commercial |
$8,019.79
|
| Rate for Payer: HFN Commercial |
$8,290.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,758.25
|
| Rate for Payer: Multiplan Commercial |
$7,208.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,406.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,290.12
|
| Rate for Payer: Quartz Beloit One Network |
$4,415.39
|
| Rate for Payer: Quartz Commercial |
$5,857.15
|
| Rate for Payer: Quartz Medicare Advantage |
$5,406.60
|
| Rate for Payer: The Alliance Commercial |
$36,044.00
|
| Rate for Payer: WEA Trust Commercial |
$4,956.05
|
| Rate for Payer: WPS Commercial |
$6,674.45
|
|
|
ARTICULAR SURFACE CD 1-2 10MM 5964-22-10
|
Facility
|
IP
|
$9,011.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967442
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,415.39 |
| Max. Negotiated Rate |
$8,290.12 |
| Rate for Payer: Aetna Commercial |
$8,109.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,749.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,775.83
|
| Rate for Payer: Cash Price |
$2,703.30
|
| Rate for Payer: Cigna Commercial |
$8,290.12
|
| Rate for Payer: Health EOS Commercial |
$8,019.79
|
| Rate for Payer: HFN Commercial |
$8,290.12
|
| Rate for Payer: Multiplan Commercial |
$7,208.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,406.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,290.12
|
| Rate for Payer: Quartz Beloit One Network |
$4,415.39
|
| Rate for Payer: Quartz Commercial |
$5,406.60
|
| Rate for Payer: WEA Trust Commercial |
$4,956.05
|
| Rate for Payer: WPS Commercial |
$6,674.45
|
|
|
ARTICULAR SURFACE CD 1-2 12MM 5964-22-12
|
Facility
|
IP
|
$9,011.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967443
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,415.39 |
| Max. Negotiated Rate |
$8,290.12 |
| Rate for Payer: Aetna Commercial |
$8,109.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,749.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,775.83
|
| Rate for Payer: Cash Price |
$2,703.30
|
| Rate for Payer: Cigna Commercial |
$8,290.12
|
| Rate for Payer: Health EOS Commercial |
$8,019.79
|
| Rate for Payer: HFN Commercial |
$8,290.12
|
| Rate for Payer: Multiplan Commercial |
$7,208.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,406.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,290.12
|
| Rate for Payer: Quartz Beloit One Network |
$4,415.39
|
| Rate for Payer: Quartz Commercial |
$5,406.60
|
| Rate for Payer: WEA Trust Commercial |
$4,956.05
|
| Rate for Payer: WPS Commercial |
$6,674.45
|
|
|
ARTICULAR SURFACE CD 1-2 12MM 5964-22-12
|
Facility
|
OP
|
$9,011.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967443
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,523.08 |
| Max. Negotiated Rate |
$36,044.00 |
| Rate for Payer: Aetna Commercial |
$8,109.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,749.46
|
| Rate for Payer: Aetna Managed Medicare |
$2,523.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,857.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,505.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,325.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,775.83
|
| Rate for Payer: Cash Price |
$2,703.30
|
| Rate for Payer: Cigna Commercial |
$8,290.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,042.56
|
| Rate for Payer: Health EOS Commercial |
$8,019.79
|
| Rate for Payer: HFN Commercial |
$8,290.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,758.25
|
| Rate for Payer: Multiplan Commercial |
$7,208.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,406.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,290.12
|
| Rate for Payer: Quartz Beloit One Network |
$4,415.39
|
| Rate for Payer: Quartz Commercial |
$5,857.15
|
| Rate for Payer: Quartz Medicare Advantage |
$5,406.60
|
| Rate for Payer: The Alliance Commercial |
$36,044.00
|
| Rate for Payer: WEA Trust Commercial |
$4,956.05
|
| Rate for Payer: WPS Commercial |
$6,674.45
|
|
|
ARTICULAR SURFACE CD 1-2 14MM 5964-22-14
|
Facility
|
IP
|
$9,011.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967444
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,415.39 |
| Max. Negotiated Rate |
$8,290.12 |
| Rate for Payer: Aetna Commercial |
$8,109.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,749.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,775.83
|
| Rate for Payer: Cash Price |
$2,703.30
|
| Rate for Payer: Cigna Commercial |
$8,290.12
|
| Rate for Payer: Health EOS Commercial |
$8,019.79
|
| Rate for Payer: HFN Commercial |
$8,290.12
|
| Rate for Payer: Multiplan Commercial |
$7,208.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,406.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,290.12
|
| Rate for Payer: Quartz Beloit One Network |
$4,415.39
|
| Rate for Payer: Quartz Commercial |
$5,406.60
|
| Rate for Payer: WEA Trust Commercial |
$4,956.05
|
| Rate for Payer: WPS Commercial |
$6,674.45
|
|
|
ARTICULAR SURFACE CD 1-2 14MM 5964-22-14
|
Facility
|
OP
|
$9,011.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967444
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,523.08 |
| Max. Negotiated Rate |
$36,044.00 |
| Rate for Payer: Aetna Commercial |
$8,109.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,749.46
|
| Rate for Payer: Aetna Managed Medicare |
$2,523.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,857.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,505.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,325.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,775.83
|
| Rate for Payer: Cash Price |
$2,703.30
|
| Rate for Payer: Cigna Commercial |
$8,290.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,042.56
|
| Rate for Payer: Health EOS Commercial |
$8,019.79
|
| Rate for Payer: HFN Commercial |
$8,290.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,758.25
|
| Rate for Payer: Multiplan Commercial |
$7,208.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,406.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,290.12
|
| Rate for Payer: Quartz Beloit One Network |
$4,415.39
|
| Rate for Payer: Quartz Commercial |
$5,857.15
|
| Rate for Payer: Quartz Medicare Advantage |
$5,406.60
|
| Rate for Payer: The Alliance Commercial |
$36,044.00
|
| Rate for Payer: WEA Trust Commercial |
$4,956.05
|
| Rate for Payer: WPS Commercial |
$6,674.45
|
|
|
ARTICULAR SURFACE CD 1-2 17MM 5964-22-17
|
Facility
|
OP
|
$9,011.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967445
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,523.08 |
| Max. Negotiated Rate |
$36,044.00 |
| Rate for Payer: Aetna Commercial |
$8,109.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,749.46
|
| Rate for Payer: Aetna Managed Medicare |
$2,523.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,857.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,505.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,325.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,775.83
|
| Rate for Payer: Cash Price |
$2,703.30
|
| Rate for Payer: Cigna Commercial |
$8,290.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,042.56
|
| Rate for Payer: Health EOS Commercial |
$8,019.79
|
| Rate for Payer: HFN Commercial |
$8,290.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,758.25
|
| Rate for Payer: Multiplan Commercial |
$7,208.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,406.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,290.12
|
| Rate for Payer: Quartz Beloit One Network |
$4,415.39
|
| Rate for Payer: Quartz Commercial |
$5,857.15
|
| Rate for Payer: Quartz Medicare Advantage |
$5,406.60
|
| Rate for Payer: The Alliance Commercial |
$36,044.00
|
| Rate for Payer: WEA Trust Commercial |
$4,956.05
|
| Rate for Payer: WPS Commercial |
$6,674.45
|
|
|
ARTICULAR SURFACE CD 1-2 17MM 5964-22-17
|
Facility
|
IP
|
$9,011.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967445
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,415.39 |
| Max. Negotiated Rate |
$8,290.12 |
| Rate for Payer: Aetna Commercial |
$8,109.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,749.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,775.83
|
| Rate for Payer: Cash Price |
$2,703.30
|
| Rate for Payer: Cigna Commercial |
$8,290.12
|
| Rate for Payer: Health EOS Commercial |
$8,019.79
|
| Rate for Payer: HFN Commercial |
$8,290.12
|
| Rate for Payer: Multiplan Commercial |
$7,208.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,406.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,290.12
|
| Rate for Payer: Quartz Beloit One Network |
$4,415.39
|
| Rate for Payer: Quartz Commercial |
$5,406.60
|
| Rate for Payer: WEA Trust Commercial |
$4,956.05
|
| Rate for Payer: WPS Commercial |
$6,674.45
|
|
|
ARTICULAR SURFACE CD 1-2 20MM 5964-22-20
|
Facility
|
OP
|
$9,011.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967446
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,523.08 |
| Max. Negotiated Rate |
$36,044.00 |
| Rate for Payer: Aetna Commercial |
$8,109.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,749.46
|
| Rate for Payer: Aetna Managed Medicare |
$2,523.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,857.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,505.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,325.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,775.83
|
| Rate for Payer: Cash Price |
$2,703.30
|
| Rate for Payer: Cigna Commercial |
$8,290.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,042.56
|
| Rate for Payer: Health EOS Commercial |
$8,019.79
|
| Rate for Payer: HFN Commercial |
$8,290.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,758.25
|
| Rate for Payer: Multiplan Commercial |
$7,208.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,406.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,290.12
|
| Rate for Payer: Quartz Beloit One Network |
$4,415.39
|
| Rate for Payer: Quartz Commercial |
$5,857.15
|
| Rate for Payer: Quartz Medicare Advantage |
$5,406.60
|
| Rate for Payer: The Alliance Commercial |
$36,044.00
|
| Rate for Payer: WEA Trust Commercial |
$4,956.05
|
| Rate for Payer: WPS Commercial |
$6,674.45
|
|
|
ARTICULAR SURFACE CD 1-2 20MM 5964-22-20
|
Facility
|
IP
|
$9,011.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967446
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,415.39 |
| Max. Negotiated Rate |
$8,290.12 |
| Rate for Payer: Aetna Commercial |
$8,109.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,749.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,775.83
|
| Rate for Payer: Cash Price |
$2,703.30
|
| Rate for Payer: Cigna Commercial |
$8,290.12
|
| Rate for Payer: Health EOS Commercial |
$8,019.79
|
| Rate for Payer: HFN Commercial |
$8,290.12
|
| Rate for Payer: Multiplan Commercial |
$7,208.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,406.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,290.12
|
| Rate for Payer: Quartz Beloit One Network |
$4,415.39
|
| Rate for Payer: Quartz Commercial |
$5,406.60
|
| Rate for Payer: WEA Trust Commercial |
$4,956.05
|
| Rate for Payer: WPS Commercial |
$6,674.45
|
|
|
ARTICULAR SURFACE CD 3-4 10MM PROLONG 5962-30-10
|
Facility
|
IP
|
$9,011.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967575
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,415.39 |
| Max. Negotiated Rate |
$8,290.12 |
| Rate for Payer: Aetna Commercial |
$8,109.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,749.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,775.83
|
| Rate for Payer: Cash Price |
$2,703.30
|
| Rate for Payer: Cigna Commercial |
$8,290.12
|
| Rate for Payer: Health EOS Commercial |
$8,019.79
|
| Rate for Payer: HFN Commercial |
$8,290.12
|
| Rate for Payer: Multiplan Commercial |
$7,208.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,406.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,290.12
|
| Rate for Payer: Quartz Beloit One Network |
$4,415.39
|
| Rate for Payer: Quartz Commercial |
$5,406.60
|
| Rate for Payer: WEA Trust Commercial |
$4,956.05
|
| Rate for Payer: WPS Commercial |
$6,674.45
|
|
|
ARTICULAR SURFACE CD 3-4 10MM PROLONG 5962-30-10
|
Facility
|
OP
|
$9,011.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967575
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,523.08 |
| Max. Negotiated Rate |
$36,044.00 |
| Rate for Payer: Aetna Commercial |
$8,109.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,749.46
|
| Rate for Payer: Aetna Managed Medicare |
$2,523.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,857.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,505.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,325.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,775.83
|
| Rate for Payer: Cash Price |
$2,703.30
|
| Rate for Payer: Cigna Commercial |
$8,290.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,042.56
|
| Rate for Payer: Health EOS Commercial |
$8,019.79
|
| Rate for Payer: HFN Commercial |
$8,290.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,758.25
|
| Rate for Payer: Multiplan Commercial |
$7,208.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,406.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,290.12
|
| Rate for Payer: Quartz Beloit One Network |
$4,415.39
|
| Rate for Payer: Quartz Commercial |
$5,857.15
|
| Rate for Payer: Quartz Medicare Advantage |
$5,406.60
|
| Rate for Payer: The Alliance Commercial |
$36,044.00
|
| Rate for Payer: WEA Trust Commercial |
$4,956.05
|
| Rate for Payer: WPS Commercial |
$6,674.45
|
|
|
ARTICULAR SURFACE CD 3-4 12MM PROLONG 5962-30-12
|
Facility
|
OP
|
$9,011.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967576
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,523.08 |
| Max. Negotiated Rate |
$36,044.00 |
| Rate for Payer: Aetna Commercial |
$8,109.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,749.46
|
| Rate for Payer: Aetna Managed Medicare |
$2,523.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,857.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,505.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,325.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,775.83
|
| Rate for Payer: Cash Price |
$2,703.30
|
| Rate for Payer: Cigna Commercial |
$8,290.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,042.56
|
| Rate for Payer: Health EOS Commercial |
$8,019.79
|
| Rate for Payer: HFN Commercial |
$8,290.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,758.25
|
| Rate for Payer: Multiplan Commercial |
$7,208.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,406.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,290.12
|
| Rate for Payer: Quartz Beloit One Network |
$4,415.39
|
| Rate for Payer: Quartz Commercial |
$5,857.15
|
| Rate for Payer: Quartz Medicare Advantage |
$5,406.60
|
| Rate for Payer: The Alliance Commercial |
$36,044.00
|
| Rate for Payer: WEA Trust Commercial |
$4,956.05
|
| Rate for Payer: WPS Commercial |
$6,674.45
|
|
|
ARTICULAR SURFACE CD 3-4 12MM PROLONG 5962-30-12
|
Facility
|
IP
|
$9,011.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967576
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,415.39 |
| Max. Negotiated Rate |
$8,290.12 |
| Rate for Payer: Aetna Commercial |
$8,109.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,749.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,775.83
|
| Rate for Payer: Cash Price |
$2,703.30
|
| Rate for Payer: Cigna Commercial |
$8,290.12
|
| Rate for Payer: Health EOS Commercial |
$8,019.79
|
| Rate for Payer: HFN Commercial |
$8,290.12
|
| Rate for Payer: Multiplan Commercial |
$7,208.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,406.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,290.12
|
| Rate for Payer: Quartz Beloit One Network |
$4,415.39
|
| Rate for Payer: Quartz Commercial |
$5,406.60
|
| Rate for Payer: WEA Trust Commercial |
$4,956.05
|
| Rate for Payer: WPS Commercial |
$6,674.45
|
|
|
ARTICULAR SURFACE CD3-4 14MM PROLONG 5962-30-14
|
Facility
|
OP
|
$9,358.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967577
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,620.24 |
| Max. Negotiated Rate |
$37,432.00 |
| Rate for Payer: Aetna Commercial |
$8,422.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,047.88
|
| Rate for Payer: Aetna Managed Medicare |
$2,620.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,082.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,679.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,491.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,959.74
|
| Rate for Payer: Cash Price |
$2,807.40
|
| Rate for Payer: Cigna Commercial |
$8,609.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,236.74
|
| Rate for Payer: Health EOS Commercial |
$8,328.62
|
| Rate for Payer: HFN Commercial |
$8,609.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,018.50
|
| Rate for Payer: Multiplan Commercial |
$7,486.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,614.80
|
| Rate for Payer: Preferred Network Access Commercial |
$8,609.36
|
| Rate for Payer: Quartz Beloit One Network |
$4,585.42
|
| Rate for Payer: Quartz Commercial |
$6,082.70
|
| Rate for Payer: Quartz Medicare Advantage |
$5,614.80
|
| Rate for Payer: The Alliance Commercial |
$37,432.00
|
| Rate for Payer: WEA Trust Commercial |
$5,146.90
|
| Rate for Payer: WPS Commercial |
$6,931.47
|
|
|
ARTICULAR SURFACE CD3-4 14MM PROLONG 5962-30-14
|
Facility
|
IP
|
$9,358.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967577
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,585.42 |
| Max. Negotiated Rate |
$8,609.36 |
| Rate for Payer: Aetna Commercial |
$8,422.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,047.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,959.74
|
| Rate for Payer: Cash Price |
$2,807.40
|
| Rate for Payer: Cigna Commercial |
$8,609.36
|
| Rate for Payer: Health EOS Commercial |
$8,328.62
|
| Rate for Payer: HFN Commercial |
$8,609.36
|
| Rate for Payer: Multiplan Commercial |
$7,486.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,614.80
|
| Rate for Payer: Preferred Network Access Commercial |
$8,609.36
|
| Rate for Payer: Quartz Beloit One Network |
$4,585.42
|
| Rate for Payer: Quartz Commercial |
$5,614.80
|
| Rate for Payer: WEA Trust Commercial |
$5,146.90
|
| Rate for Payer: WPS Commercial |
$6,931.47
|
|
