|
ARTICULAR SURFACE PERSONA CPS VE RT 10-12 G-H 12MM 42-5226-010-12
|
Facility
OP
|
$11,893.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5240732
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,330.04 |
| Max. Negotiated Rate |
$10,941.56 |
| Rate for Payer: Aetna Commercial |
$10,703.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,227.98
|
| Rate for Payer: Aetna Managed Medicare |
$3,330.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,730.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,946.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,708.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,303.29
|
| Rate for Payer: Cash Price |
$3,567.90
|
| Rate for Payer: Cigna Commercial |
$10,941.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,655.32
|
| Rate for Payer: Health EOS Commercial |
$10,584.77
|
| Rate for Payer: HFN Commercial |
$10,941.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,919.75
|
| Rate for Payer: Multiplan Commercial |
$9,514.40
|
| Rate for Payer: NAPHCARE Commercial |
$7,135.80
|
| Rate for Payer: Preferred Network Access Commercial |
$10,941.56
|
| Rate for Payer: Quartz Beloit One Network |
$5,827.57
|
| Rate for Payer: Quartz Commercial |
$7,730.45
|
| Rate for Payer: Quartz Medicare Advantage |
$7,135.80
|
| Rate for Payer: WEA Trust Commercial |
$6,541.15
|
| Rate for Payer: WPS Commercial |
$8,809.15
|
|
|
ARTICULAR SURFACE PERSONA CPS VE RT 10-12 G-H 12MM 42-5226-010-12
|
Facility
IP
|
$11,893.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5240732
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,827.57 |
| Max. Negotiated Rate |
$10,941.56 |
| Rate for Payer: Aetna Commercial |
$10,703.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,303.29
|
| Rate for Payer: Cash Price |
$3,567.90
|
| Rate for Payer: Cigna Commercial |
$10,941.56
|
| Rate for Payer: Health EOS Commercial |
$10,584.77
|
| Rate for Payer: HFN Commercial |
$10,941.56
|
| Rate for Payer: Multiplan Commercial |
$9,514.40
|
| Rate for Payer: NAPHCARE Commercial |
$7,135.80
|
| Rate for Payer: Preferred Network Access Commercial |
$10,941.56
|
| Rate for Payer: Quartz Beloit One Network |
$5,827.57
|
| Rate for Payer: Quartz Commercial |
$7,135.80
|
| Rate for Payer: WEA Trust Commercial |
$6,541.15
|
| Rate for Payer: WPS Commercial |
$8,809.15
|
|
|
ARTICULAR SURFACE PERSONA CPS VE RT 3-5 EF 16MM 42-5226-006-16
|
Facility
IP
|
$6,656.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5831802
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,261.44 |
| Max. Negotiated Rate |
$6,123.52 |
| Rate for Payer: Aetna Commercial |
$5,990.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,527.68
|
| Rate for Payer: Cash Price |
$1,996.80
|
| Rate for Payer: Cigna Commercial |
$6,123.52
|
| Rate for Payer: Health EOS Commercial |
$5,923.84
|
| Rate for Payer: HFN Commercial |
$6,123.52
|
| Rate for Payer: Multiplan Commercial |
$5,324.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,993.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,123.52
|
| Rate for Payer: Quartz Beloit One Network |
$3,261.44
|
| Rate for Payer: Quartz Commercial |
$3,993.60
|
| Rate for Payer: WEA Trust Commercial |
$3,660.80
|
| Rate for Payer: WPS Commercial |
$4,930.10
|
|
|
ARTICULAR SURFACE PERSONA CPS VE RT 3-5 EF 16MM 42-5226-006-16
|
Facility
OP
|
$6,656.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5831802
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,863.68 |
| Max. Negotiated Rate |
$6,123.52 |
| Rate for Payer: Aetna Commercial |
$5,990.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,724.16
|
| Rate for Payer: Aetna Managed Medicare |
$1,863.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,326.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,328.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,194.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,527.68
|
| Rate for Payer: Cash Price |
$1,996.80
|
| Rate for Payer: Cigna Commercial |
$6,123.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,724.70
|
| Rate for Payer: Health EOS Commercial |
$5,923.84
|
| Rate for Payer: HFN Commercial |
$6,123.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,992.00
|
| Rate for Payer: Multiplan Commercial |
$5,324.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,993.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,123.52
|
| Rate for Payer: Quartz Beloit One Network |
$3,261.44
|
| Rate for Payer: Quartz Commercial |
$4,326.40
|
| Rate for Payer: Quartz Medicare Advantage |
$3,993.60
|
| Rate for Payer: WEA Trust Commercial |
$3,660.80
|
| Rate for Payer: WPS Commercial |
$4,930.10
|
|
|
ARTICULAR SURFACE PERSONA CPS VE RT 6-9 EF 12MM 42-5226-007-12
|
Facility
OP
|
$12,350.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5456691
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,458.00 |
| Max. Negotiated Rate |
$11,362.00 |
| Rate for Payer: Aetna Commercial |
$11,115.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,621.00
|
| Rate for Payer: Aetna Managed Medicare |
$3,458.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,027.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,175.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,928.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,545.50
|
| Rate for Payer: Cash Price |
$3,705.00
|
| Rate for Payer: Cigna Commercial |
$11,362.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,911.06
|
| Rate for Payer: Health EOS Commercial |
$10,991.50
|
| Rate for Payer: HFN Commercial |
$11,362.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,262.50
|
| Rate for Payer: Multiplan Commercial |
$9,880.00
|
| Rate for Payer: NAPHCARE Commercial |
$7,410.00
|
| Rate for Payer: Preferred Network Access Commercial |
$11,362.00
|
| Rate for Payer: Quartz Beloit One Network |
$6,051.50
|
| Rate for Payer: Quartz Commercial |
$8,027.50
|
| Rate for Payer: Quartz Medicare Advantage |
$7,410.00
|
| Rate for Payer: WEA Trust Commercial |
$6,792.50
|
| Rate for Payer: WPS Commercial |
$9,147.64
|
|
|
ARTICULAR SURFACE PERSONA CPS VE RT 6-9 EF 12MM 42-5226-007-12
|
Facility
IP
|
$12,350.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5456691
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6,051.50 |
| Max. Negotiated Rate |
$11,362.00 |
| Rate for Payer: Aetna Commercial |
$11,115.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,545.50
|
| Rate for Payer: Cash Price |
$3,705.00
|
| Rate for Payer: Cigna Commercial |
$11,362.00
|
| Rate for Payer: Health EOS Commercial |
$10,991.50
|
| Rate for Payer: HFN Commercial |
$11,362.00
|
| Rate for Payer: Multiplan Commercial |
$9,880.00
|
| Rate for Payer: NAPHCARE Commercial |
$7,410.00
|
| Rate for Payer: Preferred Network Access Commercial |
$11,362.00
|
| Rate for Payer: Quartz Beloit One Network |
$6,051.50
|
| Rate for Payer: Quartz Commercial |
$7,410.00
|
| Rate for Payer: WEA Trust Commercial |
$6,792.50
|
| Rate for Payer: WPS Commercial |
$9,147.64
|
|
|
ARTICULAR SURFACE PERSONA CPS VE RT 6-9 EF 14MM 42-5226-007-14
|
Facility
OP
|
$6,656.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4509069
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,863.68 |
| Max. Negotiated Rate |
$6,123.52 |
| Rate for Payer: Aetna Commercial |
$5,990.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,724.16
|
| Rate for Payer: Aetna Managed Medicare |
$1,863.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,326.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,328.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,194.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,527.68
|
| Rate for Payer: Cash Price |
$1,996.80
|
| Rate for Payer: Cigna Commercial |
$6,123.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,724.70
|
| Rate for Payer: Health EOS Commercial |
$5,923.84
|
| Rate for Payer: HFN Commercial |
$6,123.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,992.00
|
| Rate for Payer: Multiplan Commercial |
$5,324.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,993.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,123.52
|
| Rate for Payer: Quartz Beloit One Network |
$3,261.44
|
| Rate for Payer: Quartz Commercial |
$4,326.40
|
| Rate for Payer: Quartz Medicare Advantage |
$3,993.60
|
| Rate for Payer: WEA Trust Commercial |
$3,660.80
|
| Rate for Payer: WPS Commercial |
$4,930.10
|
|
|
ARTICULAR SURFACE PERSONA CPS VE RT 6-9 EF 14MM 42-5226-007-14
|
Facility
IP
|
$6,656.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4509069
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,261.44 |
| Max. Negotiated Rate |
$6,123.52 |
| Rate for Payer: Aetna Commercial |
$5,990.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,527.68
|
| Rate for Payer: Cash Price |
$1,996.80
|
| Rate for Payer: Cigna Commercial |
$6,123.52
|
| Rate for Payer: Health EOS Commercial |
$5,923.84
|
| Rate for Payer: HFN Commercial |
$6,123.52
|
| Rate for Payer: Multiplan Commercial |
$5,324.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,993.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,123.52
|
| Rate for Payer: Quartz Beloit One Network |
$3,261.44
|
| Rate for Payer: Quartz Commercial |
$3,993.60
|
| Rate for Payer: WEA Trust Commercial |
$3,660.80
|
| Rate for Payer: WPS Commercial |
$4,930.10
|
|
|
ARTICULAR SURFACE PERSONA CR VE 3-11 EF 11MM RT 42-5220-005-11
|
Facility
OP
|
$8,771.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3491509
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,455.88 |
| Max. Negotiated Rate |
$8,069.32 |
| Rate for Payer: Aetna Commercial |
$7,893.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,543.06
|
| Rate for Payer: Aetna Managed Medicare |
$2,455.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,701.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,385.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,210.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,648.63
|
| Rate for Payer: Cash Price |
$2,631.30
|
| Rate for Payer: Cigna Commercial |
$8,069.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,908.25
|
| Rate for Payer: Health EOS Commercial |
$7,806.19
|
| Rate for Payer: HFN Commercial |
$8,069.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,578.25
|
| Rate for Payer: Multiplan Commercial |
$7,016.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,262.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,069.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,297.79
|
| Rate for Payer: Quartz Commercial |
$5,701.15
|
| Rate for Payer: Quartz Medicare Advantage |
$5,262.60
|
| Rate for Payer: WEA Trust Commercial |
$4,824.05
|
| Rate for Payer: WPS Commercial |
$6,496.68
|
|
|
ARTICULAR SURFACE PERSONA CR VE 3-11 EF 11MM RT 42-5220-005-11
|
Facility
IP
|
$8,771.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3491509
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,297.79 |
| Max. Negotiated Rate |
$8,069.32 |
| Rate for Payer: Aetna Commercial |
$7,893.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,648.63
|
| Rate for Payer: Cash Price |
$2,631.30
|
| Rate for Payer: Cigna Commercial |
$8,069.32
|
| Rate for Payer: Health EOS Commercial |
$7,806.19
|
| Rate for Payer: HFN Commercial |
$8,069.32
|
| Rate for Payer: Multiplan Commercial |
$7,016.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,262.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,069.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,297.79
|
| Rate for Payer: Quartz Commercial |
$5,262.60
|
| Rate for Payer: WEA Trust Commercial |
$4,824.05
|
| Rate for Payer: WPS Commercial |
$6,496.68
|
|
|
ARTICULAR SURFACE PERSONA CR VE 3-11 EF 12MM RT 42-5220-005-12
|
Facility
IP
|
$8,446.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3615502
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,138.54 |
| Max. Negotiated Rate |
$7,770.32 |
| Rate for Payer: Aetna Commercial |
$7,601.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,476.38
|
| Rate for Payer: Cash Price |
$2,533.80
|
| Rate for Payer: Cigna Commercial |
$7,770.32
|
| Rate for Payer: Health EOS Commercial |
$7,516.94
|
| Rate for Payer: HFN Commercial |
$7,770.32
|
| Rate for Payer: Multiplan Commercial |
$6,756.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,067.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,770.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,138.54
|
| Rate for Payer: Quartz Commercial |
$5,067.60
|
| Rate for Payer: WEA Trust Commercial |
$4,645.30
|
| Rate for Payer: WPS Commercial |
$6,255.95
|
|
|
ARTICULAR SURFACE PERSONA CR VE 3-11 EF 12MM RT 42-5220-005-12
|
Facility
OP
|
$8,446.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3615502
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,364.88 |
| Max. Negotiated Rate |
$7,770.32 |
| Rate for Payer: Aetna Commercial |
$7,601.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,263.56
|
| Rate for Payer: Aetna Managed Medicare |
$2,364.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,489.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,223.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,054.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,476.38
|
| Rate for Payer: Cash Price |
$2,533.80
|
| Rate for Payer: Cigna Commercial |
$7,770.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,726.38
|
| Rate for Payer: Health EOS Commercial |
$7,516.94
|
| Rate for Payer: HFN Commercial |
$7,770.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,334.50
|
| Rate for Payer: Multiplan Commercial |
$6,756.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,067.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,770.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,138.54
|
| Rate for Payer: Quartz Commercial |
$5,489.90
|
| Rate for Payer: Quartz Medicare Advantage |
$5,067.60
|
| Rate for Payer: WEA Trust Commercial |
$4,645.30
|
| Rate for Payer: WPS Commercial |
$6,255.95
|
|
|
ARTICULAR SURFACE PERSONA CR VE 3-9 CD 11MM RT 42-5220-004-11
|
Facility
IP
|
$8,446.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3898148
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,138.54 |
| Max. Negotiated Rate |
$7,770.32 |
| Rate for Payer: Aetna Commercial |
$7,601.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,476.38
|
| Rate for Payer: Cash Price |
$2,533.80
|
| Rate for Payer: Cigna Commercial |
$7,770.32
|
| Rate for Payer: Health EOS Commercial |
$7,516.94
|
| Rate for Payer: HFN Commercial |
$7,770.32
|
| Rate for Payer: Multiplan Commercial |
$6,756.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,067.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,770.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,138.54
|
| Rate for Payer: Quartz Commercial |
$5,067.60
|
| Rate for Payer: WEA Trust Commercial |
$4,645.30
|
| Rate for Payer: WPS Commercial |
$6,255.95
|
|
|
ARTICULAR SURFACE PERSONA CR VE 3-9 CD 11MM RT 42-5220-004-11
|
Facility
OP
|
$8,446.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3898148
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,364.88 |
| Max. Negotiated Rate |
$7,770.32 |
| Rate for Payer: Aetna Commercial |
$7,601.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,263.56
|
| Rate for Payer: Aetna Managed Medicare |
$2,364.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,489.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,223.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,054.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,476.38
|
| Rate for Payer: Cash Price |
$2,533.80
|
| Rate for Payer: Cigna Commercial |
$7,770.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,726.38
|
| Rate for Payer: Health EOS Commercial |
$7,516.94
|
| Rate for Payer: HFN Commercial |
$7,770.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,334.50
|
| Rate for Payer: Multiplan Commercial |
$6,756.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,067.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,770.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,138.54
|
| Rate for Payer: Quartz Commercial |
$5,489.90
|
| Rate for Payer: Quartz Medicare Advantage |
$5,067.60
|
| Rate for Payer: WEA Trust Commercial |
$4,645.30
|
| Rate for Payer: WPS Commercial |
$6,255.95
|
|
|
ARTICULAR SURFACE PERSONA CR VE 3-9 CD 12MM RT 42-5220-004-12
|
Facility
IP
|
$8,771.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4510809
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,297.79 |
| Max. Negotiated Rate |
$8,069.32 |
| Rate for Payer: Aetna Commercial |
$7,893.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,648.63
|
| Rate for Payer: Cash Price |
$2,631.30
|
| Rate for Payer: Cigna Commercial |
$8,069.32
|
| Rate for Payer: Health EOS Commercial |
$7,806.19
|
| Rate for Payer: HFN Commercial |
$8,069.32
|
| Rate for Payer: Multiplan Commercial |
$7,016.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,262.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,069.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,297.79
|
| Rate for Payer: Quartz Commercial |
$5,262.60
|
| Rate for Payer: WEA Trust Commercial |
$4,824.05
|
| Rate for Payer: WPS Commercial |
$6,496.68
|
|
|
ARTICULAR SURFACE PERSONA CR VE 3-9 CD 12MM RT 42-5220-004-12
|
Facility
OP
|
$8,771.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4510809
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,455.88 |
| Max. Negotiated Rate |
$8,069.32 |
| Rate for Payer: Aetna Commercial |
$7,893.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,543.06
|
| Rate for Payer: Aetna Managed Medicare |
$2,455.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,701.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,385.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,210.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,648.63
|
| Rate for Payer: Cash Price |
$2,631.30
|
| Rate for Payer: Cigna Commercial |
$8,069.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,908.25
|
| Rate for Payer: Health EOS Commercial |
$7,806.19
|
| Rate for Payer: HFN Commercial |
$8,069.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,578.25
|
| Rate for Payer: Multiplan Commercial |
$7,016.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,262.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,069.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,297.79
|
| Rate for Payer: Quartz Commercial |
$5,701.15
|
| Rate for Payer: Quartz Medicare Advantage |
$5,262.60
|
| Rate for Payer: WEA Trust Commercial |
$4,824.05
|
| Rate for Payer: WPS Commercial |
$6,496.68
|
|
|
ARTICULAR SURFACE PERSONA CR VE 7-12 GH 10MM RT 42-5220-006-10
|
Facility
OP
|
$8,446.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4518701
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,364.88 |
| Max. Negotiated Rate |
$7,770.32 |
| Rate for Payer: Aetna Commercial |
$7,601.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,263.56
|
| Rate for Payer: Aetna Managed Medicare |
$2,364.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,489.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,223.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,054.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,476.38
|
| Rate for Payer: Cash Price |
$2,533.80
|
| Rate for Payer: Cigna Commercial |
$7,770.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,726.38
|
| Rate for Payer: Health EOS Commercial |
$7,516.94
|
| Rate for Payer: HFN Commercial |
$7,770.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,334.50
|
| Rate for Payer: Multiplan Commercial |
$6,756.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,067.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,770.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,138.54
|
| Rate for Payer: Quartz Commercial |
$5,489.90
|
| Rate for Payer: Quartz Medicare Advantage |
$5,067.60
|
| Rate for Payer: WEA Trust Commercial |
$4,645.30
|
| Rate for Payer: WPS Commercial |
$6,255.95
|
|
|
ARTICULAR SURFACE PERSONA CR VE 7-12 GH 10MM RT 42-5220-006-10
|
Facility
IP
|
$8,446.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4518701
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,138.54 |
| Max. Negotiated Rate |
$7,770.32 |
| Rate for Payer: Aetna Commercial |
$7,601.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,476.38
|
| Rate for Payer: Cash Price |
$2,533.80
|
| Rate for Payer: Cigna Commercial |
$7,770.32
|
| Rate for Payer: Health EOS Commercial |
$7,516.94
|
| Rate for Payer: HFN Commercial |
$7,770.32
|
| Rate for Payer: Multiplan Commercial |
$6,756.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,067.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,770.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,138.54
|
| Rate for Payer: Quartz Commercial |
$5,067.60
|
| Rate for Payer: WEA Trust Commercial |
$4,645.30
|
| Rate for Payer: WPS Commercial |
$6,255.95
|
|
|
ARTICULAR SURFACE PERSONA CR VE 7-12 GH 11MM RT 42-5220-006-11
|
Facility
OP
|
$8,771.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3739520
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,455.88 |
| Max. Negotiated Rate |
$8,069.32 |
| Rate for Payer: Aetna Commercial |
$7,893.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,543.06
|
| Rate for Payer: Aetna Managed Medicare |
$2,455.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,701.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,385.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,210.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,648.63
|
| Rate for Payer: Cash Price |
$2,631.30
|
| Rate for Payer: Cigna Commercial |
$8,069.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,908.25
|
| Rate for Payer: Health EOS Commercial |
$7,806.19
|
| Rate for Payer: HFN Commercial |
$8,069.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,578.25
|
| Rate for Payer: Multiplan Commercial |
$7,016.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,262.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,069.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,297.79
|
| Rate for Payer: Quartz Commercial |
$5,701.15
|
| Rate for Payer: Quartz Medicare Advantage |
$5,262.60
|
| Rate for Payer: WEA Trust Commercial |
$4,824.05
|
| Rate for Payer: WPS Commercial |
$6,496.68
|
|
|
ARTICULAR SURFACE PERSONA CR VE 7-12 GH 11MM RT 42-5220-006-11
|
Facility
IP
|
$8,771.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3739520
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,297.79 |
| Max. Negotiated Rate |
$8,069.32 |
| Rate for Payer: Aetna Commercial |
$7,893.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,648.63
|
| Rate for Payer: Cash Price |
$2,631.30
|
| Rate for Payer: Cigna Commercial |
$8,069.32
|
| Rate for Payer: Health EOS Commercial |
$7,806.19
|
| Rate for Payer: HFN Commercial |
$8,069.32
|
| Rate for Payer: Multiplan Commercial |
$7,016.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,262.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,069.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,297.79
|
| Rate for Payer: Quartz Commercial |
$5,262.60
|
| Rate for Payer: WEA Trust Commercial |
$4,824.05
|
| Rate for Payer: WPS Commercial |
$6,496.68
|
|
|
ARTICULAR SURFACE PERSONA CR VE 7-12 GH 12MM RT 42-5220-006-12
|
Facility
IP
|
$8,446.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4509078
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,138.54 |
| Max. Negotiated Rate |
$7,770.32 |
| Rate for Payer: Aetna Commercial |
$7,601.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,476.38
|
| Rate for Payer: Cash Price |
$2,533.80
|
| Rate for Payer: Cigna Commercial |
$7,770.32
|
| Rate for Payer: Health EOS Commercial |
$7,516.94
|
| Rate for Payer: HFN Commercial |
$7,770.32
|
| Rate for Payer: Multiplan Commercial |
$6,756.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,067.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,770.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,138.54
|
| Rate for Payer: Quartz Commercial |
$5,067.60
|
| Rate for Payer: WEA Trust Commercial |
$4,645.30
|
| Rate for Payer: WPS Commercial |
$6,255.95
|
|
|
ARTICULAR SURFACE PERSONA CR VE 7-12 GH 12MM RT 42-5220-006-12
|
Facility
OP
|
$8,446.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4509078
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,364.88 |
| Max. Negotiated Rate |
$7,770.32 |
| Rate for Payer: Aetna Commercial |
$7,601.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,263.56
|
| Rate for Payer: Aetna Managed Medicare |
$2,364.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,489.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,223.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,054.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,476.38
|
| Rate for Payer: Cash Price |
$2,533.80
|
| Rate for Payer: Cigna Commercial |
$7,770.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,726.38
|
| Rate for Payer: Health EOS Commercial |
$7,516.94
|
| Rate for Payer: HFN Commercial |
$7,770.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,334.50
|
| Rate for Payer: Multiplan Commercial |
$6,756.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,067.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,770.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,138.54
|
| Rate for Payer: Quartz Commercial |
$5,489.90
|
| Rate for Payer: Quartz Medicare Advantage |
$5,067.60
|
| Rate for Payer: WEA Trust Commercial |
$4,645.30
|
| Rate for Payer: WPS Commercial |
$6,255.95
|
|
|
ARTICULAR SURFACE PERSONA CR VE 7-12 GH 14MM RT 42-5220-006-14
|
Facility
IP
|
$8,446.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4047405
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,138.54 |
| Max. Negotiated Rate |
$7,770.32 |
| Rate for Payer: Aetna Commercial |
$7,601.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,476.38
|
| Rate for Payer: Cash Price |
$2,533.80
|
| Rate for Payer: Cigna Commercial |
$7,770.32
|
| Rate for Payer: Health EOS Commercial |
$7,516.94
|
| Rate for Payer: HFN Commercial |
$7,770.32
|
| Rate for Payer: Multiplan Commercial |
$6,756.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,067.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,770.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,138.54
|
| Rate for Payer: Quartz Commercial |
$5,067.60
|
| Rate for Payer: WEA Trust Commercial |
$4,645.30
|
| Rate for Payer: WPS Commercial |
$6,255.95
|
|
|
ARTICULAR SURFACE PERSONA CR VE 7-12 GH 14MM RT 42-5220-006-14
|
Facility
OP
|
$8,446.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4047405
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,364.88 |
| Max. Negotiated Rate |
$7,770.32 |
| Rate for Payer: Aetna Commercial |
$7,601.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,263.56
|
| Rate for Payer: Aetna Managed Medicare |
$2,364.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,489.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,223.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,054.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,476.38
|
| Rate for Payer: Cash Price |
$2,533.80
|
| Rate for Payer: Cigna Commercial |
$7,770.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,726.38
|
| Rate for Payer: Health EOS Commercial |
$7,516.94
|
| Rate for Payer: HFN Commercial |
$7,770.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,334.50
|
| Rate for Payer: Multiplan Commercial |
$6,756.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,067.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,770.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,138.54
|
| Rate for Payer: Quartz Commercial |
$5,489.90
|
| Rate for Payer: Quartz Medicare Advantage |
$5,067.60
|
| Rate for Payer: WEA Trust Commercial |
$4,645.30
|
| Rate for Payer: WPS Commercial |
$6,255.95
|
|
|
ARTICULAR SURFACE PERSONA CR VE SZ 6 13MM RT 42-5220-005-13
|
Facility
IP
|
$8,446.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3715500
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,138.54 |
| Max. Negotiated Rate |
$7,770.32 |
| Rate for Payer: Aetna Commercial |
$7,601.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,476.38
|
| Rate for Payer: Cash Price |
$2,533.80
|
| Rate for Payer: Cigna Commercial |
$7,770.32
|
| Rate for Payer: Health EOS Commercial |
$7,516.94
|
| Rate for Payer: HFN Commercial |
$7,770.32
|
| Rate for Payer: Multiplan Commercial |
$6,756.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,067.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,770.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,138.54
|
| Rate for Payer: Quartz Commercial |
$5,067.60
|
| Rate for Payer: WEA Trust Commercial |
$4,645.30
|
| Rate for Payer: WPS Commercial |
$6,255.95
|
|
