|
ARTICULAR SURFACE GREEN EF 12MM LCCK 5994-40-12
|
Facility
|
OP
|
$10,348.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2973985
|
|
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 GREEN EF 14MM LCCK 5994-40-14
|
Facility
|
IP
|
$10,348.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2973997
|
|
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 GREEN EF 14MM LCCK 5994-40-14
|
Facility
|
OP
|
$10,348.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2973997
|
|
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 GREEN EF 17MM LCCK 5994-40-17
|
Facility
|
OP
|
$10,348.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2974000
|
|
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 GREEN EF 17MM LCCK 5994-40-17
|
Facility
|
IP
|
$10,348.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2974000
|
|
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 GREEN SZ G 10MM LCCK 5994-42-10
|
Facility
|
IP
|
$10,348.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2973986
|
|
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 GREEN SZ G 10MM LCCK 5994-42-10
|
Facility
|
OP
|
$10,348.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2973986
|
|
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 GREEN SZ G 12MM LCCK 5994-42-12
|
Facility
|
IP
|
$10,348.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2973987
|
|
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 GREEN SZ G 12MM LCCK 5994-42-12
|
Facility
|
OP
|
$10,348.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2973987
|
|
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 GREEN SZ G 14MM LCCK 5994-42-14
|
Facility
|
IP
|
$10,348.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2973988
|
|
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 GREEN SZ G 14MM LCCK 5994-42-14
|
Facility
|
OP
|
$10,348.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2973988
|
|
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 GREEN SZ G 17MM LCCK 5994-42-17
|
Facility
|
IP
|
$10,348.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2973989
|
|
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 GREEN SZ G 17MM LCCK 5994-42-17
|
Facility
|
OP
|
$10,348.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2973989
|
|
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 LPS FLEX EF 3-4 12MM 5962-32-12
|
Facility
|
OP
|
$9,011.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967603
|
|
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 LPS FLEX EF 3-4 12MM 5962-32-12
|
Facility
|
IP
|
$9,011.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967603
|
|
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 PERSONA CPS VE RT 10-11 E-F 10MM 42-5226-008-10
|
Facility
|
OP
|
$6,154.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6201079
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,723.12 |
| Max. Negotiated Rate |
$24,616.00 |
| Rate for Payer: Aetna Commercial |
$5,538.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,292.44
|
| Rate for Payer: Aetna Managed Medicare |
$1,723.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,000.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,077.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,953.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,261.62
|
| Rate for Payer: Cash Price |
$1,846.20
|
| Rate for Payer: Cigna Commercial |
$5,661.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,443.78
|
| Rate for Payer: Health EOS Commercial |
$5,477.06
|
| Rate for Payer: HFN Commercial |
$5,661.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,615.50
|
| Rate for Payer: Multiplan Commercial |
$4,923.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,692.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,661.68
|
| Rate for Payer: Quartz Beloit One Network |
$3,015.46
|
| Rate for Payer: Quartz Commercial |
$4,000.10
|
| Rate for Payer: Quartz Medicare Advantage |
$3,692.40
|
| Rate for Payer: The Alliance Commercial |
$24,616.00
|
| Rate for Payer: WEA Trust Commercial |
$3,384.70
|
| Rate for Payer: WPS Commercial |
$4,558.27
|
|
|
ARTICULAR SURFACE PERSONA CPS VE RT 10-11 E-F 10MM 42-5226-008-10
|
Facility
|
IP
|
$6,154.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6201079
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,015.46 |
| Max. Negotiated Rate |
$5,661.68 |
| Rate for Payer: Aetna Commercial |
$5,538.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,292.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,261.62
|
| Rate for Payer: Cash Price |
$1,846.20
|
| Rate for Payer: Cigna Commercial |
$5,661.68
|
| Rate for Payer: Health EOS Commercial |
$5,477.06
|
| Rate for Payer: HFN Commercial |
$5,661.68
|
| Rate for Payer: Multiplan Commercial |
$4,923.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,692.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,661.68
|
| Rate for Payer: Quartz Beloit One Network |
$3,015.46
|
| Rate for Payer: Quartz Commercial |
$3,692.40
|
| Rate for Payer: WEA Trust Commercial |
$3,384.70
|
| Rate for Payer: WPS Commercial |
$4,558.27
|
|
|
ARTICULAR SURFACE PERSONA CPS VE RT 10-11 E-F 14MM 42-5226-008-14
|
Facility
|
OP
|
$6,656.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5805697
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1,863.68 |
| Max. Negotiated Rate |
$26,624.00 |
| 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: The Alliance Commercial |
$26,624.00
|
| Rate for Payer: WEA Trust Commercial |
$3,660.80
|
| Rate for Payer: WPS Commercial |
$4,930.10
|
|
|
ARTICULAR SURFACE PERSONA CPS VE RT 10-11 E-F 14MM 42-5226-008-14
|
Facility
|
IP
|
$6,656.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5805697
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$3,261.44 |
| 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: 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 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: Aetna Gatekeeper/Not Gatekeeper |
$10,227.98
|
| 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 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 |
$47,572.00 |
| 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: The Alliance Commercial |
$47,572.00
|
| 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
|
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 |
$26,624.00 |
| 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: The Alliance Commercial |
$26,624.00
|
| 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
|
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: Aetna Gatekeeper/Not Gatekeeper |
$5,724.16
|
| 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 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 |
$49,400.00 |
| 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: The Alliance Commercial |
$49,400.00
|
| 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: Aetna Gatekeeper/Not Gatekeeper |
$10,621.00
|
| 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
|
|
