|
ARTHROTOMY ELBOW W/SYNOVECTOMY 24102
|
Professional
|
Both
|
$3,623.00
|
|
|
Service Code
|
CPT 24102
|
| Hospital Charge Code |
6174917
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$551.88 |
| Max. Negotiated Rate |
$3,579.52 |
| Rate for Payer: Aetna Commercial |
$3,579.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,240.41
|
| Rate for Payer: Aetna Managed Medicare |
$551.88
|
| Rate for Payer: Anthem Medicare Advantage |
$551.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$551.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$551.88
|
| Rate for Payer: Cash Price |
$1,086.90
|
| Rate for Payer: Cash Price |
$1,086.90
|
| Rate for Payer: Cash Price |
$1,086.90
|
| Rate for Payer: Cigna Commercial |
$3,579.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$653.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$551.88
|
| Rate for Payer: Health EOS Commercial |
$3,428.81
|
| Rate for Payer: HFN Commercial |
$3,579.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,141.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,141.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$551.88
|
| Rate for Payer: Multiplan Commercial |
$3,014.34
|
| Rate for Payer: NAPHCARE Commercial |
$827.81
|
| Rate for Payer: Preferred Network Access Commercial |
$3,579.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,657.88
|
| Rate for Payer: Quartz Commercial |
$2,147.71
|
| Rate for Payer: Quartz Medicare Advantage |
$551.88
|
| Rate for Payer: The Alliance Commercial |
$2,345.47
|
| Rate for Payer: United Healthcare Medicaid |
$653.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$551.88
|
| Rate for Payer: WEA Trust Commercial |
$2,072.36
|
| Rate for Payer: WPS Commercial |
$2,483.44
|
|
|
ARTHROTOMY, POSTERIOR CAPSULAR RELEASE, ANKLE, WITH OR WITHOUT ACHILLES TENDON LENGTHENING
|
Facility
|
OP
|
$13,773.68
|
|
|
Service Code
|
CPT 27612
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,443.42 |
| Max. Negotiated Rate |
$13,773.68 |
| Rate for Payer: Aetna Managed Medicare |
$3,443.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,443.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,443.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,443.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,443.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,443.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,809.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,443.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,443.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,443.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,443.42
|
| Rate for Payer: NAPHCARE Commercial |
$5,165.13
|
| Rate for Payer: Quartz Medicare Advantage |
$3,443.42
|
| Rate for Payer: The Alliance Commercial |
$13,773.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,443.42
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$3,443.42
|
|
|
ARTHROTOMY WITH BIOPSY; INTERPHALANGEAL JOINT, EACH
|
Facility
|
OP
|
$6,768.94
|
|
|
Service Code
|
CPT 26110
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,692.24 |
| Max. Negotiated Rate |
$6,768.94 |
| Rate for Payer: Aetna Managed Medicare |
$1,692.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$1,692.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,692.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,692.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,692.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,692.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,295.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,692.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,692.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,692.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,692.24
|
| Rate for Payer: NAPHCARE Commercial |
$2,538.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,692.24
|
| Rate for Payer: The Alliance Commercial |
$6,768.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,692.24
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$1,692.24
|
|
|
ARTHROTOMY, WITH EXPLORATION, DRAINAGE, OR REMOVAL OF LOOSE OR FOREIGN BODY; INTERPHALANGEAL JOINT, EACH
|
Facility
|
OP
|
$8,107.14
|
|
|
Service Code
|
CPT 26080
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,692.24 |
| Max. Negotiated Rate |
$8,107.14 |
| Rate for Payer: Aetna Managed Medicare |
$1,692.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$1,692.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,692.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,692.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,692.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,107.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,692.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,295.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,692.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,692.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,692.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,692.24
|
| Rate for Payer: NAPHCARE Commercial |
$2,538.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,692.24
|
| Rate for Payer: The Alliance Commercial |
$6,768.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,692.24
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$1,692.24
|
|
|
ARTICULAR COMPONENT 10x11mm
|
Facility
|
OP
|
$24,667.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2964723
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,183.03 |
| Max. Negotiated Rate |
$23,601.39 |
| Rate for Payer: Aetna Commercial |
$23,088.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$22,062.16
|
| Rate for Payer: Aetna Managed Medicare |
$7,183.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,674.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,826.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,313.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,596.45
|
| Rate for Payer: Cash Price |
$7,400.10
|
| Rate for Payer: Cigna Commercial |
$23,601.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14,356.19
|
| Rate for Payer: Health EOS Commercial |
$22,831.78
|
| Rate for Payer: HFN Commercial |
$23,601.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19,240.26
|
| Rate for Payer: Multiplan Commercial |
$20,522.94
|
| Rate for Payer: NAPHCARE Commercial |
$15,392.21
|
| Rate for Payer: Preferred Network Access Commercial |
$23,601.39
|
| Rate for Payer: Quartz Beloit One Network |
$12,570.30
|
| Rate for Payer: Quartz Commercial |
$16,674.89
|
| Rate for Payer: Quartz Medicare Advantage |
$15,392.21
|
| Rate for Payer: The Alliance Commercial |
$12,826.84
|
| Rate for Payer: WEA Trust Commercial |
$14,109.52
|
| Rate for Payer: WPS Commercial |
$19,000.99
|
|
|
ARTICULAR COMPONENT 10x11mm
|
Facility
|
IP
|
$24,667.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2964723
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,570.30 |
| Max. Negotiated Rate |
$23,601.39 |
| Rate for Payer: Aetna Commercial |
$23,088.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$22,062.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,596.45
|
| Rate for Payer: Cash Price |
$7,400.10
|
| Rate for Payer: Cigna Commercial |
$23,601.39
|
| Rate for Payer: Health EOS Commercial |
$22,831.78
|
| Rate for Payer: HFN Commercial |
$23,601.39
|
| Rate for Payer: Multiplan Commercial |
$20,522.94
|
| Rate for Payer: Preferred Network Access Commercial |
$23,601.39
|
| Rate for Payer: Quartz Beloit One Network |
$12,570.30
|
| Rate for Payer: Quartz Commercial |
$15,392.21
|
| Rate for Payer: WEA Trust Commercial |
$14,109.52
|
| Rate for Payer: WPS Commercial |
$19,000.99
|
|
|
ARTICULAR COMPONENT HEMI-CAP 1.5 X 3.5MM 9M52-1535-W
|
Facility
|
IP
|
$14,033.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2965211
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,151.22 |
| Max. Negotiated Rate |
$13,426.77 |
| Rate for Payer: Aetna Commercial |
$13,134.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,551.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,734.99
|
| Rate for Payer: Cash Price |
$4,209.90
|
| Rate for Payer: Cigna Commercial |
$13,426.77
|
| Rate for Payer: Health EOS Commercial |
$12,988.94
|
| Rate for Payer: HFN Commercial |
$13,426.77
|
| Rate for Payer: Multiplan Commercial |
$11,675.46
|
| Rate for Payer: Preferred Network Access Commercial |
$13,426.77
|
| Rate for Payer: Quartz Beloit One Network |
$7,151.22
|
| Rate for Payer: Quartz Commercial |
$8,756.59
|
| Rate for Payer: WEA Trust Commercial |
$8,026.88
|
| Rate for Payer: WPS Commercial |
$10,809.62
|
|
|
ARTICULAR COMPONENT HEMI-CAP 1.5 X 3.5MM 9M52-1535-W
|
Facility
|
OP
|
$14,033.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2965211
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,086.41 |
| Max. Negotiated Rate |
$13,426.77 |
| Rate for Payer: Aetna Commercial |
$13,134.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,551.12
|
| Rate for Payer: Aetna Managed Medicare |
$4,086.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,486.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,297.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,005.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,734.99
|
| Rate for Payer: Cash Price |
$4,209.90
|
| Rate for Payer: Cigna Commercial |
$13,426.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,167.21
|
| Rate for Payer: Health EOS Commercial |
$12,988.94
|
| Rate for Payer: HFN Commercial |
$13,426.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,945.74
|
| Rate for Payer: Multiplan Commercial |
$11,675.46
|
| Rate for Payer: NAPHCARE Commercial |
$8,756.59
|
| Rate for Payer: Preferred Network Access Commercial |
$13,426.77
|
| Rate for Payer: Quartz Beloit One Network |
$7,151.22
|
| Rate for Payer: Quartz Commercial |
$9,486.31
|
| Rate for Payer: Quartz Medicare Advantage |
$8,756.59
|
| Rate for Payer: The Alliance Commercial |
$7,297.16
|
| Rate for Payer: WEA Trust Commercial |
$8,026.88
|
| Rate for Payer: WPS Commercial |
$10,809.62
|
|
|
ARTICULAR COMPONENT HEMI-CAP 1.5 X4.5 9M52-1545W
|
Facility
|
OP
|
$14,033.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2965212
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,086.41 |
| Max. Negotiated Rate |
$13,426.77 |
| Rate for Payer: Aetna Commercial |
$13,134.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,551.12
|
| Rate for Payer: Aetna Managed Medicare |
$4,086.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,486.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,297.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,005.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,734.99
|
| Rate for Payer: Cash Price |
$4,209.90
|
| Rate for Payer: Cigna Commercial |
$13,426.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,167.21
|
| Rate for Payer: Health EOS Commercial |
$12,988.94
|
| Rate for Payer: HFN Commercial |
$13,426.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,945.74
|
| Rate for Payer: Multiplan Commercial |
$11,675.46
|
| Rate for Payer: NAPHCARE Commercial |
$8,756.59
|
| Rate for Payer: Preferred Network Access Commercial |
$13,426.77
|
| Rate for Payer: Quartz Beloit One Network |
$7,151.22
|
| Rate for Payer: Quartz Commercial |
$9,486.31
|
| Rate for Payer: Quartz Medicare Advantage |
$8,756.59
|
| Rate for Payer: The Alliance Commercial |
$7,297.16
|
| Rate for Payer: WEA Trust Commercial |
$8,026.88
|
| Rate for Payer: WPS Commercial |
$10,809.62
|
|
|
ARTICULAR COMPONENT HEMI-CAP 1.5 X4.5 9M52-1545W
|
Facility
|
IP
|
$14,033.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2965212
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,151.22 |
| Max. Negotiated Rate |
$13,426.77 |
| Rate for Payer: Aetna Commercial |
$13,134.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,551.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,734.99
|
| Rate for Payer: Cash Price |
$4,209.90
|
| Rate for Payer: Cigna Commercial |
$13,426.77
|
| Rate for Payer: Health EOS Commercial |
$12,988.94
|
| Rate for Payer: HFN Commercial |
$13,426.77
|
| Rate for Payer: Multiplan Commercial |
$11,675.46
|
| Rate for Payer: Preferred Network Access Commercial |
$13,426.77
|
| Rate for Payer: Quartz Beloit One Network |
$7,151.22
|
| Rate for Payer: Quartz Commercial |
$8,756.59
|
| Rate for Payer: WEA Trust Commercial |
$8,026.88
|
| Rate for Payer: WPS Commercial |
$10,809.62
|
|
|
ARTICULAR INSERT 15MM GENESIS 71421511
|
Facility
|
IP
|
$11,422.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2965972
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,820.65 |
| Max. Negotiated Rate |
$10,928.57 |
| Rate for Payer: Aetna Commercial |
$10,690.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,215.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,295.81
|
| Rate for Payer: Cash Price |
$3,426.60
|
| Rate for Payer: Cigna Commercial |
$10,928.57
|
| Rate for Payer: Health EOS Commercial |
$10,572.20
|
| Rate for Payer: HFN Commercial |
$10,928.57
|
| Rate for Payer: Multiplan Commercial |
$9,503.10
|
| Rate for Payer: Preferred Network Access Commercial |
$10,928.57
|
| Rate for Payer: Quartz Beloit One Network |
$5,820.65
|
| Rate for Payer: Quartz Commercial |
$7,127.33
|
| Rate for Payer: WEA Trust Commercial |
$6,533.38
|
| Rate for Payer: WPS Commercial |
$8,798.37
|
|
|
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 |
$3,326.09 |
| Max. Negotiated Rate |
$10,928.57 |
| Rate for Payer: Aetna Commercial |
$10,690.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,215.84
|
| Rate for Payer: Aetna Managed Medicare |
$3,326.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,721.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,939.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,701.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,295.81
|
| Rate for Payer: Cash Price |
$3,426.60
|
| Rate for Payer: Cigna Commercial |
$10,928.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,647.60
|
| Rate for Payer: Health EOS Commercial |
$10,572.20
|
| Rate for Payer: HFN Commercial |
$10,928.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,909.16
|
| Rate for Payer: Multiplan Commercial |
$9,503.10
|
| Rate for Payer: NAPHCARE Commercial |
$7,127.33
|
| Rate for Payer: Preferred Network Access Commercial |
$10,928.57
|
| Rate for Payer: Quartz Beloit One Network |
$5,820.65
|
| Rate for Payer: Quartz Commercial |
$7,721.27
|
| Rate for Payer: Quartz Medicare Advantage |
$7,127.33
|
| Rate for Payer: The Alliance Commercial |
$5,939.44
|
| Rate for Payer: WEA Trust Commercial |
$6,533.38
|
| Rate for Payer: WPS Commercial |
$8,798.37
|
|
|
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 |
$5,273.34 |
| Max. Negotiated Rate |
$9,900.97 |
| Rate for Payer: Aetna Commercial |
$9,685.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,255.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,703.82
|
| Rate for Payer: Cash Price |
$3,104.40
|
| Rate for Payer: Cigna Commercial |
$9,900.97
|
| Rate for Payer: Health EOS Commercial |
$9,578.11
|
| Rate for Payer: HFN Commercial |
$9,900.97
|
| Rate for Payer: Multiplan Commercial |
$8,609.54
|
| Rate for Payer: Preferred Network Access Commercial |
$9,900.97
|
| Rate for Payer: Quartz Beloit One Network |
$5,273.34
|
| Rate for Payer: Quartz Commercial |
$6,457.15
|
| Rate for Payer: WEA Trust Commercial |
$5,919.06
|
| Rate for Payer: WPS Commercial |
$7,971.06
|
|
|
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 |
$3,013.34 |
| Max. Negotiated Rate |
$9,900.97 |
| Rate for Payer: Aetna Commercial |
$9,685.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,255.25
|
| Rate for Payer: Aetna Managed Medicare |
$3,013.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,995.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,380.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,165.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,703.82
|
| Rate for Payer: Cash Price |
$3,104.40
|
| Rate for Payer: Cigna Commercial |
$9,900.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,022.54
|
| Rate for Payer: Health EOS Commercial |
$9,578.11
|
| Rate for Payer: HFN Commercial |
$9,900.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,071.44
|
| Rate for Payer: Multiplan Commercial |
$8,609.54
|
| Rate for Payer: NAPHCARE Commercial |
$6,457.15
|
| Rate for Payer: Preferred Network Access Commercial |
$9,900.97
|
| Rate for Payer: Quartz Beloit One Network |
$5,273.34
|
| Rate for Payer: Quartz Commercial |
$6,995.25
|
| Rate for Payer: Quartz Medicare Advantage |
$6,457.15
|
| Rate for Payer: The Alliance Commercial |
$5,380.96
|
| Rate for Payer: WEA Trust Commercial |
$5,919.06
|
| Rate for Payer: WPS Commercial |
$7,971.06
|
|
|
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 |
$5,273.34 |
| Max. Negotiated Rate |
$9,900.97 |
| Rate for Payer: Aetna Commercial |
$9,685.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,255.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,703.82
|
| Rate for Payer: Cash Price |
$3,104.40
|
| Rate for Payer: Cigna Commercial |
$9,900.97
|
| Rate for Payer: Health EOS Commercial |
$9,578.11
|
| Rate for Payer: HFN Commercial |
$9,900.97
|
| Rate for Payer: Multiplan Commercial |
$8,609.54
|
| Rate for Payer: Preferred Network Access Commercial |
$9,900.97
|
| Rate for Payer: Quartz Beloit One Network |
$5,273.34
|
| Rate for Payer: Quartz Commercial |
$6,457.15
|
| Rate for Payer: WEA Trust Commercial |
$5,919.06
|
| Rate for Payer: WPS Commercial |
$7,971.06
|
|
|
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 |
$3,013.34 |
| Max. Negotiated Rate |
$9,900.97 |
| Rate for Payer: Aetna Commercial |
$9,685.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,255.25
|
| Rate for Payer: Aetna Managed Medicare |
$3,013.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,995.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,380.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,165.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,703.82
|
| Rate for Payer: Cash Price |
$3,104.40
|
| Rate for Payer: Cigna Commercial |
$9,900.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,022.54
|
| Rate for Payer: Health EOS Commercial |
$9,578.11
|
| Rate for Payer: HFN Commercial |
$9,900.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,071.44
|
| Rate for Payer: Multiplan Commercial |
$8,609.54
|
| Rate for Payer: NAPHCARE Commercial |
$6,457.15
|
| Rate for Payer: Preferred Network Access Commercial |
$9,900.97
|
| Rate for Payer: Quartz Beloit One Network |
$5,273.34
|
| Rate for Payer: Quartz Commercial |
$6,995.25
|
| Rate for Payer: Quartz Medicare Advantage |
$6,457.15
|
| Rate for Payer: The Alliance Commercial |
$5,380.96
|
| Rate for Payer: WEA Trust Commercial |
$5,919.06
|
| Rate for Payer: WPS Commercial |
$7,971.06
|
|
|
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 |
$3,013.34 |
| Max. Negotiated Rate |
$9,900.97 |
| Rate for Payer: Aetna Commercial |
$9,685.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,255.25
|
| Rate for Payer: Aetna Managed Medicare |
$3,013.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,995.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,380.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,165.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,703.82
|
| Rate for Payer: Cash Price |
$3,104.40
|
| Rate for Payer: Cigna Commercial |
$9,900.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,022.54
|
| Rate for Payer: Health EOS Commercial |
$9,578.11
|
| Rate for Payer: HFN Commercial |
$9,900.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,071.44
|
| Rate for Payer: Multiplan Commercial |
$8,609.54
|
| Rate for Payer: NAPHCARE Commercial |
$6,457.15
|
| Rate for Payer: Preferred Network Access Commercial |
$9,900.97
|
| Rate for Payer: Quartz Beloit One Network |
$5,273.34
|
| Rate for Payer: Quartz Commercial |
$6,995.25
|
| Rate for Payer: Quartz Medicare Advantage |
$6,457.15
|
| Rate for Payer: The Alliance Commercial |
$5,380.96
|
| Rate for Payer: WEA Trust Commercial |
$5,919.06
|
| Rate for Payer: WPS Commercial |
$7,971.06
|
|
|
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 |
$5,273.34 |
| Max. Negotiated Rate |
$9,900.97 |
| Rate for Payer: Aetna Commercial |
$9,685.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,255.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,703.82
|
| Rate for Payer: Cash Price |
$3,104.40
|
| Rate for Payer: Cigna Commercial |
$9,900.97
|
| Rate for Payer: Health EOS Commercial |
$9,578.11
|
| Rate for Payer: HFN Commercial |
$9,900.97
|
| Rate for Payer: Multiplan Commercial |
$8,609.54
|
| Rate for Payer: Preferred Network Access Commercial |
$9,900.97
|
| Rate for Payer: Quartz Beloit One Network |
$5,273.34
|
| Rate for Payer: Quartz Commercial |
$6,457.15
|
| Rate for Payer: WEA Trust Commercial |
$5,919.06
|
| Rate for Payer: WPS Commercial |
$7,971.06
|
|
|
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 |
$5,273.34 |
| Max. Negotiated Rate |
$9,900.97 |
| Rate for Payer: Aetna Commercial |
$9,685.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,255.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,703.82
|
| Rate for Payer: Cash Price |
$3,104.40
|
| Rate for Payer: Cigna Commercial |
$9,900.97
|
| Rate for Payer: Health EOS Commercial |
$9,578.11
|
| Rate for Payer: HFN Commercial |
$9,900.97
|
| Rate for Payer: Multiplan Commercial |
$8,609.54
|
| Rate for Payer: Preferred Network Access Commercial |
$9,900.97
|
| Rate for Payer: Quartz Beloit One Network |
$5,273.34
|
| Rate for Payer: Quartz Commercial |
$6,457.15
|
| Rate for Payer: WEA Trust Commercial |
$5,919.06
|
| Rate for Payer: WPS Commercial |
$7,971.06
|
|
|
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 |
$3,013.34 |
| Max. Negotiated Rate |
$9,900.97 |
| Rate for Payer: Aetna Commercial |
$9,685.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,255.25
|
| Rate for Payer: Aetna Managed Medicare |
$3,013.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,995.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,380.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,165.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,703.82
|
| Rate for Payer: Cash Price |
$3,104.40
|
| Rate for Payer: Cigna Commercial |
$9,900.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,022.54
|
| Rate for Payer: Health EOS Commercial |
$9,578.11
|
| Rate for Payer: HFN Commercial |
$9,900.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,071.44
|
| Rate for Payer: Multiplan Commercial |
$8,609.54
|
| Rate for Payer: NAPHCARE Commercial |
$6,457.15
|
| Rate for Payer: Preferred Network Access Commercial |
$9,900.97
|
| Rate for Payer: Quartz Beloit One Network |
$5,273.34
|
| Rate for Payer: Quartz Commercial |
$6,995.25
|
| Rate for Payer: Quartz Medicare Advantage |
$6,457.15
|
| Rate for Payer: The Alliance Commercial |
$5,380.96
|
| Rate for Payer: WEA Trust Commercial |
$5,919.06
|
| Rate for Payer: WPS Commercial |
$7,971.06
|
|
|
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 |
$4,592.01 |
| Max. Negotiated Rate |
$8,621.72 |
| Rate for Payer: Aetna Commercial |
$8,434.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,059.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,966.86
|
| Rate for Payer: Cash Price |
$2,703.30
|
| Rate for Payer: Cigna Commercial |
$8,621.72
|
| Rate for Payer: Health EOS Commercial |
$8,340.58
|
| Rate for Payer: HFN Commercial |
$8,621.72
|
| Rate for Payer: Multiplan Commercial |
$7,497.15
|
| Rate for Payer: Preferred Network Access Commercial |
$8,621.72
|
| Rate for Payer: Quartz Beloit One Network |
$4,592.01
|
| Rate for Payer: Quartz Commercial |
$5,622.86
|
| Rate for Payer: WEA Trust Commercial |
$5,154.29
|
| Rate for Payer: WPS Commercial |
$6,941.17
|
|
|
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 |
$2,624.00 |
| Max. Negotiated Rate |
$8,621.72 |
| Rate for Payer: Aetna Commercial |
$8,434.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,059.44
|
| Rate for Payer: Aetna Managed Medicare |
$2,624.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,091.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,685.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,498.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,966.86
|
| Rate for Payer: Cash Price |
$2,703.30
|
| Rate for Payer: Cigna Commercial |
$8,621.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,244.40
|
| Rate for Payer: Health EOS Commercial |
$8,340.58
|
| Rate for Payer: HFN Commercial |
$8,621.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,028.58
|
| Rate for Payer: Multiplan Commercial |
$7,497.15
|
| Rate for Payer: NAPHCARE Commercial |
$5,622.86
|
| Rate for Payer: Preferred Network Access Commercial |
$8,621.72
|
| Rate for Payer: Quartz Beloit One Network |
$4,592.01
|
| Rate for Payer: Quartz Commercial |
$6,091.44
|
| Rate for Payer: Quartz Medicare Advantage |
$5,622.86
|
| Rate for Payer: The Alliance Commercial |
$4,685.72
|
| Rate for Payer: WEA Trust Commercial |
$5,154.29
|
| Rate for Payer: WPS Commercial |
$6,941.17
|
|
|
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 |
$2,624.00 |
| Max. Negotiated Rate |
$8,621.72 |
| Rate for Payer: Aetna Commercial |
$8,434.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,059.44
|
| Rate for Payer: Aetna Managed Medicare |
$2,624.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,091.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,685.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,498.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,966.86
|
| Rate for Payer: Cash Price |
$2,703.30
|
| Rate for Payer: Cigna Commercial |
$8,621.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,244.40
|
| Rate for Payer: Health EOS Commercial |
$8,340.58
|
| Rate for Payer: HFN Commercial |
$8,621.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,028.58
|
| Rate for Payer: Multiplan Commercial |
$7,497.15
|
| Rate for Payer: NAPHCARE Commercial |
$5,622.86
|
| Rate for Payer: Preferred Network Access Commercial |
$8,621.72
|
| Rate for Payer: Quartz Beloit One Network |
$4,592.01
|
| Rate for Payer: Quartz Commercial |
$6,091.44
|
| Rate for Payer: Quartz Medicare Advantage |
$5,622.86
|
| Rate for Payer: The Alliance Commercial |
$4,685.72
|
| Rate for Payer: WEA Trust Commercial |
$5,154.29
|
| Rate for Payer: WPS Commercial |
$6,941.17
|
|
|
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 |
$4,592.01 |
| Max. Negotiated Rate |
$8,621.72 |
| Rate for Payer: Aetna Commercial |
$8,434.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,059.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,966.86
|
| Rate for Payer: Cash Price |
$2,703.30
|
| Rate for Payer: Cigna Commercial |
$8,621.72
|
| Rate for Payer: Health EOS Commercial |
$8,340.58
|
| Rate for Payer: HFN Commercial |
$8,621.72
|
| Rate for Payer: Multiplan Commercial |
$7,497.15
|
| Rate for Payer: Preferred Network Access Commercial |
$8,621.72
|
| Rate for Payer: Quartz Beloit One Network |
$4,592.01
|
| Rate for Payer: Quartz Commercial |
$5,622.86
|
| Rate for Payer: WEA Trust Commercial |
$5,154.29
|
| Rate for Payer: WPS Commercial |
$6,941.17
|
|
|
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 |
$2,624.00 |
| Max. Negotiated Rate |
$8,621.72 |
| Rate for Payer: Aetna Commercial |
$8,434.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,059.44
|
| Rate for Payer: Aetna Managed Medicare |
$2,624.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,091.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,685.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,498.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,966.86
|
| Rate for Payer: Cash Price |
$2,703.30
|
| Rate for Payer: Cigna Commercial |
$8,621.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,244.40
|
| Rate for Payer: Health EOS Commercial |
$8,340.58
|
| Rate for Payer: HFN Commercial |
$8,621.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,028.58
|
| Rate for Payer: Multiplan Commercial |
$7,497.15
|
| Rate for Payer: NAPHCARE Commercial |
$5,622.86
|
| Rate for Payer: Preferred Network Access Commercial |
$8,621.72
|
| Rate for Payer: Quartz Beloit One Network |
$4,592.01
|
| Rate for Payer: Quartz Commercial |
$6,091.44
|
| Rate for Payer: Quartz Medicare Advantage |
$5,622.86
|
| Rate for Payer: The Alliance Commercial |
$4,685.72
|
| Rate for Payer: WEA Trust Commercial |
$5,154.29
|
| Rate for Payer: WPS Commercial |
$6,941.17
|
|
