|
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 |
$2,624.00 |
| 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 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 |
$3,136.08 |
| Max. Negotiated Rate |
$5,888.15 |
| Rate for Payer: Aetna Commercial |
$5,760.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,504.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,392.08
|
| Rate for Payer: Cash Price |
$1,846.20
|
| Rate for Payer: Cigna Commercial |
$5,888.15
|
| Rate for Payer: Health EOS Commercial |
$5,696.14
|
| Rate for Payer: HFN Commercial |
$5,888.15
|
| Rate for Payer: Multiplan Commercial |
$5,120.13
|
| Rate for Payer: Preferred Network Access Commercial |
$5,888.15
|
| Rate for Payer: Quartz Beloit One Network |
$3,136.08
|
| Rate for Payer: Quartz Commercial |
$3,840.10
|
| Rate for Payer: WEA Trust Commercial |
$3,520.09
|
| Rate for Payer: WPS Commercial |
$4,740.43
|
|
|
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 |
$1,792.04 |
| Max. Negotiated Rate |
$5,888.15 |
| Rate for Payer: Aetna Commercial |
$5,760.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,504.14
|
| Rate for Payer: Aetna Managed Medicare |
$1,792.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,160.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,200.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,072.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,392.08
|
| Rate for Payer: Cash Price |
$1,846.20
|
| Rate for Payer: Cigna Commercial |
$5,888.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,581.63
|
| Rate for Payer: Health EOS Commercial |
$5,696.14
|
| Rate for Payer: HFN Commercial |
$5,888.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,800.12
|
| Rate for Payer: Multiplan Commercial |
$5,120.13
|
| Rate for Payer: NAPHCARE Commercial |
$3,840.10
|
| Rate for Payer: Preferred Network Access Commercial |
$5,888.15
|
| Rate for Payer: Quartz Beloit One Network |
$3,136.08
|
| Rate for Payer: Quartz Commercial |
$4,160.10
|
| Rate for Payer: Quartz Medicare Advantage |
$3,840.10
|
| Rate for Payer: The Alliance Commercial |
$3,200.08
|
| Rate for Payer: WEA Trust Commercial |
$3,520.09
|
| Rate for Payer: WPS Commercial |
$4,740.43
|
|
|
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 |
$3,391.90 |
| Max. Negotiated Rate |
$6,368.46 |
| Rate for Payer: Aetna Commercial |
$6,230.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,953.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,668.79
|
| Rate for Payer: Cash Price |
$1,996.80
|
| Rate for Payer: Cigna Commercial |
$6,368.46
|
| Rate for Payer: Health EOS Commercial |
$6,160.79
|
| Rate for Payer: HFN Commercial |
$6,368.46
|
| Rate for Payer: Multiplan Commercial |
$5,537.79
|
| Rate for Payer: Preferred Network Access Commercial |
$6,368.46
|
| Rate for Payer: Quartz Beloit One Network |
$3,391.90
|
| Rate for Payer: Quartz Commercial |
$4,153.34
|
| Rate for Payer: WEA Trust Commercial |
$3,807.23
|
| Rate for Payer: WPS Commercial |
$5,127.12
|
|
|
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 |
$1,938.23 |
| Max. Negotiated Rate |
$6,368.46 |
| Rate for Payer: Aetna Commercial |
$6,230.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,953.13
|
| Rate for Payer: Aetna Managed Medicare |
$1,938.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,499.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,461.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,322.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,668.79
|
| Rate for Payer: Cash Price |
$1,996.80
|
| Rate for Payer: Cigna Commercial |
$6,368.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,873.79
|
| Rate for Payer: Health EOS Commercial |
$6,160.79
|
| Rate for Payer: HFN Commercial |
$6,368.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,191.68
|
| Rate for Payer: Multiplan Commercial |
$5,537.79
|
| Rate for Payer: NAPHCARE Commercial |
$4,153.34
|
| Rate for Payer: Preferred Network Access Commercial |
$6,368.46
|
| Rate for Payer: Quartz Beloit One Network |
$3,391.90
|
| Rate for Payer: Quartz Commercial |
$4,499.46
|
| Rate for Payer: Quartz Medicare Advantage |
$4,153.34
|
| Rate for Payer: The Alliance Commercial |
$3,461.12
|
| Rate for Payer: WEA Trust Commercial |
$3,807.23
|
| Rate for Payer: WPS Commercial |
$5,127.12
|
|
|
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 |
$3,463.24 |
| Max. Negotiated Rate |
$11,379.22 |
| Rate for Payer: Aetna Commercial |
$11,131.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,637.10
|
| Rate for Payer: Aetna Managed Medicare |
$3,463.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,039.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,184.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,936.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,555.42
|
| Rate for Payer: Cash Price |
$3,567.90
|
| Rate for Payer: Cigna Commercial |
$11,379.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,921.73
|
| Rate for Payer: Health EOS Commercial |
$11,008.16
|
| Rate for Payer: HFN Commercial |
$11,379.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,276.54
|
| Rate for Payer: Multiplan Commercial |
$9,894.98
|
| Rate for Payer: NAPHCARE Commercial |
$7,421.23
|
| Rate for Payer: Preferred Network Access Commercial |
$11,379.22
|
| Rate for Payer: Quartz Beloit One Network |
$6,060.67
|
| Rate for Payer: Quartz Commercial |
$8,039.67
|
| Rate for Payer: Quartz Medicare Advantage |
$7,421.23
|
| Rate for Payer: The Alliance Commercial |
$6,184.36
|
| Rate for Payer: WEA Trust Commercial |
$6,802.80
|
| Rate for Payer: WPS Commercial |
$9,161.18
|
|
|
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 |
$6,060.67 |
| Max. Negotiated Rate |
$11,379.22 |
| Rate for Payer: Aetna Commercial |
$11,131.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,637.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,555.42
|
| Rate for Payer: Cash Price |
$3,567.90
|
| Rate for Payer: Cigna Commercial |
$11,379.22
|
| Rate for Payer: Health EOS Commercial |
$11,008.16
|
| Rate for Payer: HFN Commercial |
$11,379.22
|
| Rate for Payer: Multiplan Commercial |
$9,894.98
|
| Rate for Payer: Preferred Network Access Commercial |
$11,379.22
|
| Rate for Payer: Quartz Beloit One Network |
$6,060.67
|
| Rate for Payer: Quartz Commercial |
$7,421.23
|
| Rate for Payer: WEA Trust Commercial |
$6,802.80
|
| Rate for Payer: WPS Commercial |
$9,161.18
|
|
|
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 |
$1,938.23 |
| Max. Negotiated Rate |
$6,368.46 |
| Rate for Payer: Aetna Commercial |
$6,230.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,953.13
|
| Rate for Payer: Aetna Managed Medicare |
$1,938.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,499.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,461.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,322.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,668.79
|
| Rate for Payer: Cash Price |
$1,996.80
|
| Rate for Payer: Cigna Commercial |
$6,368.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,873.79
|
| Rate for Payer: Health EOS Commercial |
$6,160.79
|
| Rate for Payer: HFN Commercial |
$6,368.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,191.68
|
| Rate for Payer: Multiplan Commercial |
$5,537.79
|
| Rate for Payer: NAPHCARE Commercial |
$4,153.34
|
| Rate for Payer: Preferred Network Access Commercial |
$6,368.46
|
| Rate for Payer: Quartz Beloit One Network |
$3,391.90
|
| Rate for Payer: Quartz Commercial |
$4,499.46
|
| Rate for Payer: Quartz Medicare Advantage |
$4,153.34
|
| Rate for Payer: The Alliance Commercial |
$3,461.12
|
| Rate for Payer: WEA Trust Commercial |
$3,807.23
|
| Rate for Payer: WPS Commercial |
$5,127.12
|
|
|
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 |
$3,391.90 |
| Max. Negotiated Rate |
$6,368.46 |
| Rate for Payer: Aetna Commercial |
$6,230.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,953.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,668.79
|
| Rate for Payer: Cash Price |
$1,996.80
|
| Rate for Payer: Cigna Commercial |
$6,368.46
|
| Rate for Payer: Health EOS Commercial |
$6,160.79
|
| Rate for Payer: HFN Commercial |
$6,368.46
|
| Rate for Payer: Multiplan Commercial |
$5,537.79
|
| Rate for Payer: Preferred Network Access Commercial |
$6,368.46
|
| Rate for Payer: Quartz Beloit One Network |
$3,391.90
|
| Rate for Payer: Quartz Commercial |
$4,153.34
|
| Rate for Payer: WEA Trust Commercial |
$3,807.23
|
| Rate for Payer: WPS Commercial |
$5,127.12
|
|
|
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 |
$3,596.32 |
| Max. Negotiated Rate |
$11,816.48 |
| Rate for Payer: Aetna Commercial |
$11,559.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,045.84
|
| Rate for Payer: Aetna Managed Medicare |
$3,596.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,348.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,422.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,165.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,807.32
|
| Rate for Payer: Cash Price |
$3,705.00
|
| Rate for Payer: Cigna Commercial |
$11,816.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,187.70
|
| Rate for Payer: Health EOS Commercial |
$11,431.16
|
| Rate for Payer: HFN Commercial |
$11,816.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,633.00
|
| Rate for Payer: Multiplan Commercial |
$10,275.20
|
| Rate for Payer: NAPHCARE Commercial |
$7,706.40
|
| Rate for Payer: Preferred Network Access Commercial |
$11,816.48
|
| Rate for Payer: Quartz Beloit One Network |
$6,293.56
|
| Rate for Payer: Quartz Commercial |
$8,348.60
|
| Rate for Payer: Quartz Medicare Advantage |
$7,706.40
|
| Rate for Payer: The Alliance Commercial |
$6,422.00
|
| Rate for Payer: WEA Trust Commercial |
$7,064.20
|
| Rate for Payer: WPS Commercial |
$9,513.20
|
|
|
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 |
$6,293.56 |
| Max. Negotiated Rate |
$11,816.48 |
| Rate for Payer: Aetna Commercial |
$11,559.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,045.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,807.32
|
| Rate for Payer: Cash Price |
$3,705.00
|
| Rate for Payer: Cigna Commercial |
$11,816.48
|
| Rate for Payer: Health EOS Commercial |
$11,431.16
|
| Rate for Payer: HFN Commercial |
$11,816.48
|
| Rate for Payer: Multiplan Commercial |
$10,275.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11,816.48
|
| Rate for Payer: Quartz Beloit One Network |
$6,293.56
|
| Rate for Payer: Quartz Commercial |
$7,706.40
|
| Rate for Payer: WEA Trust Commercial |
$7,064.20
|
| Rate for Payer: WPS Commercial |
$9,513.20
|
|
|
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 |
$3,391.90 |
| Max. Negotiated Rate |
$6,368.46 |
| Rate for Payer: Aetna Commercial |
$6,230.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,953.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,668.79
|
| Rate for Payer: Cash Price |
$1,996.80
|
| Rate for Payer: Cigna Commercial |
$6,368.46
|
| Rate for Payer: Health EOS Commercial |
$6,160.79
|
| Rate for Payer: HFN Commercial |
$6,368.46
|
| Rate for Payer: Multiplan Commercial |
$5,537.79
|
| Rate for Payer: Preferred Network Access Commercial |
$6,368.46
|
| Rate for Payer: Quartz Beloit One Network |
$3,391.90
|
| Rate for Payer: Quartz Commercial |
$4,153.34
|
| Rate for Payer: WEA Trust Commercial |
$3,807.23
|
| Rate for Payer: WPS Commercial |
$5,127.12
|
|
|
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 |
$1,938.23 |
| Max. Negotiated Rate |
$6,368.46 |
| Rate for Payer: Aetna Commercial |
$6,230.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,953.13
|
| Rate for Payer: Aetna Managed Medicare |
$1,938.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,499.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,461.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,322.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,668.79
|
| Rate for Payer: Cash Price |
$1,996.80
|
| Rate for Payer: Cigna Commercial |
$6,368.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,873.79
|
| Rate for Payer: Health EOS Commercial |
$6,160.79
|
| Rate for Payer: HFN Commercial |
$6,368.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,191.68
|
| Rate for Payer: Multiplan Commercial |
$5,537.79
|
| Rate for Payer: NAPHCARE Commercial |
$4,153.34
|
| Rate for Payer: Preferred Network Access Commercial |
$6,368.46
|
| Rate for Payer: Quartz Beloit One Network |
$3,391.90
|
| Rate for Payer: Quartz Commercial |
$4,499.46
|
| Rate for Payer: Quartz Medicare Advantage |
$4,153.34
|
| Rate for Payer: The Alliance Commercial |
$3,461.12
|
| Rate for Payer: WEA Trust Commercial |
$3,807.23
|
| Rate for Payer: WPS Commercial |
$5,127.12
|
|
|
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 |
$2,554.12 |
| Max. Negotiated Rate |
$8,392.09 |
| Rate for Payer: Aetna Commercial |
$8,209.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,844.78
|
| Rate for Payer: Aetna Managed Medicare |
$2,554.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,929.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,560.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,378.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,834.58
|
| Rate for Payer: Cash Price |
$2,631.30
|
| Rate for Payer: Cigna Commercial |
$8,392.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,104.72
|
| Rate for Payer: Health EOS Commercial |
$8,118.44
|
| Rate for Payer: HFN Commercial |
$8,392.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,841.38
|
| Rate for Payer: Multiplan Commercial |
$7,297.47
|
| Rate for Payer: NAPHCARE Commercial |
$5,473.10
|
| Rate for Payer: Preferred Network Access Commercial |
$8,392.09
|
| Rate for Payer: Quartz Beloit One Network |
$4,469.70
|
| Rate for Payer: Quartz Commercial |
$5,929.20
|
| Rate for Payer: Quartz Medicare Advantage |
$5,473.10
|
| Rate for Payer: The Alliance Commercial |
$4,560.92
|
| Rate for Payer: WEA Trust Commercial |
$5,017.01
|
| Rate for Payer: WPS Commercial |
$6,756.30
|
|
|
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 |
$4,469.70 |
| Max. Negotiated Rate |
$8,392.09 |
| Rate for Payer: Aetna Commercial |
$8,209.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,844.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,834.58
|
| Rate for Payer: Cash Price |
$2,631.30
|
| Rate for Payer: Cigna Commercial |
$8,392.09
|
| Rate for Payer: Health EOS Commercial |
$8,118.44
|
| Rate for Payer: HFN Commercial |
$8,392.09
|
| Rate for Payer: Multiplan Commercial |
$7,297.47
|
| Rate for Payer: Preferred Network Access Commercial |
$8,392.09
|
| Rate for Payer: Quartz Beloit One Network |
$4,469.70
|
| Rate for Payer: Quartz Commercial |
$5,473.10
|
| Rate for Payer: WEA Trust Commercial |
$5,017.01
|
| Rate for Payer: WPS Commercial |
$6,756.30
|
|
|
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 |
$4,304.08 |
| Max. Negotiated Rate |
$8,081.13 |
| Rate for Payer: Aetna Commercial |
$7,905.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,554.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,655.44
|
| Rate for Payer: Cash Price |
$2,533.80
|
| Rate for Payer: Cigna Commercial |
$8,081.13
|
| Rate for Payer: Health EOS Commercial |
$7,817.62
|
| Rate for Payer: HFN Commercial |
$8,081.13
|
| Rate for Payer: Multiplan Commercial |
$7,027.07
|
| Rate for Payer: Preferred Network Access Commercial |
$8,081.13
|
| Rate for Payer: Quartz Beloit One Network |
$4,304.08
|
| Rate for Payer: Quartz Commercial |
$5,270.30
|
| Rate for Payer: WEA Trust Commercial |
$4,831.11
|
| Rate for Payer: WPS Commercial |
$6,505.95
|
|
|
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 |
$2,459.48 |
| Max. Negotiated Rate |
$8,081.13 |
| Rate for Payer: Aetna Commercial |
$7,905.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,554.10
|
| Rate for Payer: Aetna Managed Medicare |
$2,459.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,709.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,391.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,216.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,655.44
|
| Rate for Payer: Cash Price |
$2,533.80
|
| Rate for Payer: Cigna Commercial |
$8,081.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,915.57
|
| Rate for Payer: Health EOS Commercial |
$7,817.62
|
| Rate for Payer: HFN Commercial |
$8,081.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,587.88
|
| Rate for Payer: Multiplan Commercial |
$7,027.07
|
| Rate for Payer: NAPHCARE Commercial |
$5,270.30
|
| Rate for Payer: Preferred Network Access Commercial |
$8,081.13
|
| Rate for Payer: Quartz Beloit One Network |
$4,304.08
|
| Rate for Payer: Quartz Commercial |
$5,709.50
|
| Rate for Payer: Quartz Medicare Advantage |
$5,270.30
|
| Rate for Payer: The Alliance Commercial |
$4,391.92
|
| Rate for Payer: WEA Trust Commercial |
$4,831.11
|
| Rate for Payer: WPS Commercial |
$6,505.95
|
|
|
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 |
$4,304.08 |
| Max. Negotiated Rate |
$8,081.13 |
| Rate for Payer: Aetna Commercial |
$7,905.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,554.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,655.44
|
| Rate for Payer: Cash Price |
$2,533.80
|
| Rate for Payer: Cigna Commercial |
$8,081.13
|
| Rate for Payer: Health EOS Commercial |
$7,817.62
|
| Rate for Payer: HFN Commercial |
$8,081.13
|
| Rate for Payer: Multiplan Commercial |
$7,027.07
|
| Rate for Payer: Preferred Network Access Commercial |
$8,081.13
|
| Rate for Payer: Quartz Beloit One Network |
$4,304.08
|
| Rate for Payer: Quartz Commercial |
$5,270.30
|
| Rate for Payer: WEA Trust Commercial |
$4,831.11
|
| Rate for Payer: WPS Commercial |
$6,505.95
|
|
|
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 |
$2,459.48 |
| Max. Negotiated Rate |
$8,081.13 |
| Rate for Payer: Aetna Commercial |
$7,905.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,554.10
|
| Rate for Payer: Aetna Managed Medicare |
$2,459.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,709.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,391.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,216.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,655.44
|
| Rate for Payer: Cash Price |
$2,533.80
|
| Rate for Payer: Cigna Commercial |
$8,081.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,915.57
|
| Rate for Payer: Health EOS Commercial |
$7,817.62
|
| Rate for Payer: HFN Commercial |
$8,081.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,587.88
|
| Rate for Payer: Multiplan Commercial |
$7,027.07
|
| Rate for Payer: NAPHCARE Commercial |
$5,270.30
|
| Rate for Payer: Preferred Network Access Commercial |
$8,081.13
|
| Rate for Payer: Quartz Beloit One Network |
$4,304.08
|
| Rate for Payer: Quartz Commercial |
$5,709.50
|
| Rate for Payer: Quartz Medicare Advantage |
$5,270.30
|
| Rate for Payer: The Alliance Commercial |
$4,391.92
|
| Rate for Payer: WEA Trust Commercial |
$4,831.11
|
| Rate for Payer: WPS Commercial |
$6,505.95
|
|
|
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 |
$4,469.70 |
| Max. Negotiated Rate |
$8,392.09 |
| Rate for Payer: Aetna Commercial |
$8,209.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,844.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,834.58
|
| Rate for Payer: Cash Price |
$2,631.30
|
| Rate for Payer: Cigna Commercial |
$8,392.09
|
| Rate for Payer: Health EOS Commercial |
$8,118.44
|
| Rate for Payer: HFN Commercial |
$8,392.09
|
| Rate for Payer: Multiplan Commercial |
$7,297.47
|
| Rate for Payer: Preferred Network Access Commercial |
$8,392.09
|
| Rate for Payer: Quartz Beloit One Network |
$4,469.70
|
| Rate for Payer: Quartz Commercial |
$5,473.10
|
| Rate for Payer: WEA Trust Commercial |
$5,017.01
|
| Rate for Payer: WPS Commercial |
$6,756.30
|
|
|
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 |
$2,554.12 |
| Max. Negotiated Rate |
$8,392.09 |
| Rate for Payer: Aetna Commercial |
$8,209.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,844.78
|
| Rate for Payer: Aetna Managed Medicare |
$2,554.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,929.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,560.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,378.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,834.58
|
| Rate for Payer: Cash Price |
$2,631.30
|
| Rate for Payer: Cigna Commercial |
$8,392.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,104.72
|
| Rate for Payer: Health EOS Commercial |
$8,118.44
|
| Rate for Payer: HFN Commercial |
$8,392.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,841.38
|
| Rate for Payer: Multiplan Commercial |
$7,297.47
|
| Rate for Payer: NAPHCARE Commercial |
$5,473.10
|
| Rate for Payer: Preferred Network Access Commercial |
$8,392.09
|
| Rate for Payer: Quartz Beloit One Network |
$4,469.70
|
| Rate for Payer: Quartz Commercial |
$5,929.20
|
| Rate for Payer: Quartz Medicare Advantage |
$5,473.10
|
| Rate for Payer: The Alliance Commercial |
$4,560.92
|
| Rate for Payer: WEA Trust Commercial |
$5,017.01
|
| Rate for Payer: WPS Commercial |
$6,756.30
|
|
|
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 |
$2,459.48 |
| Max. Negotiated Rate |
$8,081.13 |
| Rate for Payer: Aetna Commercial |
$7,905.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,554.10
|
| Rate for Payer: Aetna Managed Medicare |
$2,459.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,709.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,391.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,216.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,655.44
|
| Rate for Payer: Cash Price |
$2,533.80
|
| Rate for Payer: Cigna Commercial |
$8,081.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,915.57
|
| Rate for Payer: Health EOS Commercial |
$7,817.62
|
| Rate for Payer: HFN Commercial |
$8,081.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,587.88
|
| Rate for Payer: Multiplan Commercial |
$7,027.07
|
| Rate for Payer: NAPHCARE Commercial |
$5,270.30
|
| Rate for Payer: Preferred Network Access Commercial |
$8,081.13
|
| Rate for Payer: Quartz Beloit One Network |
$4,304.08
|
| Rate for Payer: Quartz Commercial |
$5,709.50
|
| Rate for Payer: Quartz Medicare Advantage |
$5,270.30
|
| Rate for Payer: The Alliance Commercial |
$4,391.92
|
| Rate for Payer: WEA Trust Commercial |
$4,831.11
|
| Rate for Payer: WPS Commercial |
$6,505.95
|
|
|
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 |
$4,304.08 |
| Max. Negotiated Rate |
$8,081.13 |
| Rate for Payer: Aetna Commercial |
$7,905.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,554.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,655.44
|
| Rate for Payer: Cash Price |
$2,533.80
|
| Rate for Payer: Cigna Commercial |
$8,081.13
|
| Rate for Payer: Health EOS Commercial |
$7,817.62
|
| Rate for Payer: HFN Commercial |
$8,081.13
|
| Rate for Payer: Multiplan Commercial |
$7,027.07
|
| Rate for Payer: Preferred Network Access Commercial |
$8,081.13
|
| Rate for Payer: Quartz Beloit One Network |
$4,304.08
|
| Rate for Payer: Quartz Commercial |
$5,270.30
|
| Rate for Payer: WEA Trust Commercial |
$4,831.11
|
| Rate for Payer: WPS Commercial |
$6,505.95
|
|
|
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 |
$4,469.70 |
| Max. Negotiated Rate |
$8,392.09 |
| Rate for Payer: Aetna Commercial |
$8,209.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,844.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,834.58
|
| Rate for Payer: Cash Price |
$2,631.30
|
| Rate for Payer: Cigna Commercial |
$8,392.09
|
| Rate for Payer: Health EOS Commercial |
$8,118.44
|
| Rate for Payer: HFN Commercial |
$8,392.09
|
| Rate for Payer: Multiplan Commercial |
$7,297.47
|
| Rate for Payer: Preferred Network Access Commercial |
$8,392.09
|
| Rate for Payer: Quartz Beloit One Network |
$4,469.70
|
| Rate for Payer: Quartz Commercial |
$5,473.10
|
| Rate for Payer: WEA Trust Commercial |
$5,017.01
|
| Rate for Payer: WPS Commercial |
$6,756.30
|
|
|
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 |
$2,554.12 |
| Max. Negotiated Rate |
$8,392.09 |
| Rate for Payer: Aetna Commercial |
$8,209.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,844.78
|
| Rate for Payer: Aetna Managed Medicare |
$2,554.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,929.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,560.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,378.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,834.58
|
| Rate for Payer: Cash Price |
$2,631.30
|
| Rate for Payer: Cigna Commercial |
$8,392.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,104.72
|
| Rate for Payer: Health EOS Commercial |
$8,118.44
|
| Rate for Payer: HFN Commercial |
$8,392.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,841.38
|
| Rate for Payer: Multiplan Commercial |
$7,297.47
|
| Rate for Payer: NAPHCARE Commercial |
$5,473.10
|
| Rate for Payer: Preferred Network Access Commercial |
$8,392.09
|
| Rate for Payer: Quartz Beloit One Network |
$4,469.70
|
| Rate for Payer: Quartz Commercial |
$5,929.20
|
| Rate for Payer: Quartz Medicare Advantage |
$5,473.10
|
| Rate for Payer: The Alliance Commercial |
$4,560.92
|
| Rate for Payer: WEA Trust Commercial |
$5,017.01
|
| Rate for Payer: WPS Commercial |
$6,756.30
|
|
