|
ARTICULAR SURFACE PSN VE EF 10-11 18MM RT 42-5224-008-18
|
Facility
IP
|
$8,446.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3964057
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,138.54 |
| Max. Negotiated Rate |
$7,770.32 |
| Rate for Payer: Aetna Commercial |
$7,601.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,476.38
|
| Rate for Payer: Cash Price |
$2,533.80
|
| Rate for Payer: Cigna Commercial |
$7,770.32
|
| Rate for Payer: Health EOS Commercial |
$7,516.94
|
| Rate for Payer: HFN Commercial |
$7,770.32
|
| Rate for Payer: Multiplan Commercial |
$6,756.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,067.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,770.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,138.54
|
| Rate for Payer: Quartz Commercial |
$5,067.60
|
| Rate for Payer: WEA Trust Commercial |
$4,645.30
|
| Rate for Payer: WPS Commercial |
$6,255.95
|
|
|
ARTICULAR SURFACE PSN VE EF 10-11 18MM RT 42-5224-008-18
|
Facility
OP
|
$8,446.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3964057
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,364.88 |
| Max. Negotiated Rate |
$7,770.32 |
| Rate for Payer: Aetna Commercial |
$7,601.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,263.56
|
| Rate for Payer: Aetna Managed Medicare |
$2,364.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,489.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,223.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,054.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,476.38
|
| Rate for Payer: Cash Price |
$2,533.80
|
| Rate for Payer: Cigna Commercial |
$7,770.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,726.38
|
| Rate for Payer: Health EOS Commercial |
$7,516.94
|
| Rate for Payer: HFN Commercial |
$7,770.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,334.50
|
| Rate for Payer: Multiplan Commercial |
$6,756.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,067.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,770.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,138.54
|
| Rate for Payer: Quartz Commercial |
$5,489.90
|
| Rate for Payer: Quartz Medicare Advantage |
$5,067.60
|
| Rate for Payer: WEA Trust Commercial |
$4,645.30
|
| Rate for Payer: WPS Commercial |
$6,255.95
|
|
|
ARTICULAR SURFACE PSN VE EF 10-11 20MM RT 42-5224-008-20
|
Facility
IP
|
$8,446.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3964058
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,138.54 |
| Max. Negotiated Rate |
$7,770.32 |
| Rate for Payer: Aetna Commercial |
$7,601.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,476.38
|
| Rate for Payer: Cash Price |
$2,533.80
|
| Rate for Payer: Cigna Commercial |
$7,770.32
|
| Rate for Payer: Health EOS Commercial |
$7,516.94
|
| Rate for Payer: HFN Commercial |
$7,770.32
|
| Rate for Payer: Multiplan Commercial |
$6,756.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,067.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,770.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,138.54
|
| Rate for Payer: Quartz Commercial |
$5,067.60
|
| Rate for Payer: WEA Trust Commercial |
$4,645.30
|
| Rate for Payer: WPS Commercial |
$6,255.95
|
|
|
ARTICULAR SURFACE PSN VE EF 10-11 20MM RT 42-5224-008-20
|
Facility
OP
|
$8,446.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3964058
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,364.88 |
| Max. Negotiated Rate |
$7,770.32 |
| Rate for Payer: Aetna Commercial |
$7,601.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,263.56
|
| Rate for Payer: Aetna Managed Medicare |
$2,364.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,489.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,223.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,054.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,476.38
|
| Rate for Payer: Cash Price |
$2,533.80
|
| Rate for Payer: Cigna Commercial |
$7,770.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,726.38
|
| Rate for Payer: Health EOS Commercial |
$7,516.94
|
| Rate for Payer: HFN Commercial |
$7,770.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,334.50
|
| Rate for Payer: Multiplan Commercial |
$6,756.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,067.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,770.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,138.54
|
| Rate for Payer: Quartz Commercial |
$5,489.90
|
| Rate for Payer: Quartz Medicare Advantage |
$5,067.60
|
| Rate for Payer: WEA Trust Commercial |
$4,645.30
|
| Rate for Payer: WPS Commercial |
$6,255.95
|
|
|
ARTICULAR SURFACE PSN VE EF 6-9 10MM 42-5124-007-10
|
Facility
IP
|
$8,771.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3697507
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,297.79 |
| Max. Negotiated Rate |
$8,069.32 |
| Rate for Payer: Aetna Commercial |
$7,893.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,648.63
|
| Rate for Payer: Cash Price |
$2,631.30
|
| Rate for Payer: Cigna Commercial |
$8,069.32
|
| Rate for Payer: Health EOS Commercial |
$7,806.19
|
| Rate for Payer: HFN Commercial |
$8,069.32
|
| Rate for Payer: Multiplan Commercial |
$7,016.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,262.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,069.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,297.79
|
| Rate for Payer: Quartz Commercial |
$5,262.60
|
| Rate for Payer: WEA Trust Commercial |
$4,824.05
|
| Rate for Payer: WPS Commercial |
$6,496.68
|
|
|
ARTICULAR SURFACE PSN VE EF 6-9 10MM 42-5124-007-10
|
Facility
OP
|
$8,771.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3697507
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,455.88 |
| Max. Negotiated Rate |
$8,069.32 |
| Rate for Payer: Aetna Commercial |
$7,893.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,543.06
|
| Rate for Payer: Aetna Managed Medicare |
$2,455.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,701.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,385.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,210.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,648.63
|
| Rate for Payer: Cash Price |
$2,631.30
|
| Rate for Payer: Cigna Commercial |
$8,069.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,908.25
|
| Rate for Payer: Health EOS Commercial |
$7,806.19
|
| Rate for Payer: HFN Commercial |
$8,069.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,578.25
|
| Rate for Payer: Multiplan Commercial |
$7,016.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,262.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,069.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,297.79
|
| Rate for Payer: Quartz Commercial |
$5,701.15
|
| Rate for Payer: Quartz Medicare Advantage |
$5,262.60
|
| Rate for Payer: WEA Trust Commercial |
$4,824.05
|
| Rate for Payer: WPS Commercial |
$6,496.68
|
|
|
ARTICULAR SURFACE PSN VE PS 12MM 6-9 C-D L 42-5124-005-12
|
Facility
OP
|
$8,446.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3263468
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,364.88 |
| Max. Negotiated Rate |
$7,770.32 |
| Rate for Payer: Aetna Commercial |
$7,601.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,263.56
|
| Rate for Payer: Aetna Managed Medicare |
$2,364.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,489.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,223.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,054.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,476.38
|
| Rate for Payer: Cash Price |
$2,533.80
|
| Rate for Payer: Cigna Commercial |
$7,770.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,726.38
|
| Rate for Payer: Health EOS Commercial |
$7,516.94
|
| Rate for Payer: HFN Commercial |
$7,770.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,334.50
|
| Rate for Payer: Multiplan Commercial |
$6,756.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,067.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,770.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,138.54
|
| Rate for Payer: Quartz Commercial |
$5,489.90
|
| Rate for Payer: Quartz Medicare Advantage |
$5,067.60
|
| Rate for Payer: WEA Trust Commercial |
$4,645.30
|
| Rate for Payer: WPS Commercial |
$6,255.95
|
|
|
ARTICULAR SURFACE PSN VE PS 12MM 6-9 C-D L 42-5124-005-12
|
Facility
IP
|
$8,446.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3263468
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,138.54 |
| Max. Negotiated Rate |
$7,770.32 |
| Rate for Payer: Aetna Commercial |
$7,601.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,476.38
|
| Rate for Payer: Cash Price |
$2,533.80
|
| Rate for Payer: Cigna Commercial |
$7,770.32
|
| Rate for Payer: Health EOS Commercial |
$7,516.94
|
| Rate for Payer: HFN Commercial |
$7,770.32
|
| Rate for Payer: Multiplan Commercial |
$6,756.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,067.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,770.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,138.54
|
| Rate for Payer: Quartz Commercial |
$5,067.60
|
| Rate for Payer: WEA Trust Commercial |
$4,645.30
|
| Rate for Payer: WPS Commercial |
$6,255.95
|
|
|
ARTICULAR SURFACE VE CR GH 7-12 10MM LEFT 42-5120-006-10
|
Facility
IP
|
$8,446.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4595153
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,138.54 |
| Max. Negotiated Rate |
$7,770.32 |
| Rate for Payer: Aetna Commercial |
$7,601.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,476.38
|
| Rate for Payer: Cash Price |
$2,533.80
|
| Rate for Payer: Cigna Commercial |
$7,770.32
|
| Rate for Payer: Health EOS Commercial |
$7,516.94
|
| Rate for Payer: HFN Commercial |
$7,770.32
|
| Rate for Payer: Multiplan Commercial |
$6,756.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,067.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,770.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,138.54
|
| Rate for Payer: Quartz Commercial |
$5,067.60
|
| Rate for Payer: WEA Trust Commercial |
$4,645.30
|
| Rate for Payer: WPS Commercial |
$6,255.95
|
|
|
ARTICULAR SURFACE VE CR GH 7-12 10MM LEFT 42-5120-006-10
|
Facility
OP
|
$8,446.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4595153
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,364.88 |
| Max. Negotiated Rate |
$7,770.32 |
| Rate for Payer: Aetna Commercial |
$7,601.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,263.56
|
| Rate for Payer: Aetna Managed Medicare |
$2,364.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,489.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,223.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,054.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,476.38
|
| Rate for Payer: Cash Price |
$2,533.80
|
| Rate for Payer: Cigna Commercial |
$7,770.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,726.38
|
| Rate for Payer: Health EOS Commercial |
$7,516.94
|
| Rate for Payer: HFN Commercial |
$7,770.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,334.50
|
| Rate for Payer: Multiplan Commercial |
$6,756.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,067.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,770.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,138.54
|
| Rate for Payer: Quartz Commercial |
$5,489.90
|
| Rate for Payer: Quartz Medicare Advantage |
$5,067.60
|
| Rate for Payer: WEA Trust Commercial |
$4,645.30
|
| Rate for Payer: WPS Commercial |
$6,255.95
|
|
|
ARTICULAR SURFACE VE CR GH 7-12 12MM LEFT 42-5120-006-12
|
Facility
IP
|
$8,446.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3697514
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,138.54 |
| Max. Negotiated Rate |
$7,770.32 |
| Rate for Payer: Aetna Commercial |
$7,601.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,476.38
|
| Rate for Payer: Cash Price |
$2,533.80
|
| Rate for Payer: Cigna Commercial |
$7,770.32
|
| Rate for Payer: Health EOS Commercial |
$7,516.94
|
| Rate for Payer: HFN Commercial |
$7,770.32
|
| Rate for Payer: Multiplan Commercial |
$6,756.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,067.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,770.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,138.54
|
| Rate for Payer: Quartz Commercial |
$5,067.60
|
| Rate for Payer: WEA Trust Commercial |
$4,645.30
|
| Rate for Payer: WPS Commercial |
$6,255.95
|
|
|
ARTICULAR SURFACE VE CR GH 7-12 12MM LEFT 42-5120-006-12
|
Facility
OP
|
$8,446.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3697514
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,364.88 |
| Max. Negotiated Rate |
$7,770.32 |
| Rate for Payer: Aetna Commercial |
$7,601.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,263.56
|
| Rate for Payer: Aetna Managed Medicare |
$2,364.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,489.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,223.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,054.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,476.38
|
| Rate for Payer: Cash Price |
$2,533.80
|
| Rate for Payer: Cigna Commercial |
$7,770.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,726.38
|
| Rate for Payer: Health EOS Commercial |
$7,516.94
|
| Rate for Payer: HFN Commercial |
$7,770.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,334.50
|
| Rate for Payer: Multiplan Commercial |
$6,756.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,067.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,770.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,138.54
|
| Rate for Payer: Quartz Commercial |
$5,489.90
|
| Rate for Payer: Quartz Medicare Advantage |
$5,067.60
|
| Rate for Payer: WEA Trust Commercial |
$4,645.30
|
| Rate for Payer: WPS Commercial |
$6,255.95
|
|
|
ARTICULAR SURFACE YELLOW CD 10MM LCCK 5994-30-10
|
Facility
IP
|
$10,348.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2973979
|
|
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: 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 YELLOW CD 10MM LCCK 5994-30-10
|
Facility
OP
|
$10,348.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2973979
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,897.44 |
| 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: 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: WEA Trust Commercial |
$5,691.40
|
| Rate for Payer: WPS Commercial |
$7,664.76
|
|
|
ARTICULAR SURFACE YELLOW CD 12MM LCCK 5994-30-12
|
Facility
IP
|
$10,348.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2973982
|
|
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: 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 YELLOW CD 12MM LCCK 5994-30-12
|
Facility
OP
|
$10,348.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2973982
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,897.44 |
| 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: 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: WEA Trust Commercial |
$5,691.40
|
| Rate for Payer: WPS Commercial |
$7,664.76
|
|
|
ARTICULAR SURFACE YELLOW CD 14MM LCCK 5994-30-14
|
Facility
IP
|
$10,348.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2973980
|
|
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: 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 YELLOW CD 14MM LCCK 5994-30-14
|
Facility
OP
|
$10,348.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2973980
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,897.44 |
| 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: 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: WEA Trust Commercial |
$5,691.40
|
| Rate for Payer: WPS Commercial |
$7,664.76
|
|
|
ARTICULAR SURFACE YELLOW CD 17MM LCCK 5994-30-17
|
Facility
OP
|
$10,348.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967447
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,897.44 |
| 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: 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: WEA Trust Commercial |
$5,691.40
|
| Rate for Payer: WPS Commercial |
$7,664.76
|
|
|
ARTICULAR SURFACE YELLOW CD 17MM LCCK 5994-30-17
|
Facility
IP
|
$10,348.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967447
|
|
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: 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 YELLOW EF 10MM LCCK 5994-32-10
|
Facility
IP
|
$10,348.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2973983
|
|
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: 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 YELLOW EF 10MM LCCK 5994-32-10
|
Facility
OP
|
$10,348.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2973983
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,897.44 |
| 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: 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: WEA Trust Commercial |
$5,691.40
|
| Rate for Payer: WPS Commercial |
$7,664.76
|
|
|
ARTICULAR SURFACE YELLOW EF 12MM LCCK 5994-32-12
|
Facility
OP
|
$10,348.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2973981
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,897.44 |
| 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: 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: WEA Trust Commercial |
$5,691.40
|
| Rate for Payer: WPS Commercial |
$7,664.76
|
|
|
ARTICULAR SURFACE YELLOW EF 12MM LCCK 5994-32-12
|
Facility
IP
|
$10,348.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2973981
|
|
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: 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 YELLOW EF 14MM LCCK 5994-32-14
|
Facility
IP
|
$10,348.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2973996
|
|
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: 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
|
|
