|
SUTURE CUP UNIVERSAL REVERSE 33 +2 RT AR-9502F-33LCPC
|
Facility
|
IP
|
$8,440.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6180301
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,135.60 |
| Max. Negotiated Rate |
$7,764.80 |
| Rate for Payer: Aetna Commercial |
$7,596.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,258.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,473.20
|
| Rate for Payer: Cash Price |
$2,532.00
|
| Rate for Payer: Cigna Commercial |
$7,764.80
|
| Rate for Payer: Health EOS Commercial |
$7,511.60
|
| Rate for Payer: HFN Commercial |
$7,764.80
|
| Rate for Payer: Multiplan Commercial |
$6,752.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,064.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,764.80
|
| Rate for Payer: Quartz Beloit One Network |
$4,135.60
|
| Rate for Payer: Quartz Commercial |
$5,064.00
|
| Rate for Payer: WEA Trust Commercial |
$4,642.00
|
| Rate for Payer: WPS Commercial |
$6,251.51
|
|
|
SUTURE CUP UNIVERSAL REVERSE 33 +2 RT AR-9502F-33LCPC
|
Facility
|
OP
|
$8,440.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6180301
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,363.20 |
| Max. Negotiated Rate |
$33,760.00 |
| Rate for Payer: Aetna Commercial |
$7,596.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,258.40
|
| Rate for Payer: Aetna Managed Medicare |
$2,363.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,486.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,220.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,051.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,473.20
|
| Rate for Payer: Cash Price |
$2,532.00
|
| Rate for Payer: Cigna Commercial |
$7,764.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,723.02
|
| Rate for Payer: Health EOS Commercial |
$7,511.60
|
| Rate for Payer: HFN Commercial |
$7,764.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,330.00
|
| Rate for Payer: Multiplan Commercial |
$6,752.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,064.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,764.80
|
| Rate for Payer: Quartz Beloit One Network |
$4,135.60
|
| Rate for Payer: Quartz Commercial |
$5,486.00
|
| Rate for Payer: Quartz Medicare Advantage |
$5,064.00
|
| Rate for Payer: The Alliance Commercial |
$33,760.00
|
| Rate for Payer: WEA Trust Commercial |
$4,642.00
|
| Rate for Payer: WPS Commercial |
$6,251.51
|
|
|
SUTURE CUP UNIVERSAL REVERSE 33 +2 RT AR-9502F-33RCPC
|
Facility
|
OP
|
$8,440.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6182328
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,363.20 |
| Max. Negotiated Rate |
$33,760.00 |
| Rate for Payer: Aetna Commercial |
$7,596.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,258.40
|
| Rate for Payer: Aetna Managed Medicare |
$2,363.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,486.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,220.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,051.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,473.20
|
| Rate for Payer: Cash Price |
$2,532.00
|
| Rate for Payer: Cigna Commercial |
$7,764.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,723.02
|
| Rate for Payer: Health EOS Commercial |
$7,511.60
|
| Rate for Payer: HFN Commercial |
$7,764.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,330.00
|
| Rate for Payer: Multiplan Commercial |
$6,752.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,064.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,764.80
|
| Rate for Payer: Quartz Beloit One Network |
$4,135.60
|
| Rate for Payer: Quartz Commercial |
$5,486.00
|
| Rate for Payer: Quartz Medicare Advantage |
$5,064.00
|
| Rate for Payer: The Alliance Commercial |
$33,760.00
|
| Rate for Payer: WEA Trust Commercial |
$4,642.00
|
| Rate for Payer: WPS Commercial |
$6,251.51
|
|
|
SUTURE CUP UNIVERSAL REVERSE 33 +2 RT AR-9502F-33RCPC
|
Facility
|
IP
|
$8,440.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6182328
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,135.60 |
| Max. Negotiated Rate |
$7,764.80 |
| Rate for Payer: Aetna Commercial |
$7,596.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,258.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,473.20
|
| Rate for Payer: Cash Price |
$2,532.00
|
| Rate for Payer: Cigna Commercial |
$7,764.80
|
| Rate for Payer: Health EOS Commercial |
$7,511.60
|
| Rate for Payer: HFN Commercial |
$7,764.80
|
| Rate for Payer: Multiplan Commercial |
$6,752.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,064.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,764.80
|
| Rate for Payer: Quartz Beloit One Network |
$4,135.60
|
| Rate for Payer: Quartz Commercial |
$5,064.00
|
| Rate for Payer: WEA Trust Commercial |
$4,642.00
|
| Rate for Payer: WPS Commercial |
$6,251.51
|
|
|
SUTURE CUP UNIVERSAL REVERSE 33 AR-9502F-33CPC
|
Facility
|
IP
|
$8,440.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6180634
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,135.60 |
| Max. Negotiated Rate |
$7,764.80 |
| Rate for Payer: Aetna Commercial |
$7,596.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,258.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,473.20
|
| Rate for Payer: Cash Price |
$2,532.00
|
| Rate for Payer: Cigna Commercial |
$7,764.80
|
| Rate for Payer: Health EOS Commercial |
$7,511.60
|
| Rate for Payer: HFN Commercial |
$7,764.80
|
| Rate for Payer: Multiplan Commercial |
$6,752.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,064.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,764.80
|
| Rate for Payer: Quartz Beloit One Network |
$4,135.60
|
| Rate for Payer: Quartz Commercial |
$5,064.00
|
| Rate for Payer: WEA Trust Commercial |
$4,642.00
|
| Rate for Payer: WPS Commercial |
$6,251.51
|
|
|
SUTURE CUP UNIVERSAL REVERSE 33 AR-9502F-33CPC
|
Facility
|
OP
|
$8,440.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6180634
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,363.20 |
| Max. Negotiated Rate |
$33,760.00 |
| Rate for Payer: Aetna Commercial |
$7,596.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,258.40
|
| Rate for Payer: Aetna Managed Medicare |
$2,363.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,486.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,220.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,051.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,473.20
|
| Rate for Payer: Cash Price |
$2,532.00
|
| Rate for Payer: Cigna Commercial |
$7,764.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,723.02
|
| Rate for Payer: Health EOS Commercial |
$7,511.60
|
| Rate for Payer: HFN Commercial |
$7,764.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,330.00
|
| Rate for Payer: Multiplan Commercial |
$6,752.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,064.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,764.80
|
| Rate for Payer: Quartz Beloit One Network |
$4,135.60
|
| Rate for Payer: Quartz Commercial |
$5,486.00
|
| Rate for Payer: Quartz Medicare Advantage |
$5,064.00
|
| Rate for Payer: The Alliance Commercial |
$33,760.00
|
| Rate for Payer: WEA Trust Commercial |
$4,642.00
|
| Rate for Payer: WPS Commercial |
$6,251.51
|
|
|
SUTURE CUP UNIVERSAL REVERSE 36 +2 RT AR-9502F-36LCPC
|
Facility
|
IP
|
$9,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5264966
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,652.06 |
| Max. Negotiated Rate |
$8,734.48 |
| Rate for Payer: Aetna Commercial |
$8,544.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,164.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,031.82
|
| Rate for Payer: Cash Price |
$2,848.20
|
| Rate for Payer: Cigna Commercial |
$8,734.48
|
| Rate for Payer: Health EOS Commercial |
$8,449.66
|
| Rate for Payer: HFN Commercial |
$8,734.48
|
| Rate for Payer: Multiplan Commercial |
$7,595.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,696.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,734.48
|
| Rate for Payer: Quartz Beloit One Network |
$4,652.06
|
| Rate for Payer: Quartz Commercial |
$5,696.40
|
| Rate for Payer: WEA Trust Commercial |
$5,221.70
|
| Rate for Payer: WPS Commercial |
$7,032.21
|
|
|
SUTURE CUP UNIVERSAL REVERSE 36 +2 RT AR-9502F-36LCPC
|
Facility
|
OP
|
$9,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5264966
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,658.32 |
| Max. Negotiated Rate |
$37,976.00 |
| Rate for Payer: Aetna Commercial |
$8,544.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,164.84
|
| Rate for Payer: Aetna Managed Medicare |
$2,658.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,171.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,747.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,557.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,031.82
|
| Rate for Payer: Cash Price |
$2,848.20
|
| Rate for Payer: Cigna Commercial |
$8,734.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,312.84
|
| Rate for Payer: Health EOS Commercial |
$8,449.66
|
| Rate for Payer: HFN Commercial |
$8,734.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,120.50
|
| Rate for Payer: Multiplan Commercial |
$7,595.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,696.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,734.48
|
| Rate for Payer: Quartz Beloit One Network |
$4,652.06
|
| Rate for Payer: Quartz Commercial |
$6,171.10
|
| Rate for Payer: Quartz Medicare Advantage |
$5,696.40
|
| Rate for Payer: The Alliance Commercial |
$37,976.00
|
| Rate for Payer: WEA Trust Commercial |
$5,221.70
|
| Rate for Payer: WPS Commercial |
$7,032.21
|
|
|
SUTURE CUP UNIVERSAL REVERSE 36 +2 RT AR-9502F-36RCPC
|
Facility
|
OP
|
$9,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5106646
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,658.32 |
| Max. Negotiated Rate |
$37,976.00 |
| Rate for Payer: Aetna Commercial |
$8,544.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,164.84
|
| Rate for Payer: Aetna Managed Medicare |
$2,658.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,171.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,747.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,557.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,031.82
|
| Rate for Payer: Cash Price |
$2,848.20
|
| Rate for Payer: Cigna Commercial |
$8,734.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,312.84
|
| Rate for Payer: Health EOS Commercial |
$8,449.66
|
| Rate for Payer: HFN Commercial |
$8,734.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,120.50
|
| Rate for Payer: Multiplan Commercial |
$7,595.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,696.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,734.48
|
| Rate for Payer: Quartz Beloit One Network |
$4,652.06
|
| Rate for Payer: Quartz Commercial |
$6,171.10
|
| Rate for Payer: Quartz Medicare Advantage |
$5,696.40
|
| Rate for Payer: The Alliance Commercial |
$37,976.00
|
| Rate for Payer: WEA Trust Commercial |
$5,221.70
|
| Rate for Payer: WPS Commercial |
$7,032.21
|
|
|
SUTURE CUP UNIVERSAL REVERSE 36 +2 RT AR-9502F-36RCPC
|
Facility
|
IP
|
$9,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5106646
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,652.06 |
| Max. Negotiated Rate |
$8,734.48 |
| Rate for Payer: Aetna Commercial |
$8,544.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,164.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,031.82
|
| Rate for Payer: Cash Price |
$2,848.20
|
| Rate for Payer: Cigna Commercial |
$8,734.48
|
| Rate for Payer: Health EOS Commercial |
$8,449.66
|
| Rate for Payer: HFN Commercial |
$8,734.48
|
| Rate for Payer: Multiplan Commercial |
$7,595.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,696.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,734.48
|
| Rate for Payer: Quartz Beloit One Network |
$4,652.06
|
| Rate for Payer: Quartz Commercial |
$5,696.40
|
| Rate for Payer: WEA Trust Commercial |
$5,221.70
|
| Rate for Payer: WPS Commercial |
$7,032.21
|
|
|
SUTURE CUP UNIVERSAL REVERSE 39 +2 LT AR-9502F-39LCPC
|
Facility
|
OP
|
$9,129.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5264969
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,556.12 |
| Max. Negotiated Rate |
$36,516.00 |
| Rate for Payer: Aetna Commercial |
$8,216.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,850.94
|
| Rate for Payer: Aetna Managed Medicare |
$2,556.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,933.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,564.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,381.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,838.37
|
| Rate for Payer: Cash Price |
$2,738.70
|
| Rate for Payer: Cigna Commercial |
$8,398.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,108.59
|
| Rate for Payer: Health EOS Commercial |
$8,124.81
|
| Rate for Payer: HFN Commercial |
$8,398.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,846.75
|
| Rate for Payer: Multiplan Commercial |
$7,303.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,477.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,398.68
|
| Rate for Payer: Quartz Beloit One Network |
$4,473.21
|
| Rate for Payer: Quartz Commercial |
$5,933.85
|
| Rate for Payer: Quartz Medicare Advantage |
$5,477.40
|
| Rate for Payer: The Alliance Commercial |
$36,516.00
|
| Rate for Payer: WEA Trust Commercial |
$5,020.95
|
| Rate for Payer: WPS Commercial |
$6,761.85
|
|
|
SUTURE CUP UNIVERSAL REVERSE 39 +2 LT AR-9502F-39LCPC
|
Facility
|
IP
|
$9,129.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5264969
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,473.21 |
| Max. Negotiated Rate |
$8,398.68 |
| Rate for Payer: Aetna Commercial |
$8,216.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,850.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,838.37
|
| Rate for Payer: Cash Price |
$2,738.70
|
| Rate for Payer: Cigna Commercial |
$8,398.68
|
| Rate for Payer: Health EOS Commercial |
$8,124.81
|
| Rate for Payer: HFN Commercial |
$8,398.68
|
| Rate for Payer: Multiplan Commercial |
$7,303.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,477.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,398.68
|
| Rate for Payer: Quartz Beloit One Network |
$4,473.21
|
| Rate for Payer: Quartz Commercial |
$5,477.40
|
| Rate for Payer: WEA Trust Commercial |
$5,020.95
|
| Rate for Payer: WPS Commercial |
$6,761.85
|
|
|
SUTURE CUP UNIVERSAL REVERSE 39 AR-9502F-39CPC
|
Facility
|
IP
|
$9,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5264970
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,652.06 |
| Max. Negotiated Rate |
$8,734.48 |
| Rate for Payer: Aetna Commercial |
$8,544.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,164.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,031.82
|
| Rate for Payer: Cash Price |
$2,848.20
|
| Rate for Payer: Cigna Commercial |
$8,734.48
|
| Rate for Payer: Health EOS Commercial |
$8,449.66
|
| Rate for Payer: HFN Commercial |
$8,734.48
|
| Rate for Payer: Multiplan Commercial |
$7,595.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,696.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,734.48
|
| Rate for Payer: Quartz Beloit One Network |
$4,652.06
|
| Rate for Payer: Quartz Commercial |
$5,696.40
|
| Rate for Payer: WEA Trust Commercial |
$5,221.70
|
| Rate for Payer: WPS Commercial |
$7,032.21
|
|
|
SUTURE CUP UNIVERSAL REVERSE 39 AR-9502F-39CPC
|
Facility
|
OP
|
$9,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5264970
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,658.32 |
| Max. Negotiated Rate |
$37,976.00 |
| Rate for Payer: Aetna Commercial |
$8,544.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,164.84
|
| Rate for Payer: Aetna Managed Medicare |
$2,658.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,171.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,747.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,557.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,031.82
|
| Rate for Payer: Cash Price |
$2,848.20
|
| Rate for Payer: Cigna Commercial |
$8,734.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,312.84
|
| Rate for Payer: Health EOS Commercial |
$8,449.66
|
| Rate for Payer: HFN Commercial |
$8,734.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,120.50
|
| Rate for Payer: Multiplan Commercial |
$7,595.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,696.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,734.48
|
| Rate for Payer: Quartz Beloit One Network |
$4,652.06
|
| Rate for Payer: Quartz Commercial |
$6,171.10
|
| Rate for Payer: Quartz Medicare Advantage |
$5,696.40
|
| Rate for Payer: The Alliance Commercial |
$37,976.00
|
| Rate for Payer: WEA Trust Commercial |
$5,221.70
|
| Rate for Payer: WPS Commercial |
$7,032.21
|
|
|
SUTURE CUP UNIVERSAL REVERSE 42 +2 LT AR-9502F-42LCPC
|
Facility
|
IP
|
$9,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5458713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,652.06 |
| Max. Negotiated Rate |
$8,734.48 |
| Rate for Payer: Aetna Commercial |
$8,544.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,164.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,031.82
|
| Rate for Payer: Cash Price |
$2,848.20
|
| Rate for Payer: Cigna Commercial |
$8,734.48
|
| Rate for Payer: Health EOS Commercial |
$8,449.66
|
| Rate for Payer: HFN Commercial |
$8,734.48
|
| Rate for Payer: Multiplan Commercial |
$7,595.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,696.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,734.48
|
| Rate for Payer: Quartz Beloit One Network |
$4,652.06
|
| Rate for Payer: Quartz Commercial |
$5,696.40
|
| Rate for Payer: WEA Trust Commercial |
$5,221.70
|
| Rate for Payer: WPS Commercial |
$7,032.21
|
|
|
SUTURE CUP UNIVERSAL REVERSE 42 +2 LT AR-9502F-42LCPC
|
Facility
|
OP
|
$9,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5458713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,658.32 |
| Max. Negotiated Rate |
$37,976.00 |
| Rate for Payer: Aetna Commercial |
$8,544.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,164.84
|
| Rate for Payer: Aetna Managed Medicare |
$2,658.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,171.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,747.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,557.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,031.82
|
| Rate for Payer: Cash Price |
$2,848.20
|
| Rate for Payer: Cigna Commercial |
$8,734.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,312.84
|
| Rate for Payer: Health EOS Commercial |
$8,449.66
|
| Rate for Payer: HFN Commercial |
$8,734.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,120.50
|
| Rate for Payer: Multiplan Commercial |
$7,595.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,696.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,734.48
|
| Rate for Payer: Quartz Beloit One Network |
$4,652.06
|
| Rate for Payer: Quartz Commercial |
$6,171.10
|
| Rate for Payer: Quartz Medicare Advantage |
$5,696.40
|
| Rate for Payer: The Alliance Commercial |
$37,976.00
|
| Rate for Payer: WEA Trust Commercial |
$5,221.70
|
| Rate for Payer: WPS Commercial |
$7,032.21
|
|
|
SUTURE CUP UNIVERSAL REVERSE 42 +2 RT AR-9502F-42RCPC
|
Facility
|
IP
|
$9,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5349059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,652.06 |
| Max. Negotiated Rate |
$8,734.48 |
| Rate for Payer: Aetna Commercial |
$8,544.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,164.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,031.82
|
| Rate for Payer: Cash Price |
$2,848.20
|
| Rate for Payer: Cigna Commercial |
$8,734.48
|
| Rate for Payer: Health EOS Commercial |
$8,449.66
|
| Rate for Payer: HFN Commercial |
$8,734.48
|
| Rate for Payer: Multiplan Commercial |
$7,595.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,696.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,734.48
|
| Rate for Payer: Quartz Beloit One Network |
$4,652.06
|
| Rate for Payer: Quartz Commercial |
$5,696.40
|
| Rate for Payer: WEA Trust Commercial |
$5,221.70
|
| Rate for Payer: WPS Commercial |
$7,032.21
|
|
|
SUTURE CUP UNIVERSAL REVERSE 42 +2 RT AR-9502F-42RCPC
|
Facility
|
OP
|
$9,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5349059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,658.32 |
| Max. Negotiated Rate |
$37,976.00 |
| Rate for Payer: Aetna Commercial |
$8,544.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,164.84
|
| Rate for Payer: Aetna Managed Medicare |
$2,658.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,171.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,747.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,557.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,031.82
|
| Rate for Payer: Cash Price |
$2,848.20
|
| Rate for Payer: Cigna Commercial |
$8,734.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,312.84
|
| Rate for Payer: Health EOS Commercial |
$8,449.66
|
| Rate for Payer: HFN Commercial |
$8,734.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,120.50
|
| Rate for Payer: Multiplan Commercial |
$7,595.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,696.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,734.48
|
| Rate for Payer: Quartz Beloit One Network |
$4,652.06
|
| Rate for Payer: Quartz Commercial |
$6,171.10
|
| Rate for Payer: Quartz Medicare Advantage |
$5,696.40
|
| Rate for Payer: The Alliance Commercial |
$37,976.00
|
| Rate for Payer: WEA Trust Commercial |
$5,221.70
|
| Rate for Payer: WPS Commercial |
$7,032.21
|
|
|
SUTURE CUP UNIVERSAL REVERSE 42 NEUTRAL AR-9502F-42CPC
|
Facility
|
IP
|
$9,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5306641
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,652.06 |
| Max. Negotiated Rate |
$8,734.48 |
| Rate for Payer: Aetna Commercial |
$8,544.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,164.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,031.82
|
| Rate for Payer: Cash Price |
$2,848.20
|
| Rate for Payer: Cigna Commercial |
$8,734.48
|
| Rate for Payer: Health EOS Commercial |
$8,449.66
|
| Rate for Payer: HFN Commercial |
$8,734.48
|
| Rate for Payer: Multiplan Commercial |
$7,595.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,696.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,734.48
|
| Rate for Payer: Quartz Beloit One Network |
$4,652.06
|
| Rate for Payer: Quartz Commercial |
$5,696.40
|
| Rate for Payer: WEA Trust Commercial |
$5,221.70
|
| Rate for Payer: WPS Commercial |
$7,032.21
|
|
|
SUTURE CUP UNIVERSAL REVERSE 42 NEUTRAL AR-9502F-42CPC
|
Facility
|
OP
|
$9,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5306641
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,658.32 |
| Max. Negotiated Rate |
$37,976.00 |
| Rate for Payer: Aetna Commercial |
$8,544.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,164.84
|
| Rate for Payer: Aetna Managed Medicare |
$2,658.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,171.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,747.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,557.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,031.82
|
| Rate for Payer: Cash Price |
$2,848.20
|
| Rate for Payer: Cigna Commercial |
$8,734.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,312.84
|
| Rate for Payer: Health EOS Commercial |
$8,449.66
|
| Rate for Payer: HFN Commercial |
$8,734.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,120.50
|
| Rate for Payer: Multiplan Commercial |
$7,595.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,696.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,734.48
|
| Rate for Payer: Quartz Beloit One Network |
$4,652.06
|
| Rate for Payer: Quartz Commercial |
$6,171.10
|
| Rate for Payer: Quartz Medicare Advantage |
$5,696.40
|
| Rate for Payer: The Alliance Commercial |
$37,976.00
|
| Rate for Payer: WEA Trust Commercial |
$5,221.70
|
| Rate for Payer: WPS Commercial |
$7,032.21
|
|
|
SUTURE CUP UNIVERS REVERS 39 +2 RT AR-9502F-39RCPC
|
Facility
|
OP
|
$9,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5074621
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,658.32 |
| Max. Negotiated Rate |
$37,976.00 |
| Rate for Payer: Aetna Commercial |
$8,544.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,164.84
|
| Rate for Payer: Aetna Managed Medicare |
$2,658.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,171.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,747.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,557.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,031.82
|
| Rate for Payer: Cash Price |
$2,848.20
|
| Rate for Payer: Cigna Commercial |
$8,734.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,312.84
|
| Rate for Payer: Health EOS Commercial |
$8,449.66
|
| Rate for Payer: HFN Commercial |
$8,734.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,120.50
|
| Rate for Payer: Multiplan Commercial |
$7,595.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,696.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,734.48
|
| Rate for Payer: Quartz Beloit One Network |
$4,652.06
|
| Rate for Payer: Quartz Commercial |
$6,171.10
|
| Rate for Payer: Quartz Medicare Advantage |
$5,696.40
|
| Rate for Payer: The Alliance Commercial |
$37,976.00
|
| Rate for Payer: WEA Trust Commercial |
$5,221.70
|
| Rate for Payer: WPS Commercial |
$7,032.21
|
|
|
SUTURE CUP UNIVERS REVERS 39 +2 RT AR-9502F-39RCPC
|
Facility
|
IP
|
$9,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5074621
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,652.06 |
| Max. Negotiated Rate |
$8,734.48 |
| Rate for Payer: Aetna Commercial |
$8,544.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,164.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,031.82
|
| Rate for Payer: Cash Price |
$2,848.20
|
| Rate for Payer: Cigna Commercial |
$8,734.48
|
| Rate for Payer: Health EOS Commercial |
$8,449.66
|
| Rate for Payer: HFN Commercial |
$8,734.48
|
| Rate for Payer: Multiplan Commercial |
$7,595.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,696.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,734.48
|
| Rate for Payer: Quartz Beloit One Network |
$4,652.06
|
| Rate for Payer: Quartz Commercial |
$5,696.40
|
| Rate for Payer: WEA Trust Commercial |
$5,221.70
|
| Rate for Payer: WPS Commercial |
$7,032.21
|
|
|
SUTURE CUP UNIVERS REVERSE 36 NUETRAL AR-9502F-36CPC
|
Facility
|
OP
|
$9,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5298726
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,658.32 |
| Max. Negotiated Rate |
$37,976.00 |
| Rate for Payer: Aetna Commercial |
$8,544.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,164.84
|
| Rate for Payer: Aetna Managed Medicare |
$2,658.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,171.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,747.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,557.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,031.82
|
| Rate for Payer: Cash Price |
$2,848.20
|
| Rate for Payer: Cigna Commercial |
$8,734.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,312.84
|
| Rate for Payer: Health EOS Commercial |
$8,449.66
|
| Rate for Payer: HFN Commercial |
$8,734.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,120.50
|
| Rate for Payer: Multiplan Commercial |
$7,595.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,696.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,734.48
|
| Rate for Payer: Quartz Beloit One Network |
$4,652.06
|
| Rate for Payer: Quartz Commercial |
$6,171.10
|
| Rate for Payer: Quartz Medicare Advantage |
$5,696.40
|
| Rate for Payer: The Alliance Commercial |
$37,976.00
|
| Rate for Payer: WEA Trust Commercial |
$5,221.70
|
| Rate for Payer: WPS Commercial |
$7,032.21
|
|
|
SUTURE CUP UNIVERS REVERSE 36 NUETRAL AR-9502F-36CPC
|
Facility
|
IP
|
$9,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5298726
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,652.06 |
| Max. Negotiated Rate |
$8,734.48 |
| Rate for Payer: Aetna Commercial |
$8,544.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,164.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,031.82
|
| Rate for Payer: Cash Price |
$2,848.20
|
| Rate for Payer: Cigna Commercial |
$8,734.48
|
| Rate for Payer: Health EOS Commercial |
$8,449.66
|
| Rate for Payer: HFN Commercial |
$8,734.48
|
| Rate for Payer: Multiplan Commercial |
$7,595.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,696.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,734.48
|
| Rate for Payer: Quartz Beloit One Network |
$4,652.06
|
| Rate for Payer: Quartz Commercial |
$5,696.40
|
| Rate for Payer: WEA Trust Commercial |
$5,221.70
|
| Rate for Payer: WPS Commercial |
$7,032.21
|
|
|
SUTURE CV4 GORTEX 3200A
|
Facility
|
IP
|
$111.00
|
|
| Hospital Charge Code |
2975075
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.39 |
| Max. Negotiated Rate |
$102.12 |
| Rate for Payer: Aetna Commercial |
$99.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.83
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$102.12
|
| Rate for Payer: Health EOS Commercial |
$98.79
|
| Rate for Payer: HFN Commercial |
$102.12
|
| Rate for Payer: Multiplan Commercial |
$88.80
|
| Rate for Payer: NAPHCARE Commercial |
$66.60
|
| Rate for Payer: Preferred Network Access Commercial |
$102.12
|
| Rate for Payer: Quartz Beloit One Network |
$54.39
|
| Rate for Payer: Quartz Commercial |
$66.60
|
| Rate for Payer: WEA Trust Commercial |
$61.05
|
| Rate for Payer: WPS Commercial |
$82.22
|
|
