|
PLATE T-FUSION 2.4/2.7 02.211.253
|
Facility
|
IP
|
$8,260.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966379
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,209.30 |
| Max. Negotiated Rate |
$7,903.17 |
| Rate for Payer: Aetna Commercial |
$7,731.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,387.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,552.91
|
| Rate for Payer: Cash Price |
$2,478.00
|
| Rate for Payer: Cigna Commercial |
$7,903.17
|
| Rate for Payer: Health EOS Commercial |
$7,645.46
|
| Rate for Payer: HFN Commercial |
$7,903.17
|
| Rate for Payer: Multiplan Commercial |
$6,872.32
|
| Rate for Payer: Preferred Network Access Commercial |
$7,903.17
|
| Rate for Payer: Quartz Beloit One Network |
$4,209.30
|
| Rate for Payer: Quartz Commercial |
$5,154.24
|
| Rate for Payer: WEA Trust Commercial |
$4,724.72
|
| Rate for Payer: WPS Commercial |
$6,362.68
|
|
|
PLATE TIBIA 2.7/ 3.5MM VA-LCP MED/DISTAL 10 HL LT 02.118.009
|
Facility
|
OP
|
$7,863.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4028666
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,289.71 |
| Max. Negotiated Rate |
$7,523.32 |
| Rate for Payer: Aetna Commercial |
$7,359.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,032.67
|
| Rate for Payer: Aetna Managed Medicare |
$2,289.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,315.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,088.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,925.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,334.09
|
| Rate for Payer: Cash Price |
$2,358.90
|
| Rate for Payer: Cigna Commercial |
$7,523.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,576.27
|
| Rate for Payer: Health EOS Commercial |
$7,277.99
|
| Rate for Payer: HFN Commercial |
$7,523.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,133.14
|
| Rate for Payer: Multiplan Commercial |
$6,542.02
|
| Rate for Payer: NAPHCARE Commercial |
$4,906.51
|
| Rate for Payer: Preferred Network Access Commercial |
$7,523.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,006.98
|
| Rate for Payer: Quartz Commercial |
$5,315.39
|
| Rate for Payer: Quartz Medicare Advantage |
$4,906.51
|
| Rate for Payer: The Alliance Commercial |
$4,088.76
|
| Rate for Payer: WEA Trust Commercial |
$4,497.64
|
| Rate for Payer: WPS Commercial |
$6,056.87
|
|
|
PLATE TIBIA 2.7/ 3.5MM VA-LCP MED/DISTAL 10 HL LT 02.118.009
|
Facility
|
IP
|
$7,863.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4028666
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,006.98 |
| Max. Negotiated Rate |
$7,523.32 |
| Rate for Payer: Aetna Commercial |
$7,359.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,032.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,334.09
|
| Rate for Payer: Cash Price |
$2,358.90
|
| Rate for Payer: Cigna Commercial |
$7,523.32
|
| Rate for Payer: Health EOS Commercial |
$7,277.99
|
| Rate for Payer: HFN Commercial |
$7,523.32
|
| Rate for Payer: Multiplan Commercial |
$6,542.02
|
| Rate for Payer: Preferred Network Access Commercial |
$7,523.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,006.98
|
| Rate for Payer: Quartz Commercial |
$4,906.51
|
| Rate for Payer: WEA Trust Commercial |
$4,497.64
|
| Rate for Payer: WPS Commercial |
$6,056.87
|
|
|
PLATE TIBIA 2.7/ 3.5MM VA-LCP MED/DISTAL 6 HL LT 02.118.005
|
Facility
|
OP
|
$7,701.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4317097
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,242.53 |
| Max. Negotiated Rate |
$7,368.32 |
| Rate for Payer: Aetna Commercial |
$7,208.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,887.77
|
| Rate for Payer: Aetna Managed Medicare |
$2,242.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,205.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,004.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,844.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,244.79
|
| Rate for Payer: Cash Price |
$2,310.30
|
| Rate for Payer: Cigna Commercial |
$7,368.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,481.98
|
| Rate for Payer: Health EOS Commercial |
$7,128.05
|
| Rate for Payer: HFN Commercial |
$7,368.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,006.78
|
| Rate for Payer: Multiplan Commercial |
$6,407.23
|
| Rate for Payer: NAPHCARE Commercial |
$4,805.42
|
| Rate for Payer: Preferred Network Access Commercial |
$7,368.32
|
| Rate for Payer: Quartz Beloit One Network |
$3,924.43
|
| Rate for Payer: Quartz Commercial |
$5,205.88
|
| Rate for Payer: Quartz Medicare Advantage |
$4,805.42
|
| Rate for Payer: The Alliance Commercial |
$4,004.52
|
| Rate for Payer: WEA Trust Commercial |
$4,404.97
|
| Rate for Payer: WPS Commercial |
$5,932.08
|
|
|
PLATE TIBIA 2.7/ 3.5MM VA-LCP MED/DISTAL 6 HL LT 02.118.005
|
Facility
|
IP
|
$7,701.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4317097
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,924.43 |
| Max. Negotiated Rate |
$7,368.32 |
| Rate for Payer: Aetna Commercial |
$7,208.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,887.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,244.79
|
| Rate for Payer: Cash Price |
$2,310.30
|
| Rate for Payer: Cigna Commercial |
$7,368.32
|
| Rate for Payer: Health EOS Commercial |
$7,128.05
|
| Rate for Payer: HFN Commercial |
$7,368.32
|
| Rate for Payer: Multiplan Commercial |
$6,407.23
|
| Rate for Payer: Preferred Network Access Commercial |
$7,368.32
|
| Rate for Payer: Quartz Beloit One Network |
$3,924.43
|
| Rate for Payer: Quartz Commercial |
$4,805.42
|
| Rate for Payer: WEA Trust Commercial |
$4,404.97
|
| Rate for Payer: WPS Commercial |
$5,932.08
|
|
|
PLATE TIBIA 2.7/ 3.5MM VA-LCP MED/DISTAL 6 RL LT 02.118.004
|
Facility
|
IP
|
$7,316.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4317099
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,728.23 |
| Max. Negotiated Rate |
$6,999.95 |
| Rate for Payer: Aetna Commercial |
$6,847.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,543.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,032.58
|
| Rate for Payer: Cash Price |
$2,194.80
|
| Rate for Payer: Cigna Commercial |
$6,999.95
|
| Rate for Payer: Health EOS Commercial |
$6,771.69
|
| Rate for Payer: HFN Commercial |
$6,999.95
|
| Rate for Payer: Multiplan Commercial |
$6,086.91
|
| Rate for Payer: Preferred Network Access Commercial |
$6,999.95
|
| Rate for Payer: Quartz Beloit One Network |
$3,728.23
|
| Rate for Payer: Quartz Commercial |
$4,565.18
|
| Rate for Payer: WEA Trust Commercial |
$4,184.75
|
| Rate for Payer: WPS Commercial |
$5,635.51
|
|
|
PLATE TIBIA 2.7/ 3.5MM VA-LCP MED/DISTAL 6 RL LT 02.118.004
|
Facility
|
OP
|
$7,316.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4317099
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,130.42 |
| Max. Negotiated Rate |
$6,999.95 |
| Rate for Payer: Aetna Commercial |
$6,847.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,543.43
|
| Rate for Payer: Aetna Managed Medicare |
$2,130.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,945.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,804.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,652.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,032.58
|
| Rate for Payer: Cash Price |
$2,194.80
|
| Rate for Payer: Cigna Commercial |
$6,999.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,257.91
|
| Rate for Payer: Health EOS Commercial |
$6,771.69
|
| Rate for Payer: HFN Commercial |
$6,999.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,706.48
|
| Rate for Payer: Multiplan Commercial |
$6,086.91
|
| Rate for Payer: NAPHCARE Commercial |
$4,565.18
|
| Rate for Payer: Preferred Network Access Commercial |
$6,999.95
|
| Rate for Payer: Quartz Beloit One Network |
$3,728.23
|
| Rate for Payer: Quartz Commercial |
$4,945.62
|
| Rate for Payer: Quartz Medicare Advantage |
$4,565.18
|
| Rate for Payer: The Alliance Commercial |
$3,804.32
|
| Rate for Payer: WEA Trust Commercial |
$4,184.75
|
| Rate for Payer: WPS Commercial |
$5,635.51
|
|
|
PLATE TIBIA 3.5MM LCP POST/MEDIAL/PROX 1HL 02.120.701
|
Facility
|
OP
|
$6,419.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6173129
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,869.21 |
| Max. Negotiated Rate |
$6,141.70 |
| Rate for Payer: Aetna Commercial |
$6,008.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,741.15
|
| Rate for Payer: Aetna Managed Medicare |
$1,869.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,339.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,337.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,204.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,538.15
|
| Rate for Payer: Cash Price |
$1,925.70
|
| Rate for Payer: Cigna Commercial |
$6,141.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,735.86
|
| Rate for Payer: Health EOS Commercial |
$5,941.43
|
| Rate for Payer: HFN Commercial |
$6,141.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,006.82
|
| Rate for Payer: Multiplan Commercial |
$5,340.61
|
| Rate for Payer: NAPHCARE Commercial |
$4,005.46
|
| Rate for Payer: Preferred Network Access Commercial |
$6,141.70
|
| Rate for Payer: Quartz Beloit One Network |
$3,271.12
|
| Rate for Payer: Quartz Commercial |
$4,339.24
|
| Rate for Payer: Quartz Medicare Advantage |
$4,005.46
|
| Rate for Payer: The Alliance Commercial |
$3,337.88
|
| Rate for Payer: WEA Trust Commercial |
$3,671.67
|
| Rate for Payer: WPS Commercial |
$4,944.56
|
|
|
PLATE TIBIA 3.5MM LCP POST/MEDIAL/PROX 1HL 02.120.701
|
Facility
|
IP
|
$6,419.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6173129
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,271.12 |
| Max. Negotiated Rate |
$6,141.70 |
| Rate for Payer: Aetna Commercial |
$6,008.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,741.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,538.15
|
| Rate for Payer: Cash Price |
$1,925.70
|
| Rate for Payer: Cigna Commercial |
$6,141.70
|
| Rate for Payer: Health EOS Commercial |
$5,941.43
|
| Rate for Payer: HFN Commercial |
$6,141.70
|
| Rate for Payer: Multiplan Commercial |
$5,340.61
|
| Rate for Payer: Preferred Network Access Commercial |
$6,141.70
|
| Rate for Payer: Quartz Beloit One Network |
$3,271.12
|
| Rate for Payer: Quartz Commercial |
$4,005.46
|
| Rate for Payer: WEA Trust Commercial |
$3,671.67
|
| Rate for Payer: WPS Commercial |
$4,944.56
|
|
|
PLATE TIBIAL MIS NEXGEN SZ 3 5950-37-01
|
Facility
|
IP
|
$7,868.00
|
|
| Hospital Charge Code |
2967776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,009.53 |
| Max. Negotiated Rate |
$7,528.10 |
| Rate for Payer: Aetna Commercial |
$7,364.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,037.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,336.84
|
| Rate for Payer: Cash Price |
$2,360.40
|
| Rate for Payer: Cigna Commercial |
$7,528.10
|
| Rate for Payer: Health EOS Commercial |
$7,282.62
|
| Rate for Payer: HFN Commercial |
$7,528.10
|
| Rate for Payer: Multiplan Commercial |
$6,546.18
|
| Rate for Payer: Preferred Network Access Commercial |
$7,528.10
|
| Rate for Payer: Quartz Beloit One Network |
$4,009.53
|
| Rate for Payer: Quartz Commercial |
$4,909.63
|
| Rate for Payer: WEA Trust Commercial |
$4,500.50
|
| Rate for Payer: WPS Commercial |
$6,060.72
|
|
|
PLATE TIBIAL MIS NEXGEN SZ 3 5950-37-01
|
Facility
|
OP
|
$7,868.00
|
|
| Hospital Charge Code |
2967776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,291.16 |
| Max. Negotiated Rate |
$7,528.10 |
| Rate for Payer: Aetna Commercial |
$7,364.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,037.14
|
| Rate for Payer: Aetna Managed Medicare |
$2,291.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,318.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,091.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,927.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,336.84
|
| Rate for Payer: Cash Price |
$2,360.40
|
| Rate for Payer: Cigna Commercial |
$7,528.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,579.18
|
| Rate for Payer: Health EOS Commercial |
$7,282.62
|
| Rate for Payer: HFN Commercial |
$7,528.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,137.04
|
| Rate for Payer: Multiplan Commercial |
$6,546.18
|
| Rate for Payer: NAPHCARE Commercial |
$4,909.63
|
| Rate for Payer: Preferred Network Access Commercial |
$7,528.10
|
| Rate for Payer: Quartz Beloit One Network |
$4,009.53
|
| Rate for Payer: Quartz Commercial |
$5,318.77
|
| Rate for Payer: Quartz Medicare Advantage |
$4,909.63
|
| Rate for Payer: The Alliance Commercial |
$4,091.36
|
| Rate for Payer: WEA Trust Commercial |
$4,500.50
|
| Rate for Payer: WPS Commercial |
$6,060.72
|
|
|
PLATE TIBIAL MIS NEXGEN SZ 4 5950-037-02
|
Facility
|
OP
|
$7,868.00
|
|
| Hospital Charge Code |
2967777
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,291.16 |
| Max. Negotiated Rate |
$7,528.10 |
| Rate for Payer: Aetna Commercial |
$7,364.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,037.14
|
| Rate for Payer: Aetna Managed Medicare |
$2,291.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,318.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,091.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,927.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,336.84
|
| Rate for Payer: Cash Price |
$2,360.40
|
| Rate for Payer: Cigna Commercial |
$7,528.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,579.18
|
| Rate for Payer: Health EOS Commercial |
$7,282.62
|
| Rate for Payer: HFN Commercial |
$7,528.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,137.04
|
| Rate for Payer: Multiplan Commercial |
$6,546.18
|
| Rate for Payer: NAPHCARE Commercial |
$4,909.63
|
| Rate for Payer: Preferred Network Access Commercial |
$7,528.10
|
| Rate for Payer: Quartz Beloit One Network |
$4,009.53
|
| Rate for Payer: Quartz Commercial |
$5,318.77
|
| Rate for Payer: Quartz Medicare Advantage |
$4,909.63
|
| Rate for Payer: The Alliance Commercial |
$4,091.36
|
| Rate for Payer: WEA Trust Commercial |
$4,500.50
|
| Rate for Payer: WPS Commercial |
$6,060.72
|
|
|
PLATE TIBIAL MIS NEXGEN SZ 4 5950-037-02
|
Facility
|
IP
|
$7,868.00
|
|
| Hospital Charge Code |
2967777
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,009.53 |
| Max. Negotiated Rate |
$7,528.10 |
| Rate for Payer: Aetna Commercial |
$7,364.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,037.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,336.84
|
| Rate for Payer: Cash Price |
$2,360.40
|
| Rate for Payer: Cigna Commercial |
$7,528.10
|
| Rate for Payer: Health EOS Commercial |
$7,282.62
|
| Rate for Payer: HFN Commercial |
$7,528.10
|
| Rate for Payer: Multiplan Commercial |
$6,546.18
|
| Rate for Payer: Preferred Network Access Commercial |
$7,528.10
|
| Rate for Payer: Quartz Beloit One Network |
$4,009.53
|
| Rate for Payer: Quartz Commercial |
$4,909.63
|
| Rate for Payer: WEA Trust Commercial |
$4,500.50
|
| Rate for Payer: WPS Commercial |
$6,060.72
|
|
|
PLATE TIBIAL MIS NEXGEN SZ 5 5950-47-01
|
Facility
|
IP
|
$7,868.00
|
|
| Hospital Charge Code |
2967778
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,009.53 |
| Max. Negotiated Rate |
$7,528.10 |
| Rate for Payer: Aetna Commercial |
$7,364.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,037.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,336.84
|
| Rate for Payer: Cash Price |
$2,360.40
|
| Rate for Payer: Cigna Commercial |
$7,528.10
|
| Rate for Payer: Health EOS Commercial |
$7,282.62
|
| Rate for Payer: HFN Commercial |
$7,528.10
|
| Rate for Payer: Multiplan Commercial |
$6,546.18
|
| Rate for Payer: Preferred Network Access Commercial |
$7,528.10
|
| Rate for Payer: Quartz Beloit One Network |
$4,009.53
|
| Rate for Payer: Quartz Commercial |
$4,909.63
|
| Rate for Payer: WEA Trust Commercial |
$4,500.50
|
| Rate for Payer: WPS Commercial |
$6,060.72
|
|
|
PLATE TIBIAL MIS NEXGEN SZ 5 5950-47-01
|
Facility
|
OP
|
$7,868.00
|
|
| Hospital Charge Code |
2967778
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,291.16 |
| Max. Negotiated Rate |
$7,528.10 |
| Rate for Payer: Aetna Commercial |
$7,364.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,037.14
|
| Rate for Payer: Aetna Managed Medicare |
$2,291.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,318.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,091.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,927.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,336.84
|
| Rate for Payer: Cash Price |
$2,360.40
|
| Rate for Payer: Cigna Commercial |
$7,528.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,579.18
|
| Rate for Payer: Health EOS Commercial |
$7,282.62
|
| Rate for Payer: HFN Commercial |
$7,528.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,137.04
|
| Rate for Payer: Multiplan Commercial |
$6,546.18
|
| Rate for Payer: NAPHCARE Commercial |
$4,909.63
|
| Rate for Payer: Preferred Network Access Commercial |
$7,528.10
|
| Rate for Payer: Quartz Beloit One Network |
$4,009.53
|
| Rate for Payer: Quartz Commercial |
$5,318.77
|
| Rate for Payer: Quartz Medicare Advantage |
$4,909.63
|
| Rate for Payer: The Alliance Commercial |
$4,091.36
|
| Rate for Payer: WEA Trust Commercial |
$4,500.50
|
| Rate for Payer: WPS Commercial |
$6,060.72
|
|
|
PLATE TIBIAL MIS NEXGEN SZ 6 5950-47-02
|
Facility
|
OP
|
$7,868.00
|
|
| Hospital Charge Code |
2967779
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,291.16 |
| Max. Negotiated Rate |
$7,528.10 |
| Rate for Payer: Aetna Commercial |
$7,364.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,037.14
|
| Rate for Payer: Aetna Managed Medicare |
$2,291.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,318.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,091.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,927.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,336.84
|
| Rate for Payer: Cash Price |
$2,360.40
|
| Rate for Payer: Cigna Commercial |
$7,528.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,579.18
|
| Rate for Payer: Health EOS Commercial |
$7,282.62
|
| Rate for Payer: HFN Commercial |
$7,528.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,137.04
|
| Rate for Payer: Multiplan Commercial |
$6,546.18
|
| Rate for Payer: NAPHCARE Commercial |
$4,909.63
|
| Rate for Payer: Preferred Network Access Commercial |
$7,528.10
|
| Rate for Payer: Quartz Beloit One Network |
$4,009.53
|
| Rate for Payer: Quartz Commercial |
$5,318.77
|
| Rate for Payer: Quartz Medicare Advantage |
$4,909.63
|
| Rate for Payer: The Alliance Commercial |
$4,091.36
|
| Rate for Payer: WEA Trust Commercial |
$4,500.50
|
| Rate for Payer: WPS Commercial |
$6,060.72
|
|
|
PLATE TIBIAL MIS NEXGEN SZ 6 5950-47-02
|
Facility
|
IP
|
$7,868.00
|
|
| Hospital Charge Code |
2967779
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,009.53 |
| Max. Negotiated Rate |
$7,528.10 |
| Rate for Payer: Aetna Commercial |
$7,364.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,037.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,336.84
|
| Rate for Payer: Cash Price |
$2,360.40
|
| Rate for Payer: Cigna Commercial |
$7,528.10
|
| Rate for Payer: Health EOS Commercial |
$7,282.62
|
| Rate for Payer: HFN Commercial |
$7,528.10
|
| Rate for Payer: Multiplan Commercial |
$6,546.18
|
| Rate for Payer: Preferred Network Access Commercial |
$7,528.10
|
| Rate for Payer: Quartz Beloit One Network |
$4,009.53
|
| Rate for Payer: Quartz Commercial |
$4,909.63
|
| Rate for Payer: WEA Trust Commercial |
$4,500.50
|
| Rate for Payer: WPS Commercial |
$6,060.72
|
|
|
PLATE TIBIAL MIS NEXGEN SZ 7 5950-57-01
|
Facility
|
OP
|
$7,868.00
|
|
| Hospital Charge Code |
2967780
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,291.16 |
| Max. Negotiated Rate |
$7,528.10 |
| Rate for Payer: Aetna Commercial |
$7,364.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,037.14
|
| Rate for Payer: Aetna Managed Medicare |
$2,291.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,318.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,091.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,927.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,336.84
|
| Rate for Payer: Cash Price |
$2,360.40
|
| Rate for Payer: Cigna Commercial |
$7,528.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,579.18
|
| Rate for Payer: Health EOS Commercial |
$7,282.62
|
| Rate for Payer: HFN Commercial |
$7,528.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,137.04
|
| Rate for Payer: Multiplan Commercial |
$6,546.18
|
| Rate for Payer: NAPHCARE Commercial |
$4,909.63
|
| Rate for Payer: Preferred Network Access Commercial |
$7,528.10
|
| Rate for Payer: Quartz Beloit One Network |
$4,009.53
|
| Rate for Payer: Quartz Commercial |
$5,318.77
|
| Rate for Payer: Quartz Medicare Advantage |
$4,909.63
|
| Rate for Payer: The Alliance Commercial |
$4,091.36
|
| Rate for Payer: WEA Trust Commercial |
$4,500.50
|
| Rate for Payer: WPS Commercial |
$6,060.72
|
|
|
PLATE TIBIAL MIS NEXGEN SZ 7 5950-57-01
|
Facility
|
IP
|
$7,868.00
|
|
| Hospital Charge Code |
2967780
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,009.53 |
| Max. Negotiated Rate |
$7,528.10 |
| Rate for Payer: Aetna Commercial |
$7,364.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,037.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,336.84
|
| Rate for Payer: Cash Price |
$2,360.40
|
| Rate for Payer: Cigna Commercial |
$7,528.10
|
| Rate for Payer: Health EOS Commercial |
$7,282.62
|
| Rate for Payer: HFN Commercial |
$7,528.10
|
| Rate for Payer: Multiplan Commercial |
$6,546.18
|
| Rate for Payer: Preferred Network Access Commercial |
$7,528.10
|
| Rate for Payer: Quartz Beloit One Network |
$4,009.53
|
| Rate for Payer: Quartz Commercial |
$4,909.63
|
| Rate for Payer: WEA Trust Commercial |
$4,500.50
|
| Rate for Payer: WPS Commercial |
$6,060.72
|
|
|
PLATE TIBIAL MIS NEXGEN SZ 8 5950-57-02
|
Facility
|
IP
|
$7,868.00
|
|
| Hospital Charge Code |
2967781
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,009.53 |
| Max. Negotiated Rate |
$7,528.10 |
| Rate for Payer: Aetna Commercial |
$7,364.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,037.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,336.84
|
| Rate for Payer: Cash Price |
$2,360.40
|
| Rate for Payer: Cigna Commercial |
$7,528.10
|
| Rate for Payer: Health EOS Commercial |
$7,282.62
|
| Rate for Payer: HFN Commercial |
$7,528.10
|
| Rate for Payer: Multiplan Commercial |
$6,546.18
|
| Rate for Payer: Preferred Network Access Commercial |
$7,528.10
|
| Rate for Payer: Quartz Beloit One Network |
$4,009.53
|
| Rate for Payer: Quartz Commercial |
$4,909.63
|
| Rate for Payer: WEA Trust Commercial |
$4,500.50
|
| Rate for Payer: WPS Commercial |
$6,060.72
|
|
|
PLATE TIBIAL MIS NEXGEN SZ 8 5950-57-02
|
Facility
|
OP
|
$7,868.00
|
|
| Hospital Charge Code |
2967781
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,291.16 |
| Max. Negotiated Rate |
$7,528.10 |
| Rate for Payer: Aetna Commercial |
$7,364.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,037.14
|
| Rate for Payer: Aetna Managed Medicare |
$2,291.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,318.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,091.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,927.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,336.84
|
| Rate for Payer: Cash Price |
$2,360.40
|
| Rate for Payer: Cigna Commercial |
$7,528.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,579.18
|
| Rate for Payer: Health EOS Commercial |
$7,282.62
|
| Rate for Payer: HFN Commercial |
$7,528.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,137.04
|
| Rate for Payer: Multiplan Commercial |
$6,546.18
|
| Rate for Payer: NAPHCARE Commercial |
$4,909.63
|
| Rate for Payer: Preferred Network Access Commercial |
$7,528.10
|
| Rate for Payer: Quartz Beloit One Network |
$4,009.53
|
| Rate for Payer: Quartz Commercial |
$5,318.77
|
| Rate for Payer: Quartz Medicare Advantage |
$4,909.63
|
| Rate for Payer: The Alliance Commercial |
$4,091.36
|
| Rate for Payer: WEA Trust Commercial |
$4,500.50
|
| Rate for Payer: WPS Commercial |
$6,060.72
|
|
|
PLATE TWO HOLE SS AR-8958-01S
|
Facility
|
IP
|
$6,463.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414794
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,293.54 |
| Max. Negotiated Rate |
$6,183.80 |
| Rate for Payer: Aetna Commercial |
$6,049.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,780.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,562.41
|
| Rate for Payer: Cash Price |
$1,938.90
|
| Rate for Payer: Cigna Commercial |
$6,183.80
|
| Rate for Payer: Health EOS Commercial |
$5,982.15
|
| Rate for Payer: HFN Commercial |
$6,183.80
|
| Rate for Payer: Multiplan Commercial |
$5,377.22
|
| Rate for Payer: Preferred Network Access Commercial |
$6,183.80
|
| Rate for Payer: Quartz Beloit One Network |
$3,293.54
|
| Rate for Payer: Quartz Commercial |
$4,032.91
|
| Rate for Payer: WEA Trust Commercial |
$3,696.84
|
| Rate for Payer: WPS Commercial |
$4,978.45
|
|
|
PLATE TWO HOLE SS AR-8958-01S
|
Facility
|
OP
|
$6,463.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414794
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,882.03 |
| Max. Negotiated Rate |
$6,183.80 |
| Rate for Payer: Aetna Commercial |
$6,049.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,780.51
|
| Rate for Payer: Aetna Managed Medicare |
$1,882.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,368.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,360.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,226.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,562.41
|
| Rate for Payer: Cash Price |
$1,938.90
|
| Rate for Payer: Cigna Commercial |
$6,183.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,761.47
|
| Rate for Payer: Health EOS Commercial |
$5,982.15
|
| Rate for Payer: HFN Commercial |
$6,183.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,041.14
|
| Rate for Payer: Multiplan Commercial |
$5,377.22
|
| Rate for Payer: NAPHCARE Commercial |
$4,032.91
|
| Rate for Payer: Preferred Network Access Commercial |
$6,183.80
|
| Rate for Payer: Quartz Beloit One Network |
$3,293.54
|
| Rate for Payer: Quartz Commercial |
$4,368.99
|
| Rate for Payer: Quartz Medicare Advantage |
$4,032.91
|
| Rate for Payer: The Alliance Commercial |
$3,360.76
|
| Rate for Payer: WEA Trust Commercial |
$3,696.84
|
| Rate for Payer: WPS Commercial |
$4,978.45
|
|
|
PLATE ULNA OSTEOTOMY 2.7MM 8 HOLE 02.111.901
|
Facility
|
OP
|
$9,974.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494346
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,904.43 |
| Max. Negotiated Rate |
$9,543.12 |
| Rate for Payer: Aetna Commercial |
$9,335.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,920.75
|
| Rate for Payer: Aetna Managed Medicare |
$2,904.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,742.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,186.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,979.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,497.67
|
| Rate for Payer: Cash Price |
$2,992.20
|
| Rate for Payer: Cigna Commercial |
$9,543.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,804.87
|
| Rate for Payer: Health EOS Commercial |
$9,231.93
|
| Rate for Payer: HFN Commercial |
$9,543.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,779.72
|
| Rate for Payer: Multiplan Commercial |
$8,298.37
|
| Rate for Payer: NAPHCARE Commercial |
$6,223.78
|
| Rate for Payer: Preferred Network Access Commercial |
$9,543.12
|
| Rate for Payer: Quartz Beloit One Network |
$5,082.75
|
| Rate for Payer: Quartz Commercial |
$6,742.42
|
| Rate for Payer: Quartz Medicare Advantage |
$6,223.78
|
| Rate for Payer: The Alliance Commercial |
$5,186.48
|
| Rate for Payer: WEA Trust Commercial |
$5,705.13
|
| Rate for Payer: WPS Commercial |
$7,682.97
|
|
|
PLATE ULNA OSTEOTOMY 2.7MM 8 HOLE 02.111.901
|
Facility
|
IP
|
$9,974.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4494346
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,082.75 |
| Max. Negotiated Rate |
$9,543.12 |
| Rate for Payer: Aetna Commercial |
$9,335.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,920.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,497.67
|
| Rate for Payer: Cash Price |
$2,992.20
|
| Rate for Payer: Cigna Commercial |
$9,543.12
|
| Rate for Payer: Health EOS Commercial |
$9,231.93
|
| Rate for Payer: HFN Commercial |
$9,543.12
|
| Rate for Payer: Multiplan Commercial |
$8,298.37
|
| Rate for Payer: Preferred Network Access Commercial |
$9,543.12
|
| Rate for Payer: Quartz Beloit One Network |
$5,082.75
|
| Rate for Payer: Quartz Commercial |
$6,223.78
|
| Rate for Payer: WEA Trust Commercial |
$5,705.13
|
| Rate for Payer: WPS Commercial |
$7,682.97
|
|
