|
PLATE T-FUSION 2.4/2.7 02.211.253
|
Facility
|
OP
|
$8,260.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966379
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,312.80 |
| Max. Negotiated Rate |
$33,040.00 |
| Rate for Payer: Aetna Commercial |
$7,434.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,103.60
|
| Rate for Payer: Aetna Managed Medicare |
$2,312.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,369.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,130.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,964.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,377.80
|
| Rate for Payer: Cash Price |
$2,478.00
|
| Rate for Payer: Cigna Commercial |
$7,599.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,622.30
|
| Rate for Payer: Health EOS Commercial |
$7,351.40
|
| Rate for Payer: HFN Commercial |
$7,599.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,195.00
|
| Rate for Payer: Multiplan Commercial |
$6,608.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,956.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,599.20
|
| Rate for Payer: Quartz Beloit One Network |
$4,047.40
|
| Rate for Payer: Quartz Commercial |
$5,369.00
|
| Rate for Payer: Quartz Medicare Advantage |
$4,956.00
|
| Rate for Payer: The Alliance Commercial |
$33,040.00
|
| Rate for Payer: WEA Trust Commercial |
$4,543.00
|
| Rate for Payer: WPS Commercial |
$6,118.18
|
|
|
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 |
$2,201.64 |
| Max. Negotiated Rate |
$31,452.00 |
| Rate for Payer: Aetna Commercial |
$7,076.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,762.18
|
| Rate for Payer: Aetna Managed Medicare |
$2,201.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,110.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,931.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,774.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,167.39
|
| Rate for Payer: Cash Price |
$2,358.90
|
| Rate for Payer: Cigna Commercial |
$7,233.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,400.13
|
| Rate for Payer: Health EOS Commercial |
$6,998.07
|
| Rate for Payer: HFN Commercial |
$7,233.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,897.25
|
| Rate for Payer: Multiplan Commercial |
$6,290.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,717.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,233.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,852.87
|
| Rate for Payer: Quartz Commercial |
$5,110.95
|
| Rate for Payer: Quartz Medicare Advantage |
$4,717.80
|
| Rate for Payer: The Alliance Commercial |
$31,452.00
|
| Rate for Payer: WEA Trust Commercial |
$4,324.65
|
| Rate for Payer: WPS Commercial |
$5,824.12
|
|
|
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 |
$3,852.87 |
| Max. Negotiated Rate |
$7,233.96 |
| Rate for Payer: Aetna Commercial |
$7,076.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,762.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,167.39
|
| Rate for Payer: Cash Price |
$2,358.90
|
| Rate for Payer: Cigna Commercial |
$7,233.96
|
| Rate for Payer: Health EOS Commercial |
$6,998.07
|
| Rate for Payer: HFN Commercial |
$7,233.96
|
| Rate for Payer: Multiplan Commercial |
$6,290.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,717.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,233.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,852.87
|
| Rate for Payer: Quartz Commercial |
$4,717.80
|
| Rate for Payer: WEA Trust Commercial |
$4,324.65
|
| Rate for Payer: WPS Commercial |
$5,824.12
|
|
|
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 |
$3,773.49 |
| Max. Negotiated Rate |
$7,084.92 |
| Rate for Payer: Aetna Commercial |
$6,930.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,622.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,081.53
|
| Rate for Payer: Cash Price |
$2,310.30
|
| Rate for Payer: Cigna Commercial |
$7,084.92
|
| Rate for Payer: Health EOS Commercial |
$6,853.89
|
| Rate for Payer: HFN Commercial |
$7,084.92
|
| Rate for Payer: Multiplan Commercial |
$6,160.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,620.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,084.92
|
| Rate for Payer: Quartz Beloit One Network |
$3,773.49
|
| Rate for Payer: Quartz Commercial |
$4,620.60
|
| Rate for Payer: WEA Trust Commercial |
$4,235.55
|
| Rate for Payer: WPS Commercial |
$5,704.13
|
|
|
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 |
$2,156.28 |
| Max. Negotiated Rate |
$30,804.00 |
| Rate for Payer: Aetna Commercial |
$6,930.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,622.86
|
| Rate for Payer: Aetna Managed Medicare |
$2,156.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,005.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,850.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,696.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,081.53
|
| Rate for Payer: Cash Price |
$2,310.30
|
| Rate for Payer: Cigna Commercial |
$7,084.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,309.48
|
| Rate for Payer: Health EOS Commercial |
$6,853.89
|
| Rate for Payer: HFN Commercial |
$7,084.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,775.75
|
| Rate for Payer: Multiplan Commercial |
$6,160.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,620.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,084.92
|
| Rate for Payer: Quartz Beloit One Network |
$3,773.49
|
| Rate for Payer: Quartz Commercial |
$5,005.65
|
| Rate for Payer: Quartz Medicare Advantage |
$4,620.60
|
| Rate for Payer: The Alliance Commercial |
$30,804.00
|
| Rate for Payer: WEA Trust Commercial |
$4,235.55
|
| Rate for Payer: WPS Commercial |
$5,704.13
|
|
|
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 |
$3,584.84 |
| Max. Negotiated Rate |
$6,730.72 |
| Rate for Payer: Aetna Commercial |
$6,584.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,291.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,877.48
|
| Rate for Payer: Cash Price |
$2,194.80
|
| Rate for Payer: Cigna Commercial |
$6,730.72
|
| Rate for Payer: Health EOS Commercial |
$6,511.24
|
| Rate for Payer: HFN Commercial |
$6,730.72
|
| Rate for Payer: Multiplan Commercial |
$5,852.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,389.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,730.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,584.84
|
| Rate for Payer: Quartz Commercial |
$4,389.60
|
| Rate for Payer: WEA Trust Commercial |
$4,023.80
|
| Rate for Payer: WPS Commercial |
$5,418.96
|
|
|
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 |
$2,048.48 |
| Max. Negotiated Rate |
$29,264.00 |
| Rate for Payer: Aetna Commercial |
$6,584.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,291.76
|
| Rate for Payer: Aetna Managed Medicare |
$2,048.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,755.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,658.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,511.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,877.48
|
| Rate for Payer: Cash Price |
$2,194.80
|
| Rate for Payer: Cigna Commercial |
$6,730.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,094.03
|
| Rate for Payer: Health EOS Commercial |
$6,511.24
|
| Rate for Payer: HFN Commercial |
$6,730.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,487.00
|
| Rate for Payer: Multiplan Commercial |
$5,852.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,389.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,730.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,584.84
|
| Rate for Payer: Quartz Commercial |
$4,755.40
|
| Rate for Payer: Quartz Medicare Advantage |
$4,389.60
|
| Rate for Payer: The Alliance Commercial |
$29,264.00
|
| Rate for Payer: WEA Trust Commercial |
$4,023.80
|
| Rate for Payer: WPS Commercial |
$5,418.96
|
|
|
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 |
$3,145.31 |
| Max. Negotiated Rate |
$5,905.48 |
| Rate for Payer: Aetna Commercial |
$5,777.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,520.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,402.07
|
| Rate for Payer: Cash Price |
$1,925.70
|
| Rate for Payer: Cigna Commercial |
$5,905.48
|
| Rate for Payer: Health EOS Commercial |
$5,712.91
|
| Rate for Payer: HFN Commercial |
$5,905.48
|
| Rate for Payer: Multiplan Commercial |
$5,135.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,851.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,905.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,145.31
|
| Rate for Payer: Quartz Commercial |
$3,851.40
|
| Rate for Payer: WEA Trust Commercial |
$3,530.45
|
| Rate for Payer: WPS Commercial |
$4,754.55
|
|
|
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 |
$1,797.32 |
| Max. Negotiated Rate |
$25,676.00 |
| Rate for Payer: Aetna Commercial |
$5,777.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,520.34
|
| Rate for Payer: Aetna Managed Medicare |
$1,797.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,172.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,209.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,081.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,402.07
|
| Rate for Payer: Cash Price |
$1,925.70
|
| Rate for Payer: Cigna Commercial |
$5,905.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,592.07
|
| Rate for Payer: Health EOS Commercial |
$5,712.91
|
| Rate for Payer: HFN Commercial |
$5,905.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,814.25
|
| Rate for Payer: Multiplan Commercial |
$5,135.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,851.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,905.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,145.31
|
| Rate for Payer: Quartz Commercial |
$4,172.35
|
| Rate for Payer: Quartz Medicare Advantage |
$3,851.40
|
| Rate for Payer: The Alliance Commercial |
$25,676.00
|
| Rate for Payer: WEA Trust Commercial |
$3,530.45
|
| Rate for Payer: WPS Commercial |
$4,754.55
|
|
|
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 |
$3,855.32 |
| Max. Negotiated Rate |
$7,238.56 |
| Rate for Payer: Aetna Commercial |
$7,081.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,766.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,170.04
|
| Rate for Payer: Cash Price |
$2,360.40
|
| Rate for Payer: Cigna Commercial |
$7,238.56
|
| Rate for Payer: Health EOS Commercial |
$7,002.52
|
| Rate for Payer: HFN Commercial |
$7,238.56
|
| Rate for Payer: Multiplan Commercial |
$6,294.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,720.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,238.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,855.32
|
| Rate for Payer: Quartz Commercial |
$4,720.80
|
| Rate for Payer: WEA Trust Commercial |
$4,327.40
|
| Rate for Payer: WPS Commercial |
$5,827.83
|
|
|
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 |
$2,203.04 |
| Max. Negotiated Rate |
$31,472.00 |
| Rate for Payer: Aetna Commercial |
$7,081.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,766.48
|
| Rate for Payer: Aetna Managed Medicare |
$2,203.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,114.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,934.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,776.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,170.04
|
| Rate for Payer: Cash Price |
$2,360.40
|
| Rate for Payer: Cigna Commercial |
$7,238.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,402.93
|
| Rate for Payer: Health EOS Commercial |
$7,002.52
|
| Rate for Payer: HFN Commercial |
$7,238.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,901.00
|
| Rate for Payer: Multiplan Commercial |
$6,294.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,720.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,238.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,855.32
|
| Rate for Payer: Quartz Commercial |
$5,114.20
|
| Rate for Payer: Quartz Medicare Advantage |
$4,720.80
|
| Rate for Payer: The Alliance Commercial |
$31,472.00
|
| Rate for Payer: WEA Trust Commercial |
$4,327.40
|
| Rate for Payer: WPS Commercial |
$5,827.83
|
|
|
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 |
$3,855.32 |
| Max. Negotiated Rate |
$7,238.56 |
| Rate for Payer: Aetna Commercial |
$7,081.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,766.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,170.04
|
| Rate for Payer: Cash Price |
$2,360.40
|
| Rate for Payer: Cigna Commercial |
$7,238.56
|
| Rate for Payer: Health EOS Commercial |
$7,002.52
|
| Rate for Payer: HFN Commercial |
$7,238.56
|
| Rate for Payer: Multiplan Commercial |
$6,294.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,720.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,238.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,855.32
|
| Rate for Payer: Quartz Commercial |
$4,720.80
|
| Rate for Payer: WEA Trust Commercial |
$4,327.40
|
| Rate for Payer: WPS Commercial |
$5,827.83
|
|
|
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 |
$2,203.04 |
| Max. Negotiated Rate |
$31,472.00 |
| Rate for Payer: Aetna Commercial |
$7,081.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,766.48
|
| Rate for Payer: Aetna Managed Medicare |
$2,203.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,114.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,934.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,776.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,170.04
|
| Rate for Payer: Cash Price |
$2,360.40
|
| Rate for Payer: Cigna Commercial |
$7,238.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,402.93
|
| Rate for Payer: Health EOS Commercial |
$7,002.52
|
| Rate for Payer: HFN Commercial |
$7,238.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,901.00
|
| Rate for Payer: Multiplan Commercial |
$6,294.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,720.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,238.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,855.32
|
| Rate for Payer: Quartz Commercial |
$5,114.20
|
| Rate for Payer: Quartz Medicare Advantage |
$4,720.80
|
| Rate for Payer: The Alliance Commercial |
$31,472.00
|
| Rate for Payer: WEA Trust Commercial |
$4,327.40
|
| Rate for Payer: WPS Commercial |
$5,827.83
|
|
|
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 |
$3,855.32 |
| Max. Negotiated Rate |
$7,238.56 |
| Rate for Payer: Aetna Commercial |
$7,081.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,766.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,170.04
|
| Rate for Payer: Cash Price |
$2,360.40
|
| Rate for Payer: Cigna Commercial |
$7,238.56
|
| Rate for Payer: Health EOS Commercial |
$7,002.52
|
| Rate for Payer: HFN Commercial |
$7,238.56
|
| Rate for Payer: Multiplan Commercial |
$6,294.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,720.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,238.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,855.32
|
| Rate for Payer: Quartz Commercial |
$4,720.80
|
| Rate for Payer: WEA Trust Commercial |
$4,327.40
|
| Rate for Payer: WPS Commercial |
$5,827.83
|
|
|
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 |
$2,203.04 |
| Max. Negotiated Rate |
$31,472.00 |
| Rate for Payer: Aetna Commercial |
$7,081.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,766.48
|
| Rate for Payer: Aetna Managed Medicare |
$2,203.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,114.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,934.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,776.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,170.04
|
| Rate for Payer: Cash Price |
$2,360.40
|
| Rate for Payer: Cigna Commercial |
$7,238.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,402.93
|
| Rate for Payer: Health EOS Commercial |
$7,002.52
|
| Rate for Payer: HFN Commercial |
$7,238.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,901.00
|
| Rate for Payer: Multiplan Commercial |
$6,294.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,720.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,238.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,855.32
|
| Rate for Payer: Quartz Commercial |
$5,114.20
|
| Rate for Payer: Quartz Medicare Advantage |
$4,720.80
|
| Rate for Payer: The Alliance Commercial |
$31,472.00
|
| Rate for Payer: WEA Trust Commercial |
$4,327.40
|
| Rate for Payer: WPS Commercial |
$5,827.83
|
|
|
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 |
$2,203.04 |
| Max. Negotiated Rate |
$31,472.00 |
| Rate for Payer: Aetna Commercial |
$7,081.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,766.48
|
| Rate for Payer: Aetna Managed Medicare |
$2,203.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,114.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,934.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,776.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,170.04
|
| Rate for Payer: Cash Price |
$2,360.40
|
| Rate for Payer: Cigna Commercial |
$7,238.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,402.93
|
| Rate for Payer: Health EOS Commercial |
$7,002.52
|
| Rate for Payer: HFN Commercial |
$7,238.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,901.00
|
| Rate for Payer: Multiplan Commercial |
$6,294.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,720.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,238.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,855.32
|
| Rate for Payer: Quartz Commercial |
$5,114.20
|
| Rate for Payer: Quartz Medicare Advantage |
$4,720.80
|
| Rate for Payer: The Alliance Commercial |
$31,472.00
|
| Rate for Payer: WEA Trust Commercial |
$4,327.40
|
| Rate for Payer: WPS Commercial |
$5,827.83
|
|
|
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 |
$3,855.32 |
| Max. Negotiated Rate |
$7,238.56 |
| Rate for Payer: Aetna Commercial |
$7,081.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,766.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,170.04
|
| Rate for Payer: Cash Price |
$2,360.40
|
| Rate for Payer: Cigna Commercial |
$7,238.56
|
| Rate for Payer: Health EOS Commercial |
$7,002.52
|
| Rate for Payer: HFN Commercial |
$7,238.56
|
| Rate for Payer: Multiplan Commercial |
$6,294.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,720.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,238.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,855.32
|
| Rate for Payer: Quartz Commercial |
$4,720.80
|
| Rate for Payer: WEA Trust Commercial |
$4,327.40
|
| Rate for Payer: WPS Commercial |
$5,827.83
|
|
|
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 |
$2,203.04 |
| Max. Negotiated Rate |
$31,472.00 |
| Rate for Payer: Aetna Commercial |
$7,081.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,766.48
|
| Rate for Payer: Aetna Managed Medicare |
$2,203.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,114.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,934.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,776.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,170.04
|
| Rate for Payer: Cash Price |
$2,360.40
|
| Rate for Payer: Cigna Commercial |
$7,238.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,402.93
|
| Rate for Payer: Health EOS Commercial |
$7,002.52
|
| Rate for Payer: HFN Commercial |
$7,238.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,901.00
|
| Rate for Payer: Multiplan Commercial |
$6,294.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,720.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,238.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,855.32
|
| Rate for Payer: Quartz Commercial |
$5,114.20
|
| Rate for Payer: Quartz Medicare Advantage |
$4,720.80
|
| Rate for Payer: The Alliance Commercial |
$31,472.00
|
| Rate for Payer: WEA Trust Commercial |
$4,327.40
|
| Rate for Payer: WPS Commercial |
$5,827.83
|
|
|
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 |
$3,855.32 |
| Max. Negotiated Rate |
$7,238.56 |
| Rate for Payer: Aetna Commercial |
$7,081.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,766.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,170.04
|
| Rate for Payer: Cash Price |
$2,360.40
|
| Rate for Payer: Cigna Commercial |
$7,238.56
|
| Rate for Payer: Health EOS Commercial |
$7,002.52
|
| Rate for Payer: HFN Commercial |
$7,238.56
|
| Rate for Payer: Multiplan Commercial |
$6,294.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,720.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,238.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,855.32
|
| Rate for Payer: Quartz Commercial |
$4,720.80
|
| Rate for Payer: WEA Trust Commercial |
$4,327.40
|
| Rate for Payer: WPS Commercial |
$5,827.83
|
|
|
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 |
$2,203.04 |
| Max. Negotiated Rate |
$31,472.00 |
| Rate for Payer: Aetna Commercial |
$7,081.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,766.48
|
| Rate for Payer: Aetna Managed Medicare |
$2,203.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,114.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,934.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,776.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,170.04
|
| Rate for Payer: Cash Price |
$2,360.40
|
| Rate for Payer: Cigna Commercial |
$7,238.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,402.93
|
| Rate for Payer: Health EOS Commercial |
$7,002.52
|
| Rate for Payer: HFN Commercial |
$7,238.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,901.00
|
| Rate for Payer: Multiplan Commercial |
$6,294.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,720.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,238.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,855.32
|
| Rate for Payer: Quartz Commercial |
$5,114.20
|
| Rate for Payer: Quartz Medicare Advantage |
$4,720.80
|
| Rate for Payer: The Alliance Commercial |
$31,472.00
|
| Rate for Payer: WEA Trust Commercial |
$4,327.40
|
| Rate for Payer: WPS Commercial |
$5,827.83
|
|
|
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 |
$3,855.32 |
| Max. Negotiated Rate |
$7,238.56 |
| Rate for Payer: Aetna Commercial |
$7,081.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,766.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,170.04
|
| Rate for Payer: Cash Price |
$2,360.40
|
| Rate for Payer: Cigna Commercial |
$7,238.56
|
| Rate for Payer: Health EOS Commercial |
$7,002.52
|
| Rate for Payer: HFN Commercial |
$7,238.56
|
| Rate for Payer: Multiplan Commercial |
$6,294.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,720.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,238.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,855.32
|
| Rate for Payer: Quartz Commercial |
$4,720.80
|
| Rate for Payer: WEA Trust Commercial |
$4,327.40
|
| Rate for Payer: WPS Commercial |
$5,827.83
|
|
|
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 |
$3,166.87 |
| Max. Negotiated Rate |
$5,945.96 |
| Rate for Payer: Aetna Commercial |
$5,816.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,558.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,425.39
|
| Rate for Payer: Cash Price |
$1,938.90
|
| Rate for Payer: Cigna Commercial |
$5,945.96
|
| Rate for Payer: Health EOS Commercial |
$5,752.07
|
| Rate for Payer: HFN Commercial |
$5,945.96
|
| Rate for Payer: Multiplan Commercial |
$5,170.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,877.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,945.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,166.87
|
| Rate for Payer: Quartz Commercial |
$3,877.80
|
| Rate for Payer: WEA Trust Commercial |
$3,554.65
|
| Rate for Payer: WPS Commercial |
$4,787.14
|
|
|
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 |
$1,809.64 |
| Max. Negotiated Rate |
$25,852.00 |
| Rate for Payer: Aetna Commercial |
$5,816.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,558.18
|
| Rate for Payer: Aetna Managed Medicare |
$1,809.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,200.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,231.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,102.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,425.39
|
| Rate for Payer: Cash Price |
$1,938.90
|
| Rate for Payer: Cigna Commercial |
$5,945.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,616.69
|
| Rate for Payer: Health EOS Commercial |
$5,752.07
|
| Rate for Payer: HFN Commercial |
$5,945.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,847.25
|
| Rate for Payer: Multiplan Commercial |
$5,170.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,877.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,945.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,166.87
|
| Rate for Payer: Quartz Commercial |
$4,200.95
|
| Rate for Payer: Quartz Medicare Advantage |
$3,877.80
|
| Rate for Payer: The Alliance Commercial |
$25,852.00
|
| Rate for Payer: WEA Trust Commercial |
$3,554.65
|
| Rate for Payer: WPS Commercial |
$4,787.14
|
|
|
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 |
$2,792.72 |
| Max. Negotiated Rate |
$39,896.00 |
| Rate for Payer: Aetna Commercial |
$8,976.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,577.64
|
| Rate for Payer: Aetna Managed Medicare |
$2,792.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,483.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,987.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,787.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,286.22
|
| Rate for Payer: Cash Price |
$2,992.20
|
| Rate for Payer: Cigna Commercial |
$9,176.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,581.45
|
| Rate for Payer: Health EOS Commercial |
$8,876.86
|
| Rate for Payer: HFN Commercial |
$9,176.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,480.50
|
| Rate for Payer: Multiplan Commercial |
$7,979.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,984.40
|
| Rate for Payer: Preferred Network Access Commercial |
$9,176.08
|
| Rate for Payer: Quartz Beloit One Network |
$4,887.26
|
| Rate for Payer: Quartz Commercial |
$6,483.10
|
| Rate for Payer: Quartz Medicare Advantage |
$5,984.40
|
| Rate for Payer: The Alliance Commercial |
$39,896.00
|
| Rate for Payer: WEA Trust Commercial |
$5,485.70
|
| Rate for Payer: WPS Commercial |
$7,387.74
|
|
|
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 |
$4,887.26 |
| Max. Negotiated Rate |
$9,176.08 |
| Rate for Payer: Aetna Commercial |
$8,976.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,577.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,286.22
|
| Rate for Payer: Cash Price |
$2,992.20
|
| Rate for Payer: Cigna Commercial |
$9,176.08
|
| Rate for Payer: Health EOS Commercial |
$8,876.86
|
| Rate for Payer: HFN Commercial |
$9,176.08
|
| Rate for Payer: Multiplan Commercial |
$7,979.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,984.40
|
| Rate for Payer: Preferred Network Access Commercial |
$9,176.08
|
| Rate for Payer: Quartz Beloit One Network |
$4,887.26
|
| Rate for Payer: Quartz Commercial |
$5,984.40
|
| Rate for Payer: WEA Trust Commercial |
$5,485.70
|
| Rate for Payer: WPS Commercial |
$7,387.74
|
|
