|
TIBIAL INSERT ROTATING PLATFORM REVISION CRS ATTUNE SZ 3 8MM 1517-10-308
|
Facility
|
IP
|
$21,382.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563338
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,477.18 |
| Max. Negotiated Rate |
$19,671.44 |
| Rate for Payer: Aetna Commercial |
$19,243.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,388.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,332.46
|
| Rate for Payer: Cash Price |
$6,414.60
|
| Rate for Payer: Cigna Commercial |
$19,671.44
|
| Rate for Payer: Health EOS Commercial |
$19,029.98
|
| Rate for Payer: HFN Commercial |
$19,671.44
|
| Rate for Payer: Multiplan Commercial |
$17,105.60
|
| Rate for Payer: NAPHCARE Commercial |
$12,829.20
|
| Rate for Payer: Preferred Network Access Commercial |
$19,671.44
|
| Rate for Payer: Quartz Beloit One Network |
$10,477.18
|
| Rate for Payer: Quartz Commercial |
$12,829.20
|
| Rate for Payer: WEA Trust Commercial |
$11,760.10
|
| Rate for Payer: WPS Commercial |
$15,837.65
|
|
|
TIBIAL INSERT ROTATING PLATFORM REVISION CRS ATTUNE SZ 4 6MM 1517-10-406
|
Facility
|
OP
|
$22,237.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5528752
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,226.36 |
| Max. Negotiated Rate |
$88,948.00 |
| Rate for Payer: Aetna Commercial |
$20,013.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19,123.82
|
| Rate for Payer: Aetna Managed Medicare |
$6,226.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14,454.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,118.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,673.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,785.61
|
| Rate for Payer: Cash Price |
$6,671.10
|
| Rate for Payer: Cigna Commercial |
$20,458.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,443.83
|
| Rate for Payer: Health EOS Commercial |
$19,790.93
|
| Rate for Payer: HFN Commercial |
$20,458.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16,677.75
|
| Rate for Payer: Multiplan Commercial |
$17,789.60
|
| Rate for Payer: NAPHCARE Commercial |
$13,342.20
|
| Rate for Payer: Preferred Network Access Commercial |
$20,458.04
|
| Rate for Payer: Quartz Beloit One Network |
$10,896.13
|
| Rate for Payer: Quartz Commercial |
$14,454.05
|
| Rate for Payer: Quartz Medicare Advantage |
$13,342.20
|
| Rate for Payer: The Alliance Commercial |
$88,948.00
|
| Rate for Payer: WEA Trust Commercial |
$12,230.35
|
| Rate for Payer: WPS Commercial |
$16,470.95
|
|
|
TIBIAL INSERT ROTATING PLATFORM REVISION CRS ATTUNE SZ 4 6MM 1517-10-406
|
Facility
|
IP
|
$22,237.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5528752
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,896.13 |
| Max. Negotiated Rate |
$20,458.04 |
| Rate for Payer: Aetna Commercial |
$20,013.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19,123.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,785.61
|
| Rate for Payer: Cash Price |
$6,671.10
|
| Rate for Payer: Cigna Commercial |
$20,458.04
|
| Rate for Payer: Health EOS Commercial |
$19,790.93
|
| Rate for Payer: HFN Commercial |
$20,458.04
|
| Rate for Payer: Multiplan Commercial |
$17,789.60
|
| Rate for Payer: NAPHCARE Commercial |
$13,342.20
|
| Rate for Payer: Preferred Network Access Commercial |
$20,458.04
|
| Rate for Payer: Quartz Beloit One Network |
$10,896.13
|
| Rate for Payer: Quartz Commercial |
$13,342.20
|
| Rate for Payer: WEA Trust Commercial |
$12,230.35
|
| Rate for Payer: WPS Commercial |
$16,470.95
|
|
|
TIBIAL INSERT ROTATING PLATFORM REVISION CRS ATTUNE SZ 5 8MM 1517-10-508
|
Facility
|
IP
|
$13,306.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6178989
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,519.94 |
| Max. Negotiated Rate |
$12,241.52 |
| Rate for Payer: Aetna Commercial |
$11,975.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,443.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,052.18
|
| Rate for Payer: Cash Price |
$3,991.80
|
| Rate for Payer: Cigna Commercial |
$12,241.52
|
| Rate for Payer: Health EOS Commercial |
$11,842.34
|
| Rate for Payer: HFN Commercial |
$12,241.52
|
| Rate for Payer: Multiplan Commercial |
$10,644.80
|
| Rate for Payer: NAPHCARE Commercial |
$7,983.60
|
| Rate for Payer: Preferred Network Access Commercial |
$12,241.52
|
| Rate for Payer: Quartz Beloit One Network |
$6,519.94
|
| Rate for Payer: Quartz Commercial |
$7,983.60
|
| Rate for Payer: WEA Trust Commercial |
$7,318.30
|
| Rate for Payer: WPS Commercial |
$9,855.75
|
|
|
TIBIAL INSERT ROTATING PLATFORM REVISION CRS ATTUNE SZ 5 8MM 1517-10-508
|
Facility
|
OP
|
$13,306.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6178989
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,725.68 |
| Max. Negotiated Rate |
$53,224.00 |
| Rate for Payer: Aetna Commercial |
$11,975.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,443.16
|
| Rate for Payer: Aetna Managed Medicare |
$3,725.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,648.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,653.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,386.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,052.18
|
| Rate for Payer: Cash Price |
$3,991.80
|
| Rate for Payer: Cigna Commercial |
$12,241.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,446.04
|
| Rate for Payer: Health EOS Commercial |
$11,842.34
|
| Rate for Payer: HFN Commercial |
$12,241.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,979.50
|
| Rate for Payer: Multiplan Commercial |
$10,644.80
|
| Rate for Payer: NAPHCARE Commercial |
$7,983.60
|
| Rate for Payer: Preferred Network Access Commercial |
$12,241.52
|
| Rate for Payer: Quartz Beloit One Network |
$6,519.94
|
| Rate for Payer: Quartz Commercial |
$8,648.90
|
| Rate for Payer: Quartz Medicare Advantage |
$7,983.60
|
| Rate for Payer: The Alliance Commercial |
$53,224.00
|
| Rate for Payer: WEA Trust Commercial |
$7,318.30
|
| Rate for Payer: WPS Commercial |
$9,855.75
|
|
|
TIBIAL INSERT ROTATING PLATFORM REVISION CRS ATTUNE SZ 6 6MM 1517-10-606
|
Facility
|
OP
|
$13,306.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6201077
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,725.68 |
| Max. Negotiated Rate |
$53,224.00 |
| Rate for Payer: Aetna Commercial |
$11,975.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,443.16
|
| Rate for Payer: Aetna Managed Medicare |
$3,725.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,648.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,653.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,386.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,052.18
|
| Rate for Payer: Cash Price |
$3,991.80
|
| Rate for Payer: Cigna Commercial |
$12,241.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,446.04
|
| Rate for Payer: Health EOS Commercial |
$11,842.34
|
| Rate for Payer: HFN Commercial |
$12,241.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,979.50
|
| Rate for Payer: Multiplan Commercial |
$10,644.80
|
| Rate for Payer: NAPHCARE Commercial |
$7,983.60
|
| Rate for Payer: Preferred Network Access Commercial |
$12,241.52
|
| Rate for Payer: Quartz Beloit One Network |
$6,519.94
|
| Rate for Payer: Quartz Commercial |
$8,648.90
|
| Rate for Payer: Quartz Medicare Advantage |
$7,983.60
|
| Rate for Payer: The Alliance Commercial |
$53,224.00
|
| Rate for Payer: WEA Trust Commercial |
$7,318.30
|
| Rate for Payer: WPS Commercial |
$9,855.75
|
|
|
TIBIAL INSERT ROTATING PLATFORM REVISION CRS ATTUNE SZ 6 6MM 1517-10-606
|
Facility
|
IP
|
$13,306.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6201077
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,519.94 |
| Max. Negotiated Rate |
$12,241.52 |
| Rate for Payer: Aetna Commercial |
$11,975.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,443.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,052.18
|
| Rate for Payer: Cash Price |
$3,991.80
|
| Rate for Payer: Cigna Commercial |
$12,241.52
|
| Rate for Payer: Health EOS Commercial |
$11,842.34
|
| Rate for Payer: HFN Commercial |
$12,241.52
|
| Rate for Payer: Multiplan Commercial |
$10,644.80
|
| Rate for Payer: NAPHCARE Commercial |
$7,983.60
|
| Rate for Payer: Preferred Network Access Commercial |
$12,241.52
|
| Rate for Payer: Quartz Beloit One Network |
$6,519.94
|
| Rate for Payer: Quartz Commercial |
$7,983.60
|
| Rate for Payer: WEA Trust Commercial |
$7,318.30
|
| Rate for Payer: WPS Commercial |
$9,855.75
|
|
|
TIBIAL INSERT ROTATING PLATFORM REVISION CRS ATTUNE SZ 6 8MM 1517-10-506
|
Facility
|
OP
|
$14,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6226147
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,102.00 |
| Max. Negotiated Rate |
$58,600.00 |
| Rate for Payer: Aetna Commercial |
$13,185.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,599.00
|
| Rate for Payer: Aetna Managed Medicare |
$4,102.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,522.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,325.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,032.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,764.50
|
| Rate for Payer: Cash Price |
$4,395.00
|
| Rate for Payer: Cigna Commercial |
$13,478.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,198.14
|
| Rate for Payer: Health EOS Commercial |
$13,038.50
|
| Rate for Payer: HFN Commercial |
$13,478.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,987.50
|
| Rate for Payer: Multiplan Commercial |
$11,720.00
|
| Rate for Payer: NAPHCARE Commercial |
$8,790.00
|
| Rate for Payer: Preferred Network Access Commercial |
$13,478.00
|
| Rate for Payer: Quartz Beloit One Network |
$7,178.50
|
| Rate for Payer: Quartz Commercial |
$9,522.50
|
| Rate for Payer: Quartz Medicare Advantage |
$8,790.00
|
| Rate for Payer: The Alliance Commercial |
$58,600.00
|
| Rate for Payer: WEA Trust Commercial |
$8,057.50
|
| Rate for Payer: WPS Commercial |
$10,851.26
|
|
|
TIBIAL INSERT ROTATING PLATFORM REVISION CRS ATTUNE SZ 6 8MM 1517-10-506
|
Facility
|
IP
|
$14,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6226147
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,178.50 |
| Max. Negotiated Rate |
$13,478.00 |
| Rate for Payer: Aetna Commercial |
$13,185.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,599.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,764.50
|
| Rate for Payer: Cash Price |
$4,395.00
|
| Rate for Payer: Cigna Commercial |
$13,478.00
|
| Rate for Payer: Health EOS Commercial |
$13,038.50
|
| Rate for Payer: HFN Commercial |
$13,478.00
|
| Rate for Payer: Multiplan Commercial |
$11,720.00
|
| Rate for Payer: NAPHCARE Commercial |
$8,790.00
|
| Rate for Payer: Preferred Network Access Commercial |
$13,478.00
|
| Rate for Payer: Quartz Beloit One Network |
$7,178.50
|
| Rate for Payer: Quartz Commercial |
$8,790.00
|
| Rate for Payer: WEA Trust Commercial |
$8,057.50
|
| Rate for Payer: WPS Commercial |
$10,851.26
|
|
|
TIBIAL INSERT ROTATING PLATFORM REVISION CRS ATTUNE SZ 7 6MM 1517-10-706
|
Facility
|
OP
|
$13,838.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6165881
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,874.64 |
| Max. Negotiated Rate |
$55,352.00 |
| Rate for Payer: Aetna Commercial |
$12,454.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,900.68
|
| Rate for Payer: Aetna Managed Medicare |
$3,874.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,994.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,919.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,642.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,334.14
|
| Rate for Payer: Cash Price |
$4,151.40
|
| Rate for Payer: Cigna Commercial |
$12,730.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,743.74
|
| Rate for Payer: Health EOS Commercial |
$12,315.82
|
| Rate for Payer: HFN Commercial |
$12,730.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,378.50
|
| Rate for Payer: Multiplan Commercial |
$11,070.40
|
| Rate for Payer: NAPHCARE Commercial |
$8,302.80
|
| Rate for Payer: Preferred Network Access Commercial |
$12,730.96
|
| Rate for Payer: Quartz Beloit One Network |
$6,780.62
|
| Rate for Payer: Quartz Commercial |
$8,994.70
|
| Rate for Payer: Quartz Medicare Advantage |
$8,302.80
|
| Rate for Payer: The Alliance Commercial |
$55,352.00
|
| Rate for Payer: WEA Trust Commercial |
$7,610.90
|
| Rate for Payer: WPS Commercial |
$10,249.81
|
|
|
TIBIAL INSERT ROTATING PLATFORM REVISION CRS ATTUNE SZ 7 6MM 1517-10-706
|
Facility
|
IP
|
$13,838.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6165881
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,780.62 |
| Max. Negotiated Rate |
$12,730.96 |
| Rate for Payer: Aetna Commercial |
$12,454.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,900.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,334.14
|
| Rate for Payer: Cash Price |
$4,151.40
|
| Rate for Payer: Cigna Commercial |
$12,730.96
|
| Rate for Payer: Health EOS Commercial |
$12,315.82
|
| Rate for Payer: HFN Commercial |
$12,730.96
|
| Rate for Payer: Multiplan Commercial |
$11,070.40
|
| Rate for Payer: NAPHCARE Commercial |
$8,302.80
|
| Rate for Payer: Preferred Network Access Commercial |
$12,730.96
|
| Rate for Payer: Quartz Beloit One Network |
$6,780.62
|
| Rate for Payer: Quartz Commercial |
$8,302.80
|
| Rate for Payer: WEA Trust Commercial |
$7,610.90
|
| Rate for Payer: WPS Commercial |
$10,249.81
|
|
|
TIBIAL INSERT ROTATING PLATFORM REVISION CRS ATTUNE SZ 8 14MM 1517-10-814
|
Facility
|
OP
|
$14,392.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5831798
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,029.76 |
| Max. Negotiated Rate |
$57,568.00 |
| Rate for Payer: Aetna Commercial |
$12,952.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,377.12
|
| Rate for Payer: Aetna Managed Medicare |
$4,029.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,354.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,196.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,908.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,627.76
|
| Rate for Payer: Cash Price |
$4,317.60
|
| Rate for Payer: Cigna Commercial |
$13,240.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,053.76
|
| Rate for Payer: Health EOS Commercial |
$12,808.88
|
| Rate for Payer: HFN Commercial |
$13,240.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,794.00
|
| Rate for Payer: Multiplan Commercial |
$11,513.60
|
| Rate for Payer: NAPHCARE Commercial |
$8,635.20
|
| Rate for Payer: Preferred Network Access Commercial |
$13,240.64
|
| Rate for Payer: Quartz Beloit One Network |
$7,052.08
|
| Rate for Payer: Quartz Commercial |
$9,354.80
|
| Rate for Payer: Quartz Medicare Advantage |
$8,635.20
|
| Rate for Payer: The Alliance Commercial |
$57,568.00
|
| Rate for Payer: WEA Trust Commercial |
$7,915.60
|
| Rate for Payer: WPS Commercial |
$10,660.15
|
|
|
TIBIAL INSERT ROTATING PLATFORM REVISION CRS ATTUNE SZ 8 14MM 1517-10-814
|
Facility
|
IP
|
$14,392.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5831798
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,052.08 |
| Max. Negotiated Rate |
$13,240.64 |
| Rate for Payer: Aetna Commercial |
$12,952.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,377.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,627.76
|
| Rate for Payer: Cash Price |
$4,317.60
|
| Rate for Payer: Cigna Commercial |
$13,240.64
|
| Rate for Payer: Health EOS Commercial |
$12,808.88
|
| Rate for Payer: HFN Commercial |
$13,240.64
|
| Rate for Payer: Multiplan Commercial |
$11,513.60
|
| Rate for Payer: NAPHCARE Commercial |
$8,635.20
|
| Rate for Payer: Preferred Network Access Commercial |
$13,240.64
|
| Rate for Payer: Quartz Beloit One Network |
$7,052.08
|
| Rate for Payer: Quartz Commercial |
$8,635.20
|
| Rate for Payer: WEA Trust Commercial |
$7,915.60
|
| Rate for Payer: WPS Commercial |
$10,660.15
|
|
|
TIBIAL INSERT ROTATING PLATFORM REVISION LPS ATTUNE 24MM X-SM 1517-60-224
|
Facility
|
IP
|
$26,735.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5813626
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13,100.15 |
| Max. Negotiated Rate |
$24,596.20 |
| Rate for Payer: Aetna Commercial |
$24,061.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$22,992.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14,169.55
|
| Rate for Payer: Cash Price |
$8,020.50
|
| Rate for Payer: Cigna Commercial |
$24,596.20
|
| Rate for Payer: Health EOS Commercial |
$23,794.15
|
| Rate for Payer: HFN Commercial |
$24,596.20
|
| Rate for Payer: Multiplan Commercial |
$21,388.00
|
| Rate for Payer: NAPHCARE Commercial |
$16,041.00
|
| Rate for Payer: Preferred Network Access Commercial |
$24,596.20
|
| Rate for Payer: Quartz Beloit One Network |
$13,100.15
|
| Rate for Payer: Quartz Commercial |
$16,041.00
|
| Rate for Payer: WEA Trust Commercial |
$14,704.25
|
| Rate for Payer: WPS Commercial |
$19,802.61
|
|
|
TIBIAL INSERT ROTATING PLATFORM REVISION LPS ATTUNE 24MM X-SM 1517-60-224
|
Facility
|
OP
|
$26,735.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5813626
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,485.80 |
| Max. Negotiated Rate |
$106,940.00 |
| Rate for Payer: Aetna Commercial |
$24,061.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$22,992.10
|
| Rate for Payer: Aetna Managed Medicare |
$7,485.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17,377.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,367.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,832.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14,169.55
|
| Rate for Payer: Cash Price |
$8,020.50
|
| Rate for Payer: Cigna Commercial |
$24,596.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14,960.91
|
| Rate for Payer: Health EOS Commercial |
$23,794.15
|
| Rate for Payer: HFN Commercial |
$24,596.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,051.25
|
| Rate for Payer: Multiplan Commercial |
$21,388.00
|
| Rate for Payer: NAPHCARE Commercial |
$16,041.00
|
| Rate for Payer: Preferred Network Access Commercial |
$24,596.20
|
| Rate for Payer: Quartz Beloit One Network |
$13,100.15
|
| Rate for Payer: Quartz Commercial |
$17,377.75
|
| Rate for Payer: Quartz Medicare Advantage |
$16,041.00
|
| Rate for Payer: The Alliance Commercial |
$106,940.00
|
| Rate for Payer: WEA Trust Commercial |
$14,704.25
|
| Rate for Payer: WPS Commercial |
$19,802.61
|
|
|
TIBIAL INSERT ROTATING PLATFORM SZ 4 12.5MM STABILIZING 96-2142
|
Facility
|
IP
|
$7,011.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3333504
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,435.39 |
| Max. Negotiated Rate |
$6,450.12 |
| Rate for Payer: Aetna Commercial |
$6,309.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,029.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,715.83
|
| Rate for Payer: Cash Price |
$2,103.30
|
| Rate for Payer: Cigna Commercial |
$6,450.12
|
| Rate for Payer: Health EOS Commercial |
$6,239.79
|
| Rate for Payer: HFN Commercial |
$6,450.12
|
| Rate for Payer: Multiplan Commercial |
$5,608.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,206.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,450.12
|
| Rate for Payer: Quartz Beloit One Network |
$3,435.39
|
| Rate for Payer: Quartz Commercial |
$4,206.60
|
| Rate for Payer: WEA Trust Commercial |
$3,856.05
|
| Rate for Payer: WPS Commercial |
$5,193.05
|
|
|
TIBIAL INSERT ROTATING PLATFORM SZ 4 12.5MM STABILIZING 96-2142
|
Facility
|
OP
|
$7,011.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3333504
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,963.08 |
| Max. Negotiated Rate |
$28,044.00 |
| Rate for Payer: Aetna Commercial |
$6,309.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,029.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,963.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,557.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,505.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,365.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,715.83
|
| Rate for Payer: Cash Price |
$2,103.30
|
| Rate for Payer: Cigna Commercial |
$6,450.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,923.36
|
| Rate for Payer: Health EOS Commercial |
$6,239.79
|
| Rate for Payer: HFN Commercial |
$6,450.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,258.25
|
| Rate for Payer: Multiplan Commercial |
$5,608.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,206.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,450.12
|
| Rate for Payer: Quartz Beloit One Network |
$3,435.39
|
| Rate for Payer: Quartz Commercial |
$4,557.15
|
| Rate for Payer: Quartz Medicare Advantage |
$4,206.60
|
| Rate for Payer: The Alliance Commercial |
$28,044.00
|
| Rate for Payer: WEA Trust Commercial |
$3,856.05
|
| Rate for Payer: WPS Commercial |
$5,193.05
|
|
|
TIBIAL INTRAMEDULLARY RODDING
|
Facility
|
OP
|
$5,974.00
|
|
| Hospital Charge Code |
2960152
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,672.72 |
| Max. Negotiated Rate |
$23,896.00 |
| Rate for Payer: Aetna Commercial |
$5,376.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,137.64
|
| Rate for Payer: Aetna Managed Medicare |
$1,672.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,883.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,987.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,867.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,166.22
|
| Rate for Payer: Cash Price |
$1,792.20
|
| Rate for Payer: Cigna Commercial |
$5,496.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,343.05
|
| Rate for Payer: Health EOS Commercial |
$5,316.86
|
| Rate for Payer: HFN Commercial |
$5,496.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,480.50
|
| Rate for Payer: Multiplan Commercial |
$4,779.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,584.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,496.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,927.26
|
| Rate for Payer: Quartz Commercial |
$3,883.10
|
| Rate for Payer: Quartz Medicare Advantage |
$3,584.40
|
| Rate for Payer: The Alliance Commercial |
$23,896.00
|
| Rate for Payer: WEA Trust Commercial |
$3,285.70
|
| Rate for Payer: WPS Commercial |
$4,424.94
|
|
|
TIBIAL INTRAMEDULLARY RODDING
|
Facility
|
IP
|
$5,974.00
|
|
| Hospital Charge Code |
2960152
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,927.26 |
| Max. Negotiated Rate |
$5,496.08 |
| Rate for Payer: Aetna Commercial |
$5,376.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,137.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,166.22
|
| Rate for Payer: Cash Price |
$1,792.20
|
| Rate for Payer: Cigna Commercial |
$5,496.08
|
| Rate for Payer: Health EOS Commercial |
$5,316.86
|
| Rate for Payer: HFN Commercial |
$5,496.08
|
| Rate for Payer: Multiplan Commercial |
$4,779.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,584.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,496.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,927.26
|
| Rate for Payer: Quartz Commercial |
$3,584.40
|
| Rate for Payer: WEA Trust Commercial |
$3,285.70
|
| Rate for Payer: WPS Commercial |
$4,424.94
|
|
|
TIBIAL LOCKING BAR MODULAR BIOMET 141205
|
Facility
|
IP
|
$1,686.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6170220
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$826.14 |
| Max. Negotiated Rate |
$1,551.12 |
| Rate for Payer: Aetna Commercial |
$1,517.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,449.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$893.58
|
| Rate for Payer: Cash Price |
$505.80
|
| Rate for Payer: Cigna Commercial |
$1,551.12
|
| Rate for Payer: Health EOS Commercial |
$1,500.54
|
| Rate for Payer: HFN Commercial |
$1,551.12
|
| Rate for Payer: Multiplan Commercial |
$1,348.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,011.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,551.12
|
| Rate for Payer: Quartz Beloit One Network |
$826.14
|
| Rate for Payer: Quartz Commercial |
$1,011.60
|
| Rate for Payer: WEA Trust Commercial |
$927.30
|
| Rate for Payer: WPS Commercial |
$1,248.82
|
|
|
TIBIAL LOCKING BAR MODULAR BIOMET 141205
|
Facility
|
OP
|
$1,686.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6170220
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$472.08 |
| Max. Negotiated Rate |
$6,744.00 |
| Rate for Payer: Aetna Commercial |
$1,517.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,449.96
|
| Rate for Payer: Aetna Managed Medicare |
$472.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,095.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$843.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$809.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$893.58
|
| Rate for Payer: Cash Price |
$505.80
|
| Rate for Payer: Cigna Commercial |
$1,551.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$943.49
|
| Rate for Payer: Health EOS Commercial |
$1,500.54
|
| Rate for Payer: HFN Commercial |
$1,551.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,264.50
|
| Rate for Payer: Multiplan Commercial |
$1,348.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,011.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,551.12
|
| Rate for Payer: Quartz Beloit One Network |
$826.14
|
| Rate for Payer: Quartz Commercial |
$1,095.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,011.60
|
| Rate for Payer: The Alliance Commercial |
$6,744.00
|
| Rate for Payer: WEA Trust Commercial |
$927.30
|
| Rate for Payer: WPS Commercial |
$1,248.82
|
|
|
TIBIAL NAIL STD 12MM X 345MM 1822-1234S
|
Facility
|
OP
|
$6,508.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5520892
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,822.24 |
| Max. Negotiated Rate |
$26,032.00 |
| Rate for Payer: Aetna Commercial |
$5,857.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,596.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,822.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,230.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,254.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,123.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,449.24
|
| Rate for Payer: Cash Price |
$1,952.40
|
| Rate for Payer: Cigna Commercial |
$5,987.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,641.88
|
| Rate for Payer: Health EOS Commercial |
$5,792.12
|
| Rate for Payer: HFN Commercial |
$5,987.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,881.00
|
| Rate for Payer: Multiplan Commercial |
$5,206.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,904.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,987.36
|
| Rate for Payer: Quartz Beloit One Network |
$3,188.92
|
| Rate for Payer: Quartz Commercial |
$4,230.20
|
| Rate for Payer: Quartz Medicare Advantage |
$3,904.80
|
| Rate for Payer: The Alliance Commercial |
$26,032.00
|
| Rate for Payer: WEA Trust Commercial |
$3,579.40
|
| Rate for Payer: WPS Commercial |
$4,820.48
|
|
|
TIBIAL NAIL STD 12MM X 345MM 1822-1234S
|
Facility
|
IP
|
$6,508.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5520892
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,188.92 |
| Max. Negotiated Rate |
$5,987.36 |
| Rate for Payer: Aetna Commercial |
$5,857.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,596.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,449.24
|
| Rate for Payer: Cash Price |
$1,952.40
|
| Rate for Payer: Cigna Commercial |
$5,987.36
|
| Rate for Payer: Health EOS Commercial |
$5,792.12
|
| Rate for Payer: HFN Commercial |
$5,987.36
|
| Rate for Payer: Multiplan Commercial |
$5,206.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,904.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,987.36
|
| Rate for Payer: Quartz Beloit One Network |
$3,188.92
|
| Rate for Payer: Quartz Commercial |
$3,904.80
|
| Rate for Payer: WEA Trust Commercial |
$3,579.40
|
| Rate for Payer: WPS Commercial |
$4,820.48
|
|
|
TIBIAL NAIL T2 ALPHA 10MM X 315MM 2341-1031S
|
Facility
|
OP
|
$10,873.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767637
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,044.44 |
| Max. Negotiated Rate |
$43,492.00 |
| Rate for Payer: Aetna Commercial |
$9,785.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,350.78
|
| Rate for Payer: Aetna Managed Medicare |
$3,044.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,067.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,436.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,219.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,762.69
|
| Rate for Payer: Cash Price |
$3,261.90
|
| Rate for Payer: Cigna Commercial |
$10,003.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,084.53
|
| Rate for Payer: Health EOS Commercial |
$9,676.97
|
| Rate for Payer: HFN Commercial |
$10,003.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,154.75
|
| Rate for Payer: Multiplan Commercial |
$8,698.40
|
| Rate for Payer: NAPHCARE Commercial |
$6,523.80
|
| Rate for Payer: Preferred Network Access Commercial |
$10,003.16
|
| Rate for Payer: Quartz Beloit One Network |
$5,327.77
|
| Rate for Payer: Quartz Commercial |
$7,067.45
|
| Rate for Payer: Quartz Medicare Advantage |
$6,523.80
|
| Rate for Payer: The Alliance Commercial |
$43,492.00
|
| Rate for Payer: WEA Trust Commercial |
$5,980.15
|
| Rate for Payer: WPS Commercial |
$8,053.63
|
|
|
TIBIAL NAIL T2 ALPHA 10MM X 315MM 2341-1031S
|
Facility
|
IP
|
$10,873.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767637
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,327.77 |
| Max. Negotiated Rate |
$10,003.16 |
| Rate for Payer: Aetna Commercial |
$9,785.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,350.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,762.69
|
| Rate for Payer: Cash Price |
$3,261.90
|
| Rate for Payer: Cigna Commercial |
$10,003.16
|
| Rate for Payer: Health EOS Commercial |
$9,676.97
|
| Rate for Payer: HFN Commercial |
$10,003.16
|
| Rate for Payer: Multiplan Commercial |
$8,698.40
|
| Rate for Payer: NAPHCARE Commercial |
$6,523.80
|
| Rate for Payer: Preferred Network Access Commercial |
$10,003.16
|
| Rate for Payer: Quartz Beloit One Network |
$5,327.77
|
| Rate for Payer: Quartz Commercial |
$6,523.80
|
| Rate for Payer: WEA Trust Commercial |
$5,980.15
|
| Rate for Payer: WPS Commercial |
$8,053.63
|
|
