|
TIBIAL NAIL T2 ALPHA 10MM X 330MM 2341-1030
|
Facility
|
OP
|
$11,308.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599788
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,166.24 |
| Max. Negotiated Rate |
$45,232.00 |
| Rate for Payer: Aetna Commercial |
$10,177.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,724.88
|
| Rate for Payer: Aetna Managed Medicare |
$3,166.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,350.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,654.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,427.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,993.24
|
| Rate for Payer: Cash Price |
$3,392.40
|
| Rate for Payer: Cigna Commercial |
$10,403.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,327.96
|
| Rate for Payer: Health EOS Commercial |
$10,064.12
|
| Rate for Payer: HFN Commercial |
$10,403.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,481.00
|
| Rate for Payer: Multiplan Commercial |
$9,046.40
|
| Rate for Payer: NAPHCARE Commercial |
$6,784.80
|
| Rate for Payer: Preferred Network Access Commercial |
$10,403.36
|
| Rate for Payer: Quartz Beloit One Network |
$5,540.92
|
| Rate for Payer: Quartz Commercial |
$7,350.20
|
| Rate for Payer: Quartz Medicare Advantage |
$6,784.80
|
| Rate for Payer: The Alliance Commercial |
$45,232.00
|
| Rate for Payer: WEA Trust Commercial |
$6,219.40
|
| Rate for Payer: WPS Commercial |
$8,375.84
|
|
|
TIBIAL NAIL T2 ALPHA 10MM X 330MM 2341-1030
|
Facility
|
IP
|
$11,308.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599788
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,540.92 |
| Max. Negotiated Rate |
$10,403.36 |
| Rate for Payer: Aetna Commercial |
$10,177.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,724.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,993.24
|
| Rate for Payer: Cash Price |
$3,392.40
|
| Rate for Payer: Cigna Commercial |
$10,403.36
|
| Rate for Payer: Health EOS Commercial |
$10,064.12
|
| Rate for Payer: HFN Commercial |
$10,403.36
|
| Rate for Payer: Multiplan Commercial |
$9,046.40
|
| Rate for Payer: NAPHCARE Commercial |
$6,784.80
|
| Rate for Payer: Preferred Network Access Commercial |
$10,403.36
|
| Rate for Payer: Quartz Beloit One Network |
$5,540.92
|
| Rate for Payer: Quartz Commercial |
$6,784.80
|
| Rate for Payer: WEA Trust Commercial |
$6,219.40
|
| Rate for Payer: WPS Commercial |
$8,375.84
|
|
|
TIBIAL NAIL T2 ALPHA 10MM X 330MM 2341-1033S
|
Facility
|
OP
|
$7,216.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6201029
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,020.48 |
| Max. Negotiated Rate |
$28,864.00 |
| Rate for Payer: Aetna Commercial |
$6,494.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,205.76
|
| Rate for Payer: Aetna Managed Medicare |
$2,020.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,690.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,608.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,463.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,824.48
|
| Rate for Payer: Cash Price |
$2,164.80
|
| Rate for Payer: Cigna Commercial |
$6,638.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,038.07
|
| Rate for Payer: Health EOS Commercial |
$6,422.24
|
| Rate for Payer: HFN Commercial |
$6,638.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,412.00
|
| Rate for Payer: Multiplan Commercial |
$5,772.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,329.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,638.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,535.84
|
| Rate for Payer: Quartz Commercial |
$4,690.40
|
| Rate for Payer: Quartz Medicare Advantage |
$4,329.60
|
| Rate for Payer: The Alliance Commercial |
$28,864.00
|
| Rate for Payer: WEA Trust Commercial |
$3,968.80
|
| Rate for Payer: WPS Commercial |
$5,344.89
|
|
|
TIBIAL NAIL T2 ALPHA 10MM X 330MM 2341-1033S
|
Facility
|
IP
|
$7,216.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6201029
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,535.84 |
| Max. Negotiated Rate |
$6,638.72 |
| Rate for Payer: Aetna Commercial |
$6,494.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,205.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,824.48
|
| Rate for Payer: Cash Price |
$2,164.80
|
| Rate for Payer: Cigna Commercial |
$6,638.72
|
| Rate for Payer: Health EOS Commercial |
$6,422.24
|
| Rate for Payer: HFN Commercial |
$6,638.72
|
| Rate for Payer: Multiplan Commercial |
$5,772.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,329.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,638.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,535.84
|
| Rate for Payer: Quartz Commercial |
$4,329.60
|
| Rate for Payer: WEA Trust Commercial |
$3,968.80
|
| Rate for Payer: WPS Commercial |
$5,344.89
|
|
|
TIBIAL NAIL T2 ALPHA 11MM X 330MM 2341-1133S
|
Facility
|
OP
|
$10,873.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5797676
|
|
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 11MM X 330MM 2341-1133S
|
Facility
|
IP
|
$10,873.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5797676
|
|
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
|
|
|
TIBIAL NAIL T2 ALPHA 11MM X 375MM 2341-1137S
|
Facility
|
OP
|
$7,216.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6199012
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,020.48 |
| Max. Negotiated Rate |
$28,864.00 |
| Rate for Payer: Aetna Commercial |
$6,494.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,205.76
|
| Rate for Payer: Aetna Managed Medicare |
$2,020.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,690.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,608.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,463.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,824.48
|
| Rate for Payer: Cash Price |
$2,164.80
|
| Rate for Payer: Cigna Commercial |
$6,638.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,038.07
|
| Rate for Payer: Health EOS Commercial |
$6,422.24
|
| Rate for Payer: HFN Commercial |
$6,638.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,412.00
|
| Rate for Payer: Multiplan Commercial |
$5,772.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,329.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,638.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,535.84
|
| Rate for Payer: Quartz Commercial |
$4,690.40
|
| Rate for Payer: Quartz Medicare Advantage |
$4,329.60
|
| Rate for Payer: The Alliance Commercial |
$28,864.00
|
| Rate for Payer: WEA Trust Commercial |
$3,968.80
|
| Rate for Payer: WPS Commercial |
$5,344.89
|
|
|
TIBIAL NAIL T2 ALPHA 11MM X 375MM 2341-1137S
|
Facility
|
IP
|
$7,216.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6199012
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,535.84 |
| Max. Negotiated Rate |
$6,638.72 |
| Rate for Payer: Aetna Commercial |
$6,494.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,205.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,824.48
|
| Rate for Payer: Cash Price |
$2,164.80
|
| Rate for Payer: Cigna Commercial |
$6,638.72
|
| Rate for Payer: Health EOS Commercial |
$6,422.24
|
| Rate for Payer: HFN Commercial |
$6,638.72
|
| Rate for Payer: Multiplan Commercial |
$5,772.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,329.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,638.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,535.84
|
| Rate for Payer: Quartz Commercial |
$4,329.60
|
| Rate for Payer: WEA Trust Commercial |
$3,968.80
|
| Rate for Payer: WPS Commercial |
$5,344.89
|
|
|
TIBIAL NAIL T2 ALPHA 12MM X 405MM 2341-1240S
|
Facility
|
OP
|
$10,873.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685868
|
|
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 12MM X 405MM 2341-1240S
|
Facility
|
IP
|
$10,873.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685868
|
|
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
|
|
|
TIBIAL NEXGEN MONOBLOCK TRABECULAR CR SZ 4 FEMUR SZ C-D 10MM 00-5886-044-10
|
Facility
|
IP
|
$12,447.00
|
|
| Hospital Charge Code |
5415893
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,099.03 |
| Max. Negotiated Rate |
$11,451.24 |
| Rate for Payer: Aetna Commercial |
$11,202.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,704.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,596.91
|
| Rate for Payer: Cash Price |
$3,734.10
|
| Rate for Payer: Cigna Commercial |
$11,451.24
|
| Rate for Payer: Health EOS Commercial |
$11,077.83
|
| Rate for Payer: HFN Commercial |
$11,451.24
|
| Rate for Payer: Multiplan Commercial |
$9,957.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,468.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11,451.24
|
| Rate for Payer: Quartz Beloit One Network |
$6,099.03
|
| Rate for Payer: Quartz Commercial |
$7,468.20
|
| Rate for Payer: WEA Trust Commercial |
$6,845.85
|
| Rate for Payer: WPS Commercial |
$9,219.49
|
|
|
TIBIAL NEXGEN MONOBLOCK TRABECULAR CR SZ 4 FEMUR SZ C-D 10MM 00-5886-044-10
|
Facility
|
OP
|
$12,447.00
|
|
| Hospital Charge Code |
5415893
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,485.16 |
| Max. Negotiated Rate |
$49,788.00 |
| Rate for Payer: Aetna Commercial |
$11,202.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,704.42
|
| Rate for Payer: Aetna Managed Medicare |
$3,485.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,090.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,223.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,974.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,596.91
|
| Rate for Payer: Cash Price |
$3,734.10
|
| Rate for Payer: Cigna Commercial |
$11,451.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,965.34
|
| Rate for Payer: Health EOS Commercial |
$11,077.83
|
| Rate for Payer: HFN Commercial |
$11,451.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,335.25
|
| Rate for Payer: Multiplan Commercial |
$9,957.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,468.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11,451.24
|
| Rate for Payer: Quartz Beloit One Network |
$6,099.03
|
| Rate for Payer: Quartz Commercial |
$8,090.55
|
| Rate for Payer: Quartz Medicare Advantage |
$7,468.20
|
| Rate for Payer: The Alliance Commercial |
$49,788.00
|
| Rate for Payer: WEA Trust Commercial |
$6,845.85
|
| Rate for Payer: WPS Commercial |
$9,219.49
|
|
|
TIBIAL NEXGEN MONOBLOCK TRABECULAR CR SZ 5 FEMUR SZ C-H 00-5886-045-14
|
Facility
|
IP
|
$12,925.00
|
|
| Hospital Charge Code |
5349220
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,333.25 |
| Max. Negotiated Rate |
$11,891.00 |
| Rate for Payer: Aetna Commercial |
$11,632.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,115.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,850.25
|
| Rate for Payer: Cash Price |
$3,877.50
|
| Rate for Payer: Cigna Commercial |
$11,891.00
|
| Rate for Payer: Health EOS Commercial |
$11,503.25
|
| Rate for Payer: HFN Commercial |
$11,891.00
|
| Rate for Payer: Multiplan Commercial |
$10,340.00
|
| Rate for Payer: NAPHCARE Commercial |
$7,755.00
|
| Rate for Payer: Preferred Network Access Commercial |
$11,891.00
|
| Rate for Payer: Quartz Beloit One Network |
$6,333.25
|
| Rate for Payer: Quartz Commercial |
$7,755.00
|
| Rate for Payer: WEA Trust Commercial |
$7,108.75
|
| Rate for Payer: WPS Commercial |
$9,573.55
|
|
|
TIBIAL NEXGEN MONOBLOCK TRABECULAR CR SZ 5 FEMUR SZ C-H 00-5886-045-14
|
Facility
|
OP
|
$12,925.00
|
|
| Hospital Charge Code |
5349220
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,619.00 |
| Max. Negotiated Rate |
$51,700.00 |
| Rate for Payer: Aetna Commercial |
$11,632.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,115.50
|
| Rate for Payer: Aetna Managed Medicare |
$3,619.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,401.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,462.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,204.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,850.25
|
| Rate for Payer: Cash Price |
$3,877.50
|
| Rate for Payer: Cigna Commercial |
$11,891.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,232.83
|
| Rate for Payer: Health EOS Commercial |
$11,503.25
|
| Rate for Payer: HFN Commercial |
$11,891.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,693.75
|
| Rate for Payer: Multiplan Commercial |
$10,340.00
|
| Rate for Payer: NAPHCARE Commercial |
$7,755.00
|
| Rate for Payer: Preferred Network Access Commercial |
$11,891.00
|
| Rate for Payer: Quartz Beloit One Network |
$6,333.25
|
| Rate for Payer: Quartz Commercial |
$8,401.25
|
| Rate for Payer: Quartz Medicare Advantage |
$7,755.00
|
| Rate for Payer: The Alliance Commercial |
$51,700.00
|
| Rate for Payer: WEA Trust Commercial |
$7,108.75
|
| Rate for Payer: WPS Commercial |
$9,573.55
|
|
|
TIBIAL NEXGEN MONOBLOCK TRABECULAR CR SZ 5 FEMUR SZ E-F 00-5886-045-12
|
Facility
|
OP
|
$12,447.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5458862
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,485.16 |
| Max. Negotiated Rate |
$49,788.00 |
| Rate for Payer: Aetna Commercial |
$11,202.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,704.42
|
| Rate for Payer: Aetna Managed Medicare |
$3,485.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,090.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,223.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,974.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,596.91
|
| Rate for Payer: Cash Price |
$3,734.10
|
| Rate for Payer: Cigna Commercial |
$11,451.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,965.34
|
| Rate for Payer: Health EOS Commercial |
$11,077.83
|
| Rate for Payer: HFN Commercial |
$11,451.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,335.25
|
| Rate for Payer: Multiplan Commercial |
$9,957.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,468.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11,451.24
|
| Rate for Payer: Quartz Beloit One Network |
$6,099.03
|
| Rate for Payer: Quartz Commercial |
$8,090.55
|
| Rate for Payer: Quartz Medicare Advantage |
$7,468.20
|
| Rate for Payer: The Alliance Commercial |
$49,788.00
|
| Rate for Payer: WEA Trust Commercial |
$6,845.85
|
| Rate for Payer: WPS Commercial |
$9,219.49
|
|
|
TIBIAL NEXGEN MONOBLOCK TRABECULAR CR SZ 5 FEMUR SZ E-F 00-5886-045-12
|
Facility
|
IP
|
$12,447.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5458862
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,099.03 |
| Max. Negotiated Rate |
$11,451.24 |
| Rate for Payer: Aetna Commercial |
$11,202.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,704.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,596.91
|
| Rate for Payer: Cash Price |
$3,734.10
|
| Rate for Payer: Cigna Commercial |
$11,451.24
|
| Rate for Payer: Health EOS Commercial |
$11,077.83
|
| Rate for Payer: HFN Commercial |
$11,451.24
|
| Rate for Payer: Multiplan Commercial |
$9,957.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,468.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11,451.24
|
| Rate for Payer: Quartz Beloit One Network |
$6,099.03
|
| Rate for Payer: Quartz Commercial |
$7,468.20
|
| Rate for Payer: WEA Trust Commercial |
$6,845.85
|
| Rate for Payer: WPS Commercial |
$9,219.49
|
|
|
TIBIAL NEXGEN MONOBLOCK TRABECULAR CR SZ 7 FEMUR SZ G-H 12MM 00-5886-047-12
|
Facility
|
OP
|
$12,447.00
|
|
| Hospital Charge Code |
5456755
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,485.16 |
| Max. Negotiated Rate |
$49,788.00 |
| Rate for Payer: Aetna Commercial |
$11,202.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,704.42
|
| Rate for Payer: Aetna Managed Medicare |
$3,485.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,090.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,223.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,974.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,596.91
|
| Rate for Payer: Cash Price |
$3,734.10
|
| Rate for Payer: Cigna Commercial |
$11,451.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,965.34
|
| Rate for Payer: Health EOS Commercial |
$11,077.83
|
| Rate for Payer: HFN Commercial |
$11,451.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,335.25
|
| Rate for Payer: Multiplan Commercial |
$9,957.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,468.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11,451.24
|
| Rate for Payer: Quartz Beloit One Network |
$6,099.03
|
| Rate for Payer: Quartz Commercial |
$8,090.55
|
| Rate for Payer: Quartz Medicare Advantage |
$7,468.20
|
| Rate for Payer: The Alliance Commercial |
$49,788.00
|
| Rate for Payer: WEA Trust Commercial |
$6,845.85
|
| Rate for Payer: WPS Commercial |
$9,219.49
|
|
|
TIBIAL NEXGEN MONOBLOCK TRABECULAR CR SZ 7 FEMUR SZ G-H 12MM 00-5886-047-12
|
Facility
|
IP
|
$12,447.00
|
|
| Hospital Charge Code |
5456755
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,099.03 |
| Max. Negotiated Rate |
$11,451.24 |
| Rate for Payer: Aetna Commercial |
$11,202.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,704.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,596.91
|
| Rate for Payer: Cash Price |
$3,734.10
|
| Rate for Payer: Cigna Commercial |
$11,451.24
|
| Rate for Payer: Health EOS Commercial |
$11,077.83
|
| Rate for Payer: HFN Commercial |
$11,451.24
|
| Rate for Payer: Multiplan Commercial |
$9,957.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,468.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11,451.24
|
| Rate for Payer: Quartz Beloit One Network |
$6,099.03
|
| Rate for Payer: Quartz Commercial |
$7,468.20
|
| Rate for Payer: WEA Trust Commercial |
$6,845.85
|
| Rate for Payer: WPS Commercial |
$9,219.49
|
|
|
TIBIAL OBTURATOR AS D12MM NN261Z
|
Facility
|
IP
|
$3,688.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6049670
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,807.12 |
| Max. Negotiated Rate |
$3,392.96 |
| Rate for Payer: Aetna Commercial |
$3,319.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,171.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,954.64
|
| Rate for Payer: Cash Price |
$1,106.40
|
| Rate for Payer: Cigna Commercial |
$3,392.96
|
| Rate for Payer: Health EOS Commercial |
$3,282.32
|
| Rate for Payer: HFN Commercial |
$3,392.96
|
| Rate for Payer: Multiplan Commercial |
$2,950.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,212.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,392.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,807.12
|
| Rate for Payer: Quartz Commercial |
$2,212.80
|
| Rate for Payer: WEA Trust Commercial |
$2,028.40
|
| Rate for Payer: WPS Commercial |
$2,731.70
|
|
|
TIBIAL OBTURATOR AS D12MM NN261Z
|
Facility
|
OP
|
$3,688.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6049670
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,032.64 |
| Max. Negotiated Rate |
$14,752.00 |
| Rate for Payer: Aetna Commercial |
$3,319.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,171.68
|
| Rate for Payer: Aetna Managed Medicare |
$1,032.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,397.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,844.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,770.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,954.64
|
| Rate for Payer: Cash Price |
$1,106.40
|
| Rate for Payer: Cigna Commercial |
$3,392.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,063.80
|
| Rate for Payer: Health EOS Commercial |
$3,282.32
|
| Rate for Payer: HFN Commercial |
$3,392.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,766.00
|
| Rate for Payer: Multiplan Commercial |
$2,950.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,212.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,392.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,807.12
|
| Rate for Payer: Quartz Commercial |
$2,397.20
|
| Rate for Payer: Quartz Medicare Advantage |
$2,212.80
|
| Rate for Payer: The Alliance Commercial |
$14,752.00
|
| Rate for Payer: WEA Trust Commercial |
$2,028.40
|
| Rate for Payer: WPS Commercial |
$2,731.70
|
|
|
TIBIAL PLATEAU AS VEGA PS CEMENTED T2 NX053Z
|
Facility
|
IP
|
$8,606.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5659636
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,216.94 |
| Max. Negotiated Rate |
$7,917.52 |
| Rate for Payer: Aetna Commercial |
$7,745.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,401.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,561.18
|
| Rate for Payer: Cash Price |
$2,581.80
|
| Rate for Payer: Cigna Commercial |
$7,917.52
|
| Rate for Payer: Health EOS Commercial |
$7,659.34
|
| Rate for Payer: HFN Commercial |
$7,917.52
|
| Rate for Payer: Multiplan Commercial |
$6,884.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,163.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,917.52
|
| Rate for Payer: Quartz Beloit One Network |
$4,216.94
|
| Rate for Payer: Quartz Commercial |
$5,163.60
|
| Rate for Payer: WEA Trust Commercial |
$4,733.30
|
| Rate for Payer: WPS Commercial |
$6,374.46
|
|
|
TIBIAL PLATEAU AS VEGA PS CEMENTED T2 NX053Z
|
Facility
|
OP
|
$8,606.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5659636
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,409.68 |
| Max. Negotiated Rate |
$34,424.00 |
| Rate for Payer: Aetna Commercial |
$7,745.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,401.16
|
| Rate for Payer: Aetna Managed Medicare |
$2,409.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,593.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,303.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,130.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,561.18
|
| Rate for Payer: Cash Price |
$2,581.80
|
| Rate for Payer: Cigna Commercial |
$7,917.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,815.92
|
| Rate for Payer: Health EOS Commercial |
$7,659.34
|
| Rate for Payer: HFN Commercial |
$7,917.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,454.50
|
| Rate for Payer: Multiplan Commercial |
$6,884.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,163.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,917.52
|
| Rate for Payer: Quartz Beloit One Network |
$4,216.94
|
| Rate for Payer: Quartz Commercial |
$5,593.90
|
| Rate for Payer: Quartz Medicare Advantage |
$5,163.60
|
| Rate for Payer: The Alliance Commercial |
$34,424.00
|
| Rate for Payer: WEA Trust Commercial |
$4,733.30
|
| Rate for Payer: WPS Commercial |
$6,374.46
|
|
|
TIBIAL PLATEAU AS VEGA PS CEMENTED T3 NX055Z
|
Facility
|
IP
|
$8,606.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6049668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,216.94 |
| Max. Negotiated Rate |
$7,917.52 |
| Rate for Payer: Aetna Commercial |
$7,745.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,401.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,561.18
|
| Rate for Payer: Cash Price |
$2,581.80
|
| Rate for Payer: Cigna Commercial |
$7,917.52
|
| Rate for Payer: Health EOS Commercial |
$7,659.34
|
| Rate for Payer: HFN Commercial |
$7,917.52
|
| Rate for Payer: Multiplan Commercial |
$6,884.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,163.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,917.52
|
| Rate for Payer: Quartz Beloit One Network |
$4,216.94
|
| Rate for Payer: Quartz Commercial |
$5,163.60
|
| Rate for Payer: WEA Trust Commercial |
$4,733.30
|
| Rate for Payer: WPS Commercial |
$6,374.46
|
|
|
TIBIAL PLATEAU AS VEGA PS CEMENTED T3 NX055Z
|
Facility
|
OP
|
$8,606.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6049668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,409.68 |
| Max. Negotiated Rate |
$34,424.00 |
| Rate for Payer: Aetna Commercial |
$7,745.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,401.16
|
| Rate for Payer: Aetna Managed Medicare |
$2,409.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,593.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,303.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,130.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,561.18
|
| Rate for Payer: Cash Price |
$2,581.80
|
| Rate for Payer: Cigna Commercial |
$7,917.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,815.92
|
| Rate for Payer: Health EOS Commercial |
$7,659.34
|
| Rate for Payer: HFN Commercial |
$7,917.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,454.50
|
| Rate for Payer: Multiplan Commercial |
$6,884.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,163.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,917.52
|
| Rate for Payer: Quartz Beloit One Network |
$4,216.94
|
| Rate for Payer: Quartz Commercial |
$5,593.90
|
| Rate for Payer: Quartz Medicare Advantage |
$5,163.60
|
| Rate for Payer: The Alliance Commercial |
$34,424.00
|
| Rate for Payer: WEA Trust Commercial |
$4,733.30
|
| Rate for Payer: WPS Commercial |
$6,374.46
|
|
|
TIBIAL PLATE ROTATING HINGE NEXGEN STEMMED RT SZ 3 00-5880-003-00
|
Facility
|
IP
|
$20,735.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6192969
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,160.15 |
| Max. Negotiated Rate |
$19,076.20 |
| Rate for Payer: Aetna Commercial |
$18,661.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,832.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,989.55
|
| Rate for Payer: Cash Price |
$6,220.50
|
| Rate for Payer: Cigna Commercial |
$19,076.20
|
| Rate for Payer: Health EOS Commercial |
$18,454.15
|
| Rate for Payer: HFN Commercial |
$19,076.20
|
| Rate for Payer: Multiplan Commercial |
$16,588.00
|
| Rate for Payer: NAPHCARE Commercial |
$12,441.00
|
| Rate for Payer: Preferred Network Access Commercial |
$19,076.20
|
| Rate for Payer: Quartz Beloit One Network |
$10,160.15
|
| Rate for Payer: Quartz Commercial |
$12,441.00
|
| Rate for Payer: WEA Trust Commercial |
$11,404.25
|
| Rate for Payer: WPS Commercial |
$15,358.41
|
|
