|
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: 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 |
$6,450.12 |
| 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: WEA Trust Commercial |
$3,856.05
|
| Rate for Payer: WPS Commercial |
$5,193.05
|
|
|
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: 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 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 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: 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 |
$1,551.12 |
| 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: 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 |
$1,196.24 |
| 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: 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: 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 |
$1,196.24
|
| 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: 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 |
$10,003.16 |
| 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: 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: 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 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 |
$10,403.36 |
| 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: 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: 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 |
$1,196.24 |
| 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: 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: 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 |
$1,196.24
|
| 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: 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
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: 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 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 |
$10,003.16 |
| 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: WEA Trust Commercial |
$5,980.15
|
| Rate for Payer: WPS Commercial |
$8,053.63
|
|
|
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: 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 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 |
$6,638.72 |
| 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: 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 |
$10,003.16 |
| 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: 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: 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: 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: 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 |
$11,451.24 |
| 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: WEA Trust Commercial |
$6,845.85
|
| Rate for Payer: WPS Commercial |
$9,219.49
|
|
