|
TIBIAL AUGMENT HALF BLOCK SZ 7 5MM LT 5545-A-702
|
Facility
|
IP
|
$6,222.00
|
|
| Hospital Charge Code |
4518670
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,170.73 |
| Max. Negotiated Rate |
$5,953.21 |
| Rate for Payer: Aetna Commercial |
$5,823.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,564.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,429.57
|
| Rate for Payer: Cash Price |
$1,866.60
|
| Rate for Payer: Cigna Commercial |
$5,953.21
|
| Rate for Payer: Health EOS Commercial |
$5,759.08
|
| Rate for Payer: HFN Commercial |
$5,953.21
|
| Rate for Payer: Multiplan Commercial |
$5,176.70
|
| Rate for Payer: Preferred Network Access Commercial |
$5,953.21
|
| Rate for Payer: Quartz Beloit One Network |
$3,170.73
|
| Rate for Payer: Quartz Commercial |
$3,882.53
|
| Rate for Payer: WEA Trust Commercial |
$3,558.98
|
| Rate for Payer: WPS Commercial |
$4,792.81
|
|
|
TIBIAL AUGMENT HALF BLOCK SZ 7 5MM RT 5545-A-701
|
Facility
|
OP
|
$6,222.00
|
|
| Hospital Charge Code |
4518669
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,811.85 |
| Max. Negotiated Rate |
$5,953.21 |
| Rate for Payer: Aetna Commercial |
$5,823.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,564.96
|
| Rate for Payer: Aetna Managed Medicare |
$1,811.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,206.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,235.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,106.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,429.57
|
| Rate for Payer: Cash Price |
$1,866.60
|
| Rate for Payer: Cigna Commercial |
$5,953.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,621.20
|
| Rate for Payer: Health EOS Commercial |
$5,759.08
|
| Rate for Payer: HFN Commercial |
$5,953.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,853.16
|
| Rate for Payer: Multiplan Commercial |
$5,176.70
|
| Rate for Payer: NAPHCARE Commercial |
$3,882.53
|
| Rate for Payer: Preferred Network Access Commercial |
$5,953.21
|
| Rate for Payer: Quartz Beloit One Network |
$3,170.73
|
| Rate for Payer: Quartz Commercial |
$4,206.07
|
| Rate for Payer: Quartz Medicare Advantage |
$3,882.53
|
| Rate for Payer: The Alliance Commercial |
$3,235.44
|
| Rate for Payer: WEA Trust Commercial |
$3,558.98
|
| Rate for Payer: WPS Commercial |
$4,792.81
|
|
|
TIBIAL AUGMENT HALF BLOCK SZ 7 5MM RT 5545-A-701
|
Facility
|
IP
|
$6,222.00
|
|
| Hospital Charge Code |
4518669
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,170.73 |
| Max. Negotiated Rate |
$5,953.21 |
| Rate for Payer: Aetna Commercial |
$5,823.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,564.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,429.57
|
| Rate for Payer: Cash Price |
$1,866.60
|
| Rate for Payer: Cigna Commercial |
$5,953.21
|
| Rate for Payer: Health EOS Commercial |
$5,759.08
|
| Rate for Payer: HFN Commercial |
$5,953.21
|
| Rate for Payer: Multiplan Commercial |
$5,176.70
|
| Rate for Payer: Preferred Network Access Commercial |
$5,953.21
|
| Rate for Payer: Quartz Beloit One Network |
$3,170.73
|
| Rate for Payer: Quartz Commercial |
$3,882.53
|
| Rate for Payer: WEA Trust Commercial |
$3,558.98
|
| Rate for Payer: WPS Commercial |
$4,792.81
|
|
|
TIBIAL BASEPLATE TRIATHLON SZ 2 5521-B-200
|
Facility
|
IP
|
$9,499.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3072402
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,840.69 |
| Max. Negotiated Rate |
$9,088.64 |
| Rate for Payer: Aetna Commercial |
$8,891.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,495.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,235.85
|
| Rate for Payer: Cash Price |
$2,849.70
|
| Rate for Payer: Cigna Commercial |
$9,088.64
|
| Rate for Payer: Health EOS Commercial |
$8,792.27
|
| Rate for Payer: HFN Commercial |
$9,088.64
|
| Rate for Payer: Multiplan Commercial |
$7,903.17
|
| Rate for Payer: Preferred Network Access Commercial |
$9,088.64
|
| Rate for Payer: Quartz Beloit One Network |
$4,840.69
|
| Rate for Payer: Quartz Commercial |
$5,927.38
|
| Rate for Payer: WEA Trust Commercial |
$5,433.43
|
| Rate for Payer: WPS Commercial |
$7,317.08
|
|
|
TIBIAL BASEPLATE TRIATHLON SZ 2 5521-B-200
|
Facility
|
OP
|
$9,499.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3072402
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,766.11 |
| Max. Negotiated Rate |
$9,088.64 |
| Rate for Payer: Aetna Commercial |
$8,891.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,495.91
|
| Rate for Payer: Aetna Managed Medicare |
$2,766.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,421.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,939.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,741.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,235.85
|
| Rate for Payer: Cash Price |
$2,849.70
|
| Rate for Payer: Cigna Commercial |
$9,088.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,528.42
|
| Rate for Payer: Health EOS Commercial |
$8,792.27
|
| Rate for Payer: HFN Commercial |
$9,088.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,409.22
|
| Rate for Payer: Multiplan Commercial |
$7,903.17
|
| Rate for Payer: NAPHCARE Commercial |
$5,927.38
|
| Rate for Payer: Preferred Network Access Commercial |
$9,088.64
|
| Rate for Payer: Quartz Beloit One Network |
$4,840.69
|
| Rate for Payer: Quartz Commercial |
$6,421.32
|
| Rate for Payer: Quartz Medicare Advantage |
$5,927.38
|
| Rate for Payer: The Alliance Commercial |
$4,939.48
|
| Rate for Payer: WEA Trust Commercial |
$5,433.43
|
| Rate for Payer: WPS Commercial |
$7,317.08
|
|
|
TIBIAL BASEPLATE TRIATHLON SZ 3 5521-B-300
|
Facility
|
IP
|
$9,499.00
|
|
| Hospital Charge Code |
3128846
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,840.69 |
| Max. Negotiated Rate |
$9,088.64 |
| Rate for Payer: Aetna Commercial |
$8,891.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,495.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,235.85
|
| Rate for Payer: Cash Price |
$2,849.70
|
| Rate for Payer: Cigna Commercial |
$9,088.64
|
| Rate for Payer: Health EOS Commercial |
$8,792.27
|
| Rate for Payer: HFN Commercial |
$9,088.64
|
| Rate for Payer: Multiplan Commercial |
$7,903.17
|
| Rate for Payer: Preferred Network Access Commercial |
$9,088.64
|
| Rate for Payer: Quartz Beloit One Network |
$4,840.69
|
| Rate for Payer: Quartz Commercial |
$5,927.38
|
| Rate for Payer: WEA Trust Commercial |
$5,433.43
|
| Rate for Payer: WPS Commercial |
$7,317.08
|
|
|
TIBIAL BASEPLATE TRIATHLON SZ 3 5521-B-300
|
Facility
|
OP
|
$9,499.00
|
|
| Hospital Charge Code |
3128846
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,766.11 |
| Max. Negotiated Rate |
$9,088.64 |
| Rate for Payer: Aetna Commercial |
$8,891.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,495.91
|
| Rate for Payer: Aetna Managed Medicare |
$2,766.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,421.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,939.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,741.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,235.85
|
| Rate for Payer: Cash Price |
$2,849.70
|
| Rate for Payer: Cigna Commercial |
$9,088.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,528.42
|
| Rate for Payer: Health EOS Commercial |
$8,792.27
|
| Rate for Payer: HFN Commercial |
$9,088.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,409.22
|
| Rate for Payer: Multiplan Commercial |
$7,903.17
|
| Rate for Payer: NAPHCARE Commercial |
$5,927.38
|
| Rate for Payer: Preferred Network Access Commercial |
$9,088.64
|
| Rate for Payer: Quartz Beloit One Network |
$4,840.69
|
| Rate for Payer: Quartz Commercial |
$6,421.32
|
| Rate for Payer: Quartz Medicare Advantage |
$5,927.38
|
| Rate for Payer: The Alliance Commercial |
$4,939.48
|
| Rate for Payer: WEA Trust Commercial |
$5,433.43
|
| Rate for Payer: WPS Commercial |
$7,317.08
|
|
|
TIBIAL BASEPLATE TRIATHLON SZ 4 5521-B-400
|
Facility
|
OP
|
$9,499.00
|
|
| Hospital Charge Code |
3127478
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,766.11 |
| Max. Negotiated Rate |
$9,088.64 |
| Rate for Payer: Aetna Commercial |
$8,891.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,495.91
|
| Rate for Payer: Aetna Managed Medicare |
$2,766.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,421.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,939.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,741.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,235.85
|
| Rate for Payer: Cash Price |
$2,849.70
|
| Rate for Payer: Cigna Commercial |
$9,088.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,528.42
|
| Rate for Payer: Health EOS Commercial |
$8,792.27
|
| Rate for Payer: HFN Commercial |
$9,088.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,409.22
|
| Rate for Payer: Multiplan Commercial |
$7,903.17
|
| Rate for Payer: NAPHCARE Commercial |
$5,927.38
|
| Rate for Payer: Preferred Network Access Commercial |
$9,088.64
|
| Rate for Payer: Quartz Beloit One Network |
$4,840.69
|
| Rate for Payer: Quartz Commercial |
$6,421.32
|
| Rate for Payer: Quartz Medicare Advantage |
$5,927.38
|
| Rate for Payer: The Alliance Commercial |
$4,939.48
|
| Rate for Payer: WEA Trust Commercial |
$5,433.43
|
| Rate for Payer: WPS Commercial |
$7,317.08
|
|
|
TIBIAL BASEPLATE TRIATHLON SZ 4 5521-B-400
|
Facility
|
IP
|
$9,499.00
|
|
| Hospital Charge Code |
3127478
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,840.69 |
| Max. Negotiated Rate |
$9,088.64 |
| Rate for Payer: Aetna Commercial |
$8,891.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,495.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,235.85
|
| Rate for Payer: Cash Price |
$2,849.70
|
| Rate for Payer: Cigna Commercial |
$9,088.64
|
| Rate for Payer: Health EOS Commercial |
$8,792.27
|
| Rate for Payer: HFN Commercial |
$9,088.64
|
| Rate for Payer: Multiplan Commercial |
$7,903.17
|
| Rate for Payer: Preferred Network Access Commercial |
$9,088.64
|
| Rate for Payer: Quartz Beloit One Network |
$4,840.69
|
| Rate for Payer: Quartz Commercial |
$5,927.38
|
| Rate for Payer: WEA Trust Commercial |
$5,433.43
|
| Rate for Payer: WPS Commercial |
$7,317.08
|
|
|
TIBIAL BASEPLATE TRIATHLON SZ 5 5521-B-500
|
Facility
|
OP
|
$9,499.00
|
|
| Hospital Charge Code |
3072433
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,766.11 |
| Max. Negotiated Rate |
$9,088.64 |
| Rate for Payer: Aetna Commercial |
$8,891.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,495.91
|
| Rate for Payer: Aetna Managed Medicare |
$2,766.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,421.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,939.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,741.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,235.85
|
| Rate for Payer: Cash Price |
$2,849.70
|
| Rate for Payer: Cigna Commercial |
$9,088.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,528.42
|
| Rate for Payer: Health EOS Commercial |
$8,792.27
|
| Rate for Payer: HFN Commercial |
$9,088.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,409.22
|
| Rate for Payer: Multiplan Commercial |
$7,903.17
|
| Rate for Payer: NAPHCARE Commercial |
$5,927.38
|
| Rate for Payer: Preferred Network Access Commercial |
$9,088.64
|
| Rate for Payer: Quartz Beloit One Network |
$4,840.69
|
| Rate for Payer: Quartz Commercial |
$6,421.32
|
| Rate for Payer: Quartz Medicare Advantage |
$5,927.38
|
| Rate for Payer: The Alliance Commercial |
$4,939.48
|
| Rate for Payer: WEA Trust Commercial |
$5,433.43
|
| Rate for Payer: WPS Commercial |
$7,317.08
|
|
|
TIBIAL BASEPLATE TRIATHLON SZ 5 5521-B-500
|
Facility
|
IP
|
$9,499.00
|
|
| Hospital Charge Code |
3072433
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,840.69 |
| Max. Negotiated Rate |
$9,088.64 |
| Rate for Payer: Aetna Commercial |
$8,891.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,495.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,235.85
|
| Rate for Payer: Cash Price |
$2,849.70
|
| Rate for Payer: Cigna Commercial |
$9,088.64
|
| Rate for Payer: Health EOS Commercial |
$8,792.27
|
| Rate for Payer: HFN Commercial |
$9,088.64
|
| Rate for Payer: Multiplan Commercial |
$7,903.17
|
| Rate for Payer: Preferred Network Access Commercial |
$9,088.64
|
| Rate for Payer: Quartz Beloit One Network |
$4,840.69
|
| Rate for Payer: Quartz Commercial |
$5,927.38
|
| Rate for Payer: WEA Trust Commercial |
$5,433.43
|
| Rate for Payer: WPS Commercial |
$7,317.08
|
|
|
TIBIAL BASEPLATE TRIATHLON SZ 6 5521-B-600
|
Facility
|
IP
|
$9,499.00
|
|
| Hospital Charge Code |
3219468
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,840.69 |
| Max. Negotiated Rate |
$9,088.64 |
| Rate for Payer: Aetna Commercial |
$8,891.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,495.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,235.85
|
| Rate for Payer: Cash Price |
$2,849.70
|
| Rate for Payer: Cigna Commercial |
$9,088.64
|
| Rate for Payer: Health EOS Commercial |
$8,792.27
|
| Rate for Payer: HFN Commercial |
$9,088.64
|
| Rate for Payer: Multiplan Commercial |
$7,903.17
|
| Rate for Payer: Preferred Network Access Commercial |
$9,088.64
|
| Rate for Payer: Quartz Beloit One Network |
$4,840.69
|
| Rate for Payer: Quartz Commercial |
$5,927.38
|
| Rate for Payer: WEA Trust Commercial |
$5,433.43
|
| Rate for Payer: WPS Commercial |
$7,317.08
|
|
|
TIBIAL BASEPLATE TRIATHLON SZ 6 5521-B-600
|
Facility
|
OP
|
$9,499.00
|
|
| Hospital Charge Code |
3219468
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,766.11 |
| Max. Negotiated Rate |
$9,088.64 |
| Rate for Payer: Aetna Commercial |
$8,891.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,495.91
|
| Rate for Payer: Aetna Managed Medicare |
$2,766.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,421.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,939.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,741.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,235.85
|
| Rate for Payer: Cash Price |
$2,849.70
|
| Rate for Payer: Cigna Commercial |
$9,088.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,528.42
|
| Rate for Payer: Health EOS Commercial |
$8,792.27
|
| Rate for Payer: HFN Commercial |
$9,088.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,409.22
|
| Rate for Payer: Multiplan Commercial |
$7,903.17
|
| Rate for Payer: NAPHCARE Commercial |
$5,927.38
|
| Rate for Payer: Preferred Network Access Commercial |
$9,088.64
|
| Rate for Payer: Quartz Beloit One Network |
$4,840.69
|
| Rate for Payer: Quartz Commercial |
$6,421.32
|
| Rate for Payer: Quartz Medicare Advantage |
$5,927.38
|
| Rate for Payer: The Alliance Commercial |
$4,939.48
|
| Rate for Payer: WEA Trust Commercial |
$5,433.43
|
| Rate for Payer: WPS Commercial |
$7,317.08
|
|
|
TIBIAL BASEPLATE TRIATHLON SZ 7 5521-B-700
|
Facility
|
OP
|
$9,499.00
|
|
| Hospital Charge Code |
4074601
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,766.11 |
| Max. Negotiated Rate |
$9,088.64 |
| Rate for Payer: Aetna Commercial |
$8,891.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,495.91
|
| Rate for Payer: Aetna Managed Medicare |
$2,766.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,421.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,939.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,741.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,235.85
|
| Rate for Payer: Cash Price |
$2,849.70
|
| Rate for Payer: Cigna Commercial |
$9,088.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,528.42
|
| Rate for Payer: Health EOS Commercial |
$8,792.27
|
| Rate for Payer: HFN Commercial |
$9,088.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,409.22
|
| Rate for Payer: Multiplan Commercial |
$7,903.17
|
| Rate for Payer: NAPHCARE Commercial |
$5,927.38
|
| Rate for Payer: Preferred Network Access Commercial |
$9,088.64
|
| Rate for Payer: Quartz Beloit One Network |
$4,840.69
|
| Rate for Payer: Quartz Commercial |
$6,421.32
|
| Rate for Payer: Quartz Medicare Advantage |
$5,927.38
|
| Rate for Payer: The Alliance Commercial |
$4,939.48
|
| Rate for Payer: WEA Trust Commercial |
$5,433.43
|
| Rate for Payer: WPS Commercial |
$7,317.08
|
|
|
TIBIAL BASEPLATE TRIATHLON SZ 7 5521-B-700
|
Facility
|
IP
|
$9,499.00
|
|
| Hospital Charge Code |
4074601
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,840.69 |
| Max. Negotiated Rate |
$9,088.64 |
| Rate for Payer: Aetna Commercial |
$8,891.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,495.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,235.85
|
| Rate for Payer: Cash Price |
$2,849.70
|
| Rate for Payer: Cigna Commercial |
$9,088.64
|
| Rate for Payer: Health EOS Commercial |
$8,792.27
|
| Rate for Payer: HFN Commercial |
$9,088.64
|
| Rate for Payer: Multiplan Commercial |
$7,903.17
|
| Rate for Payer: Preferred Network Access Commercial |
$9,088.64
|
| Rate for Payer: Quartz Beloit One Network |
$4,840.69
|
| Rate for Payer: Quartz Commercial |
$5,927.38
|
| Rate for Payer: WEA Trust Commercial |
$5,433.43
|
| Rate for Payer: WPS Commercial |
$7,317.08
|
|
|
TIBIAL BASEPLATE TRIATHLON SZ 8 5521-B-800
|
Facility
|
OP
|
$9,147.00
|
|
| Hospital Charge Code |
4493857
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,663.61 |
| Max. Negotiated Rate |
$8,751.85 |
| Rate for Payer: Aetna Commercial |
$8,561.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,181.08
|
| Rate for Payer: Aetna Managed Medicare |
$2,663.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,183.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,756.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,566.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,041.83
|
| Rate for Payer: Cash Price |
$2,744.10
|
| Rate for Payer: Cigna Commercial |
$8,751.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,323.55
|
| Rate for Payer: Health EOS Commercial |
$8,466.46
|
| Rate for Payer: HFN Commercial |
$8,751.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,134.66
|
| Rate for Payer: Multiplan Commercial |
$7,610.30
|
| Rate for Payer: NAPHCARE Commercial |
$5,707.73
|
| Rate for Payer: Preferred Network Access Commercial |
$8,751.85
|
| Rate for Payer: Quartz Beloit One Network |
$4,661.31
|
| Rate for Payer: Quartz Commercial |
$6,183.37
|
| Rate for Payer: Quartz Medicare Advantage |
$5,707.73
|
| Rate for Payer: The Alliance Commercial |
$4,756.44
|
| Rate for Payer: WEA Trust Commercial |
$5,232.08
|
| Rate for Payer: WPS Commercial |
$7,045.93
|
|
|
TIBIAL BASEPLATE TRIATHLON SZ 8 5521-B-800
|
Facility
|
IP
|
$9,147.00
|
|
| Hospital Charge Code |
4493857
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,661.31 |
| Max. Negotiated Rate |
$8,751.85 |
| Rate for Payer: Aetna Commercial |
$8,561.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,181.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,041.83
|
| Rate for Payer: Cash Price |
$2,744.10
|
| Rate for Payer: Cigna Commercial |
$8,751.85
|
| Rate for Payer: Health EOS Commercial |
$8,466.46
|
| Rate for Payer: HFN Commercial |
$8,751.85
|
| Rate for Payer: Multiplan Commercial |
$7,610.30
|
| Rate for Payer: Preferred Network Access Commercial |
$8,751.85
|
| Rate for Payer: Quartz Beloit One Network |
$4,661.31
|
| Rate for Payer: Quartz Commercial |
$5,707.73
|
| Rate for Payer: WEA Trust Commercial |
$5,232.08
|
| Rate for Payer: WPS Commercial |
$7,045.93
|
|
|
TIBIAL BASE ROTATING PLATFORM ATTUNE SZ 10 CEMENTED 1506-80-010
|
Facility
|
OP
|
$6,885.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6166144
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,004.91 |
| Max. Negotiated Rate |
$6,587.57 |
| Rate for Payer: Aetna Commercial |
$6,444.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,157.94
|
| Rate for Payer: Aetna Managed Medicare |
$2,004.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,654.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,580.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,436.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,795.01
|
| Rate for Payer: Cash Price |
$2,065.50
|
| Rate for Payer: Cigna Commercial |
$6,587.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,007.07
|
| Rate for Payer: Health EOS Commercial |
$6,372.76
|
| Rate for Payer: HFN Commercial |
$6,587.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,370.30
|
| Rate for Payer: Multiplan Commercial |
$5,728.32
|
| Rate for Payer: NAPHCARE Commercial |
$4,296.24
|
| Rate for Payer: Preferred Network Access Commercial |
$6,587.57
|
| Rate for Payer: Quartz Beloit One Network |
$3,508.60
|
| Rate for Payer: Quartz Commercial |
$4,654.26
|
| Rate for Payer: Quartz Medicare Advantage |
$4,296.24
|
| Rate for Payer: The Alliance Commercial |
$3,580.20
|
| Rate for Payer: WEA Trust Commercial |
$3,938.22
|
| Rate for Payer: WPS Commercial |
$5,303.52
|
|
|
TIBIAL BASE ROTATING PLATFORM ATTUNE SZ 10 CEMENTED 1506-80-010
|
Facility
|
IP
|
$6,885.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6166144
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,508.60 |
| Max. Negotiated Rate |
$6,587.57 |
| Rate for Payer: Aetna Commercial |
$6,444.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,157.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,795.01
|
| Rate for Payer: Cash Price |
$2,065.50
|
| Rate for Payer: Cigna Commercial |
$6,587.57
|
| Rate for Payer: Health EOS Commercial |
$6,372.76
|
| Rate for Payer: HFN Commercial |
$6,587.57
|
| Rate for Payer: Multiplan Commercial |
$5,728.32
|
| Rate for Payer: Preferred Network Access Commercial |
$6,587.57
|
| Rate for Payer: Quartz Beloit One Network |
$3,508.60
|
| Rate for Payer: Quartz Commercial |
$4,296.24
|
| Rate for Payer: WEA Trust Commercial |
$3,938.22
|
| Rate for Payer: WPS Commercial |
$5,303.52
|
|
|
TIBIAL BASE ROTATING PLATFORM ATTUNE SZ 2 CEMENTED 1506-80-002
|
Facility
|
IP
|
$5,674.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6182934
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,891.47 |
| Max. Negotiated Rate |
$5,428.88 |
| Rate for Payer: Aetna Commercial |
$5,310.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,074.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,127.51
|
| Rate for Payer: Cash Price |
$1,702.20
|
| Rate for Payer: Cigna Commercial |
$5,428.88
|
| Rate for Payer: Health EOS Commercial |
$5,251.85
|
| Rate for Payer: HFN Commercial |
$5,428.88
|
| Rate for Payer: Multiplan Commercial |
$4,720.77
|
| Rate for Payer: Preferred Network Access Commercial |
$5,428.88
|
| Rate for Payer: Quartz Beloit One Network |
$2,891.47
|
| Rate for Payer: Quartz Commercial |
$3,540.58
|
| Rate for Payer: WEA Trust Commercial |
$3,245.53
|
| Rate for Payer: WPS Commercial |
$4,370.68
|
|
|
TIBIAL BASE ROTATING PLATFORM ATTUNE SZ 2 CEMENTED 1506-80-002
|
Facility
|
OP
|
$5,674.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6182934
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,652.27 |
| Max. Negotiated Rate |
$5,428.88 |
| Rate for Payer: Aetna Commercial |
$5,310.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,074.83
|
| Rate for Payer: Aetna Managed Medicare |
$1,652.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,835.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,950.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,832.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,127.51
|
| Rate for Payer: Cash Price |
$1,702.20
|
| Rate for Payer: Cigna Commercial |
$5,428.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,302.27
|
| Rate for Payer: Health EOS Commercial |
$5,251.85
|
| Rate for Payer: HFN Commercial |
$5,428.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,425.72
|
| Rate for Payer: Multiplan Commercial |
$4,720.77
|
| Rate for Payer: NAPHCARE Commercial |
$3,540.58
|
| Rate for Payer: Preferred Network Access Commercial |
$5,428.88
|
| Rate for Payer: Quartz Beloit One Network |
$2,891.47
|
| Rate for Payer: Quartz Commercial |
$3,835.62
|
| Rate for Payer: Quartz Medicare Advantage |
$3,540.58
|
| Rate for Payer: The Alliance Commercial |
$2,950.48
|
| Rate for Payer: WEA Trust Commercial |
$3,245.53
|
| Rate for Payer: WPS Commercial |
$4,370.68
|
|
|
TIBIAL BASE ROTATING PLATFORM ATTUNE SZ 3 CEMENTED 1506-80-003
|
Facility
|
IP
|
$8,616.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5521121
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,390.71 |
| Max. Negotiated Rate |
$8,243.79 |
| Rate for Payer: Aetna Commercial |
$8,064.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,706.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,749.14
|
| Rate for Payer: Cash Price |
$2,584.80
|
| Rate for Payer: Cigna Commercial |
$8,243.79
|
| Rate for Payer: Health EOS Commercial |
$7,974.97
|
| Rate for Payer: HFN Commercial |
$8,243.79
|
| Rate for Payer: Multiplan Commercial |
$7,168.51
|
| Rate for Payer: Preferred Network Access Commercial |
$8,243.79
|
| Rate for Payer: Quartz Beloit One Network |
$4,390.71
|
| Rate for Payer: Quartz Commercial |
$5,376.38
|
| Rate for Payer: WEA Trust Commercial |
$4,928.35
|
| Rate for Payer: WPS Commercial |
$6,636.90
|
|
|
TIBIAL BASE ROTATING PLATFORM ATTUNE SZ 3 CEMENTED 1506-80-003
|
Facility
|
OP
|
$8,616.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5521121
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,508.98 |
| Max. Negotiated Rate |
$8,243.79 |
| Rate for Payer: Aetna Commercial |
$8,064.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,706.15
|
| Rate for Payer: Aetna Managed Medicare |
$2,508.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,824.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,480.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,301.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,749.14
|
| Rate for Payer: Cash Price |
$2,584.80
|
| Rate for Payer: Cigna Commercial |
$8,243.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,014.51
|
| Rate for Payer: Health EOS Commercial |
$7,974.97
|
| Rate for Payer: HFN Commercial |
$8,243.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,720.48
|
| Rate for Payer: Multiplan Commercial |
$7,168.51
|
| Rate for Payer: NAPHCARE Commercial |
$5,376.38
|
| Rate for Payer: Preferred Network Access Commercial |
$8,243.79
|
| Rate for Payer: Quartz Beloit One Network |
$4,390.71
|
| Rate for Payer: Quartz Commercial |
$5,824.42
|
| Rate for Payer: Quartz Medicare Advantage |
$5,376.38
|
| Rate for Payer: The Alliance Commercial |
$4,480.32
|
| Rate for Payer: WEA Trust Commercial |
$4,928.35
|
| Rate for Payer: WPS Commercial |
$6,636.90
|
|
|
TIBIAL BASE ROTATING PLATFORM ATTUNE SZ 4 CEMENTED 1506-80-004
|
Facility
|
IP
|
$8,616.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5459751
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,390.71 |
| Max. Negotiated Rate |
$8,243.79 |
| Rate for Payer: Aetna Commercial |
$8,064.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,706.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,749.14
|
| Rate for Payer: Cash Price |
$2,584.80
|
| Rate for Payer: Cigna Commercial |
$8,243.79
|
| Rate for Payer: Health EOS Commercial |
$7,974.97
|
| Rate for Payer: HFN Commercial |
$8,243.79
|
| Rate for Payer: Multiplan Commercial |
$7,168.51
|
| Rate for Payer: Preferred Network Access Commercial |
$8,243.79
|
| Rate for Payer: Quartz Beloit One Network |
$4,390.71
|
| Rate for Payer: Quartz Commercial |
$5,376.38
|
| Rate for Payer: WEA Trust Commercial |
$4,928.35
|
| Rate for Payer: WPS Commercial |
$6,636.90
|
|
|
TIBIAL BASE ROTATING PLATFORM ATTUNE SZ 4 CEMENTED 1506-80-004
|
Facility
|
OP
|
$8,616.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5459751
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,508.98 |
| Max. Negotiated Rate |
$8,243.79 |
| Rate for Payer: Aetna Commercial |
$8,064.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,706.15
|
| Rate for Payer: Aetna Managed Medicare |
$2,508.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,824.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,480.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,301.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,749.14
|
| Rate for Payer: Cash Price |
$2,584.80
|
| Rate for Payer: Cigna Commercial |
$8,243.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,014.51
|
| Rate for Payer: Health EOS Commercial |
$7,974.97
|
| Rate for Payer: HFN Commercial |
$8,243.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,720.48
|
| Rate for Payer: Multiplan Commercial |
$7,168.51
|
| Rate for Payer: NAPHCARE Commercial |
$5,376.38
|
| Rate for Payer: Preferred Network Access Commercial |
$8,243.79
|
| Rate for Payer: Quartz Beloit One Network |
$4,390.71
|
| Rate for Payer: Quartz Commercial |
$5,824.42
|
| Rate for Payer: Quartz Medicare Advantage |
$5,376.38
|
| Rate for Payer: The Alliance Commercial |
$4,480.32
|
| Rate for Payer: WEA Trust Commercial |
$4,928.35
|
| Rate for Payer: WPS Commercial |
$6,636.90
|
|
