|
TIBIAL INSERT ROTATING PLATFORM REVISION LPS ATTUNE 24MM X-SM 1517-60-224
|
Facility
|
IP
|
$26,735.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5813626
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13,624.16 |
| Max. Negotiated Rate |
$25,580.05 |
| Rate for Payer: Aetna Commercial |
$25,023.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$23,911.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14,736.33
|
| Rate for Payer: Cash Price |
$8,020.50
|
| Rate for Payer: Cigna Commercial |
$25,580.05
|
| Rate for Payer: Health EOS Commercial |
$24,745.92
|
| Rate for Payer: HFN Commercial |
$25,580.05
|
| Rate for Payer: Multiplan Commercial |
$22,243.52
|
| Rate for Payer: Preferred Network Access Commercial |
$25,580.05
|
| Rate for Payer: Quartz Beloit One Network |
$13,624.16
|
| Rate for Payer: Quartz Commercial |
$16,682.64
|
| Rate for Payer: WEA Trust Commercial |
$15,292.42
|
| Rate for Payer: WPS Commercial |
$20,593.97
|
|
|
TIBIAL INSERT ROTATING PLATFORM REVISION LPS ATTUNE 24MM X-SM 1517-60-224
|
Facility
|
OP
|
$26,735.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5813626
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,785.23 |
| Max. Negotiated Rate |
$25,580.05 |
| Rate for Payer: Aetna Commercial |
$25,023.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$23,911.78
|
| Rate for Payer: Aetna Managed Medicare |
$7,785.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,072.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,902.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,346.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14,736.33
|
| Rate for Payer: Cash Price |
$8,020.50
|
| Rate for Payer: Cigna Commercial |
$25,580.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15,559.77
|
| Rate for Payer: Health EOS Commercial |
$24,745.92
|
| Rate for Payer: HFN Commercial |
$25,580.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,853.30
|
| Rate for Payer: Multiplan Commercial |
$22,243.52
|
| Rate for Payer: NAPHCARE Commercial |
$16,682.64
|
| Rate for Payer: Preferred Network Access Commercial |
$25,580.05
|
| Rate for Payer: Quartz Beloit One Network |
$13,624.16
|
| Rate for Payer: Quartz Commercial |
$18,072.86
|
| Rate for Payer: Quartz Medicare Advantage |
$16,682.64
|
| Rate for Payer: The Alliance Commercial |
$13,902.20
|
| Rate for Payer: WEA Trust Commercial |
$15,292.42
|
| Rate for Payer: WPS Commercial |
$20,593.97
|
|
|
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 |
$3,572.81 |
| Max. Negotiated Rate |
$6,708.12 |
| Rate for Payer: Aetna Commercial |
$6,562.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,270.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,864.46
|
| Rate for Payer: Cash Price |
$2,103.30
|
| Rate for Payer: Cigna Commercial |
$6,708.12
|
| Rate for Payer: Health EOS Commercial |
$6,489.38
|
| Rate for Payer: HFN Commercial |
$6,708.12
|
| Rate for Payer: Multiplan Commercial |
$5,833.15
|
| Rate for Payer: Preferred Network Access Commercial |
$6,708.12
|
| Rate for Payer: Quartz Beloit One Network |
$3,572.81
|
| Rate for Payer: Quartz Commercial |
$4,374.86
|
| Rate for Payer: WEA Trust Commercial |
$4,010.29
|
| Rate for Payer: WPS Commercial |
$5,400.57
|
|
|
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 |
$2,041.60 |
| Max. Negotiated Rate |
$6,708.12 |
| Rate for Payer: Aetna Commercial |
$6,562.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,270.64
|
| Rate for Payer: Aetna Managed Medicare |
$2,041.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,739.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,645.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,499.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,864.46
|
| Rate for Payer: Cash Price |
$2,103.30
|
| Rate for Payer: Cigna Commercial |
$6,708.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,080.40
|
| Rate for Payer: Health EOS Commercial |
$6,489.38
|
| Rate for Payer: HFN Commercial |
$6,708.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,468.58
|
| Rate for Payer: Multiplan Commercial |
$5,833.15
|
| Rate for Payer: NAPHCARE Commercial |
$4,374.86
|
| Rate for Payer: Preferred Network Access Commercial |
$6,708.12
|
| Rate for Payer: Quartz Beloit One Network |
$3,572.81
|
| Rate for Payer: Quartz Commercial |
$4,739.44
|
| Rate for Payer: Quartz Medicare Advantage |
$4,374.86
|
| Rate for Payer: The Alliance Commercial |
$3,645.72
|
| Rate for Payer: WEA Trust Commercial |
$4,010.29
|
| Rate for Payer: WPS Commercial |
$5,400.57
|
|
|
TIBIAL INTRAMEDULLARY RODDING
|
Facility
|
IP
|
$5,974.00
|
|
| Hospital Charge Code |
2960152
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,044.35 |
| Max. Negotiated Rate |
$5,715.92 |
| Rate for Payer: Aetna Commercial |
$5,591.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,343.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,292.87
|
| Rate for Payer: Cash Price |
$1,792.20
|
| Rate for Payer: Cigna Commercial |
$5,715.92
|
| Rate for Payer: Health EOS Commercial |
$5,529.53
|
| Rate for Payer: HFN Commercial |
$5,715.92
|
| Rate for Payer: Multiplan Commercial |
$4,970.37
|
| Rate for Payer: Preferred Network Access Commercial |
$5,715.92
|
| Rate for Payer: Quartz Beloit One Network |
$3,044.35
|
| Rate for Payer: Quartz Commercial |
$3,727.78
|
| Rate for Payer: WEA Trust Commercial |
$3,417.13
|
| Rate for Payer: WPS Commercial |
$4,601.77
|
|
|
TIBIAL INTRAMEDULLARY RODDING
|
Facility
|
OP
|
$5,974.00
|
|
| Hospital Charge Code |
2960152
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,739.63 |
| Max. Negotiated Rate |
$5,715.92 |
| Rate for Payer: Aetna Commercial |
$5,591.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,343.15
|
| Rate for Payer: Aetna Managed Medicare |
$1,739.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,038.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,106.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,982.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,292.87
|
| Rate for Payer: Cash Price |
$1,792.20
|
| Rate for Payer: Cigna Commercial |
$5,715.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,476.87
|
| Rate for Payer: Health EOS Commercial |
$5,529.53
|
| Rate for Payer: HFN Commercial |
$5,715.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,659.72
|
| Rate for Payer: Multiplan Commercial |
$4,970.37
|
| Rate for Payer: NAPHCARE Commercial |
$3,727.78
|
| Rate for Payer: Preferred Network Access Commercial |
$5,715.92
|
| Rate for Payer: Quartz Beloit One Network |
$3,044.35
|
| Rate for Payer: Quartz Commercial |
$4,038.42
|
| Rate for Payer: Quartz Medicare Advantage |
$3,727.78
|
| Rate for Payer: The Alliance Commercial |
$3,106.48
|
| Rate for Payer: WEA Trust Commercial |
$3,417.13
|
| Rate for Payer: WPS Commercial |
$4,601.77
|
|
|
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 |
$859.19 |
| Max. Negotiated Rate |
$1,613.16 |
| Rate for Payer: Aetna Commercial |
$1,578.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,507.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$929.32
|
| Rate for Payer: Cash Price |
$505.80
|
| Rate for Payer: Cigna Commercial |
$1,613.16
|
| Rate for Payer: Health EOS Commercial |
$1,560.56
|
| Rate for Payer: HFN Commercial |
$1,613.16
|
| Rate for Payer: Multiplan Commercial |
$1,402.75
|
| Rate for Payer: Preferred Network Access Commercial |
$1,613.16
|
| Rate for Payer: Quartz Beloit One Network |
$859.19
|
| Rate for Payer: Quartz Commercial |
$1,052.06
|
| Rate for Payer: WEA Trust Commercial |
$964.39
|
| Rate for Payer: WPS Commercial |
$1,298.73
|
|
|
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 |
$490.96 |
| Max. Negotiated Rate |
$1,613.16 |
| Rate for Payer: Aetna Commercial |
$1,578.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,507.96
|
| Rate for Payer: Aetna Managed Medicare |
$490.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,139.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$876.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$841.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$929.32
|
| Rate for Payer: Cash Price |
$505.80
|
| Rate for Payer: Cigna Commercial |
$1,613.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$981.25
|
| Rate for Payer: Health EOS Commercial |
$1,560.56
|
| Rate for Payer: HFN Commercial |
$1,613.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,315.08
|
| Rate for Payer: Multiplan Commercial |
$1,402.75
|
| Rate for Payer: NAPHCARE Commercial |
$1,052.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,613.16
|
| Rate for Payer: Quartz Beloit One Network |
$859.19
|
| Rate for Payer: Quartz Commercial |
$1,139.74
|
| Rate for Payer: Quartz Medicare Advantage |
$1,052.06
|
| Rate for Payer: The Alliance Commercial |
$876.72
|
| Rate for Payer: WEA Trust Commercial |
$964.39
|
| Rate for Payer: WPS Commercial |
$1,298.73
|
|
|
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 |
$1,895.13 |
| Max. Negotiated Rate |
$6,226.85 |
| Rate for Payer: Aetna Commercial |
$6,091.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,820.76
|
| Rate for Payer: Aetna Managed Medicare |
$1,895.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,399.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,384.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,248.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,587.21
|
| Rate for Payer: Cash Price |
$1,952.40
|
| Rate for Payer: Cigna Commercial |
$6,226.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,787.66
|
| Rate for Payer: Health EOS Commercial |
$6,023.80
|
| Rate for Payer: HFN Commercial |
$6,226.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,076.24
|
| Rate for Payer: Multiplan Commercial |
$5,414.66
|
| Rate for Payer: NAPHCARE Commercial |
$4,060.99
|
| Rate for Payer: Preferred Network Access Commercial |
$6,226.85
|
| Rate for Payer: Quartz Beloit One Network |
$3,316.48
|
| Rate for Payer: Quartz Commercial |
$4,399.41
|
| Rate for Payer: Quartz Medicare Advantage |
$4,060.99
|
| Rate for Payer: The Alliance Commercial |
$3,384.16
|
| Rate for Payer: WEA Trust Commercial |
$3,722.58
|
| Rate for Payer: WPS Commercial |
$5,013.11
|
|
|
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 |
$3,316.48 |
| Max. Negotiated Rate |
$6,226.85 |
| Rate for Payer: Aetna Commercial |
$6,091.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,820.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,587.21
|
| Rate for Payer: Cash Price |
$1,952.40
|
| Rate for Payer: Cigna Commercial |
$6,226.85
|
| Rate for Payer: Health EOS Commercial |
$6,023.80
|
| Rate for Payer: HFN Commercial |
$6,226.85
|
| Rate for Payer: Multiplan Commercial |
$5,414.66
|
| Rate for Payer: Preferred Network Access Commercial |
$6,226.85
|
| Rate for Payer: Quartz Beloit One Network |
$3,316.48
|
| Rate for Payer: Quartz Commercial |
$4,060.99
|
| Rate for Payer: WEA Trust Commercial |
$3,722.58
|
| Rate for Payer: WPS Commercial |
$5,013.11
|
|
|
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 |
$5,540.88 |
| Max. Negotiated Rate |
$10,403.29 |
| Rate for Payer: Aetna Commercial |
$10,177.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,724.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,993.20
|
| Rate for Payer: Cash Price |
$3,261.90
|
| Rate for Payer: Cigna Commercial |
$10,403.29
|
| Rate for Payer: Health EOS Commercial |
$10,064.05
|
| Rate for Payer: HFN Commercial |
$10,403.29
|
| Rate for Payer: Multiplan Commercial |
$9,046.34
|
| Rate for Payer: Preferred Network Access Commercial |
$10,403.29
|
| Rate for Payer: Quartz Beloit One Network |
$5,540.88
|
| Rate for Payer: Quartz Commercial |
$6,784.75
|
| Rate for Payer: WEA Trust Commercial |
$6,219.36
|
| Rate for Payer: WPS Commercial |
$8,375.47
|
|
|
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 |
$3,166.22 |
| Max. Negotiated Rate |
$10,403.29 |
| Rate for Payer: Aetna Commercial |
$10,177.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,724.81
|
| Rate for Payer: Aetna Managed Medicare |
$3,166.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,350.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,653.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,427.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,993.20
|
| Rate for Payer: Cash Price |
$3,261.90
|
| Rate for Payer: Cigna Commercial |
$10,403.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,328.09
|
| Rate for Payer: Health EOS Commercial |
$10,064.05
|
| Rate for Payer: HFN Commercial |
$10,403.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,480.94
|
| Rate for Payer: Multiplan Commercial |
$9,046.34
|
| Rate for Payer: NAPHCARE Commercial |
$6,784.75
|
| Rate for Payer: Preferred Network Access Commercial |
$10,403.29
|
| Rate for Payer: Quartz Beloit One Network |
$5,540.88
|
| Rate for Payer: Quartz Commercial |
$7,350.15
|
| Rate for Payer: Quartz Medicare Advantage |
$6,784.75
|
| Rate for Payer: The Alliance Commercial |
$5,653.96
|
| Rate for Payer: WEA Trust Commercial |
$6,219.36
|
| Rate for Payer: WPS Commercial |
$8,375.47
|
|
|
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 |
$5,762.56 |
| Max. Negotiated Rate |
$10,819.49 |
| Rate for Payer: Aetna Commercial |
$10,584.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,113.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,232.97
|
| Rate for Payer: Cash Price |
$3,392.40
|
| Rate for Payer: Cigna Commercial |
$10,819.49
|
| Rate for Payer: Health EOS Commercial |
$10,466.68
|
| Rate for Payer: HFN Commercial |
$10,819.49
|
| Rate for Payer: Multiplan Commercial |
$9,408.26
|
| Rate for Payer: Preferred Network Access Commercial |
$10,819.49
|
| Rate for Payer: Quartz Beloit One Network |
$5,762.56
|
| Rate for Payer: Quartz Commercial |
$7,056.19
|
| Rate for Payer: WEA Trust Commercial |
$6,468.18
|
| Rate for Payer: WPS Commercial |
$8,710.55
|
|
|
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 |
$3,292.89 |
| Max. Negotiated Rate |
$10,819.49 |
| Rate for Payer: Aetna Commercial |
$10,584.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,113.88
|
| Rate for Payer: Aetna Managed Medicare |
$3,292.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,644.21
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,880.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,644.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,232.97
|
| Rate for Payer: Cash Price |
$3,392.40
|
| Rate for Payer: Cigna Commercial |
$10,819.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,581.26
|
| Rate for Payer: Health EOS Commercial |
$10,466.68
|
| Rate for Payer: HFN Commercial |
$10,819.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,820.24
|
| Rate for Payer: Multiplan Commercial |
$9,408.26
|
| Rate for Payer: NAPHCARE Commercial |
$7,056.19
|
| Rate for Payer: Preferred Network Access Commercial |
$10,819.49
|
| Rate for Payer: Quartz Beloit One Network |
$5,762.56
|
| Rate for Payer: Quartz Commercial |
$7,644.21
|
| Rate for Payer: Quartz Medicare Advantage |
$7,056.19
|
| Rate for Payer: The Alliance Commercial |
$5,880.16
|
| Rate for Payer: WEA Trust Commercial |
$6,468.18
|
| Rate for Payer: WPS Commercial |
$8,710.55
|
|
|
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 |
$3,677.27 |
| Max. Negotiated Rate |
$6,904.27 |
| Rate for Payer: Aetna Commercial |
$6,754.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,453.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,977.46
|
| Rate for Payer: Cash Price |
$2,164.80
|
| Rate for Payer: Cigna Commercial |
$6,904.27
|
| Rate for Payer: Health EOS Commercial |
$6,679.13
|
| Rate for Payer: HFN Commercial |
$6,904.27
|
| Rate for Payer: Multiplan Commercial |
$6,003.71
|
| Rate for Payer: Preferred Network Access Commercial |
$6,904.27
|
| Rate for Payer: Quartz Beloit One Network |
$3,677.27
|
| Rate for Payer: Quartz Commercial |
$4,502.78
|
| Rate for Payer: WEA Trust Commercial |
$4,127.55
|
| Rate for Payer: WPS Commercial |
$5,558.48
|
|
|
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 |
$2,101.30 |
| Max. Negotiated Rate |
$6,904.27 |
| Rate for Payer: Aetna Commercial |
$6,754.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,453.99
|
| Rate for Payer: Aetna Managed Medicare |
$2,101.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,878.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,752.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,602.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,977.46
|
| Rate for Payer: Cash Price |
$2,164.80
|
| Rate for Payer: Cigna Commercial |
$6,904.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,199.71
|
| Rate for Payer: Health EOS Commercial |
$6,679.13
|
| Rate for Payer: HFN Commercial |
$6,904.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,628.48
|
| Rate for Payer: Multiplan Commercial |
$6,003.71
|
| Rate for Payer: NAPHCARE Commercial |
$4,502.78
|
| Rate for Payer: Preferred Network Access Commercial |
$6,904.27
|
| Rate for Payer: Quartz Beloit One Network |
$3,677.27
|
| Rate for Payer: Quartz Commercial |
$4,878.02
|
| Rate for Payer: Quartz Medicare Advantage |
$4,502.78
|
| Rate for Payer: The Alliance Commercial |
$3,752.32
|
| Rate for Payer: WEA Trust Commercial |
$4,127.55
|
| Rate for Payer: WPS Commercial |
$5,558.48
|
|
|
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 |
$3,166.22 |
| Max. Negotiated Rate |
$10,403.29 |
| Rate for Payer: Aetna Commercial |
$10,177.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,724.81
|
| Rate for Payer: Aetna Managed Medicare |
$3,166.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,350.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,653.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,427.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,993.20
|
| Rate for Payer: Cash Price |
$3,261.90
|
| Rate for Payer: Cigna Commercial |
$10,403.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,328.09
|
| Rate for Payer: Health EOS Commercial |
$10,064.05
|
| Rate for Payer: HFN Commercial |
$10,403.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,480.94
|
| Rate for Payer: Multiplan Commercial |
$9,046.34
|
| Rate for Payer: NAPHCARE Commercial |
$6,784.75
|
| Rate for Payer: Preferred Network Access Commercial |
$10,403.29
|
| Rate for Payer: Quartz Beloit One Network |
$5,540.88
|
| Rate for Payer: Quartz Commercial |
$7,350.15
|
| Rate for Payer: Quartz Medicare Advantage |
$6,784.75
|
| Rate for Payer: The Alliance Commercial |
$5,653.96
|
| Rate for Payer: WEA Trust Commercial |
$6,219.36
|
| Rate for Payer: WPS Commercial |
$8,375.47
|
|
|
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 |
$5,540.88 |
| Max. Negotiated Rate |
$10,403.29 |
| Rate for Payer: Aetna Commercial |
$10,177.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,724.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,993.20
|
| Rate for Payer: Cash Price |
$3,261.90
|
| Rate for Payer: Cigna Commercial |
$10,403.29
|
| Rate for Payer: Health EOS Commercial |
$10,064.05
|
| Rate for Payer: HFN Commercial |
$10,403.29
|
| Rate for Payer: Multiplan Commercial |
$9,046.34
|
| Rate for Payer: Preferred Network Access Commercial |
$10,403.29
|
| Rate for Payer: Quartz Beloit One Network |
$5,540.88
|
| Rate for Payer: Quartz Commercial |
$6,784.75
|
| Rate for Payer: WEA Trust Commercial |
$6,219.36
|
| Rate for Payer: WPS Commercial |
$8,375.47
|
|
|
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 |
$3,677.27 |
| Max. Negotiated Rate |
$6,904.27 |
| Rate for Payer: Aetna Commercial |
$6,754.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,453.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,977.46
|
| Rate for Payer: Cash Price |
$2,164.80
|
| Rate for Payer: Cigna Commercial |
$6,904.27
|
| Rate for Payer: Health EOS Commercial |
$6,679.13
|
| Rate for Payer: HFN Commercial |
$6,904.27
|
| Rate for Payer: Multiplan Commercial |
$6,003.71
|
| Rate for Payer: Preferred Network Access Commercial |
$6,904.27
|
| Rate for Payer: Quartz Beloit One Network |
$3,677.27
|
| Rate for Payer: Quartz Commercial |
$4,502.78
|
| Rate for Payer: WEA Trust Commercial |
$4,127.55
|
| Rate for Payer: WPS Commercial |
$5,558.48
|
|
|
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 |
$2,101.30 |
| Max. Negotiated Rate |
$6,904.27 |
| Rate for Payer: Aetna Commercial |
$6,754.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,453.99
|
| Rate for Payer: Aetna Managed Medicare |
$2,101.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,878.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,752.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,602.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,977.46
|
| Rate for Payer: Cash Price |
$2,164.80
|
| Rate for Payer: Cigna Commercial |
$6,904.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,199.71
|
| Rate for Payer: Health EOS Commercial |
$6,679.13
|
| Rate for Payer: HFN Commercial |
$6,904.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,628.48
|
| Rate for Payer: Multiplan Commercial |
$6,003.71
|
| Rate for Payer: NAPHCARE Commercial |
$4,502.78
|
| Rate for Payer: Preferred Network Access Commercial |
$6,904.27
|
| Rate for Payer: Quartz Beloit One Network |
$3,677.27
|
| Rate for Payer: Quartz Commercial |
$4,878.02
|
| Rate for Payer: Quartz Medicare Advantage |
$4,502.78
|
| Rate for Payer: The Alliance Commercial |
$3,752.32
|
| Rate for Payer: WEA Trust Commercial |
$4,127.55
|
| Rate for Payer: WPS Commercial |
$5,558.48
|
|
|
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 |
$3,166.22 |
| Max. Negotiated Rate |
$10,403.29 |
| Rate for Payer: Aetna Commercial |
$10,177.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,724.81
|
| Rate for Payer: Aetna Managed Medicare |
$3,166.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,350.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,653.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,427.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,993.20
|
| Rate for Payer: Cash Price |
$3,261.90
|
| Rate for Payer: Cigna Commercial |
$10,403.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,328.09
|
| Rate for Payer: Health EOS Commercial |
$10,064.05
|
| Rate for Payer: HFN Commercial |
$10,403.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,480.94
|
| Rate for Payer: Multiplan Commercial |
$9,046.34
|
| Rate for Payer: NAPHCARE Commercial |
$6,784.75
|
| Rate for Payer: Preferred Network Access Commercial |
$10,403.29
|
| Rate for Payer: Quartz Beloit One Network |
$5,540.88
|
| Rate for Payer: Quartz Commercial |
$7,350.15
|
| Rate for Payer: Quartz Medicare Advantage |
$6,784.75
|
| Rate for Payer: The Alliance Commercial |
$5,653.96
|
| Rate for Payer: WEA Trust Commercial |
$6,219.36
|
| Rate for Payer: WPS Commercial |
$8,375.47
|
|
|
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 |
$5,540.88 |
| Max. Negotiated Rate |
$10,403.29 |
| Rate for Payer: Aetna Commercial |
$10,177.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,724.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,993.20
|
| Rate for Payer: Cash Price |
$3,261.90
|
| Rate for Payer: Cigna Commercial |
$10,403.29
|
| Rate for Payer: Health EOS Commercial |
$10,064.05
|
| Rate for Payer: HFN Commercial |
$10,403.29
|
| Rate for Payer: Multiplan Commercial |
$9,046.34
|
| Rate for Payer: Preferred Network Access Commercial |
$10,403.29
|
| Rate for Payer: Quartz Beloit One Network |
$5,540.88
|
| Rate for Payer: Quartz Commercial |
$6,784.75
|
| Rate for Payer: WEA Trust Commercial |
$6,219.36
|
| Rate for Payer: WPS Commercial |
$8,375.47
|
|
|
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 |
$6,342.99 |
| Max. Negotiated Rate |
$11,909.29 |
| Rate for Payer: Aetna Commercial |
$11,650.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,132.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,860.79
|
| Rate for Payer: Cash Price |
$3,734.10
|
| Rate for Payer: Cigna Commercial |
$11,909.29
|
| Rate for Payer: Health EOS Commercial |
$11,520.94
|
| Rate for Payer: HFN Commercial |
$11,909.29
|
| Rate for Payer: Multiplan Commercial |
$10,355.90
|
| Rate for Payer: Preferred Network Access Commercial |
$11,909.29
|
| Rate for Payer: Quartz Beloit One Network |
$6,342.99
|
| Rate for Payer: Quartz Commercial |
$7,766.93
|
| Rate for Payer: WEA Trust Commercial |
$7,119.68
|
| Rate for Payer: WPS Commercial |
$9,587.92
|
|
|
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 |
$3,624.57 |
| Max. Negotiated Rate |
$11,909.29 |
| Rate for Payer: Aetna Commercial |
$11,650.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,132.60
|
| Rate for Payer: Aetna Managed Medicare |
$3,624.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,414.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,472.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,213.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,860.79
|
| Rate for Payer: Cash Price |
$3,734.10
|
| Rate for Payer: Cigna Commercial |
$11,909.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,244.15
|
| Rate for Payer: Health EOS Commercial |
$11,520.94
|
| Rate for Payer: HFN Commercial |
$11,909.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,708.66
|
| Rate for Payer: Multiplan Commercial |
$10,355.90
|
| Rate for Payer: NAPHCARE Commercial |
$7,766.93
|
| Rate for Payer: Preferred Network Access Commercial |
$11,909.29
|
| Rate for Payer: Quartz Beloit One Network |
$6,342.99
|
| Rate for Payer: Quartz Commercial |
$8,414.17
|
| Rate for Payer: Quartz Medicare Advantage |
$7,766.93
|
| Rate for Payer: The Alliance Commercial |
$6,472.44
|
| Rate for Payer: WEA Trust Commercial |
$7,119.68
|
| Rate for Payer: WPS Commercial |
$9,587.92
|
|
|
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 |
$3,763.76 |
| Max. Negotiated Rate |
$12,366.64 |
| Rate for Payer: Aetna Commercial |
$12,097.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,560.12
|
| Rate for Payer: Aetna Managed Medicare |
$3,763.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,737.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,721.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,452.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,124.26
|
| Rate for Payer: Cash Price |
$3,877.50
|
| Rate for Payer: Cigna Commercial |
$12,366.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,522.35
|
| Rate for Payer: Health EOS Commercial |
$11,963.38
|
| Rate for Payer: HFN Commercial |
$12,366.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,081.50
|
| Rate for Payer: Multiplan Commercial |
$10,753.60
|
| Rate for Payer: NAPHCARE Commercial |
$8,065.20
|
| Rate for Payer: Preferred Network Access Commercial |
$12,366.64
|
| Rate for Payer: Quartz Beloit One Network |
$6,586.58
|
| Rate for Payer: Quartz Commercial |
$8,737.30
|
| Rate for Payer: Quartz Medicare Advantage |
$8,065.20
|
| Rate for Payer: The Alliance Commercial |
$6,721.00
|
| Rate for Payer: WEA Trust Commercial |
$7,393.10
|
| Rate for Payer: WPS Commercial |
$9,956.13
|
|
