|
TIBIALPLATE SZ 5 5980-47-01
|
Facility
|
OP
|
$6,084.00
|
|
| Hospital Charge Code |
5307141
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,771.66 |
| Max. Negotiated Rate |
$5,821.17 |
| Rate for Payer: Aetna Commercial |
$5,694.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,441.53
|
| Rate for Payer: Aetna Managed Medicare |
$1,771.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,112.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,163.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,037.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,353.50
|
| Rate for Payer: Cash Price |
$1,825.20
|
| Rate for Payer: Cigna Commercial |
$5,821.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,540.89
|
| Rate for Payer: Health EOS Commercial |
$5,631.35
|
| Rate for Payer: HFN Commercial |
$5,821.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,745.52
|
| Rate for Payer: Multiplan Commercial |
$5,061.89
|
| Rate for Payer: NAPHCARE Commercial |
$3,796.42
|
| Rate for Payer: Preferred Network Access Commercial |
$5,821.17
|
| Rate for Payer: Quartz Beloit One Network |
$3,100.41
|
| Rate for Payer: Quartz Commercial |
$4,112.78
|
| Rate for Payer: Quartz Medicare Advantage |
$3,796.42
|
| Rate for Payer: The Alliance Commercial |
$3,163.68
|
| Rate for Payer: WEA Trust Commercial |
$3,480.05
|
| Rate for Payer: WPS Commercial |
$4,686.51
|
|
|
TIBIALPLATE SZ 5 5980-47-01
|
Facility
|
IP
|
$6,084.00
|
|
| Hospital Charge Code |
5307141
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,100.41 |
| Max. Negotiated Rate |
$5,821.17 |
| Rate for Payer: Aetna Commercial |
$5,694.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,441.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,353.50
|
| Rate for Payer: Cash Price |
$1,825.20
|
| Rate for Payer: Cigna Commercial |
$5,821.17
|
| Rate for Payer: Health EOS Commercial |
$5,631.35
|
| Rate for Payer: HFN Commercial |
$5,821.17
|
| Rate for Payer: Multiplan Commercial |
$5,061.89
|
| Rate for Payer: Preferred Network Access Commercial |
$5,821.17
|
| Rate for Payer: Quartz Beloit One Network |
$3,100.41
|
| Rate for Payer: Quartz Commercial |
$3,796.42
|
| Rate for Payer: WEA Trust Commercial |
$3,480.05
|
| Rate for Payer: WPS Commercial |
$4,686.51
|
|
|
TIBIAL PLATE SZ 6 5980-47-02
|
Facility
|
IP
|
$7,868.00
|
|
| Hospital Charge Code |
2967761
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,009.53 |
| Max. Negotiated Rate |
$7,528.10 |
| Rate for Payer: Aetna Commercial |
$7,364.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,037.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,336.84
|
| Rate for Payer: Cash Price |
$2,360.40
|
| Rate for Payer: Cigna Commercial |
$7,528.10
|
| Rate for Payer: Health EOS Commercial |
$7,282.62
|
| Rate for Payer: HFN Commercial |
$7,528.10
|
| Rate for Payer: Multiplan Commercial |
$6,546.18
|
| Rate for Payer: Preferred Network Access Commercial |
$7,528.10
|
| Rate for Payer: Quartz Beloit One Network |
$4,009.53
|
| Rate for Payer: Quartz Commercial |
$4,909.63
|
| Rate for Payer: WEA Trust Commercial |
$4,500.50
|
| Rate for Payer: WPS Commercial |
$6,060.72
|
|
|
TIBIAL PLATE SZ 6 5980-47-02
|
Facility
|
OP
|
$7,868.00
|
|
| Hospital Charge Code |
2967761
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,291.16 |
| Max. Negotiated Rate |
$7,528.10 |
| Rate for Payer: Aetna Commercial |
$7,364.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,037.14
|
| Rate for Payer: Aetna Managed Medicare |
$2,291.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,318.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,091.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,927.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,336.84
|
| Rate for Payer: Cash Price |
$2,360.40
|
| Rate for Payer: Cigna Commercial |
$7,528.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,579.18
|
| Rate for Payer: Health EOS Commercial |
$7,282.62
|
| Rate for Payer: HFN Commercial |
$7,528.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,137.04
|
| Rate for Payer: Multiplan Commercial |
$6,546.18
|
| Rate for Payer: NAPHCARE Commercial |
$4,909.63
|
| Rate for Payer: Preferred Network Access Commercial |
$7,528.10
|
| Rate for Payer: Quartz Beloit One Network |
$4,009.53
|
| Rate for Payer: Quartz Commercial |
$5,318.77
|
| Rate for Payer: Quartz Medicare Advantage |
$4,909.63
|
| Rate for Payer: The Alliance Commercial |
$4,091.36
|
| Rate for Payer: WEA Trust Commercial |
$4,500.50
|
| Rate for Payer: WPS Commercial |
$6,060.72
|
|
|
TIBIAL PLATE SZ 7 5980-57-01
|
Facility
|
IP
|
$7,868.00
|
|
| Hospital Charge Code |
2967762
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,009.53 |
| Max. Negotiated Rate |
$7,528.10 |
| Rate for Payer: Aetna Commercial |
$7,364.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,037.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,336.84
|
| Rate for Payer: Cash Price |
$2,360.40
|
| Rate for Payer: Cigna Commercial |
$7,528.10
|
| Rate for Payer: Health EOS Commercial |
$7,282.62
|
| Rate for Payer: HFN Commercial |
$7,528.10
|
| Rate for Payer: Multiplan Commercial |
$6,546.18
|
| Rate for Payer: Preferred Network Access Commercial |
$7,528.10
|
| Rate for Payer: Quartz Beloit One Network |
$4,009.53
|
| Rate for Payer: Quartz Commercial |
$4,909.63
|
| Rate for Payer: WEA Trust Commercial |
$4,500.50
|
| Rate for Payer: WPS Commercial |
$6,060.72
|
|
|
TIBIAL PLATE SZ 7 5980-57-01
|
Facility
|
OP
|
$7,868.00
|
|
| Hospital Charge Code |
2967762
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,291.16 |
| Max. Negotiated Rate |
$7,528.10 |
| Rate for Payer: Aetna Commercial |
$7,364.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,037.14
|
| Rate for Payer: Aetna Managed Medicare |
$2,291.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,318.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,091.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,927.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,336.84
|
| Rate for Payer: Cash Price |
$2,360.40
|
| Rate for Payer: Cigna Commercial |
$7,528.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,579.18
|
| Rate for Payer: Health EOS Commercial |
$7,282.62
|
| Rate for Payer: HFN Commercial |
$7,528.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,137.04
|
| Rate for Payer: Multiplan Commercial |
$6,546.18
|
| Rate for Payer: NAPHCARE Commercial |
$4,909.63
|
| Rate for Payer: Preferred Network Access Commercial |
$7,528.10
|
| Rate for Payer: Quartz Beloit One Network |
$4,009.53
|
| Rate for Payer: Quartz Commercial |
$5,318.77
|
| Rate for Payer: Quartz Medicare Advantage |
$4,909.63
|
| Rate for Payer: The Alliance Commercial |
$4,091.36
|
| Rate for Payer: WEA Trust Commercial |
$4,500.50
|
| Rate for Payer: WPS Commercial |
$6,060.72
|
|
|
TIBIAL PLATE SZ 8 5980-57-02
|
Facility
|
IP
|
$7,868.00
|
|
| Hospital Charge Code |
2967763
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,009.53 |
| Max. Negotiated Rate |
$7,528.10 |
| Rate for Payer: Aetna Commercial |
$7,364.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,037.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,336.84
|
| Rate for Payer: Cash Price |
$2,360.40
|
| Rate for Payer: Cigna Commercial |
$7,528.10
|
| Rate for Payer: Health EOS Commercial |
$7,282.62
|
| Rate for Payer: HFN Commercial |
$7,528.10
|
| Rate for Payer: Multiplan Commercial |
$6,546.18
|
| Rate for Payer: Preferred Network Access Commercial |
$7,528.10
|
| Rate for Payer: Quartz Beloit One Network |
$4,009.53
|
| Rate for Payer: Quartz Commercial |
$4,909.63
|
| Rate for Payer: WEA Trust Commercial |
$4,500.50
|
| Rate for Payer: WPS Commercial |
$6,060.72
|
|
|
TIBIAL PLATE SZ 8 5980-57-02
|
Facility
|
OP
|
$7,868.00
|
|
| Hospital Charge Code |
2967763
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,291.16 |
| Max. Negotiated Rate |
$7,528.10 |
| Rate for Payer: Aetna Commercial |
$7,364.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,037.14
|
| Rate for Payer: Aetna Managed Medicare |
$2,291.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,318.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,091.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,927.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,336.84
|
| Rate for Payer: Cash Price |
$2,360.40
|
| Rate for Payer: Cigna Commercial |
$7,528.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,579.18
|
| Rate for Payer: Health EOS Commercial |
$7,282.62
|
| Rate for Payer: HFN Commercial |
$7,528.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,137.04
|
| Rate for Payer: Multiplan Commercial |
$6,546.18
|
| Rate for Payer: NAPHCARE Commercial |
$4,909.63
|
| Rate for Payer: Preferred Network Access Commercial |
$7,528.10
|
| Rate for Payer: Quartz Beloit One Network |
$4,009.53
|
| Rate for Payer: Quartz Commercial |
$5,318.77
|
| Rate for Payer: Quartz Medicare Advantage |
$4,909.63
|
| Rate for Payer: The Alliance Commercial |
$4,091.36
|
| Rate for Payer: WEA Trust Commercial |
$4,500.50
|
| Rate for Payer: WPS Commercial |
$6,060.72
|
|
|
TIBIAL PLATE SZ 9 5980-57-03
|
Facility
|
OP
|
$7,868.00
|
|
| Hospital Charge Code |
2967541
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,291.16 |
| Max. Negotiated Rate |
$7,528.10 |
| Rate for Payer: Aetna Commercial |
$7,364.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,037.14
|
| Rate for Payer: Aetna Managed Medicare |
$2,291.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,318.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,091.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,927.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,336.84
|
| Rate for Payer: Cash Price |
$2,360.40
|
| Rate for Payer: Cigna Commercial |
$7,528.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,579.18
|
| Rate for Payer: Health EOS Commercial |
$7,282.62
|
| Rate for Payer: HFN Commercial |
$7,528.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,137.04
|
| Rate for Payer: Multiplan Commercial |
$6,546.18
|
| Rate for Payer: NAPHCARE Commercial |
$4,909.63
|
| Rate for Payer: Preferred Network Access Commercial |
$7,528.10
|
| Rate for Payer: Quartz Beloit One Network |
$4,009.53
|
| Rate for Payer: Quartz Commercial |
$5,318.77
|
| Rate for Payer: Quartz Medicare Advantage |
$4,909.63
|
| Rate for Payer: The Alliance Commercial |
$4,091.36
|
| Rate for Payer: WEA Trust Commercial |
$4,500.50
|
| Rate for Payer: WPS Commercial |
$6,060.72
|
|
|
TIBIAL PLATE SZ 9 5980-57-03
|
Facility
|
IP
|
$7,868.00
|
|
| Hospital Charge Code |
2967541
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,009.53 |
| Max. Negotiated Rate |
$7,528.10 |
| Rate for Payer: Aetna Commercial |
$7,364.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,037.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,336.84
|
| Rate for Payer: Cash Price |
$2,360.40
|
| Rate for Payer: Cigna Commercial |
$7,528.10
|
| Rate for Payer: Health EOS Commercial |
$7,282.62
|
| Rate for Payer: HFN Commercial |
$7,528.10
|
| Rate for Payer: Multiplan Commercial |
$6,546.18
|
| Rate for Payer: Preferred Network Access Commercial |
$7,528.10
|
| Rate for Payer: Quartz Beloit One Network |
$4,009.53
|
| Rate for Payer: Quartz Commercial |
$4,909.63
|
| Rate for Payer: WEA Trust Commercial |
$4,500.50
|
| Rate for Payer: WPS Commercial |
$6,060.72
|
|
|
TIBIAL SHEATH INTRAFIX 30MM 254601
|
Facility
|
OP
|
$3,780.00
|
|
| Hospital Charge Code |
4520591
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,100.74 |
| Max. Negotiated Rate |
$3,616.70 |
| Rate for Payer: Aetna Commercial |
$3,538.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,380.83
|
| Rate for Payer: Aetna Managed Medicare |
$1,100.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,555.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,965.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,886.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,083.54
|
| Rate for Payer: Cash Price |
$1,134.00
|
| Rate for Payer: Cigna Commercial |
$3,616.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,199.96
|
| Rate for Payer: Health EOS Commercial |
$3,498.77
|
| Rate for Payer: HFN Commercial |
$3,616.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,948.40
|
| Rate for Payer: Multiplan Commercial |
$3,144.96
|
| Rate for Payer: NAPHCARE Commercial |
$2,358.72
|
| Rate for Payer: Preferred Network Access Commercial |
$3,616.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,926.29
|
| Rate for Payer: Quartz Commercial |
$2,555.28
|
| Rate for Payer: Quartz Medicare Advantage |
$2,358.72
|
| Rate for Payer: The Alliance Commercial |
$1,965.60
|
| Rate for Payer: WEA Trust Commercial |
$2,162.16
|
| Rate for Payer: WPS Commercial |
$2,911.73
|
|
|
TIBIAL SHEATH INTRAFIX 30MM 254601
|
Facility
|
IP
|
$3,780.00
|
|
| Hospital Charge Code |
4520591
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,926.29 |
| Max. Negotiated Rate |
$3,616.70 |
| Rate for Payer: Aetna Commercial |
$3,538.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,380.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,083.54
|
| Rate for Payer: Cash Price |
$1,134.00
|
| Rate for Payer: Cigna Commercial |
$3,616.70
|
| Rate for Payer: Health EOS Commercial |
$3,498.77
|
| Rate for Payer: HFN Commercial |
$3,616.70
|
| Rate for Payer: Multiplan Commercial |
$3,144.96
|
| Rate for Payer: Preferred Network Access Commercial |
$3,616.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,926.29
|
| Rate for Payer: Quartz Commercial |
$2,358.72
|
| Rate for Payer: WEA Trust Commercial |
$2,162.16
|
| Rate for Payer: WPS Commercial |
$2,911.73
|
|
|
TIBIAL SLEEVE REVISION FULLY COATED ATTUNE 29MM 1511-11-201
|
Facility
|
OP
|
$17,856.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6244176
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,199.77 |
| Max. Negotiated Rate |
$17,084.97 |
| Rate for Payer: Aetna Commercial |
$16,713.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,970.73
|
| Rate for Payer: Aetna Managed Medicare |
$5,199.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,070.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,285.31
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,913.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,842.43
|
| Rate for Payer: Cash Price |
$5,356.91
|
| Rate for Payer: Cigna Commercial |
$17,084.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,392.40
|
| Rate for Payer: Health EOS Commercial |
$16,527.85
|
| Rate for Payer: HFN Commercial |
$17,084.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,927.96
|
| Rate for Payer: Multiplan Commercial |
$14,856.49
|
| Rate for Payer: NAPHCARE Commercial |
$11,142.37
|
| Rate for Payer: Preferred Network Access Commercial |
$17,084.97
|
| Rate for Payer: Quartz Beloit One Network |
$9,099.60
|
| Rate for Payer: Quartz Commercial |
$12,070.90
|
| Rate for Payer: Quartz Medicare Advantage |
$11,142.37
|
| Rate for Payer: The Alliance Commercial |
$9,285.31
|
| Rate for Payer: WEA Trust Commercial |
$10,213.84
|
| Rate for Payer: WPS Commercial |
$13,754.75
|
|
|
TIBIAL SLEEVE REVISION FULLY COATED ATTUNE 29MM 1511-11-201
|
Facility
|
IP
|
$17,856.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6244176
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,099.60 |
| Max. Negotiated Rate |
$17,084.97 |
| Rate for Payer: Aetna Commercial |
$16,713.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,970.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,842.43
|
| Rate for Payer: Cash Price |
$5,356.91
|
| Rate for Payer: Cigna Commercial |
$17,084.97
|
| Rate for Payer: Health EOS Commercial |
$16,527.85
|
| Rate for Payer: HFN Commercial |
$17,084.97
|
| Rate for Payer: Multiplan Commercial |
$14,856.49
|
| Rate for Payer: Preferred Network Access Commercial |
$17,084.97
|
| Rate for Payer: Quartz Beloit One Network |
$9,099.60
|
| Rate for Payer: Quartz Commercial |
$11,142.37
|
| Rate for Payer: WEA Trust Commercial |
$10,213.84
|
| Rate for Payer: WPS Commercial |
$13,754.75
|
|
|
TIBIAL SLEEVE REVISION FULLY COATED ATTUNE 37MM 1511-11-202
|
Facility
|
IP
|
$27,408.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5528750
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13,967.12 |
| Max. Negotiated Rate |
$26,223.97 |
| Rate for Payer: Aetna Commercial |
$25,653.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24,513.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15,107.29
|
| Rate for Payer: Cash Price |
$8,222.40
|
| Rate for Payer: Cigna Commercial |
$26,223.97
|
| Rate for Payer: Health EOS Commercial |
$25,368.84
|
| Rate for Payer: HFN Commercial |
$26,223.97
|
| Rate for Payer: Multiplan Commercial |
$22,803.46
|
| Rate for Payer: Preferred Network Access Commercial |
$26,223.97
|
| Rate for Payer: Quartz Beloit One Network |
$13,967.12
|
| Rate for Payer: Quartz Commercial |
$17,102.59
|
| Rate for Payer: WEA Trust Commercial |
$15,677.38
|
| Rate for Payer: WPS Commercial |
$21,112.38
|
|
|
TIBIAL SLEEVE REVISION FULLY COATED ATTUNE 37MM 1511-11-202
|
Facility
|
OP
|
$27,408.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5528750
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,981.21 |
| Max. Negotiated Rate |
$26,223.97 |
| Rate for Payer: Aetna Commercial |
$25,653.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24,513.72
|
| Rate for Payer: Aetna Managed Medicare |
$7,981.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,527.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,252.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,682.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15,107.29
|
| Rate for Payer: Cash Price |
$8,222.40
|
| Rate for Payer: Cigna Commercial |
$26,223.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15,951.46
|
| Rate for Payer: Health EOS Commercial |
$25,368.84
|
| Rate for Payer: HFN Commercial |
$26,223.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21,378.24
|
| Rate for Payer: Multiplan Commercial |
$22,803.46
|
| Rate for Payer: NAPHCARE Commercial |
$17,102.59
|
| Rate for Payer: Preferred Network Access Commercial |
$26,223.97
|
| Rate for Payer: Quartz Beloit One Network |
$13,967.12
|
| Rate for Payer: Quartz Commercial |
$18,527.81
|
| Rate for Payer: Quartz Medicare Advantage |
$17,102.59
|
| Rate for Payer: The Alliance Commercial |
$14,252.16
|
| Rate for Payer: WEA Trust Commercial |
$15,677.38
|
| Rate for Payer: WPS Commercial |
$21,112.38
|
|
|
TIBIAL TRAY INFINITY ADAPTIS SZ 2 33680002
|
Facility
|
OP
|
$39,477.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6175037
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,495.70 |
| Max. Negotiated Rate |
$37,771.59 |
| Rate for Payer: Aetna Commercial |
$36,950.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$35,308.23
|
| Rate for Payer: Aetna Managed Medicare |
$11,495.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$26,686.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20,528.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19,706.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$21,759.72
|
| Rate for Payer: Cash Price |
$11,843.10
|
| Rate for Payer: Cigna Commercial |
$37,771.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22,975.61
|
| Rate for Payer: Health EOS Commercial |
$36,539.91
|
| Rate for Payer: HFN Commercial |
$37,771.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30,792.06
|
| Rate for Payer: Multiplan Commercial |
$32,844.86
|
| Rate for Payer: NAPHCARE Commercial |
$24,633.65
|
| Rate for Payer: Preferred Network Access Commercial |
$37,771.59
|
| Rate for Payer: Quartz Beloit One Network |
$20,117.48
|
| Rate for Payer: Quartz Commercial |
$26,686.45
|
| Rate for Payer: Quartz Medicare Advantage |
$24,633.65
|
| Rate for Payer: The Alliance Commercial |
$20,528.04
|
| Rate for Payer: WEA Trust Commercial |
$22,580.84
|
| Rate for Payer: WPS Commercial |
$30,409.13
|
|
|
TIBIAL TRAY INFINITY ADAPTIS SZ 2 33680002
|
Facility
|
IP
|
$39,477.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6175037
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20,117.48 |
| Max. Negotiated Rate |
$37,771.59 |
| Rate for Payer: Aetna Commercial |
$36,950.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$35,308.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$21,759.72
|
| Rate for Payer: Cash Price |
$11,843.10
|
| Rate for Payer: Cigna Commercial |
$37,771.59
|
| Rate for Payer: Health EOS Commercial |
$36,539.91
|
| Rate for Payer: HFN Commercial |
$37,771.59
|
| Rate for Payer: Multiplan Commercial |
$32,844.86
|
| Rate for Payer: Preferred Network Access Commercial |
$37,771.59
|
| Rate for Payer: Quartz Beloit One Network |
$20,117.48
|
| Rate for Payer: Quartz Commercial |
$24,633.65
|
| Rate for Payer: WEA Trust Commercial |
$22,580.84
|
| Rate for Payer: WPS Commercial |
$30,409.13
|
|
|
TIBIAL TRAY INFINITY ADAPTIS SZ 3 33680003
|
Facility
|
OP
|
$39,861.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5831724
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,607.52 |
| Max. Negotiated Rate |
$38,139.00 |
| Rate for Payer: Aetna Commercial |
$37,309.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$35,651.68
|
| Rate for Payer: Aetna Managed Medicare |
$11,607.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$26,946.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20,727.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19,898.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$21,971.38
|
| Rate for Payer: Cash Price |
$11,958.30
|
| Rate for Payer: Cigna Commercial |
$38,139.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23,199.10
|
| Rate for Payer: Health EOS Commercial |
$36,895.34
|
| Rate for Payer: HFN Commercial |
$38,139.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31,091.58
|
| Rate for Payer: Multiplan Commercial |
$33,164.35
|
| Rate for Payer: NAPHCARE Commercial |
$24,873.26
|
| Rate for Payer: Preferred Network Access Commercial |
$38,139.00
|
| Rate for Payer: Quartz Beloit One Network |
$20,313.17
|
| Rate for Payer: Quartz Commercial |
$26,946.04
|
| Rate for Payer: Quartz Medicare Advantage |
$24,873.26
|
| Rate for Payer: The Alliance Commercial |
$20,727.72
|
| Rate for Payer: WEA Trust Commercial |
$22,800.49
|
| Rate for Payer: WPS Commercial |
$30,704.93
|
|
|
TIBIAL TRAY INFINITY ADAPTIS SZ 3 33680003
|
Facility
|
IP
|
$39,861.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5831724
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20,313.17 |
| Max. Negotiated Rate |
$38,139.00 |
| Rate for Payer: Aetna Commercial |
$37,309.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$35,651.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$21,971.38
|
| Rate for Payer: Cash Price |
$11,958.30
|
| Rate for Payer: Cigna Commercial |
$38,139.00
|
| Rate for Payer: Health EOS Commercial |
$36,895.34
|
| Rate for Payer: HFN Commercial |
$38,139.00
|
| Rate for Payer: Multiplan Commercial |
$33,164.35
|
| Rate for Payer: Preferred Network Access Commercial |
$38,139.00
|
| Rate for Payer: Quartz Beloit One Network |
$20,313.17
|
| Rate for Payer: Quartz Commercial |
$24,873.26
|
| Rate for Payer: WEA Trust Commercial |
$22,800.49
|
| Rate for Payer: WPS Commercial |
$30,704.93
|
|
|
TIBIAL TRAY OXFORD LT MEDIAL SZ B 154720
|
Facility
|
OP
|
$7,286.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5603560
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,121.68 |
| Max. Negotiated Rate |
$6,971.24 |
| Rate for Payer: Aetna Commercial |
$6,819.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,516.60
|
| Rate for Payer: Aetna Managed Medicare |
$2,121.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,925.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,788.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,637.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,016.04
|
| Rate for Payer: Cash Price |
$2,185.80
|
| Rate for Payer: Cigna Commercial |
$6,971.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,240.45
|
| Rate for Payer: Health EOS Commercial |
$6,743.92
|
| Rate for Payer: HFN Commercial |
$6,971.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,683.08
|
| Rate for Payer: Multiplan Commercial |
$6,061.95
|
| Rate for Payer: NAPHCARE Commercial |
$4,546.46
|
| Rate for Payer: Preferred Network Access Commercial |
$6,971.24
|
| Rate for Payer: Quartz Beloit One Network |
$3,712.95
|
| Rate for Payer: Quartz Commercial |
$4,925.34
|
| Rate for Payer: Quartz Medicare Advantage |
$4,546.46
|
| Rate for Payer: The Alliance Commercial |
$3,788.72
|
| Rate for Payer: WEA Trust Commercial |
$4,167.59
|
| Rate for Payer: WPS Commercial |
$5,612.41
|
|
|
TIBIAL TRAY OXFORD LT MEDIAL SZ B 154720
|
Facility
|
IP
|
$7,286.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5603560
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,712.95 |
| Max. Negotiated Rate |
$6,971.24 |
| Rate for Payer: Aetna Commercial |
$6,819.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,516.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,016.04
|
| Rate for Payer: Cash Price |
$2,185.80
|
| Rate for Payer: Cigna Commercial |
$6,971.24
|
| Rate for Payer: Health EOS Commercial |
$6,743.92
|
| Rate for Payer: HFN Commercial |
$6,971.24
|
| Rate for Payer: Multiplan Commercial |
$6,061.95
|
| Rate for Payer: Preferred Network Access Commercial |
$6,971.24
|
| Rate for Payer: Quartz Beloit One Network |
$3,712.95
|
| Rate for Payer: Quartz Commercial |
$4,546.46
|
| Rate for Payer: WEA Trust Commercial |
$4,167.59
|
| Rate for Payer: WPS Commercial |
$5,612.41
|
|
|
TIBIAL TRAY OXFORD LT MEDIAL SZ C 154722
|
Facility
|
OP
|
$7,286.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5106734
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,121.68 |
| Max. Negotiated Rate |
$6,971.24 |
| Rate for Payer: Aetna Commercial |
$6,819.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,516.60
|
| Rate for Payer: Aetna Managed Medicare |
$2,121.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,925.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,788.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,637.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,016.04
|
| Rate for Payer: Cash Price |
$2,185.80
|
| Rate for Payer: Cigna Commercial |
$6,971.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,240.45
|
| Rate for Payer: Health EOS Commercial |
$6,743.92
|
| Rate for Payer: HFN Commercial |
$6,971.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,683.08
|
| Rate for Payer: Multiplan Commercial |
$6,061.95
|
| Rate for Payer: NAPHCARE Commercial |
$4,546.46
|
| Rate for Payer: Preferred Network Access Commercial |
$6,971.24
|
| Rate for Payer: Quartz Beloit One Network |
$3,712.95
|
| Rate for Payer: Quartz Commercial |
$4,925.34
|
| Rate for Payer: Quartz Medicare Advantage |
$4,546.46
|
| Rate for Payer: The Alliance Commercial |
$3,788.72
|
| Rate for Payer: WEA Trust Commercial |
$4,167.59
|
| Rate for Payer: WPS Commercial |
$5,612.41
|
|
|
TIBIAL TRAY OXFORD LT MEDIAL SZ C 154722
|
Facility
|
IP
|
$7,286.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5106734
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,712.95 |
| Max. Negotiated Rate |
$6,971.24 |
| Rate for Payer: Aetna Commercial |
$6,819.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,516.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,016.04
|
| Rate for Payer: Cash Price |
$2,185.80
|
| Rate for Payer: Cigna Commercial |
$6,971.24
|
| Rate for Payer: Health EOS Commercial |
$6,743.92
|
| Rate for Payer: HFN Commercial |
$6,971.24
|
| Rate for Payer: Multiplan Commercial |
$6,061.95
|
| Rate for Payer: Preferred Network Access Commercial |
$6,971.24
|
| Rate for Payer: Quartz Beloit One Network |
$3,712.95
|
| Rate for Payer: Quartz Commercial |
$4,546.46
|
| Rate for Payer: WEA Trust Commercial |
$4,167.59
|
| Rate for Payer: WPS Commercial |
$5,612.41
|
|
|
TIBIAL TRAY OXFORD LT MEDIAL SZ D 154724
|
Facility
|
IP
|
$7,006.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5384758
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,570.26 |
| Max. Negotiated Rate |
$6,703.34 |
| Rate for Payer: Aetna Commercial |
$6,557.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,266.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,861.71
|
| Rate for Payer: Cash Price |
$2,101.80
|
| Rate for Payer: Cigna Commercial |
$6,703.34
|
| Rate for Payer: Health EOS Commercial |
$6,484.75
|
| Rate for Payer: HFN Commercial |
$6,703.34
|
| Rate for Payer: Multiplan Commercial |
$5,828.99
|
| Rate for Payer: Preferred Network Access Commercial |
$6,703.34
|
| Rate for Payer: Quartz Beloit One Network |
$3,570.26
|
| Rate for Payer: Quartz Commercial |
$4,371.74
|
| Rate for Payer: WEA Trust Commercial |
$4,007.43
|
| Rate for Payer: WPS Commercial |
$5,396.72
|
|
