|
TIBIAL BASE ROTATING PLATFORM REVISION ATTUNE SZ 4 CEMENTED 1506-60-004
|
Facility
|
IP
|
$22,293.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6182159
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,923.57 |
| Max. Negotiated Rate |
$20,509.56 |
| Rate for Payer: Aetna Commercial |
$20,063.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19,171.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,815.29
|
| Rate for Payer: Cash Price |
$6,687.90
|
| Rate for Payer: Cigna Commercial |
$20,509.56
|
| Rate for Payer: Health EOS Commercial |
$19,840.77
|
| Rate for Payer: HFN Commercial |
$20,509.56
|
| Rate for Payer: Multiplan Commercial |
$17,834.40
|
| Rate for Payer: NAPHCARE Commercial |
$13,375.80
|
| Rate for Payer: Preferred Network Access Commercial |
$20,509.56
|
| Rate for Payer: Quartz Beloit One Network |
$10,923.57
|
| Rate for Payer: Quartz Commercial |
$13,375.80
|
| Rate for Payer: WEA Trust Commercial |
$12,261.15
|
| Rate for Payer: WPS Commercial |
$16,512.43
|
|
|
TIBIAL BASE ROTATING PLATFORM REVISION ATTUNE SZ 4 CEMENTED 1506-60-004
|
Facility
|
OP
|
$22,293.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6182159
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,242.04 |
| Max. Negotiated Rate |
$89,172.00 |
| Rate for Payer: Aetna Commercial |
$20,063.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19,171.98
|
| Rate for Payer: Aetna Managed Medicare |
$6,242.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14,490.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,146.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,700.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,815.29
|
| Rate for Payer: Cash Price |
$6,687.90
|
| Rate for Payer: Cigna Commercial |
$20,509.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,475.16
|
| Rate for Payer: Health EOS Commercial |
$19,840.77
|
| Rate for Payer: HFN Commercial |
$20,509.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16,719.75
|
| Rate for Payer: Multiplan Commercial |
$17,834.40
|
| Rate for Payer: NAPHCARE Commercial |
$13,375.80
|
| Rate for Payer: Preferred Network Access Commercial |
$20,509.56
|
| Rate for Payer: Quartz Beloit One Network |
$10,923.57
|
| Rate for Payer: Quartz Commercial |
$14,490.45
|
| Rate for Payer: Quartz Medicare Advantage |
$13,375.80
|
| Rate for Payer: The Alliance Commercial |
$89,172.00
|
| Rate for Payer: WEA Trust Commercial |
$12,261.15
|
| Rate for Payer: WPS Commercial |
$16,512.43
|
|
|
TIBIAL BASE ROTATING PLATFORM REVISION ATTUNE SZ 5 CEMENTED 1506-60-005
|
Facility
|
IP
|
$25,076.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563691
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,287.24 |
| Max. Negotiated Rate |
$23,069.92 |
| Rate for Payer: Aetna Commercial |
$22,568.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21,565.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,290.28
|
| Rate for Payer: Cash Price |
$7,522.80
|
| Rate for Payer: Cigna Commercial |
$23,069.92
|
| Rate for Payer: Health EOS Commercial |
$22,317.64
|
| Rate for Payer: HFN Commercial |
$23,069.92
|
| Rate for Payer: Multiplan Commercial |
$20,060.80
|
| Rate for Payer: NAPHCARE Commercial |
$15,045.60
|
| Rate for Payer: Preferred Network Access Commercial |
$23,069.92
|
| Rate for Payer: Quartz Beloit One Network |
$12,287.24
|
| Rate for Payer: Quartz Commercial |
$15,045.60
|
| Rate for Payer: WEA Trust Commercial |
$13,791.80
|
| Rate for Payer: WPS Commercial |
$18,573.79
|
|
|
TIBIAL BASE ROTATING PLATFORM REVISION ATTUNE SZ 5 CEMENTED 1506-60-005
|
Facility
|
OP
|
$25,076.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563691
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,021.28 |
| Max. Negotiated Rate |
$100,304.00 |
| Rate for Payer: Aetna Commercial |
$22,568.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21,565.36
|
| Rate for Payer: Aetna Managed Medicare |
$7,021.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,299.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,538.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,036.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,290.28
|
| Rate for Payer: Cash Price |
$7,522.80
|
| Rate for Payer: Cigna Commercial |
$23,069.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14,032.53
|
| Rate for Payer: Health EOS Commercial |
$22,317.64
|
| Rate for Payer: HFN Commercial |
$23,069.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18,807.00
|
| Rate for Payer: Multiplan Commercial |
$20,060.80
|
| Rate for Payer: NAPHCARE Commercial |
$15,045.60
|
| Rate for Payer: Preferred Network Access Commercial |
$23,069.92
|
| Rate for Payer: Quartz Beloit One Network |
$12,287.24
|
| Rate for Payer: Quartz Commercial |
$16,299.40
|
| Rate for Payer: Quartz Medicare Advantage |
$15,045.60
|
| Rate for Payer: The Alliance Commercial |
$100,304.00
|
| Rate for Payer: WEA Trust Commercial |
$13,791.80
|
| Rate for Payer: WPS Commercial |
$18,573.79
|
|
|
TIBIAL BASE ROTATING PLATFORM REVISION ATTUNE SZ 6 CEMENTED 1506-60-006
|
Facility
|
OP
|
$25,076.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563679
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,021.28 |
| Max. Negotiated Rate |
$100,304.00 |
| Rate for Payer: Aetna Commercial |
$22,568.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21,565.36
|
| Rate for Payer: Aetna Managed Medicare |
$7,021.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,299.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,538.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,036.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,290.28
|
| Rate for Payer: Cash Price |
$7,522.80
|
| Rate for Payer: Cigna Commercial |
$23,069.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14,032.53
|
| Rate for Payer: Health EOS Commercial |
$22,317.64
|
| Rate for Payer: HFN Commercial |
$23,069.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18,807.00
|
| Rate for Payer: Multiplan Commercial |
$20,060.80
|
| Rate for Payer: NAPHCARE Commercial |
$15,045.60
|
| Rate for Payer: Preferred Network Access Commercial |
$23,069.92
|
| Rate for Payer: Quartz Beloit One Network |
$12,287.24
|
| Rate for Payer: Quartz Commercial |
$16,299.40
|
| Rate for Payer: Quartz Medicare Advantage |
$15,045.60
|
| Rate for Payer: The Alliance Commercial |
$100,304.00
|
| Rate for Payer: WEA Trust Commercial |
$13,791.80
|
| Rate for Payer: WPS Commercial |
$18,573.79
|
|
|
TIBIAL BASE ROTATING PLATFORM REVISION ATTUNE SZ 6 CEMENTED 1506-60-006
|
Facility
|
IP
|
$25,076.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563679
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,287.24 |
| Max. Negotiated Rate |
$23,069.92 |
| Rate for Payer: Aetna Commercial |
$22,568.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21,565.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,290.28
|
| Rate for Payer: Cash Price |
$7,522.80
|
| Rate for Payer: Cigna Commercial |
$23,069.92
|
| Rate for Payer: Health EOS Commercial |
$22,317.64
|
| Rate for Payer: HFN Commercial |
$23,069.92
|
| Rate for Payer: Multiplan Commercial |
$20,060.80
|
| Rate for Payer: NAPHCARE Commercial |
$15,045.60
|
| Rate for Payer: Preferred Network Access Commercial |
$23,069.92
|
| Rate for Payer: Quartz Beloit One Network |
$12,287.24
|
| Rate for Payer: Quartz Commercial |
$15,045.60
|
| Rate for Payer: WEA Trust Commercial |
$13,791.80
|
| Rate for Payer: WPS Commercial |
$18,573.79
|
|
|
TIBIAL BASE ROTATING PLATFORM REVISION ATTUNE SZ 7 CEMENTED 1506-60-007
|
Facility
|
IP
|
$23,185.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6165877
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,360.65 |
| Max. Negotiated Rate |
$21,330.20 |
| Rate for Payer: Aetna Commercial |
$20,866.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19,939.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12,288.05
|
| Rate for Payer: Cash Price |
$6,955.50
|
| Rate for Payer: Cigna Commercial |
$21,330.20
|
| Rate for Payer: Health EOS Commercial |
$20,634.65
|
| Rate for Payer: HFN Commercial |
$21,330.20
|
| Rate for Payer: Multiplan Commercial |
$18,548.00
|
| Rate for Payer: NAPHCARE Commercial |
$13,911.00
|
| Rate for Payer: Preferred Network Access Commercial |
$21,330.20
|
| Rate for Payer: Quartz Beloit One Network |
$11,360.65
|
| Rate for Payer: Quartz Commercial |
$13,911.00
|
| Rate for Payer: WEA Trust Commercial |
$12,751.75
|
| Rate for Payer: WPS Commercial |
$17,173.13
|
|
|
TIBIAL BASE ROTATING PLATFORM REVISION ATTUNE SZ 7 CEMENTED 1506-60-007
|
Facility
|
OP
|
$23,185.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6165877
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,491.80 |
| Max. Negotiated Rate |
$92,740.00 |
| Rate for Payer: Aetna Commercial |
$20,866.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19,939.10
|
| Rate for Payer: Aetna Managed Medicare |
$6,491.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,070.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,592.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,128.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12,288.05
|
| Rate for Payer: Cash Price |
$6,955.50
|
| Rate for Payer: Cigna Commercial |
$21,330.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,974.33
|
| Rate for Payer: Health EOS Commercial |
$20,634.65
|
| Rate for Payer: HFN Commercial |
$21,330.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17,388.75
|
| Rate for Payer: Multiplan Commercial |
$18,548.00
|
| Rate for Payer: NAPHCARE Commercial |
$13,911.00
|
| Rate for Payer: Preferred Network Access Commercial |
$21,330.20
|
| Rate for Payer: Quartz Beloit One Network |
$11,360.65
|
| Rate for Payer: Quartz Commercial |
$15,070.25
|
| Rate for Payer: Quartz Medicare Advantage |
$13,911.00
|
| Rate for Payer: The Alliance Commercial |
$92,740.00
|
| Rate for Payer: WEA Trust Commercial |
$12,751.75
|
| Rate for Payer: WPS Commercial |
$17,173.13
|
|
|
TIBIAL BASE ROTATING PLATFORM REVISION ATTUNE SZ 8 CEMENTED 1506-60-008
|
Facility
|
IP
|
$24,112.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5831796
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,814.88 |
| Max. Negotiated Rate |
$22,183.04 |
| Rate for Payer: Aetna Commercial |
$21,700.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20,736.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12,779.36
|
| Rate for Payer: Cash Price |
$7,233.60
|
| Rate for Payer: Cigna Commercial |
$22,183.04
|
| Rate for Payer: Health EOS Commercial |
$21,459.68
|
| Rate for Payer: HFN Commercial |
$22,183.04
|
| Rate for Payer: Multiplan Commercial |
$19,289.60
|
| Rate for Payer: NAPHCARE Commercial |
$14,467.20
|
| Rate for Payer: Preferred Network Access Commercial |
$22,183.04
|
| Rate for Payer: Quartz Beloit One Network |
$11,814.88
|
| Rate for Payer: Quartz Commercial |
$14,467.20
|
| Rate for Payer: WEA Trust Commercial |
$13,261.60
|
| Rate for Payer: WPS Commercial |
$17,859.76
|
|
|
TIBIAL BASE ROTATING PLATFORM REVISION ATTUNE SZ 8 CEMENTED 1506-60-008
|
Facility
|
OP
|
$24,112.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5831796
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,751.36 |
| Max. Negotiated Rate |
$96,448.00 |
| Rate for Payer: Aetna Commercial |
$21,700.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20,736.32
|
| Rate for Payer: Aetna Managed Medicare |
$6,751.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,672.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,056.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,573.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12,779.36
|
| Rate for Payer: Cash Price |
$7,233.60
|
| Rate for Payer: Cigna Commercial |
$22,183.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13,493.08
|
| Rate for Payer: Health EOS Commercial |
$21,459.68
|
| Rate for Payer: HFN Commercial |
$22,183.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18,084.00
|
| Rate for Payer: Multiplan Commercial |
$19,289.60
|
| Rate for Payer: NAPHCARE Commercial |
$14,467.20
|
| Rate for Payer: Preferred Network Access Commercial |
$22,183.04
|
| Rate for Payer: Quartz Beloit One Network |
$11,814.88
|
| Rate for Payer: Quartz Commercial |
$15,672.80
|
| Rate for Payer: Quartz Medicare Advantage |
$14,467.20
|
| Rate for Payer: The Alliance Commercial |
$96,448.00
|
| Rate for Payer: WEA Trust Commercial |
$13,261.60
|
| Rate for Payer: WPS Commercial |
$17,859.76
|
|
|
TIBIAL BEARING INSERT TRIATHLON PS SZ 2 11MM 5532-G-211
|
Facility
|
OP
|
$8,080.00
|
|
| Hospital Charge Code |
4493906
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,262.40 |
| Max. Negotiated Rate |
$32,320.00 |
| Rate for Payer: Aetna Commercial |
$7,272.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,948.80
|
| Rate for Payer: Aetna Managed Medicare |
$2,262.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,252.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,040.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,878.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,282.40
|
| Rate for Payer: Cash Price |
$2,424.00
|
| Rate for Payer: Cigna Commercial |
$7,433.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,521.57
|
| Rate for Payer: Health EOS Commercial |
$7,191.20
|
| Rate for Payer: HFN Commercial |
$7,433.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,060.00
|
| Rate for Payer: Multiplan Commercial |
$6,464.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,848.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,433.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,959.20
|
| Rate for Payer: Quartz Commercial |
$5,252.00
|
| Rate for Payer: Quartz Medicare Advantage |
$4,848.00
|
| Rate for Payer: The Alliance Commercial |
$32,320.00
|
| Rate for Payer: WEA Trust Commercial |
$4,444.00
|
| Rate for Payer: WPS Commercial |
$5,984.86
|
|
|
TIBIAL BEARING INSERT TRIATHLON PS SZ 2 11MM 5532-G-211
|
Facility
|
IP
|
$8,080.00
|
|
| Hospital Charge Code |
4493906
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,959.20 |
| Max. Negotiated Rate |
$7,433.60 |
| Rate for Payer: Aetna Commercial |
$7,272.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,948.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,282.40
|
| Rate for Payer: Cash Price |
$2,424.00
|
| Rate for Payer: Cigna Commercial |
$7,433.60
|
| Rate for Payer: Health EOS Commercial |
$7,191.20
|
| Rate for Payer: HFN Commercial |
$7,433.60
|
| Rate for Payer: Multiplan Commercial |
$6,464.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,848.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,433.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,959.20
|
| Rate for Payer: Quartz Commercial |
$4,848.00
|
| Rate for Payer: WEA Trust Commercial |
$4,444.00
|
| Rate for Payer: WPS Commercial |
$5,984.86
|
|
|
TIBIAL BEARING INSERT TRIATHLON PS SZ 2 13MM 5532-G-213
|
Facility
|
OP
|
$8,080.00
|
|
| Hospital Charge Code |
4493911
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,262.40 |
| Max. Negotiated Rate |
$32,320.00 |
| Rate for Payer: Aetna Commercial |
$7,272.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,948.80
|
| Rate for Payer: Aetna Managed Medicare |
$2,262.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,252.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,040.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,878.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,282.40
|
| Rate for Payer: Cash Price |
$2,424.00
|
| Rate for Payer: Cigna Commercial |
$7,433.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,521.57
|
| Rate for Payer: Health EOS Commercial |
$7,191.20
|
| Rate for Payer: HFN Commercial |
$7,433.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,060.00
|
| Rate for Payer: Multiplan Commercial |
$6,464.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,848.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,433.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,959.20
|
| Rate for Payer: Quartz Commercial |
$5,252.00
|
| Rate for Payer: Quartz Medicare Advantage |
$4,848.00
|
| Rate for Payer: The Alliance Commercial |
$32,320.00
|
| Rate for Payer: WEA Trust Commercial |
$4,444.00
|
| Rate for Payer: WPS Commercial |
$5,984.86
|
|
|
TIBIAL BEARING INSERT TRIATHLON PS SZ 2 13MM 5532-G-213
|
Facility
|
IP
|
$8,080.00
|
|
| Hospital Charge Code |
4493911
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,959.20 |
| Max. Negotiated Rate |
$7,433.60 |
| Rate for Payer: Aetna Commercial |
$7,272.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,948.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,282.40
|
| Rate for Payer: Cash Price |
$2,424.00
|
| Rate for Payer: Cigna Commercial |
$7,433.60
|
| Rate for Payer: Health EOS Commercial |
$7,191.20
|
| Rate for Payer: HFN Commercial |
$7,433.60
|
| Rate for Payer: Multiplan Commercial |
$6,464.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,848.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,433.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,959.20
|
| Rate for Payer: Quartz Commercial |
$4,848.00
|
| Rate for Payer: WEA Trust Commercial |
$4,444.00
|
| Rate for Payer: WPS Commercial |
$5,984.86
|
|
|
TIBIAL BEARING INSERT TRIATHLON PS SZ 2 16MM 5532-G-216
|
Facility
|
OP
|
$8,080.00
|
|
| Hospital Charge Code |
4493912
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,262.40 |
| Max. Negotiated Rate |
$32,320.00 |
| Rate for Payer: Aetna Commercial |
$7,272.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,948.80
|
| Rate for Payer: Aetna Managed Medicare |
$2,262.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,252.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,040.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,878.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,282.40
|
| Rate for Payer: Cash Price |
$2,424.00
|
| Rate for Payer: Cigna Commercial |
$7,433.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,521.57
|
| Rate for Payer: Health EOS Commercial |
$7,191.20
|
| Rate for Payer: HFN Commercial |
$7,433.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,060.00
|
| Rate for Payer: Multiplan Commercial |
$6,464.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,848.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,433.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,959.20
|
| Rate for Payer: Quartz Commercial |
$5,252.00
|
| Rate for Payer: Quartz Medicare Advantage |
$4,848.00
|
| Rate for Payer: The Alliance Commercial |
$32,320.00
|
| Rate for Payer: WEA Trust Commercial |
$4,444.00
|
| Rate for Payer: WPS Commercial |
$5,984.86
|
|
|
TIBIAL BEARING INSERT TRIATHLON PS SZ 2 16MM 5532-G-216
|
Facility
|
IP
|
$8,080.00
|
|
| Hospital Charge Code |
4493912
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,959.20 |
| Max. Negotiated Rate |
$7,433.60 |
| Rate for Payer: Aetna Commercial |
$7,272.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,948.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,282.40
|
| Rate for Payer: Cash Price |
$2,424.00
|
| Rate for Payer: Cigna Commercial |
$7,433.60
|
| Rate for Payer: Health EOS Commercial |
$7,191.20
|
| Rate for Payer: HFN Commercial |
$7,433.60
|
| Rate for Payer: Multiplan Commercial |
$6,464.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,848.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,433.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,959.20
|
| Rate for Payer: Quartz Commercial |
$4,848.00
|
| Rate for Payer: WEA Trust Commercial |
$4,444.00
|
| Rate for Payer: WPS Commercial |
$5,984.86
|
|
|
TIBIAL BEARING INSERT TRIATHLON PS SZ 2 19MM 5532-G-219
|
Facility
|
OP
|
$8,080.00
|
|
| Hospital Charge Code |
4493913
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,262.40 |
| Max. Negotiated Rate |
$32,320.00 |
| Rate for Payer: Aetna Commercial |
$7,272.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,948.80
|
| Rate for Payer: Aetna Managed Medicare |
$2,262.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,252.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,040.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,878.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,282.40
|
| Rate for Payer: Cash Price |
$2,424.00
|
| Rate for Payer: Cigna Commercial |
$7,433.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,521.57
|
| Rate for Payer: Health EOS Commercial |
$7,191.20
|
| Rate for Payer: HFN Commercial |
$7,433.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,060.00
|
| Rate for Payer: Multiplan Commercial |
$6,464.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,848.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,433.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,959.20
|
| Rate for Payer: Quartz Commercial |
$5,252.00
|
| Rate for Payer: Quartz Medicare Advantage |
$4,848.00
|
| Rate for Payer: The Alliance Commercial |
$32,320.00
|
| Rate for Payer: WEA Trust Commercial |
$4,444.00
|
| Rate for Payer: WPS Commercial |
$5,984.86
|
|
|
TIBIAL BEARING INSERT TRIATHLON PS SZ 2 19MM 5532-G-219
|
Facility
|
IP
|
$8,080.00
|
|
| Hospital Charge Code |
4493913
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,959.20 |
| Max. Negotiated Rate |
$7,433.60 |
| Rate for Payer: Aetna Commercial |
$7,272.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,948.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,282.40
|
| Rate for Payer: Cash Price |
$2,424.00
|
| Rate for Payer: Cigna Commercial |
$7,433.60
|
| Rate for Payer: Health EOS Commercial |
$7,191.20
|
| Rate for Payer: HFN Commercial |
$7,433.60
|
| Rate for Payer: Multiplan Commercial |
$6,464.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,848.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,433.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,959.20
|
| Rate for Payer: Quartz Commercial |
$4,848.00
|
| Rate for Payer: WEA Trust Commercial |
$4,444.00
|
| Rate for Payer: WPS Commercial |
$5,984.86
|
|
|
TIBIAL BEARING INSERT TRIATHLON PS SZ 2 9MM 5532-G-209
|
Facility
|
OP
|
$8,080.00
|
|
| Hospital Charge Code |
4493903
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,262.40 |
| Max. Negotiated Rate |
$32,320.00 |
| Rate for Payer: Aetna Commercial |
$7,272.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,948.80
|
| Rate for Payer: Aetna Managed Medicare |
$2,262.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,252.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,040.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,878.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,282.40
|
| Rate for Payer: Cash Price |
$2,424.00
|
| Rate for Payer: Cigna Commercial |
$7,433.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,521.57
|
| Rate for Payer: Health EOS Commercial |
$7,191.20
|
| Rate for Payer: HFN Commercial |
$7,433.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,060.00
|
| Rate for Payer: Multiplan Commercial |
$6,464.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,848.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,433.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,959.20
|
| Rate for Payer: Quartz Commercial |
$5,252.00
|
| Rate for Payer: Quartz Medicare Advantage |
$4,848.00
|
| Rate for Payer: The Alliance Commercial |
$32,320.00
|
| Rate for Payer: WEA Trust Commercial |
$4,444.00
|
| Rate for Payer: WPS Commercial |
$5,984.86
|
|
|
TIBIAL BEARING INSERT TRIATHLON PS SZ 2 9MM 5532-G-209
|
Facility
|
IP
|
$8,080.00
|
|
| Hospital Charge Code |
4493903
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,959.20 |
| Max. Negotiated Rate |
$7,433.60 |
| Rate for Payer: Aetna Commercial |
$7,272.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,948.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,282.40
|
| Rate for Payer: Cash Price |
$2,424.00
|
| Rate for Payer: Cigna Commercial |
$7,433.60
|
| Rate for Payer: Health EOS Commercial |
$7,191.20
|
| Rate for Payer: HFN Commercial |
$7,433.60
|
| Rate for Payer: Multiplan Commercial |
$6,464.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,848.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,433.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,959.20
|
| Rate for Payer: Quartz Commercial |
$4,848.00
|
| Rate for Payer: WEA Trust Commercial |
$4,444.00
|
| Rate for Payer: WPS Commercial |
$5,984.86
|
|
|
TIBIAL BEARING INSERT TRIATHLON PS SZ 3 11MM 5532-G-311
|
Facility
|
OP
|
$8,080.00
|
|
| Hospital Charge Code |
4493914
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,262.40 |
| Max. Negotiated Rate |
$32,320.00 |
| Rate for Payer: Aetna Commercial |
$7,272.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,948.80
|
| Rate for Payer: Aetna Managed Medicare |
$2,262.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,252.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,040.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,878.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,282.40
|
| Rate for Payer: Cash Price |
$2,424.00
|
| Rate for Payer: Cigna Commercial |
$7,433.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,521.57
|
| Rate for Payer: Health EOS Commercial |
$7,191.20
|
| Rate for Payer: HFN Commercial |
$7,433.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,060.00
|
| Rate for Payer: Multiplan Commercial |
$6,464.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,848.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,433.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,959.20
|
| Rate for Payer: Quartz Commercial |
$5,252.00
|
| Rate for Payer: Quartz Medicare Advantage |
$4,848.00
|
| Rate for Payer: The Alliance Commercial |
$32,320.00
|
| Rate for Payer: WEA Trust Commercial |
$4,444.00
|
| Rate for Payer: WPS Commercial |
$5,984.86
|
|
|
TIBIAL BEARING INSERT TRIATHLON PS SZ 3 11MM 5532-G-311
|
Facility
|
IP
|
$8,080.00
|
|
| Hospital Charge Code |
4493914
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,959.20 |
| Max. Negotiated Rate |
$7,433.60 |
| Rate for Payer: Aetna Commercial |
$7,272.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,948.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,282.40
|
| Rate for Payer: Cash Price |
$2,424.00
|
| Rate for Payer: Cigna Commercial |
$7,433.60
|
| Rate for Payer: Health EOS Commercial |
$7,191.20
|
| Rate for Payer: HFN Commercial |
$7,433.60
|
| Rate for Payer: Multiplan Commercial |
$6,464.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,848.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,433.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,959.20
|
| Rate for Payer: Quartz Commercial |
$4,848.00
|
| Rate for Payer: WEA Trust Commercial |
$4,444.00
|
| Rate for Payer: WPS Commercial |
$5,984.86
|
|
|
TIBIAL BEARING INSERT TRIATHLON PS SZ 3 19MM 5532-G-319
|
Facility
|
IP
|
$8,080.00
|
|
| Hospital Charge Code |
4493916
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,959.20 |
| Max. Negotiated Rate |
$7,433.60 |
| Rate for Payer: Aetna Commercial |
$7,272.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,948.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,282.40
|
| Rate for Payer: Cash Price |
$2,424.00
|
| Rate for Payer: Cigna Commercial |
$7,433.60
|
| Rate for Payer: Health EOS Commercial |
$7,191.20
|
| Rate for Payer: HFN Commercial |
$7,433.60
|
| Rate for Payer: Multiplan Commercial |
$6,464.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,848.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,433.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,959.20
|
| Rate for Payer: Quartz Commercial |
$4,848.00
|
| Rate for Payer: WEA Trust Commercial |
$4,444.00
|
| Rate for Payer: WPS Commercial |
$5,984.86
|
|
|
TIBIAL BEARING INSERT TRIATHLON PS SZ 3 19MM 5532-G-319
|
Facility
|
OP
|
$8,080.00
|
|
| Hospital Charge Code |
4493916
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,262.40 |
| Max. Negotiated Rate |
$32,320.00 |
| Rate for Payer: Aetna Commercial |
$7,272.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,948.80
|
| Rate for Payer: Aetna Managed Medicare |
$2,262.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,252.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,040.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,878.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,282.40
|
| Rate for Payer: Cash Price |
$2,424.00
|
| Rate for Payer: Cigna Commercial |
$7,433.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,521.57
|
| Rate for Payer: Health EOS Commercial |
$7,191.20
|
| Rate for Payer: HFN Commercial |
$7,433.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,060.00
|
| Rate for Payer: Multiplan Commercial |
$6,464.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,848.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,433.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,959.20
|
| Rate for Payer: Quartz Commercial |
$5,252.00
|
| Rate for Payer: Quartz Medicare Advantage |
$4,848.00
|
| Rate for Payer: The Alliance Commercial |
$32,320.00
|
| Rate for Payer: WEA Trust Commercial |
$4,444.00
|
| Rate for Payer: WPS Commercial |
$5,984.86
|
|
|
TIBIAL BLOCK SZ 3 5MM THICK 00-5988-003-26
|
Facility
|
OP
|
$8,160.00
|
|
| Hospital Charge Code |
2969405
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,284.80 |
| Max. Negotiated Rate |
$32,640.00 |
| Rate for Payer: Aetna Commercial |
$7,344.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,017.60
|
| Rate for Payer: Aetna Managed Medicare |
$2,284.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,304.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,080.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,916.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,324.80
|
| Rate for Payer: Cash Price |
$2,448.00
|
| Rate for Payer: Cigna Commercial |
$7,507.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,566.34
|
| Rate for Payer: Health EOS Commercial |
$7,262.40
|
| Rate for Payer: HFN Commercial |
$7,507.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,120.00
|
| Rate for Payer: Multiplan Commercial |
$6,528.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,896.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,507.20
|
| Rate for Payer: Quartz Beloit One Network |
$3,998.40
|
| Rate for Payer: Quartz Commercial |
$5,304.00
|
| Rate for Payer: Quartz Medicare Advantage |
$4,896.00
|
| Rate for Payer: The Alliance Commercial |
$32,640.00
|
| Rate for Payer: WEA Trust Commercial |
$4,488.00
|
| Rate for Payer: WPS Commercial |
$6,044.11
|
|
