|
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 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: 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 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: 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 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: 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 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: 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 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: 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 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 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: 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 BLOCK SZ 3 5MM THICK 00-5988-003-26
|
Facility
IP
|
$8,160.00
|
|
| Hospital Charge Code |
2969405
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,998.40 |
| Max. Negotiated Rate |
$7,507.20 |
| Rate for Payer: Aetna Commercial |
$7,344.00
|
| 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: Health EOS Commercial |
$7,262.40
|
| Rate for Payer: HFN Commercial |
$7,507.20
|
| 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 |
$4,896.00
|
| Rate for Payer: WEA Trust Commercial |
$4,488.00
|
| Rate for Payer: WPS Commercial |
$6,044.11
|
|
|
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
|
|
|
TIBIAL BLOCK SZ 4 5MM THICK 5988-04-26
|
Facility
IP
|
$8,160.00
|
|
| Hospital Charge Code |
2974033
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,998.40 |
| Max. Negotiated Rate |
$7,507.20 |
| Rate for Payer: Aetna Commercial |
$7,344.00
|
| 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: Health EOS Commercial |
$7,262.40
|
| Rate for Payer: HFN Commercial |
$7,507.20
|
| 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 |
$4,896.00
|
| Rate for Payer: WEA Trust Commercial |
$4,488.00
|
| Rate for Payer: WPS Commercial |
$6,044.11
|
|
|
TIBIAL BLOCK SZ 4 5MM THICK 5988-04-26
|
Facility
OP
|
$8,160.00
|
|
| Hospital Charge Code |
2974033
|
|
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
|
|
|
TIBIAL BLOCK SZ 5 5MM THICK 5988-05-26
|
Facility
OP
|
$8,160.00
|
|
| Hospital Charge Code |
2973967
|
|
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
|
|
|
TIBIAL BLOCK SZ 5 5MM THICK 5988-05-26
|
Facility
IP
|
$8,160.00
|
|
| Hospital Charge Code |
2973967
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,998.40 |
| Max. Negotiated Rate |
$7,507.20 |
| Rate for Payer: Aetna Commercial |
$7,344.00
|
| 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: Health EOS Commercial |
$7,262.40
|
| Rate for Payer: HFN Commercial |
$7,507.20
|
| 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 |
$4,896.00
|
| Rate for Payer: WEA Trust Commercial |
$4,488.00
|
| Rate for Payer: WPS Commercial |
$6,044.11
|
|
|
TIBIAL BLOCK SZ 6 5MM THICK 5988-06-26
|
Facility
IP
|
$8,160.00
|
|
| Hospital Charge Code |
2974038
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,998.40 |
| Max. Negotiated Rate |
$7,507.20 |
| Rate for Payer: Aetna Commercial |
$7,344.00
|
| 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: Health EOS Commercial |
$7,262.40
|
| Rate for Payer: HFN Commercial |
$7,507.20
|
| 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 |
$4,896.00
|
| Rate for Payer: WEA Trust Commercial |
$4,488.00
|
| Rate for Payer: WPS Commercial |
$6,044.11
|
|
|
TIBIAL BLOCK SZ 6 5MM THICK 5988-06-26
|
Facility
OP
|
$8,160.00
|
|
| Hospital Charge Code |
2974038
|
|
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
|
|
|
TIBIAL BLOCK SZ 7 5MM THICK 5988-07-26
|
Facility
IP
|
$8,160.00
|
|
| Hospital Charge Code |
2974037
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,998.40 |
| Max. Negotiated Rate |
$7,507.20 |
| Rate for Payer: Aetna Commercial |
$7,344.00
|
| 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: Health EOS Commercial |
$7,262.40
|
| Rate for Payer: HFN Commercial |
$7,507.20
|
| 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 |
$4,896.00
|
| Rate for Payer: WEA Trust Commercial |
$4,488.00
|
| Rate for Payer: WPS Commercial |
$6,044.11
|
|
|
TIBIAL BLOCK SZ 7 5MM THICK 5988-07-26
|
Facility
OP
|
$8,160.00
|
|
| Hospital Charge Code |
2974037
|
|
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
|
|
|
TIBIAL BONE GRAFTING
|
Facility
IP
|
$4,170.00
|
|
| Hospital Charge Code |
2959866
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,043.30 |
| Max. Negotiated Rate |
$3,836.40 |
| Rate for Payer: Aetna Commercial |
$3,753.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,210.10
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cigna Commercial |
$3,836.40
|
| Rate for Payer: Health EOS Commercial |
$3,711.30
|
| Rate for Payer: HFN Commercial |
$3,836.40
|
| Rate for Payer: Multiplan Commercial |
$3,336.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,502.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,836.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,043.30
|
| Rate for Payer: Quartz Commercial |
$2,502.00
|
| Rate for Payer: WEA Trust Commercial |
$2,293.50
|
| Rate for Payer: WPS Commercial |
$3,088.72
|
|
|
TIBIAL BONE GRAFTING
|
Facility
OP
|
$4,170.00
|
|
| Hospital Charge Code |
2959866
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,167.60 |
| Max. Negotiated Rate |
$16,680.00 |
| Rate for Payer: Aetna Commercial |
$3,753.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,586.20
|
| Rate for Payer: Aetna Managed Medicare |
$1,167.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,710.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,085.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,001.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,210.10
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cigna Commercial |
$3,836.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,333.53
|
| Rate for Payer: Health EOS Commercial |
$3,711.30
|
| Rate for Payer: HFN Commercial |
$3,836.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,127.50
|
| Rate for Payer: Multiplan Commercial |
$3,336.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,502.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,836.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,043.30
|
| Rate for Payer: Quartz Commercial |
$2,710.50
|
| Rate for Payer: Quartz Medicare Advantage |
$2,502.00
|
| Rate for Payer: The Alliance Commercial |
$16,680.00
|
| Rate for Payer: WEA Trust Commercial |
$2,293.50
|
| Rate for Payer: WPS Commercial |
$3,088.72
|
|
