|
TIBIAL AUGMENT HALF BLOCK SZ 2 5MM RT 5545-A-201
|
Facility
|
OP
|
$6,222.00
|
|
| Hospital Charge Code |
4518662
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,742.16 |
| Max. Negotiated Rate |
$24,888.00 |
| Rate for Payer: Aetna Commercial |
$5,599.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,350.92
|
| Rate for Payer: Aetna Managed Medicare |
$1,742.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,044.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,111.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,986.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,297.66
|
| Rate for Payer: Cash Price |
$1,866.60
|
| Rate for Payer: Cigna Commercial |
$5,724.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,481.83
|
| Rate for Payer: Health EOS Commercial |
$5,537.58
|
| Rate for Payer: HFN Commercial |
$5,724.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,666.50
|
| Rate for Payer: Multiplan Commercial |
$4,977.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,733.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,724.24
|
| Rate for Payer: Quartz Beloit One Network |
$3,048.78
|
| Rate for Payer: Quartz Commercial |
$4,044.30
|
| Rate for Payer: Quartz Medicare Advantage |
$3,733.20
|
| Rate for Payer: The Alliance Commercial |
$24,888.00
|
| Rate for Payer: WEA Trust Commercial |
$3,422.10
|
| Rate for Payer: WPS Commercial |
$4,608.64
|
|
|
TIBIAL AUGMENT HALF BLOCK SZ 3 5MM LT 5545-A-302
|
Facility
|
IP
|
$6,222.00
|
|
| Hospital Charge Code |
4493839
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,048.78 |
| Max. Negotiated Rate |
$5,724.24 |
| Rate for Payer: Aetna Commercial |
$5,599.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,350.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,297.66
|
| Rate for Payer: Cash Price |
$1,866.60
|
| Rate for Payer: Cigna Commercial |
$5,724.24
|
| Rate for Payer: Health EOS Commercial |
$5,537.58
|
| Rate for Payer: HFN Commercial |
$5,724.24
|
| Rate for Payer: Multiplan Commercial |
$4,977.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,733.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,724.24
|
| Rate for Payer: Quartz Beloit One Network |
$3,048.78
|
| Rate for Payer: Quartz Commercial |
$3,733.20
|
| Rate for Payer: WEA Trust Commercial |
$3,422.10
|
| Rate for Payer: WPS Commercial |
$4,608.64
|
|
|
TIBIAL AUGMENT HALF BLOCK SZ 3 5MM LT 5545-A-302
|
Facility
|
OP
|
$6,222.00
|
|
| Hospital Charge Code |
4493839
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,742.16 |
| Max. Negotiated Rate |
$24,888.00 |
| Rate for Payer: Aetna Commercial |
$5,599.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,350.92
|
| Rate for Payer: Aetna Managed Medicare |
$1,742.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,044.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,111.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,986.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,297.66
|
| Rate for Payer: Cash Price |
$1,866.60
|
| Rate for Payer: Cigna Commercial |
$5,724.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,481.83
|
| Rate for Payer: Health EOS Commercial |
$5,537.58
|
| Rate for Payer: HFN Commercial |
$5,724.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,666.50
|
| Rate for Payer: Multiplan Commercial |
$4,977.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,733.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,724.24
|
| Rate for Payer: Quartz Beloit One Network |
$3,048.78
|
| Rate for Payer: Quartz Commercial |
$4,044.30
|
| Rate for Payer: Quartz Medicare Advantage |
$3,733.20
|
| Rate for Payer: The Alliance Commercial |
$24,888.00
|
| Rate for Payer: WEA Trust Commercial |
$3,422.10
|
| Rate for Payer: WPS Commercial |
$4,608.64
|
|
|
TIBIAL AUGMENT HALF BLOCK SZ 3 5MM RT 5545-A-301
|
Facility
|
OP
|
$6,222.00
|
|
| Hospital Charge Code |
4518661
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,742.16 |
| Max. Negotiated Rate |
$24,888.00 |
| Rate for Payer: Aetna Commercial |
$5,599.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,350.92
|
| Rate for Payer: Aetna Managed Medicare |
$1,742.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,044.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,111.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,986.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,297.66
|
| Rate for Payer: Cash Price |
$1,866.60
|
| Rate for Payer: Cigna Commercial |
$5,724.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,481.83
|
| Rate for Payer: Health EOS Commercial |
$5,537.58
|
| Rate for Payer: HFN Commercial |
$5,724.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,666.50
|
| Rate for Payer: Multiplan Commercial |
$4,977.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,733.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,724.24
|
| Rate for Payer: Quartz Beloit One Network |
$3,048.78
|
| Rate for Payer: Quartz Commercial |
$4,044.30
|
| Rate for Payer: Quartz Medicare Advantage |
$3,733.20
|
| Rate for Payer: The Alliance Commercial |
$24,888.00
|
| Rate for Payer: WEA Trust Commercial |
$3,422.10
|
| Rate for Payer: WPS Commercial |
$4,608.64
|
|
|
TIBIAL AUGMENT HALF BLOCK SZ 3 5MM RT 5545-A-301
|
Facility
|
IP
|
$6,222.00
|
|
| Hospital Charge Code |
4518661
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,048.78 |
| Max. Negotiated Rate |
$5,724.24 |
| Rate for Payer: Aetna Commercial |
$5,599.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,350.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,297.66
|
| Rate for Payer: Cash Price |
$1,866.60
|
| Rate for Payer: Cigna Commercial |
$5,724.24
|
| Rate for Payer: Health EOS Commercial |
$5,537.58
|
| Rate for Payer: HFN Commercial |
$5,724.24
|
| Rate for Payer: Multiplan Commercial |
$4,977.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,733.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,724.24
|
| Rate for Payer: Quartz Beloit One Network |
$3,048.78
|
| Rate for Payer: Quartz Commercial |
$3,733.20
|
| Rate for Payer: WEA Trust Commercial |
$3,422.10
|
| Rate for Payer: WPS Commercial |
$4,608.64
|
|
|
TIBIAL AUGMENT HALF BLOCK SZ 4 5MM LT 5545-A-402
|
Facility
|
OP
|
$6,222.00
|
|
| Hospital Charge Code |
4518665
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,742.16 |
| Max. Negotiated Rate |
$24,888.00 |
| Rate for Payer: Aetna Commercial |
$5,599.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,350.92
|
| Rate for Payer: Aetna Managed Medicare |
$1,742.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,044.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,111.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,986.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,297.66
|
| Rate for Payer: Cash Price |
$1,866.60
|
| Rate for Payer: Cigna Commercial |
$5,724.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,481.83
|
| Rate for Payer: Health EOS Commercial |
$5,537.58
|
| Rate for Payer: HFN Commercial |
$5,724.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,666.50
|
| Rate for Payer: Multiplan Commercial |
$4,977.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,733.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,724.24
|
| Rate for Payer: Quartz Beloit One Network |
$3,048.78
|
| Rate for Payer: Quartz Commercial |
$4,044.30
|
| Rate for Payer: Quartz Medicare Advantage |
$3,733.20
|
| Rate for Payer: The Alliance Commercial |
$24,888.00
|
| Rate for Payer: WEA Trust Commercial |
$3,422.10
|
| Rate for Payer: WPS Commercial |
$4,608.64
|
|
|
TIBIAL AUGMENT HALF BLOCK SZ 4 5MM LT 5545-A-402
|
Facility
|
IP
|
$6,222.00
|
|
| Hospital Charge Code |
4518665
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,048.78 |
| Max. Negotiated Rate |
$5,724.24 |
| Rate for Payer: Aetna Commercial |
$5,599.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,350.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,297.66
|
| Rate for Payer: Cash Price |
$1,866.60
|
| Rate for Payer: Cigna Commercial |
$5,724.24
|
| Rate for Payer: Health EOS Commercial |
$5,537.58
|
| Rate for Payer: HFN Commercial |
$5,724.24
|
| Rate for Payer: Multiplan Commercial |
$4,977.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,733.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,724.24
|
| Rate for Payer: Quartz Beloit One Network |
$3,048.78
|
| Rate for Payer: Quartz Commercial |
$3,733.20
|
| Rate for Payer: WEA Trust Commercial |
$3,422.10
|
| Rate for Payer: WPS Commercial |
$4,608.64
|
|
|
TIBIAL AUGMENT HALF BLOCK SZ 4 5MM RT 5545-A-401
|
Facility
|
IP
|
$6,222.00
|
|
| Hospital Charge Code |
4518664
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,048.78 |
| Max. Negotiated Rate |
$5,724.24 |
| Rate for Payer: Aetna Commercial |
$5,599.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,350.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,297.66
|
| Rate for Payer: Cash Price |
$1,866.60
|
| Rate for Payer: Cigna Commercial |
$5,724.24
|
| Rate for Payer: Health EOS Commercial |
$5,537.58
|
| Rate for Payer: HFN Commercial |
$5,724.24
|
| Rate for Payer: Multiplan Commercial |
$4,977.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,733.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,724.24
|
| Rate for Payer: Quartz Beloit One Network |
$3,048.78
|
| Rate for Payer: Quartz Commercial |
$3,733.20
|
| Rate for Payer: WEA Trust Commercial |
$3,422.10
|
| Rate for Payer: WPS Commercial |
$4,608.64
|
|
|
TIBIAL AUGMENT HALF BLOCK SZ 4 5MM RT 5545-A-401
|
Facility
|
OP
|
$6,222.00
|
|
| Hospital Charge Code |
4518664
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,742.16 |
| Max. Negotiated Rate |
$24,888.00 |
| Rate for Payer: Aetna Commercial |
$5,599.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,350.92
|
| Rate for Payer: Aetna Managed Medicare |
$1,742.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,044.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,111.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,986.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,297.66
|
| Rate for Payer: Cash Price |
$1,866.60
|
| Rate for Payer: Cigna Commercial |
$5,724.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,481.83
|
| Rate for Payer: Health EOS Commercial |
$5,537.58
|
| Rate for Payer: HFN Commercial |
$5,724.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,666.50
|
| Rate for Payer: Multiplan Commercial |
$4,977.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,733.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,724.24
|
| Rate for Payer: Quartz Beloit One Network |
$3,048.78
|
| Rate for Payer: Quartz Commercial |
$4,044.30
|
| Rate for Payer: Quartz Medicare Advantage |
$3,733.20
|
| Rate for Payer: The Alliance Commercial |
$24,888.00
|
| Rate for Payer: WEA Trust Commercial |
$3,422.10
|
| Rate for Payer: WPS Commercial |
$4,608.64
|
|
|
TIBIAL AUGMENT HALF BLOCK SZ 5 5MM 5545-A-502
|
Facility
|
OP
|
$6,222.00
|
|
| Hospital Charge Code |
3263469
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,742.16 |
| Max. Negotiated Rate |
$24,888.00 |
| Rate for Payer: Aetna Commercial |
$5,599.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,350.92
|
| Rate for Payer: Aetna Managed Medicare |
$1,742.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,044.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,111.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,986.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,297.66
|
| Rate for Payer: Cash Price |
$1,866.60
|
| Rate for Payer: Cigna Commercial |
$5,724.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,481.83
|
| Rate for Payer: Health EOS Commercial |
$5,537.58
|
| Rate for Payer: HFN Commercial |
$5,724.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,666.50
|
| Rate for Payer: Multiplan Commercial |
$4,977.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,733.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,724.24
|
| Rate for Payer: Quartz Beloit One Network |
$3,048.78
|
| Rate for Payer: Quartz Commercial |
$4,044.30
|
| Rate for Payer: Quartz Medicare Advantage |
$3,733.20
|
| Rate for Payer: The Alliance Commercial |
$24,888.00
|
| Rate for Payer: WEA Trust Commercial |
$3,422.10
|
| Rate for Payer: WPS Commercial |
$4,608.64
|
|
|
TIBIAL AUGMENT HALF BLOCK SZ 5 5MM 5545-A-502
|
Facility
|
IP
|
$6,222.00
|
|
| Hospital Charge Code |
3263469
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,048.78 |
| Max. Negotiated Rate |
$5,724.24 |
| Rate for Payer: Aetna Commercial |
$5,599.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,350.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,297.66
|
| Rate for Payer: Cash Price |
$1,866.60
|
| Rate for Payer: Cigna Commercial |
$5,724.24
|
| Rate for Payer: Health EOS Commercial |
$5,537.58
|
| Rate for Payer: HFN Commercial |
$5,724.24
|
| Rate for Payer: Multiplan Commercial |
$4,977.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,733.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,724.24
|
| Rate for Payer: Quartz Beloit One Network |
$3,048.78
|
| Rate for Payer: Quartz Commercial |
$3,733.20
|
| Rate for Payer: WEA Trust Commercial |
$3,422.10
|
| Rate for Payer: WPS Commercial |
$4,608.64
|
|
|
TIBIAL AUGMENT HALF BLOCK SZ 5 5MM LT 5545-A-502
|
Facility
|
IP
|
$6,222.00
|
|
| Hospital Charge Code |
4518666
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,048.78 |
| Max. Negotiated Rate |
$5,724.24 |
| Rate for Payer: Aetna Commercial |
$5,599.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,350.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,297.66
|
| Rate for Payer: Cash Price |
$1,866.60
|
| Rate for Payer: Cigna Commercial |
$5,724.24
|
| Rate for Payer: Health EOS Commercial |
$5,537.58
|
| Rate for Payer: HFN Commercial |
$5,724.24
|
| Rate for Payer: Multiplan Commercial |
$4,977.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,733.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,724.24
|
| Rate for Payer: Quartz Beloit One Network |
$3,048.78
|
| Rate for Payer: Quartz Commercial |
$3,733.20
|
| Rate for Payer: WEA Trust Commercial |
$3,422.10
|
| Rate for Payer: WPS Commercial |
$4,608.64
|
|
|
TIBIAL AUGMENT HALF BLOCK SZ 5 5MM LT 5545-A-502
|
Facility
|
OP
|
$6,222.00
|
|
| Hospital Charge Code |
4518666
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,742.16 |
| Max. Negotiated Rate |
$24,888.00 |
| Rate for Payer: Aetna Commercial |
$5,599.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,350.92
|
| Rate for Payer: Aetna Managed Medicare |
$1,742.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,044.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,111.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,986.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,297.66
|
| Rate for Payer: Cash Price |
$1,866.60
|
| Rate for Payer: Cigna Commercial |
$5,724.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,481.83
|
| Rate for Payer: Health EOS Commercial |
$5,537.58
|
| Rate for Payer: HFN Commercial |
$5,724.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,666.50
|
| Rate for Payer: Multiplan Commercial |
$4,977.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,733.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,724.24
|
| Rate for Payer: Quartz Beloit One Network |
$3,048.78
|
| Rate for Payer: Quartz Commercial |
$4,044.30
|
| Rate for Payer: Quartz Medicare Advantage |
$3,733.20
|
| Rate for Payer: The Alliance Commercial |
$24,888.00
|
| Rate for Payer: WEA Trust Commercial |
$3,422.10
|
| Rate for Payer: WPS Commercial |
$4,608.64
|
|
|
TIBIAL AUGMENT HALF BLOCK SZ 5 5MM RT 5545-A-501
|
Facility
|
OP
|
$6,222.00
|
|
| Hospital Charge Code |
4494014
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,742.16 |
| Max. Negotiated Rate |
$24,888.00 |
| Rate for Payer: Aetna Commercial |
$5,599.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,350.92
|
| Rate for Payer: Aetna Managed Medicare |
$1,742.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,044.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,111.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,986.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,297.66
|
| Rate for Payer: Cash Price |
$1,866.60
|
| Rate for Payer: Cigna Commercial |
$5,724.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,481.83
|
| Rate for Payer: Health EOS Commercial |
$5,537.58
|
| Rate for Payer: HFN Commercial |
$5,724.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,666.50
|
| Rate for Payer: Multiplan Commercial |
$4,977.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,733.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,724.24
|
| Rate for Payer: Quartz Beloit One Network |
$3,048.78
|
| Rate for Payer: Quartz Commercial |
$4,044.30
|
| Rate for Payer: Quartz Medicare Advantage |
$3,733.20
|
| Rate for Payer: The Alliance Commercial |
$24,888.00
|
| Rate for Payer: WEA Trust Commercial |
$3,422.10
|
| Rate for Payer: WPS Commercial |
$4,608.64
|
|
|
TIBIAL AUGMENT HALF BLOCK SZ 5 5MM RT 5545-A-501
|
Facility
|
IP
|
$6,222.00
|
|
| Hospital Charge Code |
4494014
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,048.78 |
| Max. Negotiated Rate |
$5,724.24 |
| Rate for Payer: Aetna Commercial |
$5,599.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,350.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,297.66
|
| Rate for Payer: Cash Price |
$1,866.60
|
| Rate for Payer: Cigna Commercial |
$5,724.24
|
| Rate for Payer: Health EOS Commercial |
$5,537.58
|
| Rate for Payer: HFN Commercial |
$5,724.24
|
| Rate for Payer: Multiplan Commercial |
$4,977.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,733.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,724.24
|
| Rate for Payer: Quartz Beloit One Network |
$3,048.78
|
| Rate for Payer: Quartz Commercial |
$3,733.20
|
| Rate for Payer: WEA Trust Commercial |
$3,422.10
|
| Rate for Payer: WPS Commercial |
$4,608.64
|
|
|
TIBIAL AUGMENT HALF BLOCK SZ 6 5MM LT 5545-A-602
|
Facility
|
OP
|
$6,222.00
|
|
| Hospital Charge Code |
4518668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,742.16 |
| Max. Negotiated Rate |
$24,888.00 |
| Rate for Payer: Aetna Commercial |
$5,599.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,350.92
|
| Rate for Payer: Aetna Managed Medicare |
$1,742.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,044.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,111.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,986.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,297.66
|
| Rate for Payer: Cash Price |
$1,866.60
|
| Rate for Payer: Cigna Commercial |
$5,724.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,481.83
|
| Rate for Payer: Health EOS Commercial |
$5,537.58
|
| Rate for Payer: HFN Commercial |
$5,724.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,666.50
|
| Rate for Payer: Multiplan Commercial |
$4,977.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,733.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,724.24
|
| Rate for Payer: Quartz Beloit One Network |
$3,048.78
|
| Rate for Payer: Quartz Commercial |
$4,044.30
|
| Rate for Payer: Quartz Medicare Advantage |
$3,733.20
|
| Rate for Payer: The Alliance Commercial |
$24,888.00
|
| Rate for Payer: WEA Trust Commercial |
$3,422.10
|
| Rate for Payer: WPS Commercial |
$4,608.64
|
|
|
TIBIAL AUGMENT HALF BLOCK SZ 6 5MM LT 5545-A-602
|
Facility
|
IP
|
$6,222.00
|
|
| Hospital Charge Code |
4518668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,048.78 |
| Max. Negotiated Rate |
$5,724.24 |
| Rate for Payer: Aetna Commercial |
$5,599.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,350.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,297.66
|
| Rate for Payer: Cash Price |
$1,866.60
|
| Rate for Payer: Cigna Commercial |
$5,724.24
|
| Rate for Payer: Health EOS Commercial |
$5,537.58
|
| Rate for Payer: HFN Commercial |
$5,724.24
|
| Rate for Payer: Multiplan Commercial |
$4,977.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,733.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,724.24
|
| Rate for Payer: Quartz Beloit One Network |
$3,048.78
|
| Rate for Payer: Quartz Commercial |
$3,733.20
|
| Rate for Payer: WEA Trust Commercial |
$3,422.10
|
| Rate for Payer: WPS Commercial |
$4,608.64
|
|
|
TIBIAL AUGMENT HALF BLOCK SZ 6 5MM RT 5545-A-601
|
Facility
|
IP
|
$6,222.00
|
|
| Hospital Charge Code |
4518667
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,048.78 |
| Max. Negotiated Rate |
$5,724.24 |
| Rate for Payer: Aetna Commercial |
$5,599.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,350.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,297.66
|
| Rate for Payer: Cash Price |
$1,866.60
|
| Rate for Payer: Cigna Commercial |
$5,724.24
|
| Rate for Payer: Health EOS Commercial |
$5,537.58
|
| Rate for Payer: HFN Commercial |
$5,724.24
|
| Rate for Payer: Multiplan Commercial |
$4,977.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,733.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,724.24
|
| Rate for Payer: Quartz Beloit One Network |
$3,048.78
|
| Rate for Payer: Quartz Commercial |
$3,733.20
|
| Rate for Payer: WEA Trust Commercial |
$3,422.10
|
| Rate for Payer: WPS Commercial |
$4,608.64
|
|
|
TIBIAL AUGMENT HALF BLOCK SZ 6 5MM RT 5545-A-601
|
Facility
|
OP
|
$6,222.00
|
|
| Hospital Charge Code |
4518667
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,742.16 |
| Max. Negotiated Rate |
$24,888.00 |
| Rate for Payer: Aetna Commercial |
$5,599.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,350.92
|
| Rate for Payer: Aetna Managed Medicare |
$1,742.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,044.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,111.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,986.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,297.66
|
| Rate for Payer: Cash Price |
$1,866.60
|
| Rate for Payer: Cigna Commercial |
$5,724.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,481.83
|
| Rate for Payer: Health EOS Commercial |
$5,537.58
|
| Rate for Payer: HFN Commercial |
$5,724.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,666.50
|
| Rate for Payer: Multiplan Commercial |
$4,977.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,733.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,724.24
|
| Rate for Payer: Quartz Beloit One Network |
$3,048.78
|
| Rate for Payer: Quartz Commercial |
$4,044.30
|
| Rate for Payer: Quartz Medicare Advantage |
$3,733.20
|
| Rate for Payer: The Alliance Commercial |
$24,888.00
|
| Rate for Payer: WEA Trust Commercial |
$3,422.10
|
| Rate for Payer: WPS Commercial |
$4,608.64
|
|
|
TIBIAL AUGMENT HALF BLOCK SZ 7 5MM LT 5545-A-702
|
Facility
|
OP
|
$6,222.00
|
|
| Hospital Charge Code |
4518670
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,742.16 |
| Max. Negotiated Rate |
$24,888.00 |
| Rate for Payer: Aetna Commercial |
$5,599.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,350.92
|
| Rate for Payer: Aetna Managed Medicare |
$1,742.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,044.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,111.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,986.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,297.66
|
| Rate for Payer: Cash Price |
$1,866.60
|
| Rate for Payer: Cigna Commercial |
$5,724.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,481.83
|
| Rate for Payer: Health EOS Commercial |
$5,537.58
|
| Rate for Payer: HFN Commercial |
$5,724.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,666.50
|
| Rate for Payer: Multiplan Commercial |
$4,977.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,733.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,724.24
|
| Rate for Payer: Quartz Beloit One Network |
$3,048.78
|
| Rate for Payer: Quartz Commercial |
$4,044.30
|
| Rate for Payer: Quartz Medicare Advantage |
$3,733.20
|
| Rate for Payer: The Alliance Commercial |
$24,888.00
|
| Rate for Payer: WEA Trust Commercial |
$3,422.10
|
| Rate for Payer: WPS Commercial |
$4,608.64
|
|
|
TIBIAL AUGMENT HALF BLOCK SZ 7 5MM LT 5545-A-702
|
Facility
|
IP
|
$6,222.00
|
|
| Hospital Charge Code |
4518670
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,048.78 |
| Max. Negotiated Rate |
$5,724.24 |
| Rate for Payer: Aetna Commercial |
$5,599.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,350.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,297.66
|
| Rate for Payer: Cash Price |
$1,866.60
|
| Rate for Payer: Cigna Commercial |
$5,724.24
|
| Rate for Payer: Health EOS Commercial |
$5,537.58
|
| Rate for Payer: HFN Commercial |
$5,724.24
|
| Rate for Payer: Multiplan Commercial |
$4,977.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,733.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,724.24
|
| Rate for Payer: Quartz Beloit One Network |
$3,048.78
|
| Rate for Payer: Quartz Commercial |
$3,733.20
|
| Rate for Payer: WEA Trust Commercial |
$3,422.10
|
| Rate for Payer: WPS Commercial |
$4,608.64
|
|
|
TIBIAL AUGMENT HALF BLOCK SZ 7 5MM RT 5545-A-701
|
Facility
|
OP
|
$6,222.00
|
|
| Hospital Charge Code |
4518669
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,742.16 |
| Max. Negotiated Rate |
$24,888.00 |
| Rate for Payer: Aetna Commercial |
$5,599.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,350.92
|
| Rate for Payer: Aetna Managed Medicare |
$1,742.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,044.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,111.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,986.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,297.66
|
| Rate for Payer: Cash Price |
$1,866.60
|
| Rate for Payer: Cigna Commercial |
$5,724.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,481.83
|
| Rate for Payer: Health EOS Commercial |
$5,537.58
|
| Rate for Payer: HFN Commercial |
$5,724.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,666.50
|
| Rate for Payer: Multiplan Commercial |
$4,977.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,733.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,724.24
|
| Rate for Payer: Quartz Beloit One Network |
$3,048.78
|
| Rate for Payer: Quartz Commercial |
$4,044.30
|
| Rate for Payer: Quartz Medicare Advantage |
$3,733.20
|
| Rate for Payer: The Alliance Commercial |
$24,888.00
|
| Rate for Payer: WEA Trust Commercial |
$3,422.10
|
| Rate for Payer: WPS Commercial |
$4,608.64
|
|
|
TIBIAL AUGMENT HALF BLOCK SZ 7 5MM RT 5545-A-701
|
Facility
|
IP
|
$6,222.00
|
|
| Hospital Charge Code |
4518669
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,048.78 |
| Max. Negotiated Rate |
$5,724.24 |
| Rate for Payer: Aetna Commercial |
$5,599.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,350.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,297.66
|
| Rate for Payer: Cash Price |
$1,866.60
|
| Rate for Payer: Cigna Commercial |
$5,724.24
|
| Rate for Payer: Health EOS Commercial |
$5,537.58
|
| Rate for Payer: HFN Commercial |
$5,724.24
|
| Rate for Payer: Multiplan Commercial |
$4,977.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,733.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,724.24
|
| Rate for Payer: Quartz Beloit One Network |
$3,048.78
|
| Rate for Payer: Quartz Commercial |
$3,733.20
|
| Rate for Payer: WEA Trust Commercial |
$3,422.10
|
| Rate for Payer: WPS Commercial |
$4,608.64
|
|
|
TIBIAL BASEPLATE TRIATHLON SZ 2 5521-B-200
|
Facility
|
IP
|
$9,499.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3072402
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,654.51 |
| Max. Negotiated Rate |
$8,739.08 |
| Rate for Payer: Aetna Commercial |
$8,549.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,169.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,034.47
|
| Rate for Payer: Cash Price |
$2,849.70
|
| Rate for Payer: Cigna Commercial |
$8,739.08
|
| Rate for Payer: Health EOS Commercial |
$8,454.11
|
| Rate for Payer: HFN Commercial |
$8,739.08
|
| Rate for Payer: Multiplan Commercial |
$7,599.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,699.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,739.08
|
| Rate for Payer: Quartz Beloit One Network |
$4,654.51
|
| Rate for Payer: Quartz Commercial |
$5,699.40
|
| Rate for Payer: WEA Trust Commercial |
$5,224.45
|
| Rate for Payer: WPS Commercial |
$7,035.91
|
|
|
TIBIAL BASEPLATE TRIATHLON SZ 2 5521-B-200
|
Facility
|
OP
|
$9,499.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3072402
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,659.72 |
| Max. Negotiated Rate |
$37,996.00 |
| Rate for Payer: Aetna Commercial |
$8,549.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,169.14
|
| Rate for Payer: Aetna Managed Medicare |
$2,659.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,174.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,749.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,559.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,034.47
|
| Rate for Payer: Cash Price |
$2,849.70
|
| Rate for Payer: Cigna Commercial |
$8,739.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,315.64
|
| Rate for Payer: Health EOS Commercial |
$8,454.11
|
| Rate for Payer: HFN Commercial |
$8,739.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,124.25
|
| Rate for Payer: Multiplan Commercial |
$7,599.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,699.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,739.08
|
| Rate for Payer: Quartz Beloit One Network |
$4,654.51
|
| Rate for Payer: Quartz Commercial |
$6,174.35
|
| Rate for Payer: Quartz Medicare Advantage |
$5,699.40
|
| Rate for Payer: The Alliance Commercial |
$37,996.00
|
| Rate for Payer: WEA Trust Commercial |
$5,224.45
|
| Rate for Payer: WPS Commercial |
$7,035.91
|
|
