|
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 |
$1,811.85 |
| Max. Negotiated Rate |
$5,953.21 |
| Rate for Payer: Aetna Commercial |
$5,823.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,564.96
|
| Rate for Payer: Aetna Managed Medicare |
$1,811.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,206.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,235.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,106.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,429.57
|
| Rate for Payer: Cash Price |
$1,866.60
|
| Rate for Payer: Cigna Commercial |
$5,953.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,621.20
|
| Rate for Payer: Health EOS Commercial |
$5,759.08
|
| Rate for Payer: HFN Commercial |
$5,953.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,853.16
|
| Rate for Payer: Multiplan Commercial |
$5,176.70
|
| Rate for Payer: NAPHCARE Commercial |
$3,882.53
|
| Rate for Payer: Preferred Network Access Commercial |
$5,953.21
|
| Rate for Payer: Quartz Beloit One Network |
$3,170.73
|
| Rate for Payer: Quartz Commercial |
$4,206.07
|
| Rate for Payer: Quartz Medicare Advantage |
$3,882.53
|
| Rate for Payer: The Alliance Commercial |
$3,235.44
|
| Rate for Payer: WEA Trust Commercial |
$3,558.98
|
| Rate for Payer: WPS Commercial |
$4,792.81
|
|
|
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 |
$3,170.73 |
| Max. Negotiated Rate |
$5,953.21 |
| Rate for Payer: Aetna Commercial |
$5,823.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,564.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,429.57
|
| Rate for Payer: Cash Price |
$1,866.60
|
| Rate for Payer: Cigna Commercial |
$5,953.21
|
| Rate for Payer: Health EOS Commercial |
$5,759.08
|
| Rate for Payer: HFN Commercial |
$5,953.21
|
| Rate for Payer: Multiplan Commercial |
$5,176.70
|
| Rate for Payer: Preferred Network Access Commercial |
$5,953.21
|
| Rate for Payer: Quartz Beloit One Network |
$3,170.73
|
| Rate for Payer: Quartz Commercial |
$3,882.53
|
| Rate for Payer: WEA Trust Commercial |
$3,558.98
|
| Rate for Payer: WPS Commercial |
$4,792.81
|
|
|
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 |
$1,811.85 |
| Max. Negotiated Rate |
$5,953.21 |
| Rate for Payer: Aetna Commercial |
$5,823.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,564.96
|
| Rate for Payer: Aetna Managed Medicare |
$1,811.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,206.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,235.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,106.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,429.57
|
| Rate for Payer: Cash Price |
$1,866.60
|
| Rate for Payer: Cigna Commercial |
$5,953.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,621.20
|
| Rate for Payer: Health EOS Commercial |
$5,759.08
|
| Rate for Payer: HFN Commercial |
$5,953.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,853.16
|
| Rate for Payer: Multiplan Commercial |
$5,176.70
|
| Rate for Payer: NAPHCARE Commercial |
$3,882.53
|
| Rate for Payer: Preferred Network Access Commercial |
$5,953.21
|
| Rate for Payer: Quartz Beloit One Network |
$3,170.73
|
| Rate for Payer: Quartz Commercial |
$4,206.07
|
| Rate for Payer: Quartz Medicare Advantage |
$3,882.53
|
| Rate for Payer: The Alliance Commercial |
$3,235.44
|
| Rate for Payer: WEA Trust Commercial |
$3,558.98
|
| Rate for Payer: WPS Commercial |
$4,792.81
|
|
|
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 |
$3,170.73 |
| Max. Negotiated Rate |
$5,953.21 |
| Rate for Payer: Aetna Commercial |
$5,823.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,564.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,429.57
|
| Rate for Payer: Cash Price |
$1,866.60
|
| Rate for Payer: Cigna Commercial |
$5,953.21
|
| Rate for Payer: Health EOS Commercial |
$5,759.08
|
| Rate for Payer: HFN Commercial |
$5,953.21
|
| Rate for Payer: Multiplan Commercial |
$5,176.70
|
| Rate for Payer: Preferred Network Access Commercial |
$5,953.21
|
| Rate for Payer: Quartz Beloit One Network |
$3,170.73
|
| Rate for Payer: Quartz Commercial |
$3,882.53
|
| Rate for Payer: WEA Trust Commercial |
$3,558.98
|
| Rate for Payer: WPS Commercial |
$4,792.81
|
|
|
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 |
$1,811.85 |
| Max. Negotiated Rate |
$5,953.21 |
| Rate for Payer: Aetna Commercial |
$5,823.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,564.96
|
| Rate for Payer: Aetna Managed Medicare |
$1,811.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,206.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,235.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,106.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,429.57
|
| Rate for Payer: Cash Price |
$1,866.60
|
| Rate for Payer: Cigna Commercial |
$5,953.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,621.20
|
| Rate for Payer: Health EOS Commercial |
$5,759.08
|
| Rate for Payer: HFN Commercial |
$5,953.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,853.16
|
| Rate for Payer: Multiplan Commercial |
$5,176.70
|
| Rate for Payer: NAPHCARE Commercial |
$3,882.53
|
| Rate for Payer: Preferred Network Access Commercial |
$5,953.21
|
| Rate for Payer: Quartz Beloit One Network |
$3,170.73
|
| Rate for Payer: Quartz Commercial |
$4,206.07
|
| Rate for Payer: Quartz Medicare Advantage |
$3,882.53
|
| Rate for Payer: The Alliance Commercial |
$3,235.44
|
| Rate for Payer: WEA Trust Commercial |
$3,558.98
|
| Rate for Payer: WPS Commercial |
$4,792.81
|
|
|
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 |
$3,170.73 |
| Max. Negotiated Rate |
$5,953.21 |
| Rate for Payer: Aetna Commercial |
$5,823.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,564.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,429.57
|
| Rate for Payer: Cash Price |
$1,866.60
|
| Rate for Payer: Cigna Commercial |
$5,953.21
|
| Rate for Payer: Health EOS Commercial |
$5,759.08
|
| Rate for Payer: HFN Commercial |
$5,953.21
|
| Rate for Payer: Multiplan Commercial |
$5,176.70
|
| Rate for Payer: Preferred Network Access Commercial |
$5,953.21
|
| Rate for Payer: Quartz Beloit One Network |
$3,170.73
|
| Rate for Payer: Quartz Commercial |
$3,882.53
|
| Rate for Payer: WEA Trust Commercial |
$3,558.98
|
| Rate for Payer: WPS Commercial |
$4,792.81
|
|
|
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 |
$1,811.85 |
| Max. Negotiated Rate |
$5,953.21 |
| Rate for Payer: Aetna Commercial |
$5,823.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,564.96
|
| Rate for Payer: Aetna Managed Medicare |
$1,811.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,206.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,235.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,106.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,429.57
|
| Rate for Payer: Cash Price |
$1,866.60
|
| Rate for Payer: Cigna Commercial |
$5,953.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,621.20
|
| Rate for Payer: Health EOS Commercial |
$5,759.08
|
| Rate for Payer: HFN Commercial |
$5,953.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,853.16
|
| Rate for Payer: Multiplan Commercial |
$5,176.70
|
| Rate for Payer: NAPHCARE Commercial |
$3,882.53
|
| Rate for Payer: Preferred Network Access Commercial |
$5,953.21
|
| Rate for Payer: Quartz Beloit One Network |
$3,170.73
|
| Rate for Payer: Quartz Commercial |
$4,206.07
|
| Rate for Payer: Quartz Medicare Advantage |
$3,882.53
|
| Rate for Payer: The Alliance Commercial |
$3,235.44
|
| Rate for Payer: WEA Trust Commercial |
$3,558.98
|
| Rate for Payer: WPS Commercial |
$4,792.81
|
|
|
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 |
$3,170.73 |
| Max. Negotiated Rate |
$5,953.21 |
| Rate for Payer: Aetna Commercial |
$5,823.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,564.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,429.57
|
| Rate for Payer: Cash Price |
$1,866.60
|
| Rate for Payer: Cigna Commercial |
$5,953.21
|
| Rate for Payer: Health EOS Commercial |
$5,759.08
|
| Rate for Payer: HFN Commercial |
$5,953.21
|
| Rate for Payer: Multiplan Commercial |
$5,176.70
|
| Rate for Payer: Preferred Network Access Commercial |
$5,953.21
|
| Rate for Payer: Quartz Beloit One Network |
$3,170.73
|
| Rate for Payer: Quartz Commercial |
$3,882.53
|
| Rate for Payer: WEA Trust Commercial |
$3,558.98
|
| Rate for Payer: WPS Commercial |
$4,792.81
|
|
|
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 |
$3,170.73 |
| Max. Negotiated Rate |
$5,953.21 |
| Rate for Payer: Aetna Commercial |
$5,823.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,564.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,429.57
|
| Rate for Payer: Cash Price |
$1,866.60
|
| Rate for Payer: Cigna Commercial |
$5,953.21
|
| Rate for Payer: Health EOS Commercial |
$5,759.08
|
| Rate for Payer: HFN Commercial |
$5,953.21
|
| Rate for Payer: Multiplan Commercial |
$5,176.70
|
| Rate for Payer: Preferred Network Access Commercial |
$5,953.21
|
| Rate for Payer: Quartz Beloit One Network |
$3,170.73
|
| Rate for Payer: Quartz Commercial |
$3,882.53
|
| Rate for Payer: WEA Trust Commercial |
$3,558.98
|
| Rate for Payer: WPS Commercial |
$4,792.81
|
|
|
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 |
$1,811.85 |
| Max. Negotiated Rate |
$5,953.21 |
| Rate for Payer: Aetna Commercial |
$5,823.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,564.96
|
| Rate for Payer: Aetna Managed Medicare |
$1,811.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,206.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,235.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,106.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,429.57
|
| Rate for Payer: Cash Price |
$1,866.60
|
| Rate for Payer: Cigna Commercial |
$5,953.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,621.20
|
| Rate for Payer: Health EOS Commercial |
$5,759.08
|
| Rate for Payer: HFN Commercial |
$5,953.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,853.16
|
| Rate for Payer: Multiplan Commercial |
$5,176.70
|
| Rate for Payer: NAPHCARE Commercial |
$3,882.53
|
| Rate for Payer: Preferred Network Access Commercial |
$5,953.21
|
| Rate for Payer: Quartz Beloit One Network |
$3,170.73
|
| Rate for Payer: Quartz Commercial |
$4,206.07
|
| Rate for Payer: Quartz Medicare Advantage |
$3,882.53
|
| Rate for Payer: The Alliance Commercial |
$3,235.44
|
| Rate for Payer: WEA Trust Commercial |
$3,558.98
|
| Rate for Payer: WPS Commercial |
$4,792.81
|
|
|
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 |
$3,170.73 |
| Max. Negotiated Rate |
$5,953.21 |
| Rate for Payer: Aetna Commercial |
$5,823.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,564.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,429.57
|
| Rate for Payer: Cash Price |
$1,866.60
|
| Rate for Payer: Cigna Commercial |
$5,953.21
|
| Rate for Payer: Health EOS Commercial |
$5,759.08
|
| Rate for Payer: HFN Commercial |
$5,953.21
|
| Rate for Payer: Multiplan Commercial |
$5,176.70
|
| Rate for Payer: Preferred Network Access Commercial |
$5,953.21
|
| Rate for Payer: Quartz Beloit One Network |
$3,170.73
|
| Rate for Payer: Quartz Commercial |
$3,882.53
|
| Rate for Payer: WEA Trust Commercial |
$3,558.98
|
| Rate for Payer: WPS Commercial |
$4,792.81
|
|
|
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 |
$1,811.85 |
| Max. Negotiated Rate |
$5,953.21 |
| Rate for Payer: Aetna Commercial |
$5,823.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,564.96
|
| Rate for Payer: Aetna Managed Medicare |
$1,811.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,206.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,235.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,106.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,429.57
|
| Rate for Payer: Cash Price |
$1,866.60
|
| Rate for Payer: Cigna Commercial |
$5,953.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,621.20
|
| Rate for Payer: Health EOS Commercial |
$5,759.08
|
| Rate for Payer: HFN Commercial |
$5,953.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,853.16
|
| Rate for Payer: Multiplan Commercial |
$5,176.70
|
| Rate for Payer: NAPHCARE Commercial |
$3,882.53
|
| Rate for Payer: Preferred Network Access Commercial |
$5,953.21
|
| Rate for Payer: Quartz Beloit One Network |
$3,170.73
|
| Rate for Payer: Quartz Commercial |
$4,206.07
|
| Rate for Payer: Quartz Medicare Advantage |
$3,882.53
|
| Rate for Payer: The Alliance Commercial |
$3,235.44
|
| Rate for Payer: WEA Trust Commercial |
$3,558.98
|
| Rate for Payer: WPS Commercial |
$4,792.81
|
|
|
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 |
$1,811.85 |
| Max. Negotiated Rate |
$5,953.21 |
| Rate for Payer: Aetna Commercial |
$5,823.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,564.96
|
| Rate for Payer: Aetna Managed Medicare |
$1,811.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,206.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,235.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,106.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,429.57
|
| Rate for Payer: Cash Price |
$1,866.60
|
| Rate for Payer: Cigna Commercial |
$5,953.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,621.20
|
| Rate for Payer: Health EOS Commercial |
$5,759.08
|
| Rate for Payer: HFN Commercial |
$5,953.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,853.16
|
| Rate for Payer: Multiplan Commercial |
$5,176.70
|
| Rate for Payer: NAPHCARE Commercial |
$3,882.53
|
| Rate for Payer: Preferred Network Access Commercial |
$5,953.21
|
| Rate for Payer: Quartz Beloit One Network |
$3,170.73
|
| Rate for Payer: Quartz Commercial |
$4,206.07
|
| Rate for Payer: Quartz Medicare Advantage |
$3,882.53
|
| Rate for Payer: The Alliance Commercial |
$3,235.44
|
| Rate for Payer: WEA Trust Commercial |
$3,558.98
|
| Rate for Payer: WPS Commercial |
$4,792.81
|
|
|
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 |
$3,170.73 |
| Max. Negotiated Rate |
$5,953.21 |
| Rate for Payer: Aetna Commercial |
$5,823.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,564.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,429.57
|
| Rate for Payer: Cash Price |
$1,866.60
|
| Rate for Payer: Cigna Commercial |
$5,953.21
|
| Rate for Payer: Health EOS Commercial |
$5,759.08
|
| Rate for Payer: HFN Commercial |
$5,953.21
|
| Rate for Payer: Multiplan Commercial |
$5,176.70
|
| Rate for Payer: Preferred Network Access Commercial |
$5,953.21
|
| Rate for Payer: Quartz Beloit One Network |
$3,170.73
|
| Rate for Payer: Quartz Commercial |
$3,882.53
|
| Rate for Payer: WEA Trust Commercial |
$3,558.98
|
| Rate for Payer: WPS Commercial |
$4,792.81
|
|
|
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 |
$3,170.73 |
| Max. Negotiated Rate |
$5,953.21 |
| Rate for Payer: Aetna Commercial |
$5,823.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,564.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,429.57
|
| Rate for Payer: Cash Price |
$1,866.60
|
| Rate for Payer: Cigna Commercial |
$5,953.21
|
| Rate for Payer: Health EOS Commercial |
$5,759.08
|
| Rate for Payer: HFN Commercial |
$5,953.21
|
| Rate for Payer: Multiplan Commercial |
$5,176.70
|
| Rate for Payer: Preferred Network Access Commercial |
$5,953.21
|
| Rate for Payer: Quartz Beloit One Network |
$3,170.73
|
| Rate for Payer: Quartz Commercial |
$3,882.53
|
| Rate for Payer: WEA Trust Commercial |
$3,558.98
|
| Rate for Payer: WPS Commercial |
$4,792.81
|
|
|
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 |
$1,811.85 |
| Max. Negotiated Rate |
$5,953.21 |
| Rate for Payer: Aetna Commercial |
$5,823.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,564.96
|
| Rate for Payer: Aetna Managed Medicare |
$1,811.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,206.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,235.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,106.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,429.57
|
| Rate for Payer: Cash Price |
$1,866.60
|
| Rate for Payer: Cigna Commercial |
$5,953.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,621.20
|
| Rate for Payer: Health EOS Commercial |
$5,759.08
|
| Rate for Payer: HFN Commercial |
$5,953.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,853.16
|
| Rate for Payer: Multiplan Commercial |
$5,176.70
|
| Rate for Payer: NAPHCARE Commercial |
$3,882.53
|
| Rate for Payer: Preferred Network Access Commercial |
$5,953.21
|
| Rate for Payer: Quartz Beloit One Network |
$3,170.73
|
| Rate for Payer: Quartz Commercial |
$4,206.07
|
| Rate for Payer: Quartz Medicare Advantage |
$3,882.53
|
| Rate for Payer: The Alliance Commercial |
$3,235.44
|
| Rate for Payer: WEA Trust Commercial |
$3,558.98
|
| Rate for Payer: WPS Commercial |
$4,792.81
|
|
|
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 |
$3,170.73 |
| Max. Negotiated Rate |
$5,953.21 |
| Rate for Payer: Aetna Commercial |
$5,823.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,564.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,429.57
|
| Rate for Payer: Cash Price |
$1,866.60
|
| Rate for Payer: Cigna Commercial |
$5,953.21
|
| Rate for Payer: Health EOS Commercial |
$5,759.08
|
| Rate for Payer: HFN Commercial |
$5,953.21
|
| Rate for Payer: Multiplan Commercial |
$5,176.70
|
| Rate for Payer: Preferred Network Access Commercial |
$5,953.21
|
| Rate for Payer: Quartz Beloit One Network |
$3,170.73
|
| Rate for Payer: Quartz Commercial |
$3,882.53
|
| Rate for Payer: WEA Trust Commercial |
$3,558.98
|
| Rate for Payer: WPS Commercial |
$4,792.81
|
|
|
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 |
$1,811.85 |
| Max. Negotiated Rate |
$5,953.21 |
| Rate for Payer: Aetna Commercial |
$5,823.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,564.96
|
| Rate for Payer: Aetna Managed Medicare |
$1,811.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,206.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,235.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,106.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,429.57
|
| Rate for Payer: Cash Price |
$1,866.60
|
| Rate for Payer: Cigna Commercial |
$5,953.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,621.20
|
| Rate for Payer: Health EOS Commercial |
$5,759.08
|
| Rate for Payer: HFN Commercial |
$5,953.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,853.16
|
| Rate for Payer: Multiplan Commercial |
$5,176.70
|
| Rate for Payer: NAPHCARE Commercial |
$3,882.53
|
| Rate for Payer: Preferred Network Access Commercial |
$5,953.21
|
| Rate for Payer: Quartz Beloit One Network |
$3,170.73
|
| Rate for Payer: Quartz Commercial |
$4,206.07
|
| Rate for Payer: Quartz Medicare Advantage |
$3,882.53
|
| Rate for Payer: The Alliance Commercial |
$3,235.44
|
| Rate for Payer: WEA Trust Commercial |
$3,558.98
|
| Rate for Payer: WPS Commercial |
$4,792.81
|
|
|
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 |
$1,811.85 |
| Max. Negotiated Rate |
$5,953.21 |
| Rate for Payer: Aetna Commercial |
$5,823.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,564.96
|
| Rate for Payer: Aetna Managed Medicare |
$1,811.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,206.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,235.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,106.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,429.57
|
| Rate for Payer: Cash Price |
$1,866.60
|
| Rate for Payer: Cigna Commercial |
$5,953.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,621.20
|
| Rate for Payer: Health EOS Commercial |
$5,759.08
|
| Rate for Payer: HFN Commercial |
$5,953.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,853.16
|
| Rate for Payer: Multiplan Commercial |
$5,176.70
|
| Rate for Payer: NAPHCARE Commercial |
$3,882.53
|
| Rate for Payer: Preferred Network Access Commercial |
$5,953.21
|
| Rate for Payer: Quartz Beloit One Network |
$3,170.73
|
| Rate for Payer: Quartz Commercial |
$4,206.07
|
| Rate for Payer: Quartz Medicare Advantage |
$3,882.53
|
| Rate for Payer: The Alliance Commercial |
$3,235.44
|
| Rate for Payer: WEA Trust Commercial |
$3,558.98
|
| Rate for Payer: WPS Commercial |
$4,792.81
|
|
|
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 |
$3,170.73 |
| Max. Negotiated Rate |
$5,953.21 |
| Rate for Payer: Aetna Commercial |
$5,823.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,564.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,429.57
|
| Rate for Payer: Cash Price |
$1,866.60
|
| Rate for Payer: Cigna Commercial |
$5,953.21
|
| Rate for Payer: Health EOS Commercial |
$5,759.08
|
| Rate for Payer: HFN Commercial |
$5,953.21
|
| Rate for Payer: Multiplan Commercial |
$5,176.70
|
| Rate for Payer: Preferred Network Access Commercial |
$5,953.21
|
| Rate for Payer: Quartz Beloit One Network |
$3,170.73
|
| Rate for Payer: Quartz Commercial |
$3,882.53
|
| Rate for Payer: WEA Trust Commercial |
$3,558.98
|
| Rate for Payer: WPS Commercial |
$4,792.81
|
|
|
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 |
$1,811.85 |
| Max. Negotiated Rate |
$5,953.21 |
| Rate for Payer: Aetna Commercial |
$5,823.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,564.96
|
| Rate for Payer: Aetna Managed Medicare |
$1,811.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,206.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,235.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,106.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,429.57
|
| Rate for Payer: Cash Price |
$1,866.60
|
| Rate for Payer: Cigna Commercial |
$5,953.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,621.20
|
| Rate for Payer: Health EOS Commercial |
$5,759.08
|
| Rate for Payer: HFN Commercial |
$5,953.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,853.16
|
| Rate for Payer: Multiplan Commercial |
$5,176.70
|
| Rate for Payer: NAPHCARE Commercial |
$3,882.53
|
| Rate for Payer: Preferred Network Access Commercial |
$5,953.21
|
| Rate for Payer: Quartz Beloit One Network |
$3,170.73
|
| Rate for Payer: Quartz Commercial |
$4,206.07
|
| Rate for Payer: Quartz Medicare Advantage |
$3,882.53
|
| Rate for Payer: The Alliance Commercial |
$3,235.44
|
| Rate for Payer: WEA Trust Commercial |
$3,558.98
|
| Rate for Payer: WPS Commercial |
$4,792.81
|
|
|
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 |
$3,170.73 |
| Max. Negotiated Rate |
$5,953.21 |
| Rate for Payer: Aetna Commercial |
$5,823.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,564.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,429.57
|
| Rate for Payer: Cash Price |
$1,866.60
|
| Rate for Payer: Cigna Commercial |
$5,953.21
|
| Rate for Payer: Health EOS Commercial |
$5,759.08
|
| Rate for Payer: HFN Commercial |
$5,953.21
|
| Rate for Payer: Multiplan Commercial |
$5,176.70
|
| Rate for Payer: Preferred Network Access Commercial |
$5,953.21
|
| Rate for Payer: Quartz Beloit One Network |
$3,170.73
|
| Rate for Payer: Quartz Commercial |
$3,882.53
|
| Rate for Payer: WEA Trust Commercial |
$3,558.98
|
| Rate for Payer: WPS Commercial |
$4,792.81
|
|
|
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 |
$4,840.69 |
| Max. Negotiated Rate |
$9,088.64 |
| Rate for Payer: Aetna Commercial |
$8,891.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,495.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,235.85
|
| Rate for Payer: Cash Price |
$2,849.70
|
| Rate for Payer: Cigna Commercial |
$9,088.64
|
| Rate for Payer: Health EOS Commercial |
$8,792.27
|
| Rate for Payer: HFN Commercial |
$9,088.64
|
| Rate for Payer: Multiplan Commercial |
$7,903.17
|
| Rate for Payer: Preferred Network Access Commercial |
$9,088.64
|
| Rate for Payer: Quartz Beloit One Network |
$4,840.69
|
| Rate for Payer: Quartz Commercial |
$5,927.38
|
| Rate for Payer: WEA Trust Commercial |
$5,433.43
|
| Rate for Payer: WPS Commercial |
$7,317.08
|
|
|
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 |
$2,766.11 |
| Max. Negotiated Rate |
$9,088.64 |
| Rate for Payer: Aetna Commercial |
$8,891.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,495.91
|
| Rate for Payer: Aetna Managed Medicare |
$2,766.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,421.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,939.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,741.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,235.85
|
| Rate for Payer: Cash Price |
$2,849.70
|
| Rate for Payer: Cigna Commercial |
$9,088.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,528.42
|
| Rate for Payer: Health EOS Commercial |
$8,792.27
|
| Rate for Payer: HFN Commercial |
$9,088.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,409.22
|
| Rate for Payer: Multiplan Commercial |
$7,903.17
|
| Rate for Payer: NAPHCARE Commercial |
$5,927.38
|
| Rate for Payer: Preferred Network Access Commercial |
$9,088.64
|
| Rate for Payer: Quartz Beloit One Network |
$4,840.69
|
| Rate for Payer: Quartz Commercial |
$6,421.32
|
| Rate for Payer: Quartz Medicare Advantage |
$5,927.38
|
| Rate for Payer: The Alliance Commercial |
$4,939.48
|
| Rate for Payer: WEA Trust Commercial |
$5,433.43
|
| Rate for Payer: WPS Commercial |
$7,317.08
|
|
|
TIBIAL BASEPLATE TRIATHLON SZ 3 5521-B-300
|
Facility
|
OP
|
$9,499.00
|
|
| Hospital Charge Code |
3128846
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,766.11 |
| Max. Negotiated Rate |
$9,088.64 |
| Rate for Payer: Aetna Commercial |
$8,891.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,495.91
|
| Rate for Payer: Aetna Managed Medicare |
$2,766.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,421.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,939.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,741.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,235.85
|
| Rate for Payer: Cash Price |
$2,849.70
|
| Rate for Payer: Cigna Commercial |
$9,088.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,528.42
|
| Rate for Payer: Health EOS Commercial |
$8,792.27
|
| Rate for Payer: HFN Commercial |
$9,088.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,409.22
|
| Rate for Payer: Multiplan Commercial |
$7,903.17
|
| Rate for Payer: NAPHCARE Commercial |
$5,927.38
|
| Rate for Payer: Preferred Network Access Commercial |
$9,088.64
|
| Rate for Payer: Quartz Beloit One Network |
$4,840.69
|
| Rate for Payer: Quartz Commercial |
$6,421.32
|
| Rate for Payer: Quartz Medicare Advantage |
$5,927.38
|
| Rate for Payer: The Alliance Commercial |
$4,939.48
|
| Rate for Payer: WEA Trust Commercial |
$5,433.43
|
| Rate for Payer: WPS Commercial |
$7,317.08
|
|
