|
HALF BLOCK TRIATHLON TIBIAL AUGMENT SZ 4 5MM 5546-A-402
|
Facility
|
OP
|
$6,324.00
|
|
| Hospital Charge Code |
5286734
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,841.55 |
| Max. Negotiated Rate |
$6,050.80 |
| Rate for Payer: Aetna Commercial |
$5,919.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,656.19
|
| Rate for Payer: Aetna Managed Medicare |
$1,841.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,275.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,288.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,156.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,485.79
|
| Rate for Payer: Cash Price |
$1,897.20
|
| Rate for Payer: Cigna Commercial |
$6,050.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,680.57
|
| Rate for Payer: Health EOS Commercial |
$5,853.49
|
| Rate for Payer: HFN Commercial |
$6,050.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,932.72
|
| Rate for Payer: Multiplan Commercial |
$5,261.57
|
| Rate for Payer: NAPHCARE Commercial |
$3,946.18
|
| Rate for Payer: Preferred Network Access Commercial |
$6,050.80
|
| Rate for Payer: Quartz Beloit One Network |
$3,222.71
|
| Rate for Payer: Quartz Commercial |
$4,275.02
|
| Rate for Payer: Quartz Medicare Advantage |
$3,946.18
|
| Rate for Payer: The Alliance Commercial |
$3,288.48
|
| Rate for Payer: WEA Trust Commercial |
$3,617.33
|
| Rate for Payer: WPS Commercial |
$4,871.38
|
|
|
HALF BLOCK TRIATHLON TIBIAL AUGMENT SZ 4 5MM 5546-A-402
|
Facility
|
IP
|
$6,324.00
|
|
| Hospital Charge Code |
5286734
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,222.71 |
| Max. Negotiated Rate |
$6,050.80 |
| Rate for Payer: Aetna Commercial |
$5,919.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,656.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,485.79
|
| Rate for Payer: Cash Price |
$1,897.20
|
| Rate for Payer: Cigna Commercial |
$6,050.80
|
| Rate for Payer: Health EOS Commercial |
$5,853.49
|
| Rate for Payer: HFN Commercial |
$6,050.80
|
| Rate for Payer: Multiplan Commercial |
$5,261.57
|
| Rate for Payer: Preferred Network Access Commercial |
$6,050.80
|
| Rate for Payer: Quartz Beloit One Network |
$3,222.71
|
| Rate for Payer: Quartz Commercial |
$3,946.18
|
| Rate for Payer: WEA Trust Commercial |
$3,617.33
|
| Rate for Payer: WPS Commercial |
$4,871.38
|
|
|
HALF BLOCK TRIATHLON TIBIAL AUGMENT SZ 5 10MM 5546-A-501
|
Facility
|
OP
|
$6,090.00
|
|
| Hospital Charge Code |
5306776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,773.41 |
| Max. Negotiated Rate |
$5,826.91 |
| Rate for Payer: Aetna Commercial |
$5,700.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,446.90
|
| Rate for Payer: Aetna Managed Medicare |
$1,773.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,116.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,166.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,040.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,356.81
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cigna Commercial |
$5,826.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,544.38
|
| Rate for Payer: Health EOS Commercial |
$5,636.90
|
| Rate for Payer: HFN Commercial |
$5,826.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,750.20
|
| Rate for Payer: Multiplan Commercial |
$5,066.88
|
| Rate for Payer: NAPHCARE Commercial |
$3,800.16
|
| Rate for Payer: Preferred Network Access Commercial |
$5,826.91
|
| Rate for Payer: Quartz Beloit One Network |
$3,103.46
|
| Rate for Payer: Quartz Commercial |
$4,116.84
|
| Rate for Payer: Quartz Medicare Advantage |
$3,800.16
|
| Rate for Payer: The Alliance Commercial |
$3,166.80
|
| Rate for Payer: WEA Trust Commercial |
$3,483.48
|
| Rate for Payer: WPS Commercial |
$4,691.13
|
|
|
HALF BLOCK TRIATHLON TIBIAL AUGMENT SZ 5 10MM 5546-A-501
|
Facility
|
IP
|
$6,090.00
|
|
| Hospital Charge Code |
5306776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,103.46 |
| Max. Negotiated Rate |
$5,826.91 |
| Rate for Payer: Aetna Commercial |
$5,700.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,446.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,356.81
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cigna Commercial |
$5,826.91
|
| Rate for Payer: Health EOS Commercial |
$5,636.90
|
| Rate for Payer: HFN Commercial |
$5,826.91
|
| Rate for Payer: Multiplan Commercial |
$5,066.88
|
| Rate for Payer: Preferred Network Access Commercial |
$5,826.91
|
| Rate for Payer: Quartz Beloit One Network |
$3,103.46
|
| Rate for Payer: Quartz Commercial |
$3,800.16
|
| Rate for Payer: WEA Trust Commercial |
$3,483.48
|
| Rate for Payer: WPS Commercial |
$4,691.13
|
|
|
HALF BLOCK TRIATHLON TIBIAL AUGMENT SZ 5 5MM 5546-A-502
|
Facility
|
OP
|
$6,090.00
|
|
| Hospital Charge Code |
5306777
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,773.41 |
| Max. Negotiated Rate |
$5,826.91 |
| Rate for Payer: Aetna Commercial |
$5,700.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,446.90
|
| Rate for Payer: Aetna Managed Medicare |
$1,773.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,116.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,166.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,040.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,356.81
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cigna Commercial |
$5,826.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,544.38
|
| Rate for Payer: Health EOS Commercial |
$5,636.90
|
| Rate for Payer: HFN Commercial |
$5,826.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,750.20
|
| Rate for Payer: Multiplan Commercial |
$5,066.88
|
| Rate for Payer: NAPHCARE Commercial |
$3,800.16
|
| Rate for Payer: Preferred Network Access Commercial |
$5,826.91
|
| Rate for Payer: Quartz Beloit One Network |
$3,103.46
|
| Rate for Payer: Quartz Commercial |
$4,116.84
|
| Rate for Payer: Quartz Medicare Advantage |
$3,800.16
|
| Rate for Payer: The Alliance Commercial |
$3,166.80
|
| Rate for Payer: WEA Trust Commercial |
$3,483.48
|
| Rate for Payer: WPS Commercial |
$4,691.13
|
|
|
HALF BLOCK TRIATHLON TIBIAL AUGMENT SZ 5 5MM 5546-A-502
|
Facility
|
IP
|
$6,090.00
|
|
| Hospital Charge Code |
5306777
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,103.46 |
| Max. Negotiated Rate |
$5,826.91 |
| Rate for Payer: Aetna Commercial |
$5,700.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,446.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,356.81
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cigna Commercial |
$5,826.91
|
| Rate for Payer: Health EOS Commercial |
$5,636.90
|
| Rate for Payer: HFN Commercial |
$5,826.91
|
| Rate for Payer: Multiplan Commercial |
$5,066.88
|
| Rate for Payer: Preferred Network Access Commercial |
$5,826.91
|
| Rate for Payer: Quartz Beloit One Network |
$3,103.46
|
| Rate for Payer: Quartz Commercial |
$3,800.16
|
| Rate for Payer: WEA Trust Commercial |
$3,483.48
|
| Rate for Payer: WPS Commercial |
$4,691.13
|
|
|
HALF BLOCK TRIATHLON TIBIAL AUGMENT SZ 6 10MM 5546-A-601
|
Facility
|
OP
|
$6,089.00
|
|
| Hospital Charge Code |
3827372
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,773.12 |
| Max. Negotiated Rate |
$5,825.96 |
| Rate for Payer: Aetna Commercial |
$5,699.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,446.00
|
| Rate for Payer: Aetna Managed Medicare |
$1,773.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,116.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,166.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,039.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,356.26
|
| Rate for Payer: Cash Price |
$1,826.70
|
| Rate for Payer: Cigna Commercial |
$5,825.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,543.80
|
| Rate for Payer: Health EOS Commercial |
$5,635.98
|
| Rate for Payer: HFN Commercial |
$5,825.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,749.42
|
| Rate for Payer: Multiplan Commercial |
$5,066.05
|
| Rate for Payer: NAPHCARE Commercial |
$3,799.54
|
| Rate for Payer: Preferred Network Access Commercial |
$5,825.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,102.95
|
| Rate for Payer: Quartz Commercial |
$4,116.16
|
| Rate for Payer: Quartz Medicare Advantage |
$3,799.54
|
| Rate for Payer: The Alliance Commercial |
$3,166.28
|
| Rate for Payer: WEA Trust Commercial |
$3,482.91
|
| Rate for Payer: WPS Commercial |
$4,690.36
|
|
|
HALF BLOCK TRIATHLON TIBIAL AUGMENT SZ 6 10MM 5546-A-601
|
Facility
|
IP
|
$6,089.00
|
|
| Hospital Charge Code |
3827372
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,102.95 |
| Max. Negotiated Rate |
$5,825.96 |
| Rate for Payer: Aetna Commercial |
$5,699.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,446.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,356.26
|
| Rate for Payer: Cash Price |
$1,826.70
|
| Rate for Payer: Cigna Commercial |
$5,825.96
|
| Rate for Payer: Health EOS Commercial |
$5,635.98
|
| Rate for Payer: HFN Commercial |
$5,825.96
|
| Rate for Payer: Multiplan Commercial |
$5,066.05
|
| Rate for Payer: Preferred Network Access Commercial |
$5,825.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,102.95
|
| Rate for Payer: Quartz Commercial |
$3,799.54
|
| Rate for Payer: WEA Trust Commercial |
$3,482.91
|
| Rate for Payer: WPS Commercial |
$4,690.36
|
|
|
HALF BLOCK TRIATHLON TIBIAL AUGMENT SZ 6 5MM 5546-A-602
|
Facility
|
IP
|
$6,089.00
|
|
| Hospital Charge Code |
3827373
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,102.95 |
| Max. Negotiated Rate |
$5,825.96 |
| Rate for Payer: Aetna Commercial |
$5,699.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,446.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,356.26
|
| Rate for Payer: Cash Price |
$1,826.70
|
| Rate for Payer: Cigna Commercial |
$5,825.96
|
| Rate for Payer: Health EOS Commercial |
$5,635.98
|
| Rate for Payer: HFN Commercial |
$5,825.96
|
| Rate for Payer: Multiplan Commercial |
$5,066.05
|
| Rate for Payer: Preferred Network Access Commercial |
$5,825.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,102.95
|
| Rate for Payer: Quartz Commercial |
$3,799.54
|
| Rate for Payer: WEA Trust Commercial |
$3,482.91
|
| Rate for Payer: WPS Commercial |
$4,690.36
|
|
|
HALF BLOCK TRIATHLON TIBIAL AUGMENT SZ 6 5MM 5546-A-602
|
Facility
|
OP
|
$6,089.00
|
|
| Hospital Charge Code |
3827373
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,773.12 |
| Max. Negotiated Rate |
$5,825.96 |
| Rate for Payer: Aetna Commercial |
$5,699.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,446.00
|
| Rate for Payer: Aetna Managed Medicare |
$1,773.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,116.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,166.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,039.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,356.26
|
| Rate for Payer: Cash Price |
$1,826.70
|
| Rate for Payer: Cigna Commercial |
$5,825.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,543.80
|
| Rate for Payer: Health EOS Commercial |
$5,635.98
|
| Rate for Payer: HFN Commercial |
$5,825.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,749.42
|
| Rate for Payer: Multiplan Commercial |
$5,066.05
|
| Rate for Payer: NAPHCARE Commercial |
$3,799.54
|
| Rate for Payer: Preferred Network Access Commercial |
$5,825.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,102.95
|
| Rate for Payer: Quartz Commercial |
$4,116.16
|
| Rate for Payer: Quartz Medicare Advantage |
$3,799.54
|
| Rate for Payer: The Alliance Commercial |
$3,166.28
|
| Rate for Payer: WEA Trust Commercial |
$3,482.91
|
| Rate for Payer: WPS Commercial |
$4,690.36
|
|
|
HALF BLOCK TRIATHLON TIBIAL AUGMENT SZ 7 10MM 5546-A-701
|
Facility
|
IP
|
$6,324.00
|
|
| Hospital Charge Code |
5106747
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,222.71 |
| Max. Negotiated Rate |
$6,050.80 |
| Rate for Payer: Aetna Commercial |
$5,919.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,656.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,485.79
|
| Rate for Payer: Cash Price |
$1,897.20
|
| Rate for Payer: Cigna Commercial |
$6,050.80
|
| Rate for Payer: Health EOS Commercial |
$5,853.49
|
| Rate for Payer: HFN Commercial |
$6,050.80
|
| Rate for Payer: Multiplan Commercial |
$5,261.57
|
| Rate for Payer: Preferred Network Access Commercial |
$6,050.80
|
| Rate for Payer: Quartz Beloit One Network |
$3,222.71
|
| Rate for Payer: Quartz Commercial |
$3,946.18
|
| Rate for Payer: WEA Trust Commercial |
$3,617.33
|
| Rate for Payer: WPS Commercial |
$4,871.38
|
|
|
HALF BLOCK TRIATHLON TIBIAL AUGMENT SZ 7 10MM 5546-A-701
|
Facility
|
OP
|
$6,324.00
|
|
| Hospital Charge Code |
5106747
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,841.55 |
| Max. Negotiated Rate |
$6,050.80 |
| Rate for Payer: Aetna Commercial |
$5,919.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,656.19
|
| Rate for Payer: Aetna Managed Medicare |
$1,841.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,275.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,288.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,156.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,485.79
|
| Rate for Payer: Cash Price |
$1,897.20
|
| Rate for Payer: Cigna Commercial |
$6,050.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,680.57
|
| Rate for Payer: Health EOS Commercial |
$5,853.49
|
| Rate for Payer: HFN Commercial |
$6,050.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,932.72
|
| Rate for Payer: Multiplan Commercial |
$5,261.57
|
| Rate for Payer: NAPHCARE Commercial |
$3,946.18
|
| Rate for Payer: Preferred Network Access Commercial |
$6,050.80
|
| Rate for Payer: Quartz Beloit One Network |
$3,222.71
|
| Rate for Payer: Quartz Commercial |
$4,275.02
|
| Rate for Payer: Quartz Medicare Advantage |
$3,946.18
|
| Rate for Payer: The Alliance Commercial |
$3,288.48
|
| Rate for Payer: WEA Trust Commercial |
$3,617.33
|
| Rate for Payer: WPS Commercial |
$4,871.38
|
|
|
HALF BLOCK TRIATHLON TIBIAL AUGMENT SZ 7 5MM 5546-A-702
|
Facility
|
OP
|
$6,090.00
|
|
| Hospital Charge Code |
4595046
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,773.41 |
| Max. Negotiated Rate |
$5,826.91 |
| Rate for Payer: Aetna Commercial |
$5,700.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,446.90
|
| Rate for Payer: Aetna Managed Medicare |
$1,773.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,116.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,166.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,040.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,356.81
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cigna Commercial |
$5,826.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,544.38
|
| Rate for Payer: Health EOS Commercial |
$5,636.90
|
| Rate for Payer: HFN Commercial |
$5,826.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,750.20
|
| Rate for Payer: Multiplan Commercial |
$5,066.88
|
| Rate for Payer: NAPHCARE Commercial |
$3,800.16
|
| Rate for Payer: Preferred Network Access Commercial |
$5,826.91
|
| Rate for Payer: Quartz Beloit One Network |
$3,103.46
|
| Rate for Payer: Quartz Commercial |
$4,116.84
|
| Rate for Payer: Quartz Medicare Advantage |
$3,800.16
|
| Rate for Payer: The Alliance Commercial |
$3,166.80
|
| Rate for Payer: WEA Trust Commercial |
$3,483.48
|
| Rate for Payer: WPS Commercial |
$4,691.13
|
|
|
HALF BLOCK TRIATHLON TIBIAL AUGMENT SZ 7 5MM 5546-A-702
|
Facility
|
IP
|
$6,090.00
|
|
| Hospital Charge Code |
4595046
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,103.46 |
| Max. Negotiated Rate |
$5,826.91 |
| Rate for Payer: Aetna Commercial |
$5,700.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,446.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,356.81
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cigna Commercial |
$5,826.91
|
| Rate for Payer: Health EOS Commercial |
$5,636.90
|
| Rate for Payer: HFN Commercial |
$5,826.91
|
| Rate for Payer: Multiplan Commercial |
$5,066.88
|
| Rate for Payer: Preferred Network Access Commercial |
$5,826.91
|
| Rate for Payer: Quartz Beloit One Network |
$3,103.46
|
| Rate for Payer: Quartz Commercial |
$3,800.16
|
| Rate for Payer: WEA Trust Commercial |
$3,483.48
|
| Rate for Payer: WPS Commercial |
$4,691.13
|
|
|
HALF BLOCK TRIATHLON TIBIAL AUGMENT SZ 8 10MM 5546-A-801
|
Facility
|
OP
|
$6,090.00
|
|
| Hospital Charge Code |
5307137
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,773.41 |
| Max. Negotiated Rate |
$5,826.91 |
| Rate for Payer: Aetna Commercial |
$5,700.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,446.90
|
| Rate for Payer: Aetna Managed Medicare |
$1,773.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,116.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,166.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,040.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,356.81
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cigna Commercial |
$5,826.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,544.38
|
| Rate for Payer: Health EOS Commercial |
$5,636.90
|
| Rate for Payer: HFN Commercial |
$5,826.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,750.20
|
| Rate for Payer: Multiplan Commercial |
$5,066.88
|
| Rate for Payer: NAPHCARE Commercial |
$3,800.16
|
| Rate for Payer: Preferred Network Access Commercial |
$5,826.91
|
| Rate for Payer: Quartz Beloit One Network |
$3,103.46
|
| Rate for Payer: Quartz Commercial |
$4,116.84
|
| Rate for Payer: Quartz Medicare Advantage |
$3,800.16
|
| Rate for Payer: The Alliance Commercial |
$3,166.80
|
| Rate for Payer: WEA Trust Commercial |
$3,483.48
|
| Rate for Payer: WPS Commercial |
$4,691.13
|
|
|
HALF BLOCK TRIATHLON TIBIAL AUGMENT SZ 8 10MM 5546-A-801
|
Facility
|
IP
|
$6,090.00
|
|
| Hospital Charge Code |
5307137
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,103.46 |
| Max. Negotiated Rate |
$5,826.91 |
| Rate for Payer: Aetna Commercial |
$5,700.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,446.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,356.81
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cigna Commercial |
$5,826.91
|
| Rate for Payer: Health EOS Commercial |
$5,636.90
|
| Rate for Payer: HFN Commercial |
$5,826.91
|
| Rate for Payer: Multiplan Commercial |
$5,066.88
|
| Rate for Payer: Preferred Network Access Commercial |
$5,826.91
|
| Rate for Payer: Quartz Beloit One Network |
$3,103.46
|
| Rate for Payer: Quartz Commercial |
$3,800.16
|
| Rate for Payer: WEA Trust Commercial |
$3,483.48
|
| Rate for Payer: WPS Commercial |
$4,691.13
|
|
|
HALF BLOCK TRIATHLON TIBIAL AUGMENT SZ 8 5MM 5546-A-802
|
Facility
|
OP
|
$6,090.00
|
|
| Hospital Charge Code |
5307139
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,773.41 |
| Max. Negotiated Rate |
$5,826.91 |
| Rate for Payer: Aetna Commercial |
$5,700.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,446.90
|
| Rate for Payer: Aetna Managed Medicare |
$1,773.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,116.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,166.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,040.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,356.81
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cigna Commercial |
$5,826.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,544.38
|
| Rate for Payer: Health EOS Commercial |
$5,636.90
|
| Rate for Payer: HFN Commercial |
$5,826.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,750.20
|
| Rate for Payer: Multiplan Commercial |
$5,066.88
|
| Rate for Payer: NAPHCARE Commercial |
$3,800.16
|
| Rate for Payer: Preferred Network Access Commercial |
$5,826.91
|
| Rate for Payer: Quartz Beloit One Network |
$3,103.46
|
| Rate for Payer: Quartz Commercial |
$4,116.84
|
| Rate for Payer: Quartz Medicare Advantage |
$3,800.16
|
| Rate for Payer: The Alliance Commercial |
$3,166.80
|
| Rate for Payer: WEA Trust Commercial |
$3,483.48
|
| Rate for Payer: WPS Commercial |
$4,691.13
|
|
|
HALF BLOCK TRIATHLON TIBIAL AUGMENT SZ 8 5MM 5546-A-802
|
Facility
|
IP
|
$6,090.00
|
|
| Hospital Charge Code |
5307139
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,103.46 |
| Max. Negotiated Rate |
$5,826.91 |
| Rate for Payer: Aetna Commercial |
$5,700.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,446.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,356.81
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cigna Commercial |
$5,826.91
|
| Rate for Payer: Health EOS Commercial |
$5,636.90
|
| Rate for Payer: HFN Commercial |
$5,826.91
|
| Rate for Payer: Multiplan Commercial |
$5,066.88
|
| Rate for Payer: Preferred Network Access Commercial |
$5,826.91
|
| Rate for Payer: Quartz Beloit One Network |
$3,103.46
|
| Rate for Payer: Quartz Commercial |
$3,800.16
|
| Rate for Payer: WEA Trust Commercial |
$3,483.48
|
| Rate for Payer: WPS Commercial |
$4,691.13
|
|
|
HALF-PIN 2.0 X 45MM 20MM BLUNT SELF-TAPPING APEX 5065-4-520
|
Facility
|
IP
|
$738.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6171750
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$376.08 |
| Max. Negotiated Rate |
$706.12 |
| Rate for Payer: Aetna Commercial |
$690.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$660.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$406.79
|
| Rate for Payer: Cash Price |
$221.40
|
| Rate for Payer: Cigna Commercial |
$706.12
|
| Rate for Payer: Health EOS Commercial |
$683.09
|
| Rate for Payer: HFN Commercial |
$706.12
|
| Rate for Payer: Multiplan Commercial |
$614.02
|
| Rate for Payer: Preferred Network Access Commercial |
$706.12
|
| Rate for Payer: Quartz Beloit One Network |
$376.08
|
| Rate for Payer: Quartz Commercial |
$460.51
|
| Rate for Payer: WEA Trust Commercial |
$422.14
|
| Rate for Payer: WPS Commercial |
$568.48
|
|
|
HALF-PIN 2.0 X 45MM 20MM BLUNT SELF-TAPPING APEX 5065-4-520
|
Facility
|
OP
|
$738.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6171750
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$214.91 |
| Max. Negotiated Rate |
$706.12 |
| Rate for Payer: Aetna Commercial |
$690.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$660.07
|
| Rate for Payer: Aetna Managed Medicare |
$214.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$498.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$383.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$368.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$406.79
|
| Rate for Payer: Cash Price |
$221.40
|
| Rate for Payer: Cigna Commercial |
$706.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$429.52
|
| Rate for Payer: Health EOS Commercial |
$683.09
|
| Rate for Payer: HFN Commercial |
$706.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$575.64
|
| Rate for Payer: Multiplan Commercial |
$614.02
|
| Rate for Payer: NAPHCARE Commercial |
$460.51
|
| Rate for Payer: Preferred Network Access Commercial |
$706.12
|
| Rate for Payer: Quartz Beloit One Network |
$376.08
|
| Rate for Payer: Quartz Commercial |
$498.89
|
| Rate for Payer: Quartz Medicare Advantage |
$460.51
|
| Rate for Payer: The Alliance Commercial |
$383.76
|
| Rate for Payer: WEA Trust Commercial |
$422.14
|
| Rate for Payer: WPS Commercial |
$568.48
|
|
|
HALF-PIN 2.0 X 45MM 20MM SELF-DRILLING/SELF-TAPPING APEX 5080-2-020
|
Facility
|
OP
|
$792.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459557
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$230.63 |
| Max. Negotiated Rate |
$757.79 |
| Rate for Payer: Aetna Commercial |
$741.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$708.36
|
| Rate for Payer: Aetna Managed Medicare |
$230.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$535.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$411.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$395.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$436.55
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cigna Commercial |
$757.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$460.94
|
| Rate for Payer: Health EOS Commercial |
$733.08
|
| Rate for Payer: HFN Commercial |
$757.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$617.76
|
| Rate for Payer: Multiplan Commercial |
$658.94
|
| Rate for Payer: NAPHCARE Commercial |
$494.21
|
| Rate for Payer: Preferred Network Access Commercial |
$757.79
|
| Rate for Payer: Quartz Beloit One Network |
$403.60
|
| Rate for Payer: Quartz Commercial |
$535.39
|
| Rate for Payer: Quartz Medicare Advantage |
$494.21
|
| Rate for Payer: The Alliance Commercial |
$411.84
|
| Rate for Payer: WEA Trust Commercial |
$453.02
|
| Rate for Payer: WPS Commercial |
$610.08
|
|
|
HALF-PIN 2.0 X 45MM 20MM SELF-DRILLING/SELF-TAPPING APEX 5080-2-020
|
Facility
|
IP
|
$792.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459557
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$403.60 |
| Max. Negotiated Rate |
$757.79 |
| Rate for Payer: Aetna Commercial |
$741.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$708.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$436.55
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cigna Commercial |
$757.79
|
| Rate for Payer: Health EOS Commercial |
$733.08
|
| Rate for Payer: HFN Commercial |
$757.79
|
| Rate for Payer: Multiplan Commercial |
$658.94
|
| Rate for Payer: Preferred Network Access Commercial |
$757.79
|
| Rate for Payer: Quartz Beloit One Network |
$403.60
|
| Rate for Payer: Quartz Commercial |
$494.21
|
| Rate for Payer: WEA Trust Commercial |
$453.02
|
| Rate for Payer: WPS Commercial |
$610.08
|
|
|
HALF-PIN 4.0 X 180MM APEX SELF-DRILLING 5023-4-180
|
Facility
|
IP
|
$1,042.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685883
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$531.00 |
| Max. Negotiated Rate |
$996.99 |
| Rate for Payer: Aetna Commercial |
$975.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$931.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.35
|
| Rate for Payer: Cash Price |
$312.60
|
| Rate for Payer: Cigna Commercial |
$996.99
|
| Rate for Payer: Health EOS Commercial |
$964.48
|
| Rate for Payer: HFN Commercial |
$996.99
|
| Rate for Payer: Multiplan Commercial |
$866.94
|
| Rate for Payer: Preferred Network Access Commercial |
$996.99
|
| Rate for Payer: Quartz Beloit One Network |
$531.00
|
| Rate for Payer: Quartz Commercial |
$650.21
|
| Rate for Payer: WEA Trust Commercial |
$596.02
|
| Rate for Payer: WPS Commercial |
$802.65
|
|
|
HALF-PIN 4.0 X 180MM APEX SELF-DRILLING 5023-4-180
|
Facility
|
OP
|
$1,042.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685883
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$303.43 |
| Max. Negotiated Rate |
$996.99 |
| Rate for Payer: Aetna Commercial |
$975.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$931.96
|
| Rate for Payer: Aetna Managed Medicare |
$303.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$704.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$541.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$520.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.35
|
| Rate for Payer: Cash Price |
$312.60
|
| Rate for Payer: Cigna Commercial |
$996.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$606.44
|
| Rate for Payer: Health EOS Commercial |
$964.48
|
| Rate for Payer: HFN Commercial |
$996.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$812.76
|
| Rate for Payer: Multiplan Commercial |
$866.94
|
| Rate for Payer: NAPHCARE Commercial |
$650.21
|
| Rate for Payer: Preferred Network Access Commercial |
$996.99
|
| Rate for Payer: Quartz Beloit One Network |
$531.00
|
| Rate for Payer: Quartz Commercial |
$704.39
|
| Rate for Payer: Quartz Medicare Advantage |
$650.21
|
| Rate for Payer: The Alliance Commercial |
$541.84
|
| Rate for Payer: WEA Trust Commercial |
$596.02
|
| Rate for Payer: WPS Commercial |
$802.65
|
|
|
HALF-PIN APEX 1.65 X 45MM 20MM THREAD 5080-1-620
|
Facility
|
IP
|
$792.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5349475
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$403.60 |
| Max. Negotiated Rate |
$757.79 |
| Rate for Payer: Aetna Commercial |
$741.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$708.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$436.55
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cigna Commercial |
$757.79
|
| Rate for Payer: Health EOS Commercial |
$733.08
|
| Rate for Payer: HFN Commercial |
$757.79
|
| Rate for Payer: Multiplan Commercial |
$658.94
|
| Rate for Payer: Preferred Network Access Commercial |
$757.79
|
| Rate for Payer: Quartz Beloit One Network |
$403.60
|
| Rate for Payer: Quartz Commercial |
$494.21
|
| Rate for Payer: WEA Trust Commercial |
$453.02
|
| Rate for Payer: WPS Commercial |
$610.08
|
|
