|
HALF BLOCK TRIATHLON TIBIAL AUGMENT SZ 1 5MM 5546-A-102
|
Facility
|
IP
|
$6,090.00
|
|
| Hospital Charge Code |
5240745
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,984.10 |
| Max. Negotiated Rate |
$5,602.80 |
| Rate for Payer: Aetna Commercial |
$5,481.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,237.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,227.70
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cigna Commercial |
$5,602.80
|
| Rate for Payer: Health EOS Commercial |
$5,420.10
|
| Rate for Payer: HFN Commercial |
$5,602.80
|
| Rate for Payer: Multiplan Commercial |
$4,872.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,654.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,602.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,984.10
|
| Rate for Payer: Quartz Commercial |
$3,654.00
|
| Rate for Payer: WEA Trust Commercial |
$3,349.50
|
| Rate for Payer: WPS Commercial |
$4,510.86
|
|
|
HALF BLOCK TRIATHLON TIBIAL AUGMENT SZ 2 10MM 5546-A-201
|
Facility
|
IP
|
$6,090.00
|
|
| Hospital Charge Code |
5264614
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,984.10 |
| Max. Negotiated Rate |
$5,602.80 |
| Rate for Payer: Aetna Commercial |
$5,481.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,237.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,227.70
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cigna Commercial |
$5,602.80
|
| Rate for Payer: Health EOS Commercial |
$5,420.10
|
| Rate for Payer: HFN Commercial |
$5,602.80
|
| Rate for Payer: Multiplan Commercial |
$4,872.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,654.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,602.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,984.10
|
| Rate for Payer: Quartz Commercial |
$3,654.00
|
| Rate for Payer: WEA Trust Commercial |
$3,349.50
|
| Rate for Payer: WPS Commercial |
$4,510.86
|
|
|
HALF BLOCK TRIATHLON TIBIAL AUGMENT SZ 2 10MM 5546-A-201
|
Facility
|
OP
|
$6,090.00
|
|
| Hospital Charge Code |
5264614
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,705.20 |
| Max. Negotiated Rate |
$24,360.00 |
| Rate for Payer: Aetna Commercial |
$5,481.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,237.40
|
| Rate for Payer: Aetna Managed Medicare |
$1,705.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,958.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,045.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,923.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,227.70
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cigna Commercial |
$5,602.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,407.96
|
| Rate for Payer: Health EOS Commercial |
$5,420.10
|
| Rate for Payer: HFN Commercial |
$5,602.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,567.50
|
| Rate for Payer: Multiplan Commercial |
$4,872.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,654.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,602.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,984.10
|
| Rate for Payer: Quartz Commercial |
$3,958.50
|
| Rate for Payer: Quartz Medicare Advantage |
$3,654.00
|
| Rate for Payer: The Alliance Commercial |
$24,360.00
|
| Rate for Payer: WEA Trust Commercial |
$3,349.50
|
| Rate for Payer: WPS Commercial |
$4,510.86
|
|
|
HALF BLOCK TRIATHLON TIBIAL AUGMENT SZ 2 5MM 5546-A-202
|
Facility
|
OP
|
$6,090.00
|
|
| Hospital Charge Code |
5074736
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,705.20 |
| Max. Negotiated Rate |
$24,360.00 |
| Rate for Payer: Aetna Commercial |
$5,481.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,237.40
|
| Rate for Payer: Aetna Managed Medicare |
$1,705.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,958.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,045.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,923.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,227.70
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cigna Commercial |
$5,602.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,407.96
|
| Rate for Payer: Health EOS Commercial |
$5,420.10
|
| Rate for Payer: HFN Commercial |
$5,602.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,567.50
|
| Rate for Payer: Multiplan Commercial |
$4,872.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,654.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,602.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,984.10
|
| Rate for Payer: Quartz Commercial |
$3,958.50
|
| Rate for Payer: Quartz Medicare Advantage |
$3,654.00
|
| Rate for Payer: The Alliance Commercial |
$24,360.00
|
| Rate for Payer: WEA Trust Commercial |
$3,349.50
|
| Rate for Payer: WPS Commercial |
$4,510.86
|
|
|
HALF BLOCK TRIATHLON TIBIAL AUGMENT SZ 2 5MM 5546-A-202
|
Facility
|
IP
|
$6,090.00
|
|
| Hospital Charge Code |
5074736
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,984.10 |
| Max. Negotiated Rate |
$5,602.80 |
| Rate for Payer: Aetna Commercial |
$5,481.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,237.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,227.70
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cigna Commercial |
$5,602.80
|
| Rate for Payer: Health EOS Commercial |
$5,420.10
|
| Rate for Payer: HFN Commercial |
$5,602.80
|
| Rate for Payer: Multiplan Commercial |
$4,872.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,654.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,602.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,984.10
|
| Rate for Payer: Quartz Commercial |
$3,654.00
|
| Rate for Payer: WEA Trust Commercial |
$3,349.50
|
| Rate for Payer: WPS Commercial |
$4,510.86
|
|
|
HALF BLOCK TRIATHLON TIBIAL AUGMENT SZ 3 10MM 5546-A-301
|
Facility
|
OP
|
$6,090.00
|
|
| Hospital Charge Code |
5286730
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,705.20 |
| Max. Negotiated Rate |
$24,360.00 |
| Rate for Payer: Aetna Commercial |
$5,481.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,237.40
|
| Rate for Payer: Aetna Managed Medicare |
$1,705.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,958.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,045.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,923.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,227.70
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cigna Commercial |
$5,602.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,407.96
|
| Rate for Payer: Health EOS Commercial |
$5,420.10
|
| Rate for Payer: HFN Commercial |
$5,602.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,567.50
|
| Rate for Payer: Multiplan Commercial |
$4,872.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,654.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,602.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,984.10
|
| Rate for Payer: Quartz Commercial |
$3,958.50
|
| Rate for Payer: Quartz Medicare Advantage |
$3,654.00
|
| Rate for Payer: The Alliance Commercial |
$24,360.00
|
| Rate for Payer: WEA Trust Commercial |
$3,349.50
|
| Rate for Payer: WPS Commercial |
$4,510.86
|
|
|
HALF BLOCK TRIATHLON TIBIAL AUGMENT SZ 3 10MM 5546-A-301
|
Facility
|
IP
|
$6,090.00
|
|
| Hospital Charge Code |
5286730
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,984.10 |
| Max. Negotiated Rate |
$5,602.80 |
| Rate for Payer: Aetna Commercial |
$5,481.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,237.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,227.70
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cigna Commercial |
$5,602.80
|
| Rate for Payer: Health EOS Commercial |
$5,420.10
|
| Rate for Payer: HFN Commercial |
$5,602.80
|
| Rate for Payer: Multiplan Commercial |
$4,872.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,654.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,602.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,984.10
|
| Rate for Payer: Quartz Commercial |
$3,654.00
|
| Rate for Payer: WEA Trust Commercial |
$3,349.50
|
| Rate for Payer: WPS Commercial |
$4,510.86
|
|
|
HALF BLOCK TRIATHLON TIBIAL AUGMENT SZ 3 5MM 5546-A-302
|
Facility
|
IP
|
$6,090.00
|
|
| Hospital Charge Code |
5286731
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,984.10 |
| Max. Negotiated Rate |
$5,602.80 |
| Rate for Payer: Aetna Commercial |
$5,481.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,237.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,227.70
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cigna Commercial |
$5,602.80
|
| Rate for Payer: Health EOS Commercial |
$5,420.10
|
| Rate for Payer: HFN Commercial |
$5,602.80
|
| Rate for Payer: Multiplan Commercial |
$4,872.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,654.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,602.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,984.10
|
| Rate for Payer: Quartz Commercial |
$3,654.00
|
| Rate for Payer: WEA Trust Commercial |
$3,349.50
|
| Rate for Payer: WPS Commercial |
$4,510.86
|
|
|
HALF BLOCK TRIATHLON TIBIAL AUGMENT SZ 3 5MM 5546-A-302
|
Facility
|
OP
|
$6,090.00
|
|
| Hospital Charge Code |
5286731
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,705.20 |
| Max. Negotiated Rate |
$24,360.00 |
| Rate for Payer: Aetna Commercial |
$5,481.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,237.40
|
| Rate for Payer: Aetna Managed Medicare |
$1,705.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,958.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,045.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,923.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,227.70
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cigna Commercial |
$5,602.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,407.96
|
| Rate for Payer: Health EOS Commercial |
$5,420.10
|
| Rate for Payer: HFN Commercial |
$5,602.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,567.50
|
| Rate for Payer: Multiplan Commercial |
$4,872.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,654.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,602.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,984.10
|
| Rate for Payer: Quartz Commercial |
$3,958.50
|
| Rate for Payer: Quartz Medicare Advantage |
$3,654.00
|
| Rate for Payer: The Alliance Commercial |
$24,360.00
|
| Rate for Payer: WEA Trust Commercial |
$3,349.50
|
| Rate for Payer: WPS Commercial |
$4,510.86
|
|
|
HALF BLOCK TRIATHLON TIBIAL AUGMENT SZ 4 10MM 5546-A-401
|
Facility
|
OP
|
$6,089.00
|
|
| Hospital Charge Code |
5286733
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,704.92 |
| Max. Negotiated Rate |
$24,356.00 |
| Rate for Payer: Aetna Commercial |
$5,480.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,236.54
|
| Rate for Payer: Aetna Managed Medicare |
$1,704.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,957.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,044.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,922.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,227.17
|
| Rate for Payer: Cash Price |
$1,826.70
|
| Rate for Payer: Cigna Commercial |
$5,601.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,407.40
|
| Rate for Payer: Health EOS Commercial |
$5,419.21
|
| Rate for Payer: HFN Commercial |
$5,601.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,566.75
|
| Rate for Payer: Multiplan Commercial |
$4,871.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,653.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,601.88
|
| Rate for Payer: Quartz Beloit One Network |
$2,983.61
|
| Rate for Payer: Quartz Commercial |
$3,957.85
|
| Rate for Payer: Quartz Medicare Advantage |
$3,653.40
|
| Rate for Payer: The Alliance Commercial |
$24,356.00
|
| Rate for Payer: WEA Trust Commercial |
$3,348.95
|
| Rate for Payer: WPS Commercial |
$4,510.12
|
|
|
HALF BLOCK TRIATHLON TIBIAL AUGMENT SZ 4 10MM 5546-A-401
|
Facility
|
IP
|
$6,089.00
|
|
| Hospital Charge Code |
5286733
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,983.61 |
| Max. Negotiated Rate |
$5,601.88 |
| Rate for Payer: Aetna Commercial |
$5,480.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,236.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,227.17
|
| Rate for Payer: Cash Price |
$1,826.70
|
| Rate for Payer: Cigna Commercial |
$5,601.88
|
| Rate for Payer: Health EOS Commercial |
$5,419.21
|
| Rate for Payer: HFN Commercial |
$5,601.88
|
| Rate for Payer: Multiplan Commercial |
$4,871.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,653.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,601.88
|
| Rate for Payer: Quartz Beloit One Network |
$2,983.61
|
| Rate for Payer: Quartz Commercial |
$3,653.40
|
| Rate for Payer: WEA Trust Commercial |
$3,348.95
|
| Rate for Payer: WPS Commercial |
$4,510.12
|
|
|
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 |
$1,770.72 |
| Max. Negotiated Rate |
$25,296.00 |
| Rate for Payer: Aetna Commercial |
$5,691.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,438.64
|
| Rate for Payer: Aetna Managed Medicare |
$1,770.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,110.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,162.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,035.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,351.72
|
| Rate for Payer: Cash Price |
$1,897.20
|
| Rate for Payer: Cigna Commercial |
$5,818.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,538.91
|
| Rate for Payer: Health EOS Commercial |
$5,628.36
|
| Rate for Payer: HFN Commercial |
$5,818.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,743.00
|
| Rate for Payer: Multiplan Commercial |
$5,059.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,794.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,818.08
|
| Rate for Payer: Quartz Beloit One Network |
$3,098.76
|
| Rate for Payer: Quartz Commercial |
$4,110.60
|
| Rate for Payer: Quartz Medicare Advantage |
$3,794.40
|
| Rate for Payer: The Alliance Commercial |
$25,296.00
|
| Rate for Payer: WEA Trust Commercial |
$3,478.20
|
| Rate for Payer: WPS Commercial |
$4,684.19
|
|
|
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 |
$3,098.76 |
| Max. Negotiated Rate |
$5,818.08 |
| Rate for Payer: Aetna Commercial |
$5,691.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,438.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,351.72
|
| Rate for Payer: Cash Price |
$1,897.20
|
| Rate for Payer: Cigna Commercial |
$5,818.08
|
| Rate for Payer: Health EOS Commercial |
$5,628.36
|
| Rate for Payer: HFN Commercial |
$5,818.08
|
| Rate for Payer: Multiplan Commercial |
$5,059.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,794.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,818.08
|
| Rate for Payer: Quartz Beloit One Network |
$3,098.76
|
| Rate for Payer: Quartz Commercial |
$3,794.40
|
| Rate for Payer: WEA Trust Commercial |
$3,478.20
|
| Rate for Payer: WPS Commercial |
$4,684.19
|
|
|
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 |
$2,984.10 |
| Max. Negotiated Rate |
$5,602.80 |
| Rate for Payer: Aetna Commercial |
$5,481.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,237.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,227.70
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cigna Commercial |
$5,602.80
|
| Rate for Payer: Health EOS Commercial |
$5,420.10
|
| Rate for Payer: HFN Commercial |
$5,602.80
|
| Rate for Payer: Multiplan Commercial |
$4,872.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,654.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,602.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,984.10
|
| Rate for Payer: Quartz Commercial |
$3,654.00
|
| Rate for Payer: WEA Trust Commercial |
$3,349.50
|
| Rate for Payer: WPS Commercial |
$4,510.86
|
|
|
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 |
$1,705.20 |
| Max. Negotiated Rate |
$24,360.00 |
| Rate for Payer: Aetna Commercial |
$5,481.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,237.40
|
| Rate for Payer: Aetna Managed Medicare |
$1,705.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,958.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,045.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,923.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,227.70
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cigna Commercial |
$5,602.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,407.96
|
| Rate for Payer: Health EOS Commercial |
$5,420.10
|
| Rate for Payer: HFN Commercial |
$5,602.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,567.50
|
| Rate for Payer: Multiplan Commercial |
$4,872.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,654.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,602.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,984.10
|
| Rate for Payer: Quartz Commercial |
$3,958.50
|
| Rate for Payer: Quartz Medicare Advantage |
$3,654.00
|
| Rate for Payer: The Alliance Commercial |
$24,360.00
|
| Rate for Payer: WEA Trust Commercial |
$3,349.50
|
| Rate for Payer: WPS Commercial |
$4,510.86
|
|
|
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 |
$1,705.20 |
| Max. Negotiated Rate |
$24,360.00 |
| Rate for Payer: Aetna Commercial |
$5,481.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,237.40
|
| Rate for Payer: Aetna Managed Medicare |
$1,705.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,958.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,045.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,923.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,227.70
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cigna Commercial |
$5,602.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,407.96
|
| Rate for Payer: Health EOS Commercial |
$5,420.10
|
| Rate for Payer: HFN Commercial |
$5,602.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,567.50
|
| Rate for Payer: Multiplan Commercial |
$4,872.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,654.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,602.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,984.10
|
| Rate for Payer: Quartz Commercial |
$3,958.50
|
| Rate for Payer: Quartz Medicare Advantage |
$3,654.00
|
| Rate for Payer: The Alliance Commercial |
$24,360.00
|
| Rate for Payer: WEA Trust Commercial |
$3,349.50
|
| Rate for Payer: WPS Commercial |
$4,510.86
|
|
|
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 |
$2,984.10 |
| Max. Negotiated Rate |
$5,602.80 |
| Rate for Payer: Aetna Commercial |
$5,481.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,237.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,227.70
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cigna Commercial |
$5,602.80
|
| Rate for Payer: Health EOS Commercial |
$5,420.10
|
| Rate for Payer: HFN Commercial |
$5,602.80
|
| Rate for Payer: Multiplan Commercial |
$4,872.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,654.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,602.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,984.10
|
| Rate for Payer: Quartz Commercial |
$3,654.00
|
| Rate for Payer: WEA Trust Commercial |
$3,349.50
|
| Rate for Payer: WPS Commercial |
$4,510.86
|
|
|
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 |
$1,704.92 |
| Max. Negotiated Rate |
$24,356.00 |
| Rate for Payer: Aetna Commercial |
$5,480.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,236.54
|
| Rate for Payer: Aetna Managed Medicare |
$1,704.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,957.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,044.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,922.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,227.17
|
| Rate for Payer: Cash Price |
$1,826.70
|
| Rate for Payer: Cigna Commercial |
$5,601.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,407.40
|
| Rate for Payer: Health EOS Commercial |
$5,419.21
|
| Rate for Payer: HFN Commercial |
$5,601.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,566.75
|
| Rate for Payer: Multiplan Commercial |
$4,871.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,653.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,601.88
|
| Rate for Payer: Quartz Beloit One Network |
$2,983.61
|
| Rate for Payer: Quartz Commercial |
$3,957.85
|
| Rate for Payer: Quartz Medicare Advantage |
$3,653.40
|
| Rate for Payer: The Alliance Commercial |
$24,356.00
|
| Rate for Payer: WEA Trust Commercial |
$3,348.95
|
| Rate for Payer: WPS Commercial |
$4,510.12
|
|
|
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 |
$2,983.61 |
| Max. Negotiated Rate |
$5,601.88 |
| Rate for Payer: Aetna Commercial |
$5,480.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,236.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,227.17
|
| Rate for Payer: Cash Price |
$1,826.70
|
| Rate for Payer: Cigna Commercial |
$5,601.88
|
| Rate for Payer: Health EOS Commercial |
$5,419.21
|
| Rate for Payer: HFN Commercial |
$5,601.88
|
| Rate for Payer: Multiplan Commercial |
$4,871.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,653.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,601.88
|
| Rate for Payer: Quartz Beloit One Network |
$2,983.61
|
| Rate for Payer: Quartz Commercial |
$3,653.40
|
| Rate for Payer: WEA Trust Commercial |
$3,348.95
|
| Rate for Payer: WPS Commercial |
$4,510.12
|
|
|
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 |
$2,983.61 |
| Max. Negotiated Rate |
$5,601.88 |
| Rate for Payer: Aetna Commercial |
$5,480.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,236.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,227.17
|
| Rate for Payer: Cash Price |
$1,826.70
|
| Rate for Payer: Cigna Commercial |
$5,601.88
|
| Rate for Payer: Health EOS Commercial |
$5,419.21
|
| Rate for Payer: HFN Commercial |
$5,601.88
|
| Rate for Payer: Multiplan Commercial |
$4,871.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,653.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,601.88
|
| Rate for Payer: Quartz Beloit One Network |
$2,983.61
|
| Rate for Payer: Quartz Commercial |
$3,653.40
|
| Rate for Payer: WEA Trust Commercial |
$3,348.95
|
| Rate for Payer: WPS Commercial |
$4,510.12
|
|
|
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 |
$1,704.92 |
| Max. Negotiated Rate |
$24,356.00 |
| Rate for Payer: Aetna Commercial |
$5,480.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,236.54
|
| Rate for Payer: Aetna Managed Medicare |
$1,704.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,957.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,044.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,922.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,227.17
|
| Rate for Payer: Cash Price |
$1,826.70
|
| Rate for Payer: Cigna Commercial |
$5,601.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,407.40
|
| Rate for Payer: Health EOS Commercial |
$5,419.21
|
| Rate for Payer: HFN Commercial |
$5,601.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,566.75
|
| Rate for Payer: Multiplan Commercial |
$4,871.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,653.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,601.88
|
| Rate for Payer: Quartz Beloit One Network |
$2,983.61
|
| Rate for Payer: Quartz Commercial |
$3,957.85
|
| Rate for Payer: Quartz Medicare Advantage |
$3,653.40
|
| Rate for Payer: The Alliance Commercial |
$24,356.00
|
| Rate for Payer: WEA Trust Commercial |
$3,348.95
|
| Rate for Payer: WPS Commercial |
$4,510.12
|
|
|
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 |
$3,098.76 |
| Max. Negotiated Rate |
$5,818.08 |
| Rate for Payer: Aetna Commercial |
$5,691.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,438.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,351.72
|
| Rate for Payer: Cash Price |
$1,897.20
|
| Rate for Payer: Cigna Commercial |
$5,818.08
|
| Rate for Payer: Health EOS Commercial |
$5,628.36
|
| Rate for Payer: HFN Commercial |
$5,818.08
|
| Rate for Payer: Multiplan Commercial |
$5,059.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,794.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,818.08
|
| Rate for Payer: Quartz Beloit One Network |
$3,098.76
|
| Rate for Payer: Quartz Commercial |
$3,794.40
|
| Rate for Payer: WEA Trust Commercial |
$3,478.20
|
| Rate for Payer: WPS Commercial |
$4,684.19
|
|
|
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 |
$1,770.72 |
| Max. Negotiated Rate |
$25,296.00 |
| Rate for Payer: Aetna Commercial |
$5,691.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,438.64
|
| Rate for Payer: Aetna Managed Medicare |
$1,770.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,110.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,162.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,035.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,351.72
|
| Rate for Payer: Cash Price |
$1,897.20
|
| Rate for Payer: Cigna Commercial |
$5,818.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,538.91
|
| Rate for Payer: Health EOS Commercial |
$5,628.36
|
| Rate for Payer: HFN Commercial |
$5,818.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,743.00
|
| Rate for Payer: Multiplan Commercial |
$5,059.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,794.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,818.08
|
| Rate for Payer: Quartz Beloit One Network |
$3,098.76
|
| Rate for Payer: Quartz Commercial |
$4,110.60
|
| Rate for Payer: Quartz Medicare Advantage |
$3,794.40
|
| Rate for Payer: The Alliance Commercial |
$25,296.00
|
| Rate for Payer: WEA Trust Commercial |
$3,478.20
|
| Rate for Payer: WPS Commercial |
$4,684.19
|
|
|
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 |
$1,705.20 |
| Max. Negotiated Rate |
$24,360.00 |
| Rate for Payer: Aetna Commercial |
$5,481.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,237.40
|
| Rate for Payer: Aetna Managed Medicare |
$1,705.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,958.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,045.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,923.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,227.70
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cigna Commercial |
$5,602.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,407.96
|
| Rate for Payer: Health EOS Commercial |
$5,420.10
|
| Rate for Payer: HFN Commercial |
$5,602.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,567.50
|
| Rate for Payer: Multiplan Commercial |
$4,872.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,654.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,602.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,984.10
|
| Rate for Payer: Quartz Commercial |
$3,958.50
|
| Rate for Payer: Quartz Medicare Advantage |
$3,654.00
|
| Rate for Payer: The Alliance Commercial |
$24,360.00
|
| Rate for Payer: WEA Trust Commercial |
$3,349.50
|
| Rate for Payer: WPS Commercial |
$4,510.86
|
|
|
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 |
$2,984.10 |
| Max. Negotiated Rate |
$5,602.80 |
| Rate for Payer: Aetna Commercial |
$5,481.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,237.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,227.70
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cigna Commercial |
$5,602.80
|
| Rate for Payer: Health EOS Commercial |
$5,420.10
|
| Rate for Payer: HFN Commercial |
$5,602.80
|
| Rate for Payer: Multiplan Commercial |
$4,872.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,654.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,602.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,984.10
|
| Rate for Payer: Quartz Commercial |
$3,654.00
|
| Rate for Payer: WEA Trust Commercial |
$3,349.50
|
| Rate for Payer: WPS Commercial |
$4,510.86
|
|
