|
INSERT TRIATHLON PS TIBIAL BEARING SZ 6 9MM 5532-G-609
|
Facility
|
OP
|
$8,080.00
|
|
| Hospital Charge Code |
4493925
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,352.90 |
| Max. Negotiated Rate |
$7,730.94 |
| Rate for Payer: Aetna Commercial |
$7,562.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,226.75
|
| Rate for Payer: Aetna Managed Medicare |
$2,352.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,462.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,201.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,033.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,453.70
|
| Rate for Payer: Cash Price |
$2,424.00
|
| Rate for Payer: Cigna Commercial |
$7,730.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,702.56
|
| Rate for Payer: Health EOS Commercial |
$7,478.85
|
| Rate for Payer: HFN Commercial |
$7,730.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,302.40
|
| Rate for Payer: Multiplan Commercial |
$6,722.56
|
| Rate for Payer: NAPHCARE Commercial |
$5,041.92
|
| Rate for Payer: Preferred Network Access Commercial |
$7,730.94
|
| Rate for Payer: Quartz Beloit One Network |
$4,117.57
|
| Rate for Payer: Quartz Commercial |
$5,462.08
|
| Rate for Payer: Quartz Medicare Advantage |
$5,041.92
|
| Rate for Payer: The Alliance Commercial |
$4,201.60
|
| Rate for Payer: WEA Trust Commercial |
$4,621.76
|
| Rate for Payer: WPS Commercial |
$6,224.02
|
|
|
INSERT TRIATHLON PS TIBIAL BEARING SZ 6 9MM 5532-G-609
|
Facility
|
IP
|
$8,080.00
|
|
| Hospital Charge Code |
4493925
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,117.57 |
| Max. Negotiated Rate |
$7,730.94 |
| Rate for Payer: Aetna Commercial |
$7,562.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,226.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,453.70
|
| Rate for Payer: Cash Price |
$2,424.00
|
| Rate for Payer: Cigna Commercial |
$7,730.94
|
| Rate for Payer: Health EOS Commercial |
$7,478.85
|
| Rate for Payer: HFN Commercial |
$7,730.94
|
| Rate for Payer: Multiplan Commercial |
$6,722.56
|
| Rate for Payer: Preferred Network Access Commercial |
$7,730.94
|
| Rate for Payer: Quartz Beloit One Network |
$4,117.57
|
| Rate for Payer: Quartz Commercial |
$5,041.92
|
| Rate for Payer: WEA Trust Commercial |
$4,621.76
|
| Rate for Payer: WPS Commercial |
$6,224.02
|
|
|
INSERT TRIATHLON TIBIA BEARING CS SZ 2 13MM 5531-G-213
|
Facility
|
OP
|
$6,708.00
|
|
| Hospital Charge Code |
4289890
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,953.37 |
| Max. Negotiated Rate |
$6,418.21 |
| Rate for Payer: Aetna Commercial |
$6,278.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,999.64
|
| Rate for Payer: Aetna Managed Medicare |
$1,953.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,534.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,488.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,348.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,697.45
|
| Rate for Payer: Cash Price |
$2,012.40
|
| Rate for Payer: Cigna Commercial |
$6,418.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,904.06
|
| Rate for Payer: Health EOS Commercial |
$6,208.92
|
| Rate for Payer: HFN Commercial |
$6,418.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,232.24
|
| Rate for Payer: Multiplan Commercial |
$5,581.06
|
| Rate for Payer: NAPHCARE Commercial |
$4,185.79
|
| Rate for Payer: Preferred Network Access Commercial |
$6,418.21
|
| Rate for Payer: Quartz Beloit One Network |
$3,418.40
|
| Rate for Payer: Quartz Commercial |
$4,534.61
|
| Rate for Payer: Quartz Medicare Advantage |
$4,185.79
|
| Rate for Payer: The Alliance Commercial |
$3,488.16
|
| Rate for Payer: WEA Trust Commercial |
$3,836.98
|
| Rate for Payer: WPS Commercial |
$5,167.17
|
|
|
INSERT TRIATHLON TIBIA BEARING CS SZ 2 13MM 5531-G-213
|
Facility
|
IP
|
$6,708.00
|
|
| Hospital Charge Code |
4289890
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,418.40 |
| Max. Negotiated Rate |
$6,418.21 |
| Rate for Payer: Aetna Commercial |
$6,278.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,999.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,697.45
|
| Rate for Payer: Cash Price |
$2,012.40
|
| Rate for Payer: Cigna Commercial |
$6,418.21
|
| Rate for Payer: Health EOS Commercial |
$6,208.92
|
| Rate for Payer: HFN Commercial |
$6,418.21
|
| Rate for Payer: Multiplan Commercial |
$5,581.06
|
| Rate for Payer: Preferred Network Access Commercial |
$6,418.21
|
| Rate for Payer: Quartz Beloit One Network |
$3,418.40
|
| Rate for Payer: Quartz Commercial |
$4,185.79
|
| Rate for Payer: WEA Trust Commercial |
$3,836.98
|
| Rate for Payer: WPS Commercial |
$5,167.17
|
|
|
INSERT TRIATHLON TIBIA BEARING CS SZ 4 13MM 5531-G-413
|
Facility
|
IP
|
$6,967.00
|
|
| Hospital Charge Code |
3779525
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,550.38 |
| Max. Negotiated Rate |
$6,666.03 |
| Rate for Payer: Aetna Commercial |
$6,521.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,231.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,840.21
|
| Rate for Payer: Cash Price |
$2,090.10
|
| Rate for Payer: Cigna Commercial |
$6,666.03
|
| Rate for Payer: Health EOS Commercial |
$6,448.66
|
| Rate for Payer: HFN Commercial |
$6,666.03
|
| Rate for Payer: Multiplan Commercial |
$5,796.54
|
| Rate for Payer: Preferred Network Access Commercial |
$6,666.03
|
| Rate for Payer: Quartz Beloit One Network |
$3,550.38
|
| Rate for Payer: Quartz Commercial |
$4,347.41
|
| Rate for Payer: WEA Trust Commercial |
$3,985.12
|
| Rate for Payer: WPS Commercial |
$5,366.68
|
|
|
INSERT TRIATHLON TIBIA BEARING CS SZ 4 13MM 5531-G-413
|
Facility
|
OP
|
$6,967.00
|
|
| Hospital Charge Code |
3779525
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,028.79 |
| Max. Negotiated Rate |
$6,666.03 |
| Rate for Payer: Aetna Commercial |
$6,521.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,231.28
|
| Rate for Payer: Aetna Managed Medicare |
$2,028.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,709.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,622.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,477.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,840.21
|
| Rate for Payer: Cash Price |
$2,090.10
|
| Rate for Payer: Cigna Commercial |
$6,666.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,054.79
|
| Rate for Payer: Health EOS Commercial |
$6,448.66
|
| Rate for Payer: HFN Commercial |
$6,666.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,434.26
|
| Rate for Payer: Multiplan Commercial |
$5,796.54
|
| Rate for Payer: NAPHCARE Commercial |
$4,347.41
|
| Rate for Payer: Preferred Network Access Commercial |
$6,666.03
|
| Rate for Payer: Quartz Beloit One Network |
$3,550.38
|
| Rate for Payer: Quartz Commercial |
$4,709.69
|
| Rate for Payer: Quartz Medicare Advantage |
$4,347.41
|
| Rate for Payer: The Alliance Commercial |
$3,622.84
|
| Rate for Payer: WEA Trust Commercial |
$3,985.12
|
| Rate for Payer: WPS Commercial |
$5,366.68
|
|
|
INSERT TRIATHLON TIBIAL BEARING CS SZ 2 11MM 5531-G-211
|
Facility
|
OP
|
$6,967.00
|
|
| Hospital Charge Code |
4493886
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,028.79 |
| Max. Negotiated Rate |
$6,666.03 |
| Rate for Payer: Aetna Commercial |
$6,521.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,231.28
|
| Rate for Payer: Aetna Managed Medicare |
$2,028.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,709.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,622.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,477.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,840.21
|
| Rate for Payer: Cash Price |
$2,090.10
|
| Rate for Payer: Cigna Commercial |
$6,666.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,054.79
|
| Rate for Payer: Health EOS Commercial |
$6,448.66
|
| Rate for Payer: HFN Commercial |
$6,666.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,434.26
|
| Rate for Payer: Multiplan Commercial |
$5,796.54
|
| Rate for Payer: NAPHCARE Commercial |
$4,347.41
|
| Rate for Payer: Preferred Network Access Commercial |
$6,666.03
|
| Rate for Payer: Quartz Beloit One Network |
$3,550.38
|
| Rate for Payer: Quartz Commercial |
$4,709.69
|
| Rate for Payer: Quartz Medicare Advantage |
$4,347.41
|
| Rate for Payer: The Alliance Commercial |
$3,622.84
|
| Rate for Payer: WEA Trust Commercial |
$3,985.12
|
| Rate for Payer: WPS Commercial |
$5,366.68
|
|
|
INSERT TRIATHLON TIBIAL BEARING CS SZ 2 11MM 5531-G-211
|
Facility
|
IP
|
$6,967.00
|
|
| Hospital Charge Code |
4493886
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,550.38 |
| Max. Negotiated Rate |
$6,666.03 |
| Rate for Payer: Aetna Commercial |
$6,521.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,231.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,840.21
|
| Rate for Payer: Cash Price |
$2,090.10
|
| Rate for Payer: Cigna Commercial |
$6,666.03
|
| Rate for Payer: Health EOS Commercial |
$6,448.66
|
| Rate for Payer: HFN Commercial |
$6,666.03
|
| Rate for Payer: Multiplan Commercial |
$5,796.54
|
| Rate for Payer: Preferred Network Access Commercial |
$6,666.03
|
| Rate for Payer: Quartz Beloit One Network |
$3,550.38
|
| Rate for Payer: Quartz Commercial |
$4,347.41
|
| Rate for Payer: WEA Trust Commercial |
$3,985.12
|
| Rate for Payer: WPS Commercial |
$5,366.68
|
|
|
INSERT TRIATHLON TIBIAL BEARING CS SZ 2 16MM 5531-G-216
|
Facility
|
OP
|
$6,708.00
|
|
| Hospital Charge Code |
4291234
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,953.37 |
| Max. Negotiated Rate |
$6,418.21 |
| Rate for Payer: Aetna Commercial |
$6,278.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,999.64
|
| Rate for Payer: Aetna Managed Medicare |
$1,953.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,534.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,488.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,348.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,697.45
|
| Rate for Payer: Cash Price |
$2,012.40
|
| Rate for Payer: Cigna Commercial |
$6,418.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,904.06
|
| Rate for Payer: Health EOS Commercial |
$6,208.92
|
| Rate for Payer: HFN Commercial |
$6,418.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,232.24
|
| Rate for Payer: Multiplan Commercial |
$5,581.06
|
| Rate for Payer: NAPHCARE Commercial |
$4,185.79
|
| Rate for Payer: Preferred Network Access Commercial |
$6,418.21
|
| Rate for Payer: Quartz Beloit One Network |
$3,418.40
|
| Rate for Payer: Quartz Commercial |
$4,534.61
|
| Rate for Payer: Quartz Medicare Advantage |
$4,185.79
|
| Rate for Payer: The Alliance Commercial |
$3,488.16
|
| Rate for Payer: WEA Trust Commercial |
$3,836.98
|
| Rate for Payer: WPS Commercial |
$5,167.17
|
|
|
INSERT TRIATHLON TIBIAL BEARING CS SZ 2 16MM 5531-G-216
|
Facility
|
IP
|
$6,708.00
|
|
| Hospital Charge Code |
4291234
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,418.40 |
| Max. Negotiated Rate |
$6,418.21 |
| Rate for Payer: Aetna Commercial |
$6,278.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,999.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,697.45
|
| Rate for Payer: Cash Price |
$2,012.40
|
| Rate for Payer: Cigna Commercial |
$6,418.21
|
| Rate for Payer: Health EOS Commercial |
$6,208.92
|
| Rate for Payer: HFN Commercial |
$6,418.21
|
| Rate for Payer: Multiplan Commercial |
$5,581.06
|
| Rate for Payer: Preferred Network Access Commercial |
$6,418.21
|
| Rate for Payer: Quartz Beloit One Network |
$3,418.40
|
| Rate for Payer: Quartz Commercial |
$4,185.79
|
| Rate for Payer: WEA Trust Commercial |
$3,836.98
|
| Rate for Payer: WPS Commercial |
$5,167.17
|
|
|
INSERT TRIATHLON TIBIAL BEARING CS SZ 2 19MM 5531-G-219
|
Facility
|
OP
|
$6,708.00
|
|
| Hospital Charge Code |
4493887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,953.37 |
| Max. Negotiated Rate |
$6,418.21 |
| Rate for Payer: Aetna Commercial |
$6,278.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,999.64
|
| Rate for Payer: Aetna Managed Medicare |
$1,953.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,534.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,488.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,348.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,697.45
|
| Rate for Payer: Cash Price |
$2,012.40
|
| Rate for Payer: Cigna Commercial |
$6,418.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,904.06
|
| Rate for Payer: Health EOS Commercial |
$6,208.92
|
| Rate for Payer: HFN Commercial |
$6,418.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,232.24
|
| Rate for Payer: Multiplan Commercial |
$5,581.06
|
| Rate for Payer: NAPHCARE Commercial |
$4,185.79
|
| Rate for Payer: Preferred Network Access Commercial |
$6,418.21
|
| Rate for Payer: Quartz Beloit One Network |
$3,418.40
|
| Rate for Payer: Quartz Commercial |
$4,534.61
|
| Rate for Payer: Quartz Medicare Advantage |
$4,185.79
|
| Rate for Payer: The Alliance Commercial |
$3,488.16
|
| Rate for Payer: WEA Trust Commercial |
$3,836.98
|
| Rate for Payer: WPS Commercial |
$5,167.17
|
|
|
INSERT TRIATHLON TIBIAL BEARING CS SZ 2 19MM 5531-G-219
|
Facility
|
IP
|
$6,708.00
|
|
| Hospital Charge Code |
4493887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,418.40 |
| Max. Negotiated Rate |
$6,418.21 |
| Rate for Payer: Aetna Commercial |
$6,278.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,999.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,697.45
|
| Rate for Payer: Cash Price |
$2,012.40
|
| Rate for Payer: Cigna Commercial |
$6,418.21
|
| Rate for Payer: Health EOS Commercial |
$6,208.92
|
| Rate for Payer: HFN Commercial |
$6,418.21
|
| Rate for Payer: Multiplan Commercial |
$5,581.06
|
| Rate for Payer: Preferred Network Access Commercial |
$6,418.21
|
| Rate for Payer: Quartz Beloit One Network |
$3,418.40
|
| Rate for Payer: Quartz Commercial |
$4,185.79
|
| Rate for Payer: WEA Trust Commercial |
$3,836.98
|
| Rate for Payer: WPS Commercial |
$5,167.17
|
|
|
INSERT TRIATHLON TIBIAL BEARING CS SZ 2 22MM 5531-G-222
|
Facility
|
OP
|
$6,708.00
|
|
| Hospital Charge Code |
4518617
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,953.37 |
| Max. Negotiated Rate |
$6,418.21 |
| Rate for Payer: Aetna Commercial |
$6,278.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,999.64
|
| Rate for Payer: Aetna Managed Medicare |
$1,953.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,534.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,488.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,348.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,697.45
|
| Rate for Payer: Cash Price |
$2,012.40
|
| Rate for Payer: Cigna Commercial |
$6,418.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,904.06
|
| Rate for Payer: Health EOS Commercial |
$6,208.92
|
| Rate for Payer: HFN Commercial |
$6,418.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,232.24
|
| Rate for Payer: Multiplan Commercial |
$5,581.06
|
| Rate for Payer: NAPHCARE Commercial |
$4,185.79
|
| Rate for Payer: Preferred Network Access Commercial |
$6,418.21
|
| Rate for Payer: Quartz Beloit One Network |
$3,418.40
|
| Rate for Payer: Quartz Commercial |
$4,534.61
|
| Rate for Payer: Quartz Medicare Advantage |
$4,185.79
|
| Rate for Payer: The Alliance Commercial |
$3,488.16
|
| Rate for Payer: WEA Trust Commercial |
$3,836.98
|
| Rate for Payer: WPS Commercial |
$5,167.17
|
|
|
INSERT TRIATHLON TIBIAL BEARING CS SZ 2 22MM 5531-G-222
|
Facility
|
IP
|
$6,708.00
|
|
| Hospital Charge Code |
4518617
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,418.40 |
| Max. Negotiated Rate |
$6,418.21 |
| Rate for Payer: Aetna Commercial |
$6,278.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,999.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,697.45
|
| Rate for Payer: Cash Price |
$2,012.40
|
| Rate for Payer: Cigna Commercial |
$6,418.21
|
| Rate for Payer: Health EOS Commercial |
$6,208.92
|
| Rate for Payer: HFN Commercial |
$6,418.21
|
| Rate for Payer: Multiplan Commercial |
$5,581.06
|
| Rate for Payer: Preferred Network Access Commercial |
$6,418.21
|
| Rate for Payer: Quartz Beloit One Network |
$3,418.40
|
| Rate for Payer: Quartz Commercial |
$4,185.79
|
| Rate for Payer: WEA Trust Commercial |
$3,836.98
|
| Rate for Payer: WPS Commercial |
$5,167.17
|
|
|
INSERT TRIATHLON TIBIAL BEARING CS SZ 2 25MM 5531-G-225
|
Facility
|
IP
|
$6,708.00
|
|
| Hospital Charge Code |
4518618
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,418.40 |
| Max. Negotiated Rate |
$6,418.21 |
| Rate for Payer: Aetna Commercial |
$6,278.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,999.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,697.45
|
| Rate for Payer: Cash Price |
$2,012.40
|
| Rate for Payer: Cigna Commercial |
$6,418.21
|
| Rate for Payer: Health EOS Commercial |
$6,208.92
|
| Rate for Payer: HFN Commercial |
$6,418.21
|
| Rate for Payer: Multiplan Commercial |
$5,581.06
|
| Rate for Payer: Preferred Network Access Commercial |
$6,418.21
|
| Rate for Payer: Quartz Beloit One Network |
$3,418.40
|
| Rate for Payer: Quartz Commercial |
$4,185.79
|
| Rate for Payer: WEA Trust Commercial |
$3,836.98
|
| Rate for Payer: WPS Commercial |
$5,167.17
|
|
|
INSERT TRIATHLON TIBIAL BEARING CS SZ 2 25MM 5531-G-225
|
Facility
|
OP
|
$6,708.00
|
|
| Hospital Charge Code |
4518618
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,953.37 |
| Max. Negotiated Rate |
$6,418.21 |
| Rate for Payer: Aetna Commercial |
$6,278.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,999.64
|
| Rate for Payer: Aetna Managed Medicare |
$1,953.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,534.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,488.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,348.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,697.45
|
| Rate for Payer: Cash Price |
$2,012.40
|
| Rate for Payer: Cigna Commercial |
$6,418.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,904.06
|
| Rate for Payer: Health EOS Commercial |
$6,208.92
|
| Rate for Payer: HFN Commercial |
$6,418.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,232.24
|
| Rate for Payer: Multiplan Commercial |
$5,581.06
|
| Rate for Payer: NAPHCARE Commercial |
$4,185.79
|
| Rate for Payer: Preferred Network Access Commercial |
$6,418.21
|
| Rate for Payer: Quartz Beloit One Network |
$3,418.40
|
| Rate for Payer: Quartz Commercial |
$4,534.61
|
| Rate for Payer: Quartz Medicare Advantage |
$4,185.79
|
| Rate for Payer: The Alliance Commercial |
$3,488.16
|
| Rate for Payer: WEA Trust Commercial |
$3,836.98
|
| Rate for Payer: WPS Commercial |
$5,167.17
|
|
|
INSERT TRIATHLON TIBIAL BEARING CS SZ 2 9MM 5531-G-209
|
Facility
|
IP
|
$6,708.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3177477
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,418.40 |
| Max. Negotiated Rate |
$6,418.21 |
| Rate for Payer: Aetna Commercial |
$6,278.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,999.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,697.45
|
| Rate for Payer: Cash Price |
$2,012.40
|
| Rate for Payer: Cigna Commercial |
$6,418.21
|
| Rate for Payer: Health EOS Commercial |
$6,208.92
|
| Rate for Payer: HFN Commercial |
$6,418.21
|
| Rate for Payer: Multiplan Commercial |
$5,581.06
|
| Rate for Payer: Preferred Network Access Commercial |
$6,418.21
|
| Rate for Payer: Quartz Beloit One Network |
$3,418.40
|
| Rate for Payer: Quartz Commercial |
$4,185.79
|
| Rate for Payer: WEA Trust Commercial |
$3,836.98
|
| Rate for Payer: WPS Commercial |
$5,167.17
|
|
|
INSERT TRIATHLON TIBIAL BEARING CS SZ 2 9MM 5531-G-209
|
Facility
|
OP
|
$6,708.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3177477
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,953.37 |
| Max. Negotiated Rate |
$6,418.21 |
| Rate for Payer: Aetna Commercial |
$6,278.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,999.64
|
| Rate for Payer: Aetna Managed Medicare |
$1,953.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,534.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,488.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,348.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,697.45
|
| Rate for Payer: Cash Price |
$2,012.40
|
| Rate for Payer: Cigna Commercial |
$6,418.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,904.06
|
| Rate for Payer: Health EOS Commercial |
$6,208.92
|
| Rate for Payer: HFN Commercial |
$6,418.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,232.24
|
| Rate for Payer: Multiplan Commercial |
$5,581.06
|
| Rate for Payer: NAPHCARE Commercial |
$4,185.79
|
| Rate for Payer: Preferred Network Access Commercial |
$6,418.21
|
| Rate for Payer: Quartz Beloit One Network |
$3,418.40
|
| Rate for Payer: Quartz Commercial |
$4,534.61
|
| Rate for Payer: Quartz Medicare Advantage |
$4,185.79
|
| Rate for Payer: The Alliance Commercial |
$3,488.16
|
| Rate for Payer: WEA Trust Commercial |
$3,836.98
|
| Rate for Payer: WPS Commercial |
$5,167.17
|
|
|
INSERT TRIATHLON TIBIAL BEARING CS SZ 3 11MM 5531-G-311
|
Facility
|
OP
|
$6,967.00
|
|
| Hospital Charge Code |
4493889
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,028.79 |
| Max. Negotiated Rate |
$6,666.03 |
| Rate for Payer: Aetna Commercial |
$6,521.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,231.28
|
| Rate for Payer: Aetna Managed Medicare |
$2,028.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,709.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,622.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,477.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,840.21
|
| Rate for Payer: Cash Price |
$2,090.10
|
| Rate for Payer: Cigna Commercial |
$6,666.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,054.79
|
| Rate for Payer: Health EOS Commercial |
$6,448.66
|
| Rate for Payer: HFN Commercial |
$6,666.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,434.26
|
| Rate for Payer: Multiplan Commercial |
$5,796.54
|
| Rate for Payer: NAPHCARE Commercial |
$4,347.41
|
| Rate for Payer: Preferred Network Access Commercial |
$6,666.03
|
| Rate for Payer: Quartz Beloit One Network |
$3,550.38
|
| Rate for Payer: Quartz Commercial |
$4,709.69
|
| Rate for Payer: Quartz Medicare Advantage |
$4,347.41
|
| Rate for Payer: The Alliance Commercial |
$3,622.84
|
| Rate for Payer: WEA Trust Commercial |
$3,985.12
|
| Rate for Payer: WPS Commercial |
$5,366.68
|
|
|
INSERT TRIATHLON TIBIAL BEARING CS SZ 3 11MM 5531-G-311
|
Facility
|
IP
|
$6,967.00
|
|
| Hospital Charge Code |
4493889
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,550.38 |
| Max. Negotiated Rate |
$6,666.03 |
| Rate for Payer: Aetna Commercial |
$6,521.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,231.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,840.21
|
| Rate for Payer: Cash Price |
$2,090.10
|
| Rate for Payer: Cigna Commercial |
$6,666.03
|
| Rate for Payer: Health EOS Commercial |
$6,448.66
|
| Rate for Payer: HFN Commercial |
$6,666.03
|
| Rate for Payer: Multiplan Commercial |
$5,796.54
|
| Rate for Payer: Preferred Network Access Commercial |
$6,666.03
|
| Rate for Payer: Quartz Beloit One Network |
$3,550.38
|
| Rate for Payer: Quartz Commercial |
$4,347.41
|
| Rate for Payer: WEA Trust Commercial |
$3,985.12
|
| Rate for Payer: WPS Commercial |
$5,366.68
|
|
|
INSERT TRIATHLON TIBIAL BEARING CS SZ 3 13MM 5531-G-313
|
Facility
|
IP
|
$6,708.00
|
|
| Hospital Charge Code |
3444850
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,418.40 |
| Max. Negotiated Rate |
$6,418.21 |
| Rate for Payer: Aetna Commercial |
$6,278.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,999.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,697.45
|
| Rate for Payer: Cash Price |
$2,012.40
|
| Rate for Payer: Cigna Commercial |
$6,418.21
|
| Rate for Payer: Health EOS Commercial |
$6,208.92
|
| Rate for Payer: HFN Commercial |
$6,418.21
|
| Rate for Payer: Multiplan Commercial |
$5,581.06
|
| Rate for Payer: Preferred Network Access Commercial |
$6,418.21
|
| Rate for Payer: Quartz Beloit One Network |
$3,418.40
|
| Rate for Payer: Quartz Commercial |
$4,185.79
|
| Rate for Payer: WEA Trust Commercial |
$3,836.98
|
| Rate for Payer: WPS Commercial |
$5,167.17
|
|
|
INSERT TRIATHLON TIBIAL BEARING CS SZ 3 13MM 5531-G-313
|
Facility
|
OP
|
$6,708.00
|
|
| Hospital Charge Code |
3444850
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,953.37 |
| Max. Negotiated Rate |
$6,418.21 |
| Rate for Payer: Aetna Commercial |
$6,278.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,999.64
|
| Rate for Payer: Aetna Managed Medicare |
$1,953.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,534.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,488.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,348.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,697.45
|
| Rate for Payer: Cash Price |
$2,012.40
|
| Rate for Payer: Cigna Commercial |
$6,418.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,904.06
|
| Rate for Payer: Health EOS Commercial |
$6,208.92
|
| Rate for Payer: HFN Commercial |
$6,418.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,232.24
|
| Rate for Payer: Multiplan Commercial |
$5,581.06
|
| Rate for Payer: NAPHCARE Commercial |
$4,185.79
|
| Rate for Payer: Preferred Network Access Commercial |
$6,418.21
|
| Rate for Payer: Quartz Beloit One Network |
$3,418.40
|
| Rate for Payer: Quartz Commercial |
$4,534.61
|
| Rate for Payer: Quartz Medicare Advantage |
$4,185.79
|
| Rate for Payer: The Alliance Commercial |
$3,488.16
|
| Rate for Payer: WEA Trust Commercial |
$3,836.98
|
| Rate for Payer: WPS Commercial |
$5,167.17
|
|
|
INSERT TRIATHLON TIBIAL BEARING CS SZ 3 16MM 5531-G-316
|
Facility
|
OP
|
$6,708.00
|
|
| Hospital Charge Code |
3789652
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,953.37 |
| Max. Negotiated Rate |
$6,418.21 |
| Rate for Payer: Aetna Commercial |
$6,278.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,999.64
|
| Rate for Payer: Aetna Managed Medicare |
$1,953.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,534.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,488.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,348.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,697.45
|
| Rate for Payer: Cash Price |
$2,012.40
|
| Rate for Payer: Cigna Commercial |
$6,418.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,904.06
|
| Rate for Payer: Health EOS Commercial |
$6,208.92
|
| Rate for Payer: HFN Commercial |
$6,418.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,232.24
|
| Rate for Payer: Multiplan Commercial |
$5,581.06
|
| Rate for Payer: NAPHCARE Commercial |
$4,185.79
|
| Rate for Payer: Preferred Network Access Commercial |
$6,418.21
|
| Rate for Payer: Quartz Beloit One Network |
$3,418.40
|
| Rate for Payer: Quartz Commercial |
$4,534.61
|
| Rate for Payer: Quartz Medicare Advantage |
$4,185.79
|
| Rate for Payer: The Alliance Commercial |
$3,488.16
|
| Rate for Payer: WEA Trust Commercial |
$3,836.98
|
| Rate for Payer: WPS Commercial |
$5,167.17
|
|
|
INSERT TRIATHLON TIBIAL BEARING CS SZ 3 16MM 5531-G-316
|
Facility
|
IP
|
$6,708.00
|
|
| Hospital Charge Code |
3789652
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,418.40 |
| Max. Negotiated Rate |
$6,418.21 |
| Rate for Payer: Aetna Commercial |
$6,278.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,999.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,697.45
|
| Rate for Payer: Cash Price |
$2,012.40
|
| Rate for Payer: Cigna Commercial |
$6,418.21
|
| Rate for Payer: Health EOS Commercial |
$6,208.92
|
| Rate for Payer: HFN Commercial |
$6,418.21
|
| Rate for Payer: Multiplan Commercial |
$5,581.06
|
| Rate for Payer: Preferred Network Access Commercial |
$6,418.21
|
| Rate for Payer: Quartz Beloit One Network |
$3,418.40
|
| Rate for Payer: Quartz Commercial |
$4,185.79
|
| Rate for Payer: WEA Trust Commercial |
$3,836.98
|
| Rate for Payer: WPS Commercial |
$5,167.17
|
|
|
INSERT TRIATHLON TIBIAL BEARING CS SZ 3 19MM 5531-G-319
|
Facility
|
IP
|
$6,708.00
|
|
| Hospital Charge Code |
4493890
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,418.40 |
| Max. Negotiated Rate |
$6,418.21 |
| Rate for Payer: Aetna Commercial |
$6,278.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,999.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,697.45
|
| Rate for Payer: Cash Price |
$2,012.40
|
| Rate for Payer: Cigna Commercial |
$6,418.21
|
| Rate for Payer: Health EOS Commercial |
$6,208.92
|
| Rate for Payer: HFN Commercial |
$6,418.21
|
| Rate for Payer: Multiplan Commercial |
$5,581.06
|
| Rate for Payer: Preferred Network Access Commercial |
$6,418.21
|
| Rate for Payer: Quartz Beloit One Network |
$3,418.40
|
| Rate for Payer: Quartz Commercial |
$4,185.79
|
| Rate for Payer: WEA Trust Commercial |
$3,836.98
|
| Rate for Payer: WPS Commercial |
$5,167.17
|
|
