|
INSERT TIBIAL TRIATHLON X3 SZ 3 16MM 5537-G-316
|
Facility
|
IP
|
$13,197.00
|
|
| Hospital Charge Code |
5179235
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,466.53 |
| Max. Negotiated Rate |
$12,141.24 |
| Rate for Payer: Aetna Commercial |
$11,877.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,349.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,994.41
|
| Rate for Payer: Cash Price |
$3,959.10
|
| Rate for Payer: Cigna Commercial |
$12,141.24
|
| Rate for Payer: Health EOS Commercial |
$11,745.33
|
| Rate for Payer: HFN Commercial |
$12,141.24
|
| Rate for Payer: Multiplan Commercial |
$10,557.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,918.20
|
| Rate for Payer: Preferred Network Access Commercial |
$12,141.24
|
| Rate for Payer: Quartz Beloit One Network |
$6,466.53
|
| Rate for Payer: Quartz Commercial |
$7,918.20
|
| Rate for Payer: WEA Trust Commercial |
$7,258.35
|
| Rate for Payer: WPS Commercial |
$9,775.02
|
|
|
INSERT TIBIAL TRIATHLON X3 SZ 3 16MM 5537-G-316
|
Facility
|
OP
|
$13,197.00
|
|
| Hospital Charge Code |
5179235
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,695.16 |
| Max. Negotiated Rate |
$52,788.00 |
| Rate for Payer: Aetna Commercial |
$11,877.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,349.42
|
| Rate for Payer: Aetna Managed Medicare |
$3,695.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,578.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,598.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,334.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,994.41
|
| Rate for Payer: Cash Price |
$3,959.10
|
| Rate for Payer: Cigna Commercial |
$12,141.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,385.04
|
| Rate for Payer: Health EOS Commercial |
$11,745.33
|
| Rate for Payer: HFN Commercial |
$12,141.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,897.75
|
| Rate for Payer: Multiplan Commercial |
$10,557.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,918.20
|
| Rate for Payer: Preferred Network Access Commercial |
$12,141.24
|
| Rate for Payer: Quartz Beloit One Network |
$6,466.53
|
| Rate for Payer: Quartz Commercial |
$8,578.05
|
| Rate for Payer: Quartz Medicare Advantage |
$7,918.20
|
| Rate for Payer: The Alliance Commercial |
$52,788.00
|
| Rate for Payer: WEA Trust Commercial |
$7,258.35
|
| Rate for Payer: WPS Commercial |
$9,775.02
|
|
|
INSERT TRIATHLON PS TIBIAL BEARING SZ 6 11MM 5532-G-611
|
Facility
|
OP
|
$8,080.00
|
|
| Hospital Charge Code |
4493926
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,262.40 |
| Max. Negotiated Rate |
$32,320.00 |
| Rate for Payer: Aetna Commercial |
$7,272.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,948.80
|
| Rate for Payer: Aetna Managed Medicare |
$2,262.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,252.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,040.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,878.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,282.40
|
| Rate for Payer: Cash Price |
$2,424.00
|
| Rate for Payer: Cigna Commercial |
$7,433.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,521.57
|
| Rate for Payer: Health EOS Commercial |
$7,191.20
|
| Rate for Payer: HFN Commercial |
$7,433.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,060.00
|
| Rate for Payer: Multiplan Commercial |
$6,464.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,848.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,433.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,959.20
|
| Rate for Payer: Quartz Commercial |
$5,252.00
|
| Rate for Payer: Quartz Medicare Advantage |
$4,848.00
|
| Rate for Payer: The Alliance Commercial |
$32,320.00
|
| Rate for Payer: WEA Trust Commercial |
$4,444.00
|
| Rate for Payer: WPS Commercial |
$5,984.86
|
|
|
INSERT TRIATHLON PS TIBIAL BEARING SZ 6 11MM 5532-G-611
|
Facility
|
IP
|
$8,080.00
|
|
| Hospital Charge Code |
4493926
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,959.20 |
| Max. Negotiated Rate |
$7,433.60 |
| Rate for Payer: Aetna Commercial |
$7,272.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,948.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,282.40
|
| Rate for Payer: Cash Price |
$2,424.00
|
| Rate for Payer: Cigna Commercial |
$7,433.60
|
| Rate for Payer: Health EOS Commercial |
$7,191.20
|
| Rate for Payer: HFN Commercial |
$7,433.60
|
| Rate for Payer: Multiplan Commercial |
$6,464.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,848.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,433.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,959.20
|
| Rate for Payer: Quartz Commercial |
$4,848.00
|
| Rate for Payer: WEA Trust Commercial |
$4,444.00
|
| Rate for Payer: WPS Commercial |
$5,984.86
|
|
|
INSERT TRIATHLON PS TIBIAL BEARING SZ 6 13MM 5532-G-613
|
Facility
|
IP
|
$8,080.00
|
|
| Hospital Charge Code |
4493929
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,959.20 |
| Max. Negotiated Rate |
$7,433.60 |
| Rate for Payer: Aetna Commercial |
$7,272.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,948.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,282.40
|
| Rate for Payer: Cash Price |
$2,424.00
|
| Rate for Payer: Cigna Commercial |
$7,433.60
|
| Rate for Payer: Health EOS Commercial |
$7,191.20
|
| Rate for Payer: HFN Commercial |
$7,433.60
|
| Rate for Payer: Multiplan Commercial |
$6,464.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,848.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,433.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,959.20
|
| Rate for Payer: Quartz Commercial |
$4,848.00
|
| Rate for Payer: WEA Trust Commercial |
$4,444.00
|
| Rate for Payer: WPS Commercial |
$5,984.86
|
|
|
INSERT TRIATHLON PS TIBIAL BEARING SZ 6 13MM 5532-G-613
|
Facility
|
OP
|
$8,080.00
|
|
| Hospital Charge Code |
4493929
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,262.40 |
| Max. Negotiated Rate |
$32,320.00 |
| Rate for Payer: Aetna Commercial |
$7,272.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,948.80
|
| Rate for Payer: Aetna Managed Medicare |
$2,262.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,252.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,040.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,878.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,282.40
|
| Rate for Payer: Cash Price |
$2,424.00
|
| Rate for Payer: Cigna Commercial |
$7,433.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,521.57
|
| Rate for Payer: Health EOS Commercial |
$7,191.20
|
| Rate for Payer: HFN Commercial |
$7,433.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,060.00
|
| Rate for Payer: Multiplan Commercial |
$6,464.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,848.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,433.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,959.20
|
| Rate for Payer: Quartz Commercial |
$5,252.00
|
| Rate for Payer: Quartz Medicare Advantage |
$4,848.00
|
| Rate for Payer: The Alliance Commercial |
$32,320.00
|
| Rate for Payer: WEA Trust Commercial |
$4,444.00
|
| Rate for Payer: WPS Commercial |
$5,984.86
|
|
|
INSERT TRIATHLON PS TIBIAL BEARING SZ 6 19MM 5532-G-619
|
Facility
|
OP
|
$8,080.00
|
|
| Hospital Charge Code |
4493930
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,262.40 |
| Max. Negotiated Rate |
$32,320.00 |
| Rate for Payer: Aetna Commercial |
$7,272.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,948.80
|
| Rate for Payer: Aetna Managed Medicare |
$2,262.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,252.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,040.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,878.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,282.40
|
| Rate for Payer: Cash Price |
$2,424.00
|
| Rate for Payer: Cigna Commercial |
$7,433.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,521.57
|
| Rate for Payer: Health EOS Commercial |
$7,191.20
|
| Rate for Payer: HFN Commercial |
$7,433.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,060.00
|
| Rate for Payer: Multiplan Commercial |
$6,464.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,848.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,433.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,959.20
|
| Rate for Payer: Quartz Commercial |
$5,252.00
|
| Rate for Payer: Quartz Medicare Advantage |
$4,848.00
|
| Rate for Payer: The Alliance Commercial |
$32,320.00
|
| Rate for Payer: WEA Trust Commercial |
$4,444.00
|
| Rate for Payer: WPS Commercial |
$5,984.86
|
|
|
INSERT TRIATHLON PS TIBIAL BEARING SZ 6 19MM 5532-G-619
|
Facility
|
IP
|
$8,080.00
|
|
| Hospital Charge Code |
4493930
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,959.20 |
| Max. Negotiated Rate |
$7,433.60 |
| Rate for Payer: Aetna Commercial |
$7,272.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,948.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,282.40
|
| Rate for Payer: Cash Price |
$2,424.00
|
| Rate for Payer: Cigna Commercial |
$7,433.60
|
| Rate for Payer: Health EOS Commercial |
$7,191.20
|
| Rate for Payer: HFN Commercial |
$7,433.60
|
| Rate for Payer: Multiplan Commercial |
$6,464.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,848.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,433.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,959.20
|
| Rate for Payer: Quartz Commercial |
$4,848.00
|
| Rate for Payer: WEA Trust Commercial |
$4,444.00
|
| Rate for Payer: WPS Commercial |
$5,984.86
|
|
|
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 |
$2,262.40 |
| Max. Negotiated Rate |
$32,320.00 |
| Rate for Payer: Aetna Commercial |
$7,272.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,948.80
|
| Rate for Payer: Aetna Managed Medicare |
$2,262.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,252.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,040.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,878.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,282.40
|
| Rate for Payer: Cash Price |
$2,424.00
|
| Rate for Payer: Cigna Commercial |
$7,433.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,521.57
|
| Rate for Payer: Health EOS Commercial |
$7,191.20
|
| Rate for Payer: HFN Commercial |
$7,433.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,060.00
|
| Rate for Payer: Multiplan Commercial |
$6,464.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,848.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,433.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,959.20
|
| Rate for Payer: Quartz Commercial |
$5,252.00
|
| Rate for Payer: Quartz Medicare Advantage |
$4,848.00
|
| Rate for Payer: The Alliance Commercial |
$32,320.00
|
| Rate for Payer: WEA Trust Commercial |
$4,444.00
|
| Rate for Payer: WPS Commercial |
$5,984.86
|
|
|
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 |
$3,959.20 |
| Max. Negotiated Rate |
$7,433.60 |
| Rate for Payer: Aetna Commercial |
$7,272.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,948.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,282.40
|
| Rate for Payer: Cash Price |
$2,424.00
|
| Rate for Payer: Cigna Commercial |
$7,433.60
|
| Rate for Payer: Health EOS Commercial |
$7,191.20
|
| Rate for Payer: HFN Commercial |
$7,433.60
|
| Rate for Payer: Multiplan Commercial |
$6,464.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,848.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,433.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,959.20
|
| Rate for Payer: Quartz Commercial |
$4,848.00
|
| Rate for Payer: WEA Trust Commercial |
$4,444.00
|
| Rate for Payer: WPS Commercial |
$5,984.86
|
|
|
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 |
$3,286.92 |
| Max. Negotiated Rate |
$6,171.36 |
| Rate for Payer: Aetna Commercial |
$6,037.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,768.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,555.24
|
| Rate for Payer: Cash Price |
$2,012.40
|
| Rate for Payer: Cigna Commercial |
$6,171.36
|
| Rate for Payer: Health EOS Commercial |
$5,970.12
|
| Rate for Payer: HFN Commercial |
$6,171.36
|
| Rate for Payer: Multiplan Commercial |
$5,366.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,024.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,171.36
|
| Rate for Payer: Quartz Beloit One Network |
$3,286.92
|
| Rate for Payer: Quartz Commercial |
$4,024.80
|
| Rate for Payer: WEA Trust Commercial |
$3,689.40
|
| Rate for Payer: WPS Commercial |
$4,968.62
|
|
|
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 |
$1,878.24 |
| Max. Negotiated Rate |
$26,832.00 |
| Rate for Payer: Aetna Commercial |
$6,037.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,768.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,878.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,360.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,354.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,219.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,555.24
|
| Rate for Payer: Cash Price |
$2,012.40
|
| Rate for Payer: Cigna Commercial |
$6,171.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,753.80
|
| Rate for Payer: Health EOS Commercial |
$5,970.12
|
| Rate for Payer: HFN Commercial |
$6,171.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,031.00
|
| Rate for Payer: Multiplan Commercial |
$5,366.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,024.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,171.36
|
| Rate for Payer: Quartz Beloit One Network |
$3,286.92
|
| Rate for Payer: Quartz Commercial |
$4,360.20
|
| Rate for Payer: Quartz Medicare Advantage |
$4,024.80
|
| Rate for Payer: The Alliance Commercial |
$26,832.00
|
| Rate for Payer: WEA Trust Commercial |
$3,689.40
|
| Rate for Payer: WPS Commercial |
$4,968.62
|
|
|
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 |
$3,413.83 |
| Max. Negotiated Rate |
$6,409.64 |
| Rate for Payer: Aetna Commercial |
$6,270.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,991.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,692.51
|
| Rate for Payer: Cash Price |
$2,090.10
|
| Rate for Payer: Cigna Commercial |
$6,409.64
|
| Rate for Payer: Health EOS Commercial |
$6,200.63
|
| Rate for Payer: HFN Commercial |
$6,409.64
|
| Rate for Payer: Multiplan Commercial |
$5,573.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,180.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,409.64
|
| Rate for Payer: Quartz Beloit One Network |
$3,413.83
|
| Rate for Payer: Quartz Commercial |
$4,180.20
|
| Rate for Payer: WEA Trust Commercial |
$3,831.85
|
| Rate for Payer: WPS Commercial |
$5,160.46
|
|
|
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 |
$1,950.76 |
| Max. Negotiated Rate |
$27,868.00 |
| Rate for Payer: Aetna Commercial |
$6,270.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,991.62
|
| Rate for Payer: Aetna Managed Medicare |
$1,950.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,528.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,483.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,344.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,692.51
|
| Rate for Payer: Cash Price |
$2,090.10
|
| Rate for Payer: Cigna Commercial |
$6,409.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,898.73
|
| Rate for Payer: Health EOS Commercial |
$6,200.63
|
| Rate for Payer: HFN Commercial |
$6,409.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,225.25
|
| Rate for Payer: Multiplan Commercial |
$5,573.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,180.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,409.64
|
| Rate for Payer: Quartz Beloit One Network |
$3,413.83
|
| Rate for Payer: Quartz Commercial |
$4,528.55
|
| Rate for Payer: Quartz Medicare Advantage |
$4,180.20
|
| Rate for Payer: The Alliance Commercial |
$27,868.00
|
| Rate for Payer: WEA Trust Commercial |
$3,831.85
|
| Rate for Payer: WPS Commercial |
$5,160.46
|
|
|
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 |
$1,950.76 |
| Max. Negotiated Rate |
$27,868.00 |
| Rate for Payer: Aetna Commercial |
$6,270.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,991.62
|
| Rate for Payer: Aetna Managed Medicare |
$1,950.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,528.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,483.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,344.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,692.51
|
| Rate for Payer: Cash Price |
$2,090.10
|
| Rate for Payer: Cigna Commercial |
$6,409.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,898.73
|
| Rate for Payer: Health EOS Commercial |
$6,200.63
|
| Rate for Payer: HFN Commercial |
$6,409.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,225.25
|
| Rate for Payer: Multiplan Commercial |
$5,573.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,180.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,409.64
|
| Rate for Payer: Quartz Beloit One Network |
$3,413.83
|
| Rate for Payer: Quartz Commercial |
$4,528.55
|
| Rate for Payer: Quartz Medicare Advantage |
$4,180.20
|
| Rate for Payer: The Alliance Commercial |
$27,868.00
|
| Rate for Payer: WEA Trust Commercial |
$3,831.85
|
| Rate for Payer: WPS Commercial |
$5,160.46
|
|
|
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 |
$3,413.83 |
| Max. Negotiated Rate |
$6,409.64 |
| Rate for Payer: Aetna Commercial |
$6,270.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,991.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,692.51
|
| Rate for Payer: Cash Price |
$2,090.10
|
| Rate for Payer: Cigna Commercial |
$6,409.64
|
| Rate for Payer: Health EOS Commercial |
$6,200.63
|
| Rate for Payer: HFN Commercial |
$6,409.64
|
| Rate for Payer: Multiplan Commercial |
$5,573.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,180.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,409.64
|
| Rate for Payer: Quartz Beloit One Network |
$3,413.83
|
| Rate for Payer: Quartz Commercial |
$4,180.20
|
| Rate for Payer: WEA Trust Commercial |
$3,831.85
|
| Rate for Payer: WPS Commercial |
$5,160.46
|
|
|
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 |
$1,878.24 |
| Max. Negotiated Rate |
$26,832.00 |
| Rate for Payer: Aetna Commercial |
$6,037.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,768.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,878.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,360.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,354.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,219.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,555.24
|
| Rate for Payer: Cash Price |
$2,012.40
|
| Rate for Payer: Cigna Commercial |
$6,171.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,753.80
|
| Rate for Payer: Health EOS Commercial |
$5,970.12
|
| Rate for Payer: HFN Commercial |
$6,171.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,031.00
|
| Rate for Payer: Multiplan Commercial |
$5,366.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,024.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,171.36
|
| Rate for Payer: Quartz Beloit One Network |
$3,286.92
|
| Rate for Payer: Quartz Commercial |
$4,360.20
|
| Rate for Payer: Quartz Medicare Advantage |
$4,024.80
|
| Rate for Payer: The Alliance Commercial |
$26,832.00
|
| Rate for Payer: WEA Trust Commercial |
$3,689.40
|
| Rate for Payer: WPS Commercial |
$4,968.62
|
|
|
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 |
$3,286.92 |
| Max. Negotiated Rate |
$6,171.36 |
| Rate for Payer: Aetna Commercial |
$6,037.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,768.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,555.24
|
| Rate for Payer: Cash Price |
$2,012.40
|
| Rate for Payer: Cigna Commercial |
$6,171.36
|
| Rate for Payer: Health EOS Commercial |
$5,970.12
|
| Rate for Payer: HFN Commercial |
$6,171.36
|
| Rate for Payer: Multiplan Commercial |
$5,366.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,024.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,171.36
|
| Rate for Payer: Quartz Beloit One Network |
$3,286.92
|
| Rate for Payer: Quartz Commercial |
$4,024.80
|
| Rate for Payer: WEA Trust Commercial |
$3,689.40
|
| Rate for Payer: WPS Commercial |
$4,968.62
|
|
|
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 |
$1,878.24 |
| Max. Negotiated Rate |
$26,832.00 |
| Rate for Payer: Aetna Commercial |
$6,037.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,768.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,878.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,360.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,354.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,219.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,555.24
|
| Rate for Payer: Cash Price |
$2,012.40
|
| Rate for Payer: Cigna Commercial |
$6,171.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,753.80
|
| Rate for Payer: Health EOS Commercial |
$5,970.12
|
| Rate for Payer: HFN Commercial |
$6,171.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,031.00
|
| Rate for Payer: Multiplan Commercial |
$5,366.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,024.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,171.36
|
| Rate for Payer: Quartz Beloit One Network |
$3,286.92
|
| Rate for Payer: Quartz Commercial |
$4,360.20
|
| Rate for Payer: Quartz Medicare Advantage |
$4,024.80
|
| Rate for Payer: The Alliance Commercial |
$26,832.00
|
| Rate for Payer: WEA Trust Commercial |
$3,689.40
|
| Rate for Payer: WPS Commercial |
$4,968.62
|
|
|
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 |
$3,286.92 |
| Max. Negotiated Rate |
$6,171.36 |
| Rate for Payer: Aetna Commercial |
$6,037.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,768.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,555.24
|
| Rate for Payer: Cash Price |
$2,012.40
|
| Rate for Payer: Cigna Commercial |
$6,171.36
|
| Rate for Payer: Health EOS Commercial |
$5,970.12
|
| Rate for Payer: HFN Commercial |
$6,171.36
|
| Rate for Payer: Multiplan Commercial |
$5,366.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,024.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,171.36
|
| Rate for Payer: Quartz Beloit One Network |
$3,286.92
|
| Rate for Payer: Quartz Commercial |
$4,024.80
|
| Rate for Payer: WEA Trust Commercial |
$3,689.40
|
| Rate for Payer: WPS Commercial |
$4,968.62
|
|
|
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 |
$1,878.24 |
| Max. Negotiated Rate |
$26,832.00 |
| Rate for Payer: Aetna Commercial |
$6,037.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,768.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,878.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,360.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,354.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,219.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,555.24
|
| Rate for Payer: Cash Price |
$2,012.40
|
| Rate for Payer: Cigna Commercial |
$6,171.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,753.80
|
| Rate for Payer: Health EOS Commercial |
$5,970.12
|
| Rate for Payer: HFN Commercial |
$6,171.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,031.00
|
| Rate for Payer: Multiplan Commercial |
$5,366.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,024.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,171.36
|
| Rate for Payer: Quartz Beloit One Network |
$3,286.92
|
| Rate for Payer: Quartz Commercial |
$4,360.20
|
| Rate for Payer: Quartz Medicare Advantage |
$4,024.80
|
| Rate for Payer: The Alliance Commercial |
$26,832.00
|
| Rate for Payer: WEA Trust Commercial |
$3,689.40
|
| Rate for Payer: WPS Commercial |
$4,968.62
|
|
|
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 |
$3,286.92 |
| Max. Negotiated Rate |
$6,171.36 |
| Rate for Payer: Aetna Commercial |
$6,037.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,768.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,555.24
|
| Rate for Payer: Cash Price |
$2,012.40
|
| Rate for Payer: Cigna Commercial |
$6,171.36
|
| Rate for Payer: Health EOS Commercial |
$5,970.12
|
| Rate for Payer: HFN Commercial |
$6,171.36
|
| Rate for Payer: Multiplan Commercial |
$5,366.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,024.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,171.36
|
| Rate for Payer: Quartz Beloit One Network |
$3,286.92
|
| Rate for Payer: Quartz Commercial |
$4,024.80
|
| Rate for Payer: WEA Trust Commercial |
$3,689.40
|
| Rate for Payer: WPS Commercial |
$4,968.62
|
|
|
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 |
$3,286.92 |
| Max. Negotiated Rate |
$6,171.36 |
| Rate for Payer: Aetna Commercial |
$6,037.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,768.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,555.24
|
| Rate for Payer: Cash Price |
$2,012.40
|
| Rate for Payer: Cigna Commercial |
$6,171.36
|
| Rate for Payer: Health EOS Commercial |
$5,970.12
|
| Rate for Payer: HFN Commercial |
$6,171.36
|
| Rate for Payer: Multiplan Commercial |
$5,366.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,024.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,171.36
|
| Rate for Payer: Quartz Beloit One Network |
$3,286.92
|
| Rate for Payer: Quartz Commercial |
$4,024.80
|
| Rate for Payer: WEA Trust Commercial |
$3,689.40
|
| Rate for Payer: WPS Commercial |
$4,968.62
|
|
|
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 |
$1,878.24 |
| Max. Negotiated Rate |
$26,832.00 |
| Rate for Payer: Aetna Commercial |
$6,037.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,768.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,878.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,360.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,354.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,219.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,555.24
|
| Rate for Payer: Cash Price |
$2,012.40
|
| Rate for Payer: Cigna Commercial |
$6,171.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,753.80
|
| Rate for Payer: Health EOS Commercial |
$5,970.12
|
| Rate for Payer: HFN Commercial |
$6,171.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,031.00
|
| Rate for Payer: Multiplan Commercial |
$5,366.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,024.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,171.36
|
| Rate for Payer: Quartz Beloit One Network |
$3,286.92
|
| Rate for Payer: Quartz Commercial |
$4,360.20
|
| Rate for Payer: Quartz Medicare Advantage |
$4,024.80
|
| Rate for Payer: The Alliance Commercial |
$26,832.00
|
| Rate for Payer: WEA Trust Commercial |
$3,689.40
|
| Rate for Payer: WPS Commercial |
$4,968.62
|
|
|
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 |
$1,878.24 |
| Max. Negotiated Rate |
$26,832.00 |
| Rate for Payer: Aetna Commercial |
$6,037.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,768.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,878.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,360.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,354.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,219.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,555.24
|
| Rate for Payer: Cash Price |
$2,012.40
|
| Rate for Payer: Cigna Commercial |
$6,171.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,753.80
|
| Rate for Payer: Health EOS Commercial |
$5,970.12
|
| Rate for Payer: HFN Commercial |
$6,171.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,031.00
|
| Rate for Payer: Multiplan Commercial |
$5,366.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,024.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,171.36
|
| Rate for Payer: Quartz Beloit One Network |
$3,286.92
|
| Rate for Payer: Quartz Commercial |
$4,360.20
|
| Rate for Payer: Quartz Medicare Advantage |
$4,024.80
|
| Rate for Payer: The Alliance Commercial |
$26,832.00
|
| Rate for Payer: WEA Trust Commercial |
$3,689.40
|
| Rate for Payer: WPS Commercial |
$4,968.62
|
|
