|
INSERT TRIATHLON TIBIAL BEARING CS SZ 4 9MM 5531-G-409
|
Facility
|
OP
|
$6,708.00
|
|
| Hospital Charge Code |
3127463
|
|
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 4 9MM 5531-G-409
|
Facility
|
IP
|
$6,708.00
|
|
| Hospital Charge Code |
3127463
|
|
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 5 11MM 5531-G-511
|
Facility
|
IP
|
$6,708.00
|
|
| Hospital Charge Code |
3072435
|
|
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 5 11MM 5531-G-511
|
Facility
|
OP
|
$6,708.00
|
|
| Hospital Charge Code |
3072435
|
|
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 5 13MM 5531-G-513
|
Facility
|
IP
|
$6,967.00
|
|
| Hospital Charge Code |
4167705
|
|
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 5 13MM 5531-G-513
|
Facility
|
OP
|
$6,967.00
|
|
| Hospital Charge Code |
4167705
|
|
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 5 16MM 5531-G-516
|
Facility
|
IP
|
$6,708.00
|
|
| Hospital Charge Code |
4493741
|
|
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 5 16MM 5531-G-516
|
Facility
|
OP
|
$6,708.00
|
|
| Hospital Charge Code |
4493741
|
|
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 5 19MM 5531-G-519
|
Facility
|
OP
|
$6,708.00
|
|
| Hospital Charge Code |
4493893
|
|
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 5 19MM 5531-G-519
|
Facility
|
IP
|
$6,708.00
|
|
| Hospital Charge Code |
4493893
|
|
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 5 22MM 5531-G-522
|
Facility
|
IP
|
$6,708.00
|
|
| Hospital Charge Code |
4493814
|
|
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 5 22MM 5531-G-522
|
Facility
|
OP
|
$6,708.00
|
|
| Hospital Charge Code |
4493814
|
|
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 5 25MM 5531-G-525
|
Facility
|
IP
|
$6,708.00
|
|
| Hospital Charge Code |
4493846
|
|
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 5 25MM 5531-G-525
|
Facility
|
OP
|
$6,708.00
|
|
| Hospital Charge Code |
4493846
|
|
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 5 9MM 5531-G-509
|
Facility
|
OP
|
$6,708.00
|
|
| Hospital Charge Code |
4493892
|
|
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 5 9MM 5531-G-509
|
Facility
|
IP
|
$6,708.00
|
|
| Hospital Charge Code |
4493892
|
|
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 6 11MM 5531-G-611
|
Facility
|
IP
|
$6,967.00
|
|
| Hospital Charge Code |
4074600
|
|
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 6 11MM 5531-G-611
|
Facility
|
OP
|
$6,967.00
|
|
| Hospital Charge Code |
4074600
|
|
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 6 13MM 5531-G-613
|
Facility
|
IP
|
$6,967.00
|
|
| Hospital Charge Code |
3935330
|
|
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 6 13MM 5531-G-613
|
Facility
|
OP
|
$6,967.00
|
|
| Hospital Charge Code |
3935330
|
|
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 6 16MM 5531-G-616
|
Facility
|
OP
|
$6,708.00
|
|
| Hospital Charge Code |
3953373
|
|
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 6 16MM 5531-G-616
|
Facility
|
IP
|
$6,708.00
|
|
| Hospital Charge Code |
3953373
|
|
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 6 19MM 5531-G-619
|
Facility
|
IP
|
$6,708.00
|
|
| Hospital Charge Code |
4493895
|
|
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 6 19MM 5531-G-619
|
Facility
|
OP
|
$6,708.00
|
|
| Hospital Charge Code |
4493895
|
|
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 6 22MM 5531-G-622
|
Facility
|
OP
|
$6,708.00
|
|
| Hospital Charge Code |
4518623
|
|
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
|
|
