|
INSERT TRIATHLON TIBIAL BEARING CS SZ 8 19MM 5531-G-819
|
Facility
|
IP
|
$6,708.00
|
|
| Hospital Charge Code |
4493902
|
|
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 8 19MM 5531-G-819
|
Facility
|
OP
|
$6,708.00
|
|
| Hospital Charge Code |
4493902
|
|
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 8 22MM 5531-G-822
|
Facility
|
OP
|
$6,708.00
|
|
| Hospital Charge Code |
4518627
|
|
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 8 22MM 5531-G-822
|
Facility
|
IP
|
$6,708.00
|
|
| Hospital Charge Code |
4518627
|
|
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 8 25MM 5531-G-825
|
Facility
|
OP
|
$6,708.00
|
|
| Hospital Charge Code |
4518628
|
|
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 8 25MM 5531-G-825
|
Facility
|
IP
|
$6,708.00
|
|
| Hospital Charge Code |
4518628
|
|
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 8 9MM 5531-G-809
|
Facility
|
IP
|
$6,708.00
|
|
| Hospital Charge Code |
4493898
|
|
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 8 9MM 5531-G-809
|
Facility
|
OP
|
$6,708.00
|
|
| Hospital Charge Code |
4493898
|
|
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 PS SZ 3 16MM 5532-G-316
|
Facility
|
OP
|
$8,080.00
|
|
| Hospital Charge Code |
4493915
|
|
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 TIBIAL BEARING PS SZ 3 16MM 5532-G-316
|
Facility
|
IP
|
$8,080.00
|
|
| Hospital Charge Code |
4493915
|
|
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 TIBIAL BEARING PS SZ 5 11MM 5532-G-511
|
Facility
|
OP
|
$8,080.00
|
|
| Hospital Charge Code |
4493922
|
|
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 TIBIAL BEARING PS SZ 5 11MM 5532-G-511
|
Facility
|
IP
|
$8,080.00
|
|
| Hospital Charge Code |
4493922
|
|
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 TIBIAL BEARING PS SZ 5 13MM 5532-G-513
|
Facility
|
OP
|
$8,080.00
|
|
| Hospital Charge Code |
4493923
|
|
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 TIBIAL BEARING PS SZ 5 13MM 5532-G-513
|
Facility
|
IP
|
$8,080.00
|
|
| Hospital Charge Code |
4493923
|
|
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 TIBIAL BEARING PS SZ 5 19MM 5532-G-519
|
Facility
|
IP
|
$8,080.00
|
|
| Hospital Charge Code |
4493924
|
|
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 TIBIAL BEARING PS SZ 5 19MM 5532-G-519
|
Facility
|
OP
|
$8,080.00
|
|
| Hospital Charge Code |
4493924
|
|
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 TIBIAL BEARING PS SZ 5 9MM 5532-G-509
|
Facility
|
IP
|
$8,080.00
|
|
| Hospital Charge Code |
4493921
|
|
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 TIBIAL BEARING PS SZ 5 9MM 5532-G-509
|
Facility
|
OP
|
$8,080.00
|
|
| Hospital Charge Code |
4493921
|
|
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 TIBIAL TOTAL STABILIZER TS SZ 5 9MM 5537-G-509
|
Facility
|
IP
|
$13,267.00
|
|
| Hospital Charge Code |
5202614
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,500.83 |
| Max. Negotiated Rate |
$12,205.64 |
| Rate for Payer: Aetna Commercial |
$11,940.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,409.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,031.51
|
| Rate for Payer: Cash Price |
$3,980.10
|
| Rate for Payer: Cigna Commercial |
$12,205.64
|
| Rate for Payer: Health EOS Commercial |
$11,807.63
|
| Rate for Payer: HFN Commercial |
$12,205.64
|
| Rate for Payer: Multiplan Commercial |
$10,613.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,960.20
|
| Rate for Payer: Preferred Network Access Commercial |
$12,205.64
|
| Rate for Payer: Quartz Beloit One Network |
$6,500.83
|
| Rate for Payer: Quartz Commercial |
$7,960.20
|
| Rate for Payer: WEA Trust Commercial |
$7,296.85
|
| Rate for Payer: WPS Commercial |
$9,826.87
|
|
|
INSERT TRIATHLON TIBIAL TOTAL STABILIZER TS SZ 5 9MM 5537-G-509
|
Facility
|
OP
|
$13,267.00
|
|
| Hospital Charge Code |
5202614
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,714.76 |
| Max. Negotiated Rate |
$53,068.00 |
| Rate for Payer: Aetna Commercial |
$11,940.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,409.62
|
| Rate for Payer: Aetna Managed Medicare |
$3,714.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,623.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,633.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,368.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,031.51
|
| Rate for Payer: Cash Price |
$3,980.10
|
| Rate for Payer: Cigna Commercial |
$12,205.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,424.21
|
| Rate for Payer: Health EOS Commercial |
$11,807.63
|
| Rate for Payer: HFN Commercial |
$12,205.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,950.25
|
| Rate for Payer: Multiplan Commercial |
$10,613.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,960.20
|
| Rate for Payer: Preferred Network Access Commercial |
$12,205.64
|
| Rate for Payer: Quartz Beloit One Network |
$6,500.83
|
| Rate for Payer: Quartz Commercial |
$8,623.55
|
| Rate for Payer: Quartz Medicare Advantage |
$7,960.20
|
| Rate for Payer: The Alliance Commercial |
$53,068.00
|
| Rate for Payer: WEA Trust Commercial |
$7,296.85
|
| Rate for Payer: WPS Commercial |
$9,826.87
|
|
|
INSERT TRIATHLON TIBIAL TOTAL STABILIZER TS SZ 6 25MM 5537-G-625
|
Facility
|
IP
|
$208.00
|
|
| Hospital Charge Code |
2972434
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.92 |
| Max. Negotiated Rate |
$191.36 |
| Rate for Payer: Aetna Commercial |
$187.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$178.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$110.24
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cigna Commercial |
$191.36
|
| Rate for Payer: Health EOS Commercial |
$185.12
|
| Rate for Payer: HFN Commercial |
$191.36
|
| Rate for Payer: Multiplan Commercial |
$166.40
|
| Rate for Payer: NAPHCARE Commercial |
$124.80
|
| Rate for Payer: Preferred Network Access Commercial |
$191.36
|
| Rate for Payer: Quartz Beloit One Network |
$101.92
|
| Rate for Payer: Quartz Commercial |
$124.80
|
| Rate for Payer: WEA Trust Commercial |
$114.40
|
| Rate for Payer: WPS Commercial |
$154.07
|
|
|
INSERT TRIATHLON TIBIAL TOTAL STABILIZER TS SZ 6 25MM 5537-G-625
|
Facility
|
OP
|
$208.00
|
|
| Hospital Charge Code |
2972434
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.24 |
| Max. Negotiated Rate |
$832.00 |
| Rate for Payer: Aetna Commercial |
$187.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$178.88
|
| Rate for Payer: Aetna Managed Medicare |
$58.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$135.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$104.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$99.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$110.24
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cigna Commercial |
$191.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$116.40
|
| Rate for Payer: Health EOS Commercial |
$185.12
|
| Rate for Payer: HFN Commercial |
$191.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$156.00
|
| Rate for Payer: Multiplan Commercial |
$166.40
|
| Rate for Payer: NAPHCARE Commercial |
$124.80
|
| Rate for Payer: Preferred Network Access Commercial |
$191.36
|
| Rate for Payer: Quartz Beloit One Network |
$101.92
|
| Rate for Payer: Quartz Commercial |
$135.20
|
| Rate for Payer: Quartz Medicare Advantage |
$124.80
|
| Rate for Payer: The Alliance Commercial |
$832.00
|
| Rate for Payer: WEA Trust Commercial |
$114.40
|
| Rate for Payer: WPS Commercial |
$154.07
|
|
|
INSERT TRIDENT 0 DEG 36MM D 623-00-36D
|
Facility
|
IP
|
$6,332.00
|
|
| Hospital Charge Code |
4364704
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,102.68 |
| Max. Negotiated Rate |
$5,825.44 |
| Rate for Payer: Aetna Commercial |
$5,698.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,445.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,355.96
|
| Rate for Payer: Cash Price |
$1,899.60
|
| Rate for Payer: Cigna Commercial |
$5,825.44
|
| Rate for Payer: Health EOS Commercial |
$5,635.48
|
| Rate for Payer: HFN Commercial |
$5,825.44
|
| Rate for Payer: Multiplan Commercial |
$5,065.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,799.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,825.44
|
| Rate for Payer: Quartz Beloit One Network |
$3,102.68
|
| Rate for Payer: Quartz Commercial |
$3,799.20
|
| Rate for Payer: WEA Trust Commercial |
$3,482.60
|
| Rate for Payer: WPS Commercial |
$4,690.11
|
|
|
INSERT TRIDENT 0 DEG 36MM D 623-00-36D
|
Facility
|
OP
|
$6,332.00
|
|
| Hospital Charge Code |
4364704
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,772.96 |
| Max. Negotiated Rate |
$25,328.00 |
| Rate for Payer: Aetna Commercial |
$5,698.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,445.52
|
| Rate for Payer: Aetna Managed Medicare |
$1,772.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,115.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,166.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,039.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,355.96
|
| Rate for Payer: Cash Price |
$1,899.60
|
| Rate for Payer: Cigna Commercial |
$5,825.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,543.39
|
| Rate for Payer: Health EOS Commercial |
$5,635.48
|
| Rate for Payer: HFN Commercial |
$5,825.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,749.00
|
| Rate for Payer: Multiplan Commercial |
$5,065.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,799.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,825.44
|
| Rate for Payer: Quartz Beloit One Network |
$3,102.68
|
| Rate for Payer: Quartz Commercial |
$4,115.80
|
| Rate for Payer: Quartz Medicare Advantage |
$3,799.20
|
| Rate for Payer: The Alliance Commercial |
$25,328.00
|
| Rate for Payer: WEA Trust Commercial |
$3,482.60
|
| Rate for Payer: WPS Commercial |
$4,690.11
|
|
|
INSERT TRIDENT 0 DEG 36MM E 623-00-36E
|
Facility
|
OP
|
$6,332.00
|
|
| Hospital Charge Code |
4595053
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,772.96 |
| Max. Negotiated Rate |
$25,328.00 |
| Rate for Payer: Aetna Commercial |
$5,698.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,445.52
|
| Rate for Payer: Aetna Managed Medicare |
$1,772.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,115.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,166.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,039.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,355.96
|
| Rate for Payer: Cash Price |
$1,899.60
|
| Rate for Payer: Cigna Commercial |
$5,825.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,543.39
|
| Rate for Payer: Health EOS Commercial |
$5,635.48
|
| Rate for Payer: HFN Commercial |
$5,825.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,749.00
|
| Rate for Payer: Multiplan Commercial |
$5,065.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,799.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,825.44
|
| Rate for Payer: Quartz Beloit One Network |
$3,102.68
|
| Rate for Payer: Quartz Commercial |
$4,115.80
|
| Rate for Payer: Quartz Medicare Advantage |
$3,799.20
|
| Rate for Payer: The Alliance Commercial |
$25,328.00
|
| Rate for Payer: WEA Trust Commercial |
$3,482.60
|
| Rate for Payer: WPS Commercial |
$4,690.11
|
|
