|
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 |
$4,117.57 |
| Max. Negotiated Rate |
$7,730.94 |
| Rate for Payer: Aetna Commercial |
$7,562.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,226.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,453.70
|
| Rate for Payer: Cash Price |
$2,424.00
|
| Rate for Payer: Cigna Commercial |
$7,730.94
|
| Rate for Payer: Health EOS Commercial |
$7,478.85
|
| Rate for Payer: HFN Commercial |
$7,730.94
|
| Rate for Payer: Multiplan Commercial |
$6,722.56
|
| Rate for Payer: Preferred Network Access Commercial |
$7,730.94
|
| Rate for Payer: Quartz Beloit One Network |
$4,117.57
|
| Rate for Payer: Quartz Commercial |
$5,041.92
|
| Rate for Payer: WEA Trust Commercial |
$4,621.76
|
| Rate for Payer: WPS Commercial |
$6,224.02
|
|
|
INSERT TRIATHLON 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 |
$2,352.90 |
| Max. Negotiated Rate |
$7,730.94 |
| Rate for Payer: Aetna Commercial |
$7,562.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,226.75
|
| Rate for Payer: Aetna Managed Medicare |
$2,352.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,462.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,201.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,033.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,453.70
|
| Rate for Payer: Cash Price |
$2,424.00
|
| Rate for Payer: Cigna Commercial |
$7,730.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,702.56
|
| Rate for Payer: Health EOS Commercial |
$7,478.85
|
| Rate for Payer: HFN Commercial |
$7,730.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,302.40
|
| Rate for Payer: Multiplan Commercial |
$6,722.56
|
| Rate for Payer: NAPHCARE Commercial |
$5,041.92
|
| Rate for Payer: Preferred Network Access Commercial |
$7,730.94
|
| Rate for Payer: Quartz Beloit One Network |
$4,117.57
|
| Rate for Payer: Quartz Commercial |
$5,462.08
|
| Rate for Payer: Quartz Medicare Advantage |
$5,041.92
|
| Rate for Payer: The Alliance Commercial |
$4,201.60
|
| Rate for Payer: WEA Trust Commercial |
$4,621.76
|
| Rate for Payer: WPS Commercial |
$6,224.02
|
|
|
INSERT TRIATHLON 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 |
$2,352.90 |
| Max. Negotiated Rate |
$7,730.94 |
| Rate for Payer: Aetna Commercial |
$7,562.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,226.75
|
| Rate for Payer: Aetna Managed Medicare |
$2,352.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,462.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,201.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,033.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,453.70
|
| Rate for Payer: Cash Price |
$2,424.00
|
| Rate for Payer: Cigna Commercial |
$7,730.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,702.56
|
| Rate for Payer: Health EOS Commercial |
$7,478.85
|
| Rate for Payer: HFN Commercial |
$7,730.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,302.40
|
| Rate for Payer: Multiplan Commercial |
$6,722.56
|
| Rate for Payer: NAPHCARE Commercial |
$5,041.92
|
| Rate for Payer: Preferred Network Access Commercial |
$7,730.94
|
| Rate for Payer: Quartz Beloit One Network |
$4,117.57
|
| Rate for Payer: Quartz Commercial |
$5,462.08
|
| Rate for Payer: Quartz Medicare Advantage |
$5,041.92
|
| Rate for Payer: The Alliance Commercial |
$4,201.60
|
| Rate for Payer: WEA Trust Commercial |
$4,621.76
|
| Rate for Payer: WPS Commercial |
$6,224.02
|
|
|
INSERT TRIATHLON 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 |
$4,117.57 |
| Max. Negotiated Rate |
$7,730.94 |
| Rate for Payer: Aetna Commercial |
$7,562.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,226.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,453.70
|
| Rate for Payer: Cash Price |
$2,424.00
|
| Rate for Payer: Cigna Commercial |
$7,730.94
|
| Rate for Payer: Health EOS Commercial |
$7,478.85
|
| Rate for Payer: HFN Commercial |
$7,730.94
|
| Rate for Payer: Multiplan Commercial |
$6,722.56
|
| Rate for Payer: Preferred Network Access Commercial |
$7,730.94
|
| Rate for Payer: Quartz Beloit One Network |
$4,117.57
|
| Rate for Payer: Quartz Commercial |
$5,041.92
|
| Rate for Payer: WEA Trust Commercial |
$4,621.76
|
| Rate for Payer: WPS Commercial |
$6,224.02
|
|
|
INSERT TRIATHLON 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 |
$4,117.57 |
| Max. Negotiated Rate |
$7,730.94 |
| Rate for Payer: Aetna Commercial |
$7,562.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,226.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,453.70
|
| Rate for Payer: Cash Price |
$2,424.00
|
| Rate for Payer: Cigna Commercial |
$7,730.94
|
| Rate for Payer: Health EOS Commercial |
$7,478.85
|
| Rate for Payer: HFN Commercial |
$7,730.94
|
| Rate for Payer: Multiplan Commercial |
$6,722.56
|
| Rate for Payer: Preferred Network Access Commercial |
$7,730.94
|
| Rate for Payer: Quartz Beloit One Network |
$4,117.57
|
| Rate for Payer: Quartz Commercial |
$5,041.92
|
| Rate for Payer: WEA Trust Commercial |
$4,621.76
|
| Rate for Payer: WPS Commercial |
$6,224.02
|
|
|
INSERT TRIATHLON 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 |
$2,352.90 |
| Max. Negotiated Rate |
$7,730.94 |
| Rate for Payer: Aetna Commercial |
$7,562.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,226.75
|
| Rate for Payer: Aetna Managed Medicare |
$2,352.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,462.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,201.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,033.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,453.70
|
| Rate for Payer: Cash Price |
$2,424.00
|
| Rate for Payer: Cigna Commercial |
$7,730.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,702.56
|
| Rate for Payer: Health EOS Commercial |
$7,478.85
|
| Rate for Payer: HFN Commercial |
$7,730.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,302.40
|
| Rate for Payer: Multiplan Commercial |
$6,722.56
|
| Rate for Payer: NAPHCARE Commercial |
$5,041.92
|
| Rate for Payer: Preferred Network Access Commercial |
$7,730.94
|
| Rate for Payer: Quartz Beloit One Network |
$4,117.57
|
| Rate for Payer: Quartz Commercial |
$5,462.08
|
| Rate for Payer: Quartz Medicare Advantage |
$5,041.92
|
| Rate for Payer: The Alliance Commercial |
$4,201.60
|
| Rate for Payer: WEA Trust Commercial |
$4,621.76
|
| Rate for Payer: WPS Commercial |
$6,224.02
|
|
|
INSERT TRIATHLON 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 |
$4,117.57 |
| Max. Negotiated Rate |
$7,730.94 |
| Rate for Payer: Aetna Commercial |
$7,562.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,226.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,453.70
|
| Rate for Payer: Cash Price |
$2,424.00
|
| Rate for Payer: Cigna Commercial |
$7,730.94
|
| Rate for Payer: Health EOS Commercial |
$7,478.85
|
| Rate for Payer: HFN Commercial |
$7,730.94
|
| Rate for Payer: Multiplan Commercial |
$6,722.56
|
| Rate for Payer: Preferred Network Access Commercial |
$7,730.94
|
| Rate for Payer: Quartz Beloit One Network |
$4,117.57
|
| Rate for Payer: Quartz Commercial |
$5,041.92
|
| Rate for Payer: WEA Trust Commercial |
$4,621.76
|
| Rate for Payer: WPS Commercial |
$6,224.02
|
|
|
INSERT TRIATHLON 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 |
$2,352.90 |
| Max. Negotiated Rate |
$7,730.94 |
| Rate for Payer: Aetna Commercial |
$7,562.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,226.75
|
| Rate for Payer: Aetna Managed Medicare |
$2,352.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,462.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,201.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,033.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,453.70
|
| Rate for Payer: Cash Price |
$2,424.00
|
| Rate for Payer: Cigna Commercial |
$7,730.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,702.56
|
| Rate for Payer: Health EOS Commercial |
$7,478.85
|
| Rate for Payer: HFN Commercial |
$7,730.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,302.40
|
| Rate for Payer: Multiplan Commercial |
$6,722.56
|
| Rate for Payer: NAPHCARE Commercial |
$5,041.92
|
| Rate for Payer: Preferred Network Access Commercial |
$7,730.94
|
| Rate for Payer: Quartz Beloit One Network |
$4,117.57
|
| Rate for Payer: Quartz Commercial |
$5,462.08
|
| Rate for Payer: Quartz Medicare Advantage |
$5,041.92
|
| Rate for Payer: The Alliance Commercial |
$4,201.60
|
| Rate for Payer: WEA Trust Commercial |
$4,621.76
|
| Rate for Payer: WPS Commercial |
$6,224.02
|
|
|
INSERT TRIATHLON 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 |
$4,117.57 |
| Max. Negotiated Rate |
$7,730.94 |
| Rate for Payer: Aetna Commercial |
$7,562.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,226.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,453.70
|
| Rate for Payer: Cash Price |
$2,424.00
|
| Rate for Payer: Cigna Commercial |
$7,730.94
|
| Rate for Payer: Health EOS Commercial |
$7,478.85
|
| Rate for Payer: HFN Commercial |
$7,730.94
|
| Rate for Payer: Multiplan Commercial |
$6,722.56
|
| Rate for Payer: Preferred Network Access Commercial |
$7,730.94
|
| Rate for Payer: Quartz Beloit One Network |
$4,117.57
|
| Rate for Payer: Quartz Commercial |
$5,041.92
|
| Rate for Payer: WEA Trust Commercial |
$4,621.76
|
| Rate for Payer: WPS Commercial |
$6,224.02
|
|
|
INSERT TRIATHLON 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 |
$2,352.90 |
| Max. Negotiated Rate |
$7,730.94 |
| Rate for Payer: Aetna Commercial |
$7,562.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,226.75
|
| Rate for Payer: Aetna Managed Medicare |
$2,352.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,462.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,201.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,033.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,453.70
|
| Rate for Payer: Cash Price |
$2,424.00
|
| Rate for Payer: Cigna Commercial |
$7,730.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,702.56
|
| Rate for Payer: Health EOS Commercial |
$7,478.85
|
| Rate for Payer: HFN Commercial |
$7,730.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,302.40
|
| Rate for Payer: Multiplan Commercial |
$6,722.56
|
| Rate for Payer: NAPHCARE Commercial |
$5,041.92
|
| Rate for Payer: Preferred Network Access Commercial |
$7,730.94
|
| Rate for Payer: Quartz Beloit One Network |
$4,117.57
|
| Rate for Payer: Quartz Commercial |
$5,462.08
|
| Rate for Payer: Quartz Medicare Advantage |
$5,041.92
|
| Rate for Payer: The Alliance Commercial |
$4,201.60
|
| Rate for Payer: WEA Trust Commercial |
$4,621.76
|
| Rate for Payer: WPS Commercial |
$6,224.02
|
|
|
INSERT TRIATHLON 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 |
$6,760.86 |
| Max. Negotiated Rate |
$12,693.87 |
| Rate for Payer: Aetna Commercial |
$12,417.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,866.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,312.77
|
| Rate for Payer: Cash Price |
$3,980.10
|
| Rate for Payer: Cigna Commercial |
$12,693.87
|
| Rate for Payer: Health EOS Commercial |
$12,279.94
|
| Rate for Payer: HFN Commercial |
$12,693.87
|
| Rate for Payer: Multiplan Commercial |
$11,038.14
|
| Rate for Payer: Preferred Network Access Commercial |
$12,693.87
|
| Rate for Payer: Quartz Beloit One Network |
$6,760.86
|
| Rate for Payer: Quartz Commercial |
$8,278.61
|
| Rate for Payer: WEA Trust Commercial |
$7,588.72
|
| Rate for Payer: WPS Commercial |
$10,219.57
|
|
|
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 |
$3,863.35 |
| Max. Negotiated Rate |
$12,693.87 |
| Rate for Payer: Aetna Commercial |
$12,417.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,866.00
|
| Rate for Payer: Aetna Managed Medicare |
$3,863.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,968.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,898.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,622.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,312.77
|
| Rate for Payer: Cash Price |
$3,980.10
|
| Rate for Payer: Cigna Commercial |
$12,693.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,721.39
|
| Rate for Payer: Health EOS Commercial |
$12,279.94
|
| Rate for Payer: HFN Commercial |
$12,693.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,348.26
|
| Rate for Payer: Multiplan Commercial |
$11,038.14
|
| Rate for Payer: NAPHCARE Commercial |
$8,278.61
|
| Rate for Payer: Preferred Network Access Commercial |
$12,693.87
|
| Rate for Payer: Quartz Beloit One Network |
$6,760.86
|
| Rate for Payer: Quartz Commercial |
$8,968.49
|
| Rate for Payer: Quartz Medicare Advantage |
$8,278.61
|
| Rate for Payer: The Alliance Commercial |
$6,898.84
|
| Rate for Payer: WEA Trust Commercial |
$7,588.72
|
| Rate for Payer: WPS Commercial |
$10,219.57
|
|
|
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 |
$60.57 |
| Max. Negotiated Rate |
$199.01 |
| Rate for Payer: Aetna Commercial |
$194.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$186.04
|
| Rate for Payer: Aetna Managed Medicare |
$60.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$140.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$108.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$103.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$114.65
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cigna Commercial |
$199.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$121.06
|
| Rate for Payer: Health EOS Commercial |
$192.52
|
| Rate for Payer: HFN Commercial |
$199.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$162.24
|
| Rate for Payer: Multiplan Commercial |
$173.06
|
| Rate for Payer: NAPHCARE Commercial |
$129.79
|
| Rate for Payer: Preferred Network Access Commercial |
$199.01
|
| Rate for Payer: Quartz Beloit One Network |
$106.00
|
| Rate for Payer: Quartz Commercial |
$140.61
|
| Rate for Payer: Quartz Medicare Advantage |
$129.79
|
| Rate for Payer: The Alliance Commercial |
$108.16
|
| Rate for Payer: WEA Trust Commercial |
$118.98
|
| Rate for Payer: WPS Commercial |
$160.22
|
|
|
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 |
$106.00 |
| Max. Negotiated Rate |
$199.01 |
| Rate for Payer: Aetna Commercial |
$194.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$186.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$114.65
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cigna Commercial |
$199.01
|
| Rate for Payer: Health EOS Commercial |
$192.52
|
| Rate for Payer: HFN Commercial |
$199.01
|
| Rate for Payer: Multiplan Commercial |
$173.06
|
| Rate for Payer: Preferred Network Access Commercial |
$199.01
|
| Rate for Payer: Quartz Beloit One Network |
$106.00
|
| Rate for Payer: Quartz Commercial |
$129.79
|
| Rate for Payer: WEA Trust Commercial |
$118.98
|
| Rate for Payer: WPS Commercial |
$160.22
|
|
|
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 |
$3,226.79 |
| Max. Negotiated Rate |
$6,058.46 |
| Rate for Payer: Aetna Commercial |
$5,926.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,663.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,490.20
|
| Rate for Payer: Cash Price |
$1,899.60
|
| Rate for Payer: Cigna Commercial |
$6,058.46
|
| Rate for Payer: Health EOS Commercial |
$5,860.90
|
| Rate for Payer: HFN Commercial |
$6,058.46
|
| Rate for Payer: Multiplan Commercial |
$5,268.22
|
| Rate for Payer: Preferred Network Access Commercial |
$6,058.46
|
| Rate for Payer: Quartz Beloit One Network |
$3,226.79
|
| Rate for Payer: Quartz Commercial |
$3,951.17
|
| Rate for Payer: WEA Trust Commercial |
$3,621.90
|
| Rate for Payer: WPS Commercial |
$4,877.54
|
|
|
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 |
$1,843.88 |
| Max. Negotiated Rate |
$6,058.46 |
| Rate for Payer: Aetna Commercial |
$5,926.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,663.34
|
| Rate for Payer: Aetna Managed Medicare |
$1,843.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,280.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,292.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,160.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,490.20
|
| Rate for Payer: Cash Price |
$1,899.60
|
| Rate for Payer: Cigna Commercial |
$6,058.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,685.22
|
| Rate for Payer: Health EOS Commercial |
$5,860.90
|
| Rate for Payer: HFN Commercial |
$6,058.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,938.96
|
| Rate for Payer: Multiplan Commercial |
$5,268.22
|
| Rate for Payer: NAPHCARE Commercial |
$3,951.17
|
| Rate for Payer: Preferred Network Access Commercial |
$6,058.46
|
| Rate for Payer: Quartz Beloit One Network |
$3,226.79
|
| Rate for Payer: Quartz Commercial |
$4,280.43
|
| Rate for Payer: Quartz Medicare Advantage |
$3,951.17
|
| Rate for Payer: The Alliance Commercial |
$3,292.64
|
| Rate for Payer: WEA Trust Commercial |
$3,621.90
|
| Rate for Payer: WPS Commercial |
$4,877.54
|
|
|
INSERT TRIDENT 0 DEG 36MM E 623-00-36E
|
Facility
|
IP
|
$6,332.00
|
|
| Hospital Charge Code |
4595053
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,226.79 |
| Max. Negotiated Rate |
$6,058.46 |
| Rate for Payer: Aetna Commercial |
$5,926.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,663.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,490.20
|
| Rate for Payer: Cash Price |
$1,899.60
|
| Rate for Payer: Cigna Commercial |
$6,058.46
|
| Rate for Payer: Health EOS Commercial |
$5,860.90
|
| Rate for Payer: HFN Commercial |
$6,058.46
|
| Rate for Payer: Multiplan Commercial |
$5,268.22
|
| Rate for Payer: Preferred Network Access Commercial |
$6,058.46
|
| Rate for Payer: Quartz Beloit One Network |
$3,226.79
|
| Rate for Payer: Quartz Commercial |
$3,951.17
|
| Rate for Payer: WEA Trust Commercial |
$3,621.90
|
| Rate for Payer: WPS Commercial |
$4,877.54
|
|
|
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 |
$1,843.88 |
| Max. Negotiated Rate |
$6,058.46 |
| Rate for Payer: Aetna Commercial |
$5,926.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,663.34
|
| Rate for Payer: Aetna Managed Medicare |
$1,843.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,280.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,292.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,160.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,490.20
|
| Rate for Payer: Cash Price |
$1,899.60
|
| Rate for Payer: Cigna Commercial |
$6,058.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,685.22
|
| Rate for Payer: Health EOS Commercial |
$5,860.90
|
| Rate for Payer: HFN Commercial |
$6,058.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,938.96
|
| Rate for Payer: Multiplan Commercial |
$5,268.22
|
| Rate for Payer: NAPHCARE Commercial |
$3,951.17
|
| Rate for Payer: Preferred Network Access Commercial |
$6,058.46
|
| Rate for Payer: Quartz Beloit One Network |
$3,226.79
|
| Rate for Payer: Quartz Commercial |
$4,280.43
|
| Rate for Payer: Quartz Medicare Advantage |
$3,951.17
|
| Rate for Payer: The Alliance Commercial |
$3,292.64
|
| Rate for Payer: WEA Trust Commercial |
$3,621.90
|
| Rate for Payer: WPS Commercial |
$4,877.54
|
|
|
INSERT TRIDENT 0 DEG 36MM F 623-00-36F
|
Facility
|
OP
|
$6,096.00
|
|
| Hospital Charge Code |
3297468
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,775.16 |
| Max. Negotiated Rate |
$5,832.65 |
| Rate for Payer: Aetna Commercial |
$5,705.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,452.26
|
| Rate for Payer: Aetna Managed Medicare |
$1,775.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,120.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,169.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,043.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,360.12
|
| Rate for Payer: Cash Price |
$1,828.80
|
| Rate for Payer: Cigna Commercial |
$5,832.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,547.87
|
| Rate for Payer: Health EOS Commercial |
$5,642.46
|
| Rate for Payer: HFN Commercial |
$5,832.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,754.88
|
| Rate for Payer: Multiplan Commercial |
$5,071.87
|
| Rate for Payer: NAPHCARE Commercial |
$3,803.90
|
| Rate for Payer: Preferred Network Access Commercial |
$5,832.65
|
| Rate for Payer: Quartz Beloit One Network |
$3,106.52
|
| Rate for Payer: Quartz Commercial |
$4,120.90
|
| Rate for Payer: Quartz Medicare Advantage |
$3,803.90
|
| Rate for Payer: The Alliance Commercial |
$3,169.92
|
| Rate for Payer: WEA Trust Commercial |
$3,486.91
|
| Rate for Payer: WPS Commercial |
$4,695.75
|
|
|
INSERT TRIDENT 0 DEG 36MM F 623-00-36F
|
Facility
|
IP
|
$6,096.00
|
|
| Hospital Charge Code |
3297468
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,106.52 |
| Max. Negotiated Rate |
$5,832.65 |
| Rate for Payer: Aetna Commercial |
$5,705.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,452.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,360.12
|
| Rate for Payer: Cash Price |
$1,828.80
|
| Rate for Payer: Cigna Commercial |
$5,832.65
|
| Rate for Payer: Health EOS Commercial |
$5,642.46
|
| Rate for Payer: HFN Commercial |
$5,832.65
|
| Rate for Payer: Multiplan Commercial |
$5,071.87
|
| Rate for Payer: Preferred Network Access Commercial |
$5,832.65
|
| Rate for Payer: Quartz Beloit One Network |
$3,106.52
|
| Rate for Payer: Quartz Commercial |
$3,803.90
|
| Rate for Payer: WEA Trust Commercial |
$3,486.91
|
| Rate for Payer: WPS Commercial |
$4,695.75
|
|
|
INSERT TRIDENT 0 DEG 40MM E 623-00-40E
|
Facility
|
OP
|
$6,096.00
|
|
| Hospital Charge Code |
3949332
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,775.16 |
| Max. Negotiated Rate |
$5,832.65 |
| Rate for Payer: Aetna Commercial |
$5,705.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,452.26
|
| Rate for Payer: Aetna Managed Medicare |
$1,775.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,120.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,169.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,043.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,360.12
|
| Rate for Payer: Cash Price |
$1,828.80
|
| Rate for Payer: Cigna Commercial |
$5,832.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,547.87
|
| Rate for Payer: Health EOS Commercial |
$5,642.46
|
| Rate for Payer: HFN Commercial |
$5,832.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,754.88
|
| Rate for Payer: Multiplan Commercial |
$5,071.87
|
| Rate for Payer: NAPHCARE Commercial |
$3,803.90
|
| Rate for Payer: Preferred Network Access Commercial |
$5,832.65
|
| Rate for Payer: Quartz Beloit One Network |
$3,106.52
|
| Rate for Payer: Quartz Commercial |
$4,120.90
|
| Rate for Payer: Quartz Medicare Advantage |
$3,803.90
|
| Rate for Payer: The Alliance Commercial |
$3,169.92
|
| Rate for Payer: WEA Trust Commercial |
$3,486.91
|
| Rate for Payer: WPS Commercial |
$4,695.75
|
|
|
INSERT TRIDENT 0 DEG 40MM E 623-00-40E
|
Facility
|
IP
|
$6,096.00
|
|
| Hospital Charge Code |
3949332
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,106.52 |
| Max. Negotiated Rate |
$5,832.65 |
| Rate for Payer: Aetna Commercial |
$5,705.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,452.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,360.12
|
| Rate for Payer: Cash Price |
$1,828.80
|
| Rate for Payer: Cigna Commercial |
$5,832.65
|
| Rate for Payer: Health EOS Commercial |
$5,642.46
|
| Rate for Payer: HFN Commercial |
$5,832.65
|
| Rate for Payer: Multiplan Commercial |
$5,071.87
|
| Rate for Payer: Preferred Network Access Commercial |
$5,832.65
|
| Rate for Payer: Quartz Beloit One Network |
$3,106.52
|
| Rate for Payer: Quartz Commercial |
$3,803.90
|
| Rate for Payer: WEA Trust Commercial |
$3,486.91
|
| Rate for Payer: WPS Commercial |
$4,695.75
|
|
|
INSERT TRIDENT 0 DEG 40MM F 623-00-40F
|
Facility
|
OP
|
$6,096.00
|
|
| Hospital Charge Code |
3779520
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,775.16 |
| Max. Negotiated Rate |
$5,832.65 |
| Rate for Payer: Aetna Commercial |
$5,705.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,452.26
|
| Rate for Payer: Aetna Managed Medicare |
$1,775.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,120.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,169.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,043.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,360.12
|
| Rate for Payer: Cash Price |
$1,828.80
|
| Rate for Payer: Cigna Commercial |
$5,832.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,547.87
|
| Rate for Payer: Health EOS Commercial |
$5,642.46
|
| Rate for Payer: HFN Commercial |
$5,832.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,754.88
|
| Rate for Payer: Multiplan Commercial |
$5,071.87
|
| Rate for Payer: NAPHCARE Commercial |
$3,803.90
|
| Rate for Payer: Preferred Network Access Commercial |
$5,832.65
|
| Rate for Payer: Quartz Beloit One Network |
$3,106.52
|
| Rate for Payer: Quartz Commercial |
$4,120.90
|
| Rate for Payer: Quartz Medicare Advantage |
$3,803.90
|
| Rate for Payer: The Alliance Commercial |
$3,169.92
|
| Rate for Payer: WEA Trust Commercial |
$3,486.91
|
| Rate for Payer: WPS Commercial |
$4,695.75
|
|
|
INSERT TRIDENT 0 DEG 40MM F 623-00-40F
|
Facility
|
IP
|
$6,096.00
|
|
| Hospital Charge Code |
3779520
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,106.52 |
| Max. Negotiated Rate |
$5,832.65 |
| Rate for Payer: Aetna Commercial |
$5,705.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,452.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,360.12
|
| Rate for Payer: Cash Price |
$1,828.80
|
| Rate for Payer: Cigna Commercial |
$5,832.65
|
| Rate for Payer: Health EOS Commercial |
$5,642.46
|
| Rate for Payer: HFN Commercial |
$5,832.65
|
| Rate for Payer: Multiplan Commercial |
$5,071.87
|
| Rate for Payer: Preferred Network Access Commercial |
$5,832.65
|
| Rate for Payer: Quartz Beloit One Network |
$3,106.52
|
| Rate for Payer: Quartz Commercial |
$3,803.90
|
| Rate for Payer: WEA Trust Commercial |
$3,486.91
|
| Rate for Payer: WPS Commercial |
$4,695.75
|
|
|
INSERT TRIDENT 0 DEG 40MM G 623-00-40G
|
Facility
|
IP
|
$6,096.00
|
|
| Hospital Charge Code |
4519928
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,106.52 |
| Max. Negotiated Rate |
$5,832.65 |
| Rate for Payer: Aetna Commercial |
$5,705.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,452.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,360.12
|
| Rate for Payer: Cash Price |
$1,828.80
|
| Rate for Payer: Cigna Commercial |
$5,832.65
|
| Rate for Payer: Health EOS Commercial |
$5,642.46
|
| Rate for Payer: HFN Commercial |
$5,832.65
|
| Rate for Payer: Multiplan Commercial |
$5,071.87
|
| Rate for Payer: Preferred Network Access Commercial |
$5,832.65
|
| Rate for Payer: Quartz Beloit One Network |
$3,106.52
|
| Rate for Payer: Quartz Commercial |
$3,803.90
|
| Rate for Payer: WEA Trust Commercial |
$3,486.91
|
| Rate for Payer: WPS Commercial |
$4,695.75
|
|
