|
PIN CLAMP SINGLE MONOTUBE TRIAX BLUE 20MM 5150-3-170
|
Facility
|
IP
|
$5,000.00
|
|
| Hospital Charge Code |
5685882
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,548.00 |
| Max. Negotiated Rate |
$4,784.00 |
| Rate for Payer: Aetna Commercial |
$4,680.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,472.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,756.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$4,784.00
|
| Rate for Payer: Health EOS Commercial |
$4,628.00
|
| Rate for Payer: HFN Commercial |
$4,784.00
|
| Rate for Payer: Multiplan Commercial |
$4,160.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,784.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,548.00
|
| Rate for Payer: Quartz Commercial |
$3,120.00
|
| Rate for Payer: WEA Trust Commercial |
$2,860.00
|
| Rate for Payer: WPS Commercial |
$3,851.50
|
|
|
PIN CLAMP SINGLE MONOTUBE TRIAX BLUE 20MM 5150-3-170
|
Facility
|
OP
|
$5,000.00
|
|
| Hospital Charge Code |
5685882
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,456.00 |
| Max. Negotiated Rate |
$4,784.00 |
| Rate for Payer: Aetna Commercial |
$4,680.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,472.00
|
| Rate for Payer: Aetna Managed Medicare |
$1,456.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,380.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,600.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,496.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,756.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$4,784.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,910.00
|
| Rate for Payer: Health EOS Commercial |
$4,628.00
|
| Rate for Payer: HFN Commercial |
$4,784.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,900.00
|
| Rate for Payer: Multiplan Commercial |
$4,160.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,120.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,784.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,548.00
|
| Rate for Payer: Quartz Commercial |
$3,380.00
|
| Rate for Payer: Quartz Medicare Advantage |
$3,120.00
|
| Rate for Payer: The Alliance Commercial |
$2,600.00
|
| Rate for Payer: WEA Trust Commercial |
$2,860.00
|
| Rate for Payer: WPS Commercial |
$3,851.50
|
|
|
PIN DYNANITE VIP GLENOID 2.8MM NITINOL AR-5400-400NS
|
Facility
|
IP
|
$4,091.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5685679
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,084.77 |
| Max. Negotiated Rate |
$3,914.27 |
| Rate for Payer: Aetna Commercial |
$3,829.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,658.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,254.96
|
| Rate for Payer: Cash Price |
$1,227.30
|
| Rate for Payer: Cigna Commercial |
$3,914.27
|
| Rate for Payer: Health EOS Commercial |
$3,786.63
|
| Rate for Payer: HFN Commercial |
$3,914.27
|
| Rate for Payer: Multiplan Commercial |
$3,403.71
|
| Rate for Payer: Preferred Network Access Commercial |
$3,914.27
|
| Rate for Payer: Quartz Beloit One Network |
$2,084.77
|
| Rate for Payer: Quartz Commercial |
$2,552.78
|
| Rate for Payer: WEA Trust Commercial |
$2,340.05
|
| Rate for Payer: WPS Commercial |
$3,151.30
|
|
|
PIN DYNANITE VIP GLENOID 2.8MM NITINOL AR-5400-400NS
|
Facility
|
OP
|
$4,091.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5685679
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,191.30 |
| Max. Negotiated Rate |
$3,914.27 |
| Rate for Payer: Aetna Commercial |
$3,829.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,658.99
|
| Rate for Payer: Aetna Managed Medicare |
$1,191.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,765.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,127.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,042.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,254.96
|
| Rate for Payer: Cash Price |
$1,227.30
|
| Rate for Payer: Cigna Commercial |
$3,914.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,380.96
|
| Rate for Payer: Health EOS Commercial |
$3,786.63
|
| Rate for Payer: HFN Commercial |
$3,914.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,190.98
|
| Rate for Payer: Multiplan Commercial |
$3,403.71
|
| Rate for Payer: NAPHCARE Commercial |
$2,552.78
|
| Rate for Payer: Preferred Network Access Commercial |
$3,914.27
|
| Rate for Payer: Quartz Beloit One Network |
$2,084.77
|
| Rate for Payer: Quartz Commercial |
$2,765.52
|
| Rate for Payer: Quartz Medicare Advantage |
$2,552.78
|
| Rate for Payer: The Alliance Commercial |
$2,127.32
|
| Rate for Payer: WEA Trust Commercial |
$2,340.05
|
| Rate for Payer: WPS Commercial |
$3,151.30
|
|
|
PIN FLUTED HEADLESS DISPOSABLE 7650-2038A
|
Facility
|
IP
|
$4,982.00
|
|
| Hospital Charge Code |
5106886
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,538.83 |
| Max. Negotiated Rate |
$4,766.78 |
| Rate for Payer: Aetna Commercial |
$4,663.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,455.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,746.08
|
| Rate for Payer: Cash Price |
$1,494.60
|
| Rate for Payer: Cigna Commercial |
$4,766.78
|
| Rate for Payer: Health EOS Commercial |
$4,611.34
|
| Rate for Payer: HFN Commercial |
$4,766.78
|
| Rate for Payer: Multiplan Commercial |
$4,145.02
|
| Rate for Payer: Preferred Network Access Commercial |
$4,766.78
|
| Rate for Payer: Quartz Beloit One Network |
$2,538.83
|
| Rate for Payer: Quartz Commercial |
$3,108.77
|
| Rate for Payer: WEA Trust Commercial |
$2,849.70
|
| Rate for Payer: WPS Commercial |
$3,837.63
|
|
|
PIN FLUTED HEADLESS DISPOSABLE 7650-2038A
|
Facility
|
OP
|
$4,982.00
|
|
| Hospital Charge Code |
5106886
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,450.76 |
| Max. Negotiated Rate |
$4,766.78 |
| Rate for Payer: Aetna Commercial |
$4,663.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,455.90
|
| Rate for Payer: Aetna Managed Medicare |
$1,450.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,367.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,590.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,487.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,746.08
|
| Rate for Payer: Cash Price |
$1,494.60
|
| Rate for Payer: Cigna Commercial |
$4,766.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,899.52
|
| Rate for Payer: Health EOS Commercial |
$4,611.34
|
| Rate for Payer: HFN Commercial |
$4,766.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,885.96
|
| Rate for Payer: Multiplan Commercial |
$4,145.02
|
| Rate for Payer: NAPHCARE Commercial |
$3,108.77
|
| Rate for Payer: Preferred Network Access Commercial |
$4,766.78
|
| Rate for Payer: Quartz Beloit One Network |
$2,538.83
|
| Rate for Payer: Quartz Commercial |
$3,367.83
|
| Rate for Payer: Quartz Medicare Advantage |
$3,108.77
|
| Rate for Payer: The Alliance Commercial |
$2,590.64
|
| Rate for Payer: WEA Trust Commercial |
$2,849.70
|
| Rate for Payer: WPS Commercial |
$3,837.63
|
|
|
PIN GUIDE PSI PERSONA CS FEMORAL-TIBIAL 00-5970-000-25
|
Facility
|
IP
|
$5,403.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3491507
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,753.37 |
| Max. Negotiated Rate |
$5,169.59 |
| Rate for Payer: Aetna Commercial |
$5,057.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,832.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,978.13
|
| Rate for Payer: Cash Price |
$1,620.90
|
| Rate for Payer: Cigna Commercial |
$5,169.59
|
| Rate for Payer: Health EOS Commercial |
$5,001.02
|
| Rate for Payer: HFN Commercial |
$5,169.59
|
| Rate for Payer: Multiplan Commercial |
$4,495.30
|
| Rate for Payer: Preferred Network Access Commercial |
$5,169.59
|
| Rate for Payer: Quartz Beloit One Network |
$2,753.37
|
| Rate for Payer: Quartz Commercial |
$3,371.47
|
| Rate for Payer: WEA Trust Commercial |
$3,090.52
|
| Rate for Payer: WPS Commercial |
$4,161.93
|
|
|
PIN GUIDE PSI PERSONA CS FEMORAL-TIBIAL 00-5970-000-25
|
Facility
|
OP
|
$5,403.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3491507
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,573.35 |
| Max. Negotiated Rate |
$5,169.59 |
| Rate for Payer: Aetna Commercial |
$5,057.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,832.44
|
| Rate for Payer: Aetna Managed Medicare |
$1,573.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,652.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,809.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,697.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,978.13
|
| Rate for Payer: Cash Price |
$1,620.90
|
| Rate for Payer: Cigna Commercial |
$5,169.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,144.55
|
| Rate for Payer: Health EOS Commercial |
$5,001.02
|
| Rate for Payer: HFN Commercial |
$5,169.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,214.34
|
| Rate for Payer: Multiplan Commercial |
$4,495.30
|
| Rate for Payer: NAPHCARE Commercial |
$3,371.47
|
| Rate for Payer: Preferred Network Access Commercial |
$5,169.59
|
| Rate for Payer: Quartz Beloit One Network |
$2,753.37
|
| Rate for Payer: Quartz Commercial |
$3,652.43
|
| Rate for Payer: Quartz Medicare Advantage |
$3,371.47
|
| Rate for Payer: The Alliance Commercial |
$2,809.56
|
| Rate for Payer: WEA Trust Commercial |
$3,090.52
|
| Rate for Payer: WPS Commercial |
$4,161.93
|
|
|
PIN GUIDE PSI PERSONA PS FEMORAL-TIBIAL 00-5970-000-29
|
Facility
|
OP
|
$5,403.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4594702
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,573.35 |
| Max. Negotiated Rate |
$5,169.59 |
| Rate for Payer: Aetna Commercial |
$5,057.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,832.44
|
| Rate for Payer: Aetna Managed Medicare |
$1,573.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,652.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,809.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,697.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,978.13
|
| Rate for Payer: Cash Price |
$1,620.90
|
| Rate for Payer: Cigna Commercial |
$5,169.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,144.55
|
| Rate for Payer: Health EOS Commercial |
$5,001.02
|
| Rate for Payer: HFN Commercial |
$5,169.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,214.34
|
| Rate for Payer: Multiplan Commercial |
$4,495.30
|
| Rate for Payer: NAPHCARE Commercial |
$3,371.47
|
| Rate for Payer: Preferred Network Access Commercial |
$5,169.59
|
| Rate for Payer: Quartz Beloit One Network |
$2,753.37
|
| Rate for Payer: Quartz Commercial |
$3,652.43
|
| Rate for Payer: Quartz Medicare Advantage |
$3,371.47
|
| Rate for Payer: The Alliance Commercial |
$2,809.56
|
| Rate for Payer: WEA Trust Commercial |
$3,090.52
|
| Rate for Payer: WPS Commercial |
$4,161.93
|
|
|
PIN GUIDE PSI PERSONA PS FEMORAL-TIBIAL 00-5970-000-29
|
Facility
|
IP
|
$5,403.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4594702
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,753.37 |
| Max. Negotiated Rate |
$5,169.59 |
| Rate for Payer: Aetna Commercial |
$5,057.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,832.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,978.13
|
| Rate for Payer: Cash Price |
$1,620.90
|
| Rate for Payer: Cigna Commercial |
$5,169.59
|
| Rate for Payer: Health EOS Commercial |
$5,001.02
|
| Rate for Payer: HFN Commercial |
$5,169.59
|
| Rate for Payer: Multiplan Commercial |
$4,495.30
|
| Rate for Payer: Preferred Network Access Commercial |
$5,169.59
|
| Rate for Payer: Quartz Beloit One Network |
$2,753.37
|
| Rate for Payer: Quartz Commercial |
$3,371.47
|
| Rate for Payer: WEA Trust Commercial |
$3,090.52
|
| Rate for Payer: WPS Commercial |
$4,161.93
|
|
|
PIN SERVICE 60M PER MONTH G0023
|
Professional
|
Both
|
$245.00
|
|
|
Service Code
|
HCPCS G0023
|
| Hospital Charge Code |
6242279
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$44.14 |
| Max. Negotiated Rate |
$242.06 |
| Rate for Payer: Aetna Commercial |
$242.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$219.13
|
| Rate for Payer: Aetna Managed Medicare |
$44.14
|
| Rate for Payer: Anthem Medicare Advantage |
$44.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$44.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$44.14
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$242.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$127.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.14
|
| Rate for Payer: Health EOS Commercial |
$231.87
|
| Rate for Payer: HFN Commercial |
$242.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$44.14
|
| Rate for Payer: Multiplan Commercial |
$203.84
|
| Rate for Payer: NAPHCARE Commercial |
$66.21
|
| Rate for Payer: Preferred Network Access Commercial |
$242.06
|
| Rate for Payer: Quartz Beloit One Network |
$112.11
|
| Rate for Payer: Quartz Commercial |
$145.24
|
| Rate for Payer: Quartz Medicare Advantage |
$44.14
|
| Rate for Payer: The Alliance Commercial |
$121.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$44.14
|
| Rate for Payer: WEA Trust Commercial |
$140.14
|
| Rate for Payer: WPS Commercial |
$77.24
|
|
|
PIN SERVICE ADD 30 MIN PER MONTH G0024
|
Professional
|
Both
|
$123.00
|
|
|
Service Code
|
HCPCS G0024
|
| Hospital Charge Code |
6242280
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.84 |
| Max. Negotiated Rate |
$121.52 |
| Rate for Payer: Aetna Commercial |
$121.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.01
|
| Rate for Payer: Aetna Managed Medicare |
$30.84
|
| Rate for Payer: Anthem Medicare Advantage |
$30.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.84
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna Commercial |
$121.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$63.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.84
|
| Rate for Payer: Health EOS Commercial |
$116.41
|
| Rate for Payer: HFN Commercial |
$121.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30.84
|
| Rate for Payer: Multiplan Commercial |
$102.34
|
| Rate for Payer: NAPHCARE Commercial |
$46.25
|
| Rate for Payer: Preferred Network Access Commercial |
$121.52
|
| Rate for Payer: Quartz Beloit One Network |
$56.28
|
| Rate for Payer: Quartz Commercial |
$72.91
|
| Rate for Payer: Quartz Medicare Advantage |
$30.84
|
| Rate for Payer: The Alliance Commercial |
$84.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.84
|
| Rate for Payer: WEA Trust Commercial |
$70.36
|
| Rate for Payer: WPS Commercial |
$53.96
|
|
|
PIN SET UNIVERSAL REVERSE SHOULDER AR-9207S
|
Facility
|
IP
|
$2,926.00
|
|
| Hospital Charge Code |
4628647
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,491.09 |
| Max. Negotiated Rate |
$2,799.60 |
| Rate for Payer: Aetna Commercial |
$2,738.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,617.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,612.81
|
| Rate for Payer: Cash Price |
$877.80
|
| Rate for Payer: Cigna Commercial |
$2,799.60
|
| Rate for Payer: Health EOS Commercial |
$2,708.31
|
| Rate for Payer: HFN Commercial |
$2,799.60
|
| Rate for Payer: Multiplan Commercial |
$2,434.43
|
| Rate for Payer: Preferred Network Access Commercial |
$2,799.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,491.09
|
| Rate for Payer: Quartz Commercial |
$1,825.82
|
| Rate for Payer: WEA Trust Commercial |
$1,673.67
|
| Rate for Payer: WPS Commercial |
$2,253.90
|
|
|
PIN SET UNIVERSAL REVERSE SHOULDER AR-9207S
|
Facility
|
OP
|
$2,926.00
|
|
| Hospital Charge Code |
4628647
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$852.05 |
| Max. Negotiated Rate |
$2,799.60 |
| Rate for Payer: Aetna Commercial |
$2,738.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,617.01
|
| Rate for Payer: Aetna Managed Medicare |
$852.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,977.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,521.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,460.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,612.81
|
| Rate for Payer: Cash Price |
$877.80
|
| Rate for Payer: Cigna Commercial |
$2,799.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,702.93
|
| Rate for Payer: Health EOS Commercial |
$2,708.31
|
| Rate for Payer: HFN Commercial |
$2,799.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,282.28
|
| Rate for Payer: Multiplan Commercial |
$2,434.43
|
| Rate for Payer: NAPHCARE Commercial |
$1,825.82
|
| Rate for Payer: Preferred Network Access Commercial |
$2,799.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,491.09
|
| Rate for Payer: Quartz Commercial |
$1,977.98
|
| Rate for Payer: Quartz Medicare Advantage |
$1,825.82
|
| Rate for Payer: The Alliance Commercial |
$1,521.52
|
| Rate for Payer: WEA Trust Commercial |
$1,673.67
|
| Rate for Payer: WPS Commercial |
$2,253.90
|
|
|
PIN SET UNIVERSAL REVERSE SHOULDER AR-9507S
|
Facility
|
OP
|
$4,255.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4595597
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,239.06 |
| Max. Negotiated Rate |
$4,071.18 |
| Rate for Payer: Aetna Commercial |
$3,982.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,805.67
|
| Rate for Payer: Aetna Managed Medicare |
$1,239.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,876.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,212.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,124.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,345.36
|
| Rate for Payer: Cash Price |
$1,276.50
|
| Rate for Payer: Cigna Commercial |
$4,071.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,476.41
|
| Rate for Payer: Health EOS Commercial |
$3,938.43
|
| Rate for Payer: HFN Commercial |
$4,071.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,318.90
|
| Rate for Payer: Multiplan Commercial |
$3,540.16
|
| Rate for Payer: NAPHCARE Commercial |
$2,655.12
|
| Rate for Payer: Preferred Network Access Commercial |
$4,071.18
|
| Rate for Payer: Quartz Beloit One Network |
$2,168.35
|
| Rate for Payer: Quartz Commercial |
$2,876.38
|
| Rate for Payer: Quartz Medicare Advantage |
$2,655.12
|
| Rate for Payer: The Alliance Commercial |
$2,212.60
|
| Rate for Payer: WEA Trust Commercial |
$2,433.86
|
| Rate for Payer: WPS Commercial |
$3,277.63
|
|
|
PIN SET UNIVERSAL REVERSE SHOULDER AR-9507S
|
Facility
|
IP
|
$4,255.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4595597
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,168.35 |
| Max. Negotiated Rate |
$4,071.18 |
| Rate for Payer: Aetna Commercial |
$3,982.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,805.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,345.36
|
| Rate for Payer: Cash Price |
$1,276.50
|
| Rate for Payer: Cigna Commercial |
$4,071.18
|
| Rate for Payer: Health EOS Commercial |
$3,938.43
|
| Rate for Payer: HFN Commercial |
$4,071.18
|
| Rate for Payer: Multiplan Commercial |
$3,540.16
|
| Rate for Payer: Preferred Network Access Commercial |
$4,071.18
|
| Rate for Payer: Quartz Beloit One Network |
$2,168.35
|
| Rate for Payer: Quartz Commercial |
$2,655.12
|
| Rate for Payer: WEA Trust Commercial |
$2,433.86
|
| Rate for Payer: WPS Commercial |
$3,277.63
|
|
|
PIN SET UNIVERS REVERS MODULAR AR-9607S
|
Facility
|
IP
|
$4,255.00
|
|
| Hospital Charge Code |
5496852
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,168.35 |
| Max. Negotiated Rate |
$4,071.18 |
| Rate for Payer: Aetna Commercial |
$3,982.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,805.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,345.36
|
| Rate for Payer: Cash Price |
$1,276.50
|
| Rate for Payer: Cigna Commercial |
$4,071.18
|
| Rate for Payer: Health EOS Commercial |
$3,938.43
|
| Rate for Payer: HFN Commercial |
$4,071.18
|
| Rate for Payer: Multiplan Commercial |
$3,540.16
|
| Rate for Payer: Preferred Network Access Commercial |
$4,071.18
|
| Rate for Payer: Quartz Beloit One Network |
$2,168.35
|
| Rate for Payer: Quartz Commercial |
$2,655.12
|
| Rate for Payer: WEA Trust Commercial |
$2,433.86
|
| Rate for Payer: WPS Commercial |
$3,277.63
|
|
|
PIN SET UNIVERS REVERS MODULAR AR-9607S
|
Facility
|
OP
|
$4,255.00
|
|
| Hospital Charge Code |
5496852
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,239.06 |
| Max. Negotiated Rate |
$4,071.18 |
| Rate for Payer: Aetna Commercial |
$3,982.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,805.67
|
| Rate for Payer: Aetna Managed Medicare |
$1,239.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,876.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,212.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,124.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,345.36
|
| Rate for Payer: Cash Price |
$1,276.50
|
| Rate for Payer: Cigna Commercial |
$4,071.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,476.41
|
| Rate for Payer: Health EOS Commercial |
$3,938.43
|
| Rate for Payer: HFN Commercial |
$4,071.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,318.90
|
| Rate for Payer: Multiplan Commercial |
$3,540.16
|
| Rate for Payer: NAPHCARE Commercial |
$2,655.12
|
| Rate for Payer: Preferred Network Access Commercial |
$4,071.18
|
| Rate for Payer: Quartz Beloit One Network |
$2,168.35
|
| Rate for Payer: Quartz Commercial |
$2,876.38
|
| Rate for Payer: Quartz Medicare Advantage |
$2,655.12
|
| Rate for Payer: The Alliance Commercial |
$2,212.60
|
| Rate for Payer: WEA Trust Commercial |
$2,433.86
|
| Rate for Payer: WPS Commercial |
$3,277.63
|
|
|
PIN SNAP-OFF 1.9MM X 10MM FULL THREAD AR-9919-10
|
Facility
|
OP
|
$3,341.84
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6252126
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$973.14 |
| Max. Negotiated Rate |
$3,197.47 |
| Rate for Payer: Aetna Commercial |
$3,127.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,988.94
|
| Rate for Payer: Aetna Managed Medicare |
$973.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,259.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,737.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,668.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,842.02
|
| Rate for Payer: Cash Price |
$1,002.55
|
| Rate for Payer: Cigna Commercial |
$3,197.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,944.95
|
| Rate for Payer: Health EOS Commercial |
$3,093.21
|
| Rate for Payer: HFN Commercial |
$3,197.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,606.64
|
| Rate for Payer: Multiplan Commercial |
$2,780.41
|
| Rate for Payer: NAPHCARE Commercial |
$2,085.31
|
| Rate for Payer: Preferred Network Access Commercial |
$3,197.47
|
| Rate for Payer: Quartz Beloit One Network |
$1,703.00
|
| Rate for Payer: Quartz Commercial |
$2,259.08
|
| Rate for Payer: Quartz Medicare Advantage |
$2,085.31
|
| Rate for Payer: The Alliance Commercial |
$1,737.76
|
| Rate for Payer: WEA Trust Commercial |
$1,911.53
|
| Rate for Payer: WPS Commercial |
$2,574.22
|
|
|
PIN SNAP-OFF 1.9MM X 10MM FULL THREAD AR-9919-10
|
Facility
|
IP
|
$3,341.84
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6252126
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,703.00 |
| Max. Negotiated Rate |
$3,197.47 |
| Rate for Payer: Aetna Commercial |
$3,127.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,988.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,842.02
|
| Rate for Payer: Cash Price |
$1,002.55
|
| Rate for Payer: Cigna Commercial |
$3,197.47
|
| Rate for Payer: Health EOS Commercial |
$3,093.21
|
| Rate for Payer: HFN Commercial |
$3,197.47
|
| Rate for Payer: Multiplan Commercial |
$2,780.41
|
| Rate for Payer: Preferred Network Access Commercial |
$3,197.47
|
| Rate for Payer: Quartz Beloit One Network |
$1,703.00
|
| Rate for Payer: Quartz Commercial |
$2,085.31
|
| Rate for Payer: WEA Trust Commercial |
$1,911.53
|
| Rate for Payer: WPS Commercial |
$2,574.22
|
|
|
PIN SNAP-OFF 1.9MM X 12MM FULL THREAD AR-9919-12
|
Facility
|
IP
|
$3,341.84
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6252127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,703.00 |
| Max. Negotiated Rate |
$3,197.47 |
| Rate for Payer: Aetna Commercial |
$3,127.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,988.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,842.02
|
| Rate for Payer: Cash Price |
$1,002.55
|
| Rate for Payer: Cigna Commercial |
$3,197.47
|
| Rate for Payer: Health EOS Commercial |
$3,093.21
|
| Rate for Payer: HFN Commercial |
$3,197.47
|
| Rate for Payer: Multiplan Commercial |
$2,780.41
|
| Rate for Payer: Preferred Network Access Commercial |
$3,197.47
|
| Rate for Payer: Quartz Beloit One Network |
$1,703.00
|
| Rate for Payer: Quartz Commercial |
$2,085.31
|
| Rate for Payer: WEA Trust Commercial |
$1,911.53
|
| Rate for Payer: WPS Commercial |
$2,574.22
|
|
|
PIN SNAP-OFF 1.9MM X 12MM FULL THREAD AR-9919-12
|
Facility
|
OP
|
$3,341.84
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6252127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$973.14 |
| Max. Negotiated Rate |
$3,197.47 |
| Rate for Payer: Aetna Commercial |
$3,127.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,988.94
|
| Rate for Payer: Aetna Managed Medicare |
$973.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,259.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,737.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,668.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,842.02
|
| Rate for Payer: Cash Price |
$1,002.55
|
| Rate for Payer: Cigna Commercial |
$3,197.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,944.95
|
| Rate for Payer: Health EOS Commercial |
$3,093.21
|
| Rate for Payer: HFN Commercial |
$3,197.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,606.64
|
| Rate for Payer: Multiplan Commercial |
$2,780.41
|
| Rate for Payer: NAPHCARE Commercial |
$2,085.31
|
| Rate for Payer: Preferred Network Access Commercial |
$3,197.47
|
| Rate for Payer: Quartz Beloit One Network |
$1,703.00
|
| Rate for Payer: Quartz Commercial |
$2,259.08
|
| Rate for Payer: Quartz Medicare Advantage |
$2,085.31
|
| Rate for Payer: The Alliance Commercial |
$1,737.76
|
| Rate for Payer: WEA Trust Commercial |
$1,911.53
|
| Rate for Payer: WPS Commercial |
$2,574.22
|
|
|
PIN STEINMAN TRACTION 4.0 X 200 CENTRAL THREAD 293.72
|
Facility
|
IP
|
$795.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4518607
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$405.13 |
| Max. Negotiated Rate |
$760.66 |
| Rate for Payer: Aetna Commercial |
$744.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$711.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$438.20
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Cigna Commercial |
$760.66
|
| Rate for Payer: Health EOS Commercial |
$735.85
|
| Rate for Payer: HFN Commercial |
$760.66
|
| Rate for Payer: Multiplan Commercial |
$661.44
|
| Rate for Payer: Preferred Network Access Commercial |
$760.66
|
| Rate for Payer: Quartz Beloit One Network |
$405.13
|
| Rate for Payer: Quartz Commercial |
$496.08
|
| Rate for Payer: WEA Trust Commercial |
$454.74
|
| Rate for Payer: WPS Commercial |
$612.39
|
|
|
PIN STEINMAN TRACTION 4.0 X 200 CENTRAL THREAD 293.72
|
Facility
|
OP
|
$795.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4518607
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.50 |
| Max. Negotiated Rate |
$760.66 |
| Rate for Payer: Aetna Commercial |
$744.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$711.05
|
| Rate for Payer: Aetna Managed Medicare |
$231.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$537.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$413.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$396.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$438.20
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Cigna Commercial |
$760.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$462.69
|
| Rate for Payer: Health EOS Commercial |
$735.85
|
| Rate for Payer: HFN Commercial |
$760.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$620.10
|
| Rate for Payer: Multiplan Commercial |
$661.44
|
| Rate for Payer: NAPHCARE Commercial |
$496.08
|
| Rate for Payer: Preferred Network Access Commercial |
$760.66
|
| Rate for Payer: Quartz Beloit One Network |
$405.13
|
| Rate for Payer: Quartz Commercial |
$537.42
|
| Rate for Payer: Quartz Medicare Advantage |
$496.08
|
| Rate for Payer: The Alliance Commercial |
$413.40
|
| Rate for Payer: WEA Trust Commercial |
$454.74
|
| Rate for Payer: WPS Commercial |
$612.39
|
|
|
PIN TEMP FIX 2.0MM THREADED ORTHOLOC 59250050
|
Facility
|
OP
|
$1,292.00
|
|
| Hospital Charge Code |
6201066
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$376.23 |
| Max. Negotiated Rate |
$1,236.19 |
| Rate for Payer: Aetna Commercial |
$1,209.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,155.56
|
| Rate for Payer: Aetna Managed Medicare |
$376.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$873.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$671.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$644.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$712.15
|
| Rate for Payer: Cash Price |
$387.60
|
| Rate for Payer: Cigna Commercial |
$1,236.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$751.94
|
| Rate for Payer: Health EOS Commercial |
$1,195.88
|
| Rate for Payer: HFN Commercial |
$1,236.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,007.76
|
| Rate for Payer: Multiplan Commercial |
$1,074.94
|
| Rate for Payer: NAPHCARE Commercial |
$806.21
|
| Rate for Payer: Preferred Network Access Commercial |
$1,236.19
|
| Rate for Payer: Quartz Beloit One Network |
$658.40
|
| Rate for Payer: Quartz Commercial |
$873.39
|
| Rate for Payer: Quartz Medicare Advantage |
$806.21
|
| Rate for Payer: The Alliance Commercial |
$671.84
|
| Rate for Payer: WEA Trust Commercial |
$739.02
|
| Rate for Payer: WPS Commercial |
$995.23
|
|
