|
Audiometry Threshold Evaluation; Comprehensive
|
Professional
|
Both
|
$288.00
|
|
|
Service Code
|
CPT 92557
|
| Hospital Charge Code |
1152819
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$26.27 |
| Max. Negotiated Rate |
$284.54 |
| Rate for Payer: Aetna Commercial |
$284.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$257.59
|
| Rate for Payer: Aetna Managed Medicare |
$26.27
|
| Rate for Payer: Anthem Medicare Advantage |
$26.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26.27
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cigna Commercial |
$284.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$41.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.27
|
| Rate for Payer: Health EOS Commercial |
$272.56
|
| Rate for Payer: HFN Commercial |
$284.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$136.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$136.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26.27
|
| Rate for Payer: Multiplan Commercial |
$239.62
|
| Rate for Payer: NAPHCARE Commercial |
$39.41
|
| Rate for Payer: Preferred Network Access Commercial |
$284.54
|
| Rate for Payer: Quartz Beloit One Network |
$131.79
|
| Rate for Payer: Quartz Commercial |
$170.73
|
| Rate for Payer: Quartz Medicare Advantage |
$26.27
|
| Rate for Payer: The Alliance Commercial |
$65.68
|
| Rate for Payer: United Healthcare Medicaid |
$41.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.27
|
| Rate for Payer: WEA Trust Commercial |
$164.74
|
| Rate for Payer: WPS Commercial |
$105.08
|
|
|
Audiometry Threshold Evaluation; Comprehensive
|
Facility
|
OP
|
$288.00
|
|
|
Service Code
|
CPT 92557
|
| Hospital Charge Code |
1152819
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$135.42 |
| Max. Negotiated Rate |
$541.67 |
| Rate for Payer: Aetna Commercial |
$269.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$257.59
|
| Rate for Payer: Aetna Managed Medicare |
$135.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$194.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$149.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$143.77
|
| Rate for Payer: Anthem Medicare Advantage |
$135.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$158.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$135.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$135.42
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cigna Commercial |
$275.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$135.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$167.62
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$135.42
|
| Rate for Payer: Health EOS Commercial |
$266.57
|
| Rate for Payer: HFN Commercial |
$275.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$503.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$135.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$135.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$135.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$135.42
|
| Rate for Payer: Multiplan Commercial |
$239.62
|
| Rate for Payer: NAPHCARE Commercial |
$203.13
|
| Rate for Payer: Preferred Network Access Commercial |
$275.56
|
| Rate for Payer: Quartz Beloit One Network |
$146.76
|
| Rate for Payer: Quartz Commercial |
$194.69
|
| Rate for Payer: Quartz Medicare Advantage |
$135.42
|
| Rate for Payer: The Alliance Commercial |
$541.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$135.42
|
| Rate for Payer: WEA Trust Commercial |
$164.74
|
| Rate for Payer: Wellcare Medicare |
$135.42
|
| Rate for Payer: WPS Commercial |
$221.85
|
|
|
AUGMENT BASEPLATE 24MM 10 FULL +2 LATERAL AR-9580-2410-2
|
Facility
|
OP
|
$16,365.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5659646
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,765.49 |
| Max. Negotiated Rate |
$15,658.03 |
| Rate for Payer: Aetna Commercial |
$15,317.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,636.86
|
| Rate for Payer: Aetna Managed Medicare |
$4,765.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,062.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,509.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,169.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,020.39
|
| Rate for Payer: Cash Price |
$4,909.50
|
| Rate for Payer: Cigna Commercial |
$15,658.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,524.43
|
| Rate for Payer: Health EOS Commercial |
$15,147.44
|
| Rate for Payer: HFN Commercial |
$15,658.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,764.70
|
| Rate for Payer: Multiplan Commercial |
$13,615.68
|
| Rate for Payer: NAPHCARE Commercial |
$10,211.76
|
| Rate for Payer: Preferred Network Access Commercial |
$15,658.03
|
| Rate for Payer: Quartz Beloit One Network |
$8,339.60
|
| Rate for Payer: Quartz Commercial |
$11,062.74
|
| Rate for Payer: Quartz Medicare Advantage |
$10,211.76
|
| Rate for Payer: The Alliance Commercial |
$8,509.80
|
| Rate for Payer: WEA Trust Commercial |
$9,360.78
|
| Rate for Payer: WPS Commercial |
$12,605.96
|
|
|
AUGMENT BASEPLATE 24MM 10 FULL +2 LATERAL AR-9580-2410-2
|
Facility
|
IP
|
$16,365.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5659646
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,339.60 |
| Max. Negotiated Rate |
$15,658.03 |
| Rate for Payer: Aetna Commercial |
$15,317.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,636.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,020.39
|
| Rate for Payer: Cash Price |
$4,909.50
|
| Rate for Payer: Cigna Commercial |
$15,658.03
|
| Rate for Payer: Health EOS Commercial |
$15,147.44
|
| Rate for Payer: HFN Commercial |
$15,658.03
|
| Rate for Payer: Multiplan Commercial |
$13,615.68
|
| Rate for Payer: Preferred Network Access Commercial |
$15,658.03
|
| Rate for Payer: Quartz Beloit One Network |
$8,339.60
|
| Rate for Payer: Quartz Commercial |
$10,211.76
|
| Rate for Payer: WEA Trust Commercial |
$9,360.78
|
| Rate for Payer: WPS Commercial |
$12,605.96
|
|
|
AUGMENT BASEPLATE 24MM 10 FULL +2 LATERAL ST AR-9580-2410-2S
|
Facility
|
OP
|
$15,131.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6220210
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,406.15 |
| Max. Negotiated Rate |
$14,477.34 |
| Rate for Payer: Aetna Commercial |
$14,162.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,533.17
|
| Rate for Payer: Aetna Managed Medicare |
$4,406.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,228.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,868.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,553.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,340.21
|
| Rate for Payer: Cash Price |
$4,539.30
|
| Rate for Payer: Cigna Commercial |
$14,477.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,806.24
|
| Rate for Payer: Health EOS Commercial |
$14,005.25
|
| Rate for Payer: HFN Commercial |
$14,477.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,802.18
|
| Rate for Payer: Multiplan Commercial |
$12,588.99
|
| Rate for Payer: NAPHCARE Commercial |
$9,441.74
|
| Rate for Payer: Preferred Network Access Commercial |
$14,477.34
|
| Rate for Payer: Quartz Beloit One Network |
$7,710.76
|
| Rate for Payer: Quartz Commercial |
$10,228.56
|
| Rate for Payer: Quartz Medicare Advantage |
$9,441.74
|
| Rate for Payer: The Alliance Commercial |
$7,868.12
|
| Rate for Payer: WEA Trust Commercial |
$8,654.93
|
| Rate for Payer: WPS Commercial |
$11,655.41
|
|
|
AUGMENT BASEPLATE 24MM 10 FULL +2 LATERAL ST AR-9580-2410-2S
|
Facility
|
IP
|
$15,131.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6220210
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,710.76 |
| Max. Negotiated Rate |
$14,477.34 |
| Rate for Payer: Aetna Commercial |
$14,162.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,533.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,340.21
|
| Rate for Payer: Cash Price |
$4,539.30
|
| Rate for Payer: Cigna Commercial |
$14,477.34
|
| Rate for Payer: Health EOS Commercial |
$14,005.25
|
| Rate for Payer: HFN Commercial |
$14,477.34
|
| Rate for Payer: Multiplan Commercial |
$12,588.99
|
| Rate for Payer: Preferred Network Access Commercial |
$14,477.34
|
| Rate for Payer: Quartz Beloit One Network |
$7,710.76
|
| Rate for Payer: Quartz Commercial |
$9,441.74
|
| Rate for Payer: WEA Trust Commercial |
$8,654.93
|
| Rate for Payer: WPS Commercial |
$11,655.41
|
|
|
AUGMENT BASEPLATE 24MM 10 FULL AR-9580-2410
|
Facility
|
OP
|
$16,365.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5831634
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,765.49 |
| Max. Negotiated Rate |
$15,658.03 |
| Rate for Payer: Aetna Commercial |
$15,317.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,636.86
|
| Rate for Payer: Aetna Managed Medicare |
$4,765.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,062.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,509.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,169.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,020.39
|
| Rate for Payer: Cash Price |
$4,909.50
|
| Rate for Payer: Cigna Commercial |
$15,658.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,524.43
|
| Rate for Payer: Health EOS Commercial |
$15,147.44
|
| Rate for Payer: HFN Commercial |
$15,658.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,764.70
|
| Rate for Payer: Multiplan Commercial |
$13,615.68
|
| Rate for Payer: NAPHCARE Commercial |
$10,211.76
|
| Rate for Payer: Preferred Network Access Commercial |
$15,658.03
|
| Rate for Payer: Quartz Beloit One Network |
$8,339.60
|
| Rate for Payer: Quartz Commercial |
$11,062.74
|
| Rate for Payer: Quartz Medicare Advantage |
$10,211.76
|
| Rate for Payer: The Alliance Commercial |
$8,509.80
|
| Rate for Payer: WEA Trust Commercial |
$9,360.78
|
| Rate for Payer: WPS Commercial |
$12,605.96
|
|
|
AUGMENT BASEPLATE 24MM 10 FULL AR-9580-2410
|
Facility
|
IP
|
$16,365.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5831634
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,339.60 |
| Max. Negotiated Rate |
$15,658.03 |
| Rate for Payer: Aetna Commercial |
$15,317.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,636.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,020.39
|
| Rate for Payer: Cash Price |
$4,909.50
|
| Rate for Payer: Cigna Commercial |
$15,658.03
|
| Rate for Payer: Health EOS Commercial |
$15,147.44
|
| Rate for Payer: HFN Commercial |
$15,658.03
|
| Rate for Payer: Multiplan Commercial |
$13,615.68
|
| Rate for Payer: Preferred Network Access Commercial |
$15,658.03
|
| Rate for Payer: Quartz Beloit One Network |
$8,339.60
|
| Rate for Payer: Quartz Commercial |
$10,211.76
|
| Rate for Payer: WEA Trust Commercial |
$9,360.78
|
| Rate for Payer: WPS Commercial |
$12,605.96
|
|
|
AUGMENT BLOCK NEXGEN DISTAL SZ D 10MM 00-5990-034-21
|
Facility
|
IP
|
$7,075.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6192967
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,605.42 |
| Max. Negotiated Rate |
$6,769.36 |
| Rate for Payer: Aetna Commercial |
$6,622.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,327.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,899.74
|
| Rate for Payer: Cash Price |
$2,122.50
|
| Rate for Payer: Cigna Commercial |
$6,769.36
|
| Rate for Payer: Health EOS Commercial |
$6,548.62
|
| Rate for Payer: HFN Commercial |
$6,769.36
|
| Rate for Payer: Multiplan Commercial |
$5,886.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,769.36
|
| Rate for Payer: Quartz Beloit One Network |
$3,605.42
|
| Rate for Payer: Quartz Commercial |
$4,414.80
|
| Rate for Payer: WEA Trust Commercial |
$4,046.90
|
| Rate for Payer: WPS Commercial |
$5,449.87
|
|
|
AUGMENT BLOCK NEXGEN DISTAL SZ D 10MM 00-5990-034-21
|
Facility
|
OP
|
$7,075.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6192967
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,060.24 |
| Max. Negotiated Rate |
$6,769.36 |
| Rate for Payer: Aetna Commercial |
$6,622.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,327.88
|
| Rate for Payer: Aetna Managed Medicare |
$2,060.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,782.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,679.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,531.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,899.74
|
| Rate for Payer: Cash Price |
$2,122.50
|
| Rate for Payer: Cigna Commercial |
$6,769.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,117.65
|
| Rate for Payer: Health EOS Commercial |
$6,548.62
|
| Rate for Payer: HFN Commercial |
$6,769.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,518.50
|
| Rate for Payer: Multiplan Commercial |
$5,886.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,414.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,769.36
|
| Rate for Payer: Quartz Beloit One Network |
$3,605.42
|
| Rate for Payer: Quartz Commercial |
$4,782.70
|
| Rate for Payer: Quartz Medicare Advantage |
$4,414.80
|
| Rate for Payer: The Alliance Commercial |
$3,679.00
|
| Rate for Payer: WEA Trust Commercial |
$4,046.90
|
| Rate for Payer: WPS Commercial |
$5,449.87
|
|
|
AUGMENT SHOULDER BASEPLATE 24MM 10 FULL AR-9580-2410S
|
Facility
|
OP
|
$15,131.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6199018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,406.15 |
| Max. Negotiated Rate |
$14,477.34 |
| Rate for Payer: Aetna Commercial |
$14,162.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,533.17
|
| Rate for Payer: Aetna Managed Medicare |
$4,406.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,228.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,868.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,553.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,340.21
|
| Rate for Payer: Cash Price |
$4,539.30
|
| Rate for Payer: Cigna Commercial |
$14,477.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,806.24
|
| Rate for Payer: Health EOS Commercial |
$14,005.25
|
| Rate for Payer: HFN Commercial |
$14,477.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,802.18
|
| Rate for Payer: Multiplan Commercial |
$12,588.99
|
| Rate for Payer: NAPHCARE Commercial |
$9,441.74
|
| Rate for Payer: Preferred Network Access Commercial |
$14,477.34
|
| Rate for Payer: Quartz Beloit One Network |
$7,710.76
|
| Rate for Payer: Quartz Commercial |
$10,228.56
|
| Rate for Payer: Quartz Medicare Advantage |
$9,441.74
|
| Rate for Payer: The Alliance Commercial |
$7,868.12
|
| Rate for Payer: WEA Trust Commercial |
$8,654.93
|
| Rate for Payer: WPS Commercial |
$11,655.41
|
|
|
AUGMENT SHOULDER BASEPLATE 24MM 10 FULL AR-9580-2410S
|
Facility
|
IP
|
$15,131.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6199018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,710.76 |
| Max. Negotiated Rate |
$14,477.34 |
| Rate for Payer: Aetna Commercial |
$14,162.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,533.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,340.21
|
| Rate for Payer: Cash Price |
$4,539.30
|
| Rate for Payer: Cigna Commercial |
$14,477.34
|
| Rate for Payer: Health EOS Commercial |
$14,005.25
|
| Rate for Payer: HFN Commercial |
$14,477.34
|
| Rate for Payer: Multiplan Commercial |
$12,588.99
|
| Rate for Payer: Preferred Network Access Commercial |
$14,477.34
|
| Rate for Payer: Quartz Beloit One Network |
$7,710.76
|
| Rate for Payer: Quartz Commercial |
$9,441.74
|
| Rate for Payer: WEA Trust Commercial |
$8,654.93
|
| Rate for Payer: WPS Commercial |
$11,655.41
|
|
|
AUGMENT SYNTHETIC BONE GRAFT 1.5CC (BOVINE COLLOGEN) K30001510
|
Facility
|
OP
|
$10,932.00
|
|
|
Service Code
|
HCPCS C1734
|
| Hospital Charge Code |
6167718
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,183.40 |
| Max. Negotiated Rate |
$10,459.74 |
| Rate for Payer: Aetna Commercial |
$10,232.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,777.58
|
| Rate for Payer: Aetna Managed Medicare |
$3,183.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,390.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,684.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,457.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,025.72
|
| Rate for Payer: Cash Price |
$3,279.60
|
| Rate for Payer: Cigna Commercial |
$10,459.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,362.42
|
| Rate for Payer: Health EOS Commercial |
$10,118.66
|
| Rate for Payer: HFN Commercial |
$10,459.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,526.96
|
| Rate for Payer: Multiplan Commercial |
$9,095.42
|
| Rate for Payer: NAPHCARE Commercial |
$6,821.57
|
| Rate for Payer: Preferred Network Access Commercial |
$10,459.74
|
| Rate for Payer: Quartz Beloit One Network |
$5,570.95
|
| Rate for Payer: Quartz Commercial |
$7,390.03
|
| Rate for Payer: Quartz Medicare Advantage |
$6,821.57
|
| Rate for Payer: The Alliance Commercial |
$5,684.64
|
| Rate for Payer: WEA Trust Commercial |
$6,253.10
|
| Rate for Payer: WPS Commercial |
$8,420.92
|
|
|
AUGMENT SYNTHETIC BONE GRAFT 1.5CC (BOVINE COLLOGEN) K30001510
|
Facility
|
IP
|
$10,932.00
|
|
|
Service Code
|
HCPCS C1734
|
| Hospital Charge Code |
6167718
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,570.95 |
| Max. Negotiated Rate |
$10,459.74 |
| Rate for Payer: Aetna Commercial |
$10,232.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,777.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,025.72
|
| Rate for Payer: Cash Price |
$3,279.60
|
| Rate for Payer: Cigna Commercial |
$10,459.74
|
| Rate for Payer: Health EOS Commercial |
$10,118.66
|
| Rate for Payer: HFN Commercial |
$10,459.74
|
| Rate for Payer: Multiplan Commercial |
$9,095.42
|
| Rate for Payer: Preferred Network Access Commercial |
$10,459.74
|
| Rate for Payer: Quartz Beloit One Network |
$5,570.95
|
| Rate for Payer: Quartz Commercial |
$6,821.57
|
| Rate for Payer: WEA Trust Commercial |
$6,253.10
|
| Rate for Payer: WPS Commercial |
$8,420.92
|
|
|
AUGMENT TRIATHLON FEMORAL DISTAL SZ 4 10MM 5541-A-402
|
Facility
|
OP
|
$4,978.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6246166
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,449.77 |
| Max. Negotiated Rate |
$4,763.52 |
| Rate for Payer: Aetna Commercial |
$4,659.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,452.86
|
| Rate for Payer: Aetna Managed Medicare |
$1,449.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,365.53
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,588.87
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,485.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,744.20
|
| Rate for Payer: Cash Price |
$1,493.58
|
| Rate for Payer: Cigna Commercial |
$4,763.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,897.55
|
| Rate for Payer: Health EOS Commercial |
$4,608.19
|
| Rate for Payer: HFN Commercial |
$4,763.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,883.31
|
| Rate for Payer: Multiplan Commercial |
$4,142.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,106.65
|
| Rate for Payer: Preferred Network Access Commercial |
$4,763.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,537.09
|
| Rate for Payer: Quartz Commercial |
$3,365.53
|
| Rate for Payer: Quartz Medicare Advantage |
$3,106.65
|
| Rate for Payer: The Alliance Commercial |
$2,588.87
|
| Rate for Payer: WEA Trust Commercial |
$2,847.76
|
| Rate for Payer: WPS Commercial |
$3,835.02
|
|
|
AUGMENT TRIATHLON FEMORAL DISTAL SZ 4 10MM 5541-A-402
|
Facility
|
IP
|
$4,978.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6246166
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,537.09 |
| Max. Negotiated Rate |
$4,763.52 |
| Rate for Payer: Aetna Commercial |
$4,659.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,452.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,744.20
|
| Rate for Payer: Cash Price |
$1,493.58
|
| Rate for Payer: Cigna Commercial |
$4,763.52
|
| Rate for Payer: Health EOS Commercial |
$4,608.19
|
| Rate for Payer: HFN Commercial |
$4,763.52
|
| Rate for Payer: Multiplan Commercial |
$4,142.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,763.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,537.09
|
| Rate for Payer: Quartz Commercial |
$3,106.65
|
| Rate for Payer: WEA Trust Commercial |
$2,847.76
|
| Rate for Payer: WPS Commercial |
$3,835.02
|
|
|
AUGMENT TRIATHLON FEMORAL DISTAL SZ 4 5MM 5540-A-402
|
Facility
|
IP
|
$4,737.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6246165
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,414.30 |
| Max. Negotiated Rate |
$4,532.96 |
| Rate for Payer: Aetna Commercial |
$4,434.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,237.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,611.38
|
| Rate for Payer: Cash Price |
$1,421.29
|
| Rate for Payer: Cigna Commercial |
$4,532.96
|
| Rate for Payer: Health EOS Commercial |
$4,385.15
|
| Rate for Payer: HFN Commercial |
$4,532.96
|
| Rate for Payer: Multiplan Commercial |
$3,941.71
|
| Rate for Payer: Preferred Network Access Commercial |
$4,532.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,414.30
|
| Rate for Payer: Quartz Commercial |
$2,956.28
|
| Rate for Payer: WEA Trust Commercial |
$2,709.92
|
| Rate for Payer: WPS Commercial |
$3,649.40
|
|
|
AUGMENT TRIATHLON FEMORAL DISTAL SZ 4 5MM 5540-A-402
|
Facility
|
OP
|
$4,737.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6246165
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,379.60 |
| Max. Negotiated Rate |
$4,532.96 |
| Rate for Payer: Aetna Commercial |
$4,434.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,237.34
|
| Rate for Payer: Aetna Managed Medicare |
$1,379.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,202.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,463.57
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,365.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,611.38
|
| Rate for Payer: Cash Price |
$1,421.29
|
| Rate for Payer: Cigna Commercial |
$4,532.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,757.30
|
| Rate for Payer: Health EOS Commercial |
$4,385.15
|
| Rate for Payer: HFN Commercial |
$4,532.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,695.35
|
| Rate for Payer: Multiplan Commercial |
$3,941.71
|
| Rate for Payer: NAPHCARE Commercial |
$2,956.28
|
| Rate for Payer: Preferred Network Access Commercial |
$4,532.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,414.30
|
| Rate for Payer: Quartz Commercial |
$3,202.64
|
| Rate for Payer: Quartz Medicare Advantage |
$2,956.28
|
| Rate for Payer: The Alliance Commercial |
$2,463.57
|
| Rate for Payer: WEA Trust Commercial |
$2,709.92
|
| Rate for Payer: WPS Commercial |
$3,649.40
|
|
|
Aural Rehabilitation
|
Facility
|
OP
|
$522.00
|
|
|
Service Code
|
CPT 92507
|
| Hospital Charge Code |
3203484
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$152.01 |
| Max. Negotiated Rate |
$499.45 |
| Rate for Payer: Aetna Commercial |
$488.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$466.88
|
| Rate for Payer: Aetna Managed Medicare |
$152.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$352.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$271.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$260.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$287.73
|
| Rate for Payer: Cash Price |
$156.60
|
| Rate for Payer: Cash Price |
$156.60
|
| Rate for Payer: Cigna Commercial |
$499.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$303.80
|
| Rate for Payer: Health EOS Commercial |
$483.16
|
| Rate for Payer: HFN Commercial |
$499.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$407.16
|
| Rate for Payer: Multiplan Commercial |
$434.30
|
| Rate for Payer: NAPHCARE Commercial |
$325.73
|
| Rate for Payer: Preferred Network Access Commercial |
$499.45
|
| Rate for Payer: Quartz Beloit One Network |
$266.01
|
| Rate for Payer: Quartz Commercial |
$352.87
|
| Rate for Payer: Quartz Medicare Advantage |
$325.73
|
| Rate for Payer: The Alliance Commercial |
$310.17
|
| Rate for Payer: United Healthcare PPO |
$407.16
|
| Rate for Payer: WEA Trust Commercial |
$298.58
|
| Rate for Payer: WPS Commercial |
$402.10
|
|
|
Aural Rehabilitation
|
Professional
|
Both
|
$522.00
|
|
|
Service Code
|
CPT 92507
|
| Hospital Charge Code |
3203484
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$77.54 |
| Max. Negotiated Rate |
$515.74 |
| Rate for Payer: Aetna Commercial |
$515.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$466.88
|
| Rate for Payer: Aetna Managed Medicare |
$77.54
|
| Rate for Payer: Anthem Medicare Advantage |
$77.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$77.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$77.54
|
| Rate for Payer: Cash Price |
$156.60
|
| Rate for Payer: Cash Price |
$156.60
|
| Rate for Payer: Cigna Commercial |
$515.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$271.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$77.54
|
| Rate for Payer: Health EOS Commercial |
$494.02
|
| Rate for Payer: HFN Commercial |
$515.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$275.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$275.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$77.54
|
| Rate for Payer: Multiplan Commercial |
$434.30
|
| Rate for Payer: NAPHCARE Commercial |
$116.31
|
| Rate for Payer: Preferred Network Access Commercial |
$515.74
|
| Rate for Payer: Quartz Beloit One Network |
$238.87
|
| Rate for Payer: Quartz Commercial |
$309.44
|
| Rate for Payer: Quartz Medicare Advantage |
$77.54
|
| Rate for Payer: The Alliance Commercial |
$193.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$77.54
|
| Rate for Payer: WEA Trust Commercial |
$298.58
|
| Rate for Payer: WPS Commercial |
$310.17
|
|
|
Aural Rehabilitation
|
Facility
|
IP
|
$522.00
|
|
|
Service Code
|
CPT 92507
|
| Hospital Charge Code |
3203484
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$266.01 |
| Max. Negotiated Rate |
$499.45 |
| Rate for Payer: Aetna Commercial |
$488.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$466.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$287.73
|
| Rate for Payer: Cash Price |
$156.60
|
| Rate for Payer: Cigna Commercial |
$499.45
|
| Rate for Payer: Health EOS Commercial |
$483.16
|
| Rate for Payer: HFN Commercial |
$499.45
|
| Rate for Payer: Multiplan Commercial |
$434.30
|
| Rate for Payer: Preferred Network Access Commercial |
$499.45
|
| Rate for Payer: Quartz Beloit One Network |
$266.01
|
| Rate for Payer: Quartz Commercial |
$325.73
|
| Rate for Payer: WEA Trust Commercial |
$298.58
|
| Rate for Payer: WPS Commercial |
$402.10
|
|
|
Aural Rehabilitation First 60 Min
|
Facility
|
OP
|
$485.00
|
|
|
Service Code
|
CPT 92626
|
| Hospital Charge Code |
3203485
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$135.42 |
| Max. Negotiated Rate |
$541.67 |
| Rate for Payer: Aetna Commercial |
$453.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$433.78
|
| Rate for Payer: Aetna Managed Medicare |
$135.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$362.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$298.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$282.88
|
| Rate for Payer: Anthem Medicare Advantage |
$135.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$267.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$135.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$135.42
|
| Rate for Payer: Cash Price |
$145.50
|
| Rate for Payer: Cash Price |
$145.50
|
| Rate for Payer: Cash Price |
$145.50
|
| Rate for Payer: Cigna Commercial |
$464.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$135.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$282.27
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$135.42
|
| Rate for Payer: Health EOS Commercial |
$448.92
|
| Rate for Payer: HFN Commercial |
$464.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$135.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$135.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$135.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$135.42
|
| Rate for Payer: Multiplan Commercial |
$403.52
|
| Rate for Payer: NAPHCARE Commercial |
$203.13
|
| Rate for Payer: Preferred Network Access Commercial |
$464.05
|
| Rate for Payer: Quartz Beloit One Network |
$247.16
|
| Rate for Payer: Quartz Commercial |
$327.86
|
| Rate for Payer: Quartz Medicare Advantage |
$135.42
|
| Rate for Payer: The Alliance Commercial |
$541.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$135.42
|
| Rate for Payer: United Healthcare PPO |
$378.30
|
| Rate for Payer: WEA Trust Commercial |
$277.42
|
| Rate for Payer: Wellcare Medicare |
$135.42
|
| Rate for Payer: WPS Commercial |
$373.60
|
|
|
Aural Rehabilitation First 60 Min
|
Facility
|
IP
|
$485.00
|
|
|
Service Code
|
CPT 92626
|
| Hospital Charge Code |
3203485
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$247.16 |
| Max. Negotiated Rate |
$464.05 |
| Rate for Payer: Aetna Commercial |
$453.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$433.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$267.33
|
| Rate for Payer: Cash Price |
$145.50
|
| Rate for Payer: Cigna Commercial |
$464.05
|
| Rate for Payer: Health EOS Commercial |
$448.92
|
| Rate for Payer: HFN Commercial |
$464.05
|
| Rate for Payer: Multiplan Commercial |
$403.52
|
| Rate for Payer: Preferred Network Access Commercial |
$464.05
|
| Rate for Payer: Quartz Beloit One Network |
$247.16
|
| Rate for Payer: Quartz Commercial |
$302.64
|
| Rate for Payer: WEA Trust Commercial |
$277.42
|
| Rate for Payer: WPS Commercial |
$373.60
|
|
|
Aural Rehabilitation First 60 Min
|
Professional
|
Both
|
$485.00
|
|
|
Service Code
|
CPT 92626
|
| Hospital Charge Code |
3203485
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$61.38 |
| Max. Negotiated Rate |
$479.18 |
| Rate for Payer: Aetna Commercial |
$479.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$433.78
|
| Rate for Payer: Aetna Managed Medicare |
$61.38
|
| Rate for Payer: Anthem Medicare Advantage |
$61.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$61.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$61.38
|
| Rate for Payer: Cash Price |
$145.50
|
| Rate for Payer: Cash Price |
$145.50
|
| Rate for Payer: Cigna Commercial |
$479.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$252.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$61.38
|
| Rate for Payer: Health EOS Commercial |
$459.00
|
| Rate for Payer: HFN Commercial |
$479.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$270.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$270.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$61.38
|
| Rate for Payer: Multiplan Commercial |
$403.52
|
| Rate for Payer: NAPHCARE Commercial |
$92.07
|
| Rate for Payer: Preferred Network Access Commercial |
$479.18
|
| Rate for Payer: Quartz Beloit One Network |
$221.94
|
| Rate for Payer: Quartz Commercial |
$287.51
|
| Rate for Payer: Quartz Medicare Advantage |
$61.38
|
| Rate for Payer: The Alliance Commercial |
$153.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$61.38
|
| Rate for Payer: WEA Trust Commercial |
$277.42
|
| Rate for Payer: WPS Commercial |
$245.52
|
|
|
Aural Rehab Next 15 Min
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
CPT 92627
|
| Hospital Charge Code |
3203483
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$14.46 |
| Max. Negotiated Rate |
$118.56 |
| Rate for Payer: Aetna Commercial |
$118.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$107.33
|
| Rate for Payer: Aetna Managed Medicare |
$14.46
|
| Rate for Payer: Anthem Medicare Advantage |
$14.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.46
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$118.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$62.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.46
|
| Rate for Payer: Health EOS Commercial |
$113.57
|
| Rate for Payer: HFN Commercial |
$118.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$64.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.46
|
| Rate for Payer: Multiplan Commercial |
$99.84
|
| Rate for Payer: NAPHCARE Commercial |
$21.68
|
| Rate for Payer: Preferred Network Access Commercial |
$118.56
|
| Rate for Payer: Quartz Beloit One Network |
$54.91
|
| Rate for Payer: Quartz Commercial |
$71.14
|
| Rate for Payer: Quartz Medicare Advantage |
$14.46
|
| Rate for Payer: The Alliance Commercial |
$36.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.46
|
| Rate for Payer: WEA Trust Commercial |
$68.64
|
| Rate for Payer: WPS Commercial |
$57.82
|
|
