|
TIGHTROPE ABS IMPLANT WITH FIBERTAG AR-1588TNT
|
Facility
|
OP
|
$3,564.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5563608
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,037.84 |
| Max. Negotiated Rate |
$3,410.04 |
| Rate for Payer: Aetna Commercial |
$3,335.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,187.64
|
| Rate for Payer: Aetna Managed Medicare |
$1,037.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,409.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,853.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,779.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,964.48
|
| Rate for Payer: Cash Price |
$1,069.20
|
| Rate for Payer: Cigna Commercial |
$3,410.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,074.25
|
| Rate for Payer: Health EOS Commercial |
$3,298.84
|
| Rate for Payer: HFN Commercial |
$3,410.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,779.92
|
| Rate for Payer: Multiplan Commercial |
$2,965.25
|
| Rate for Payer: NAPHCARE Commercial |
$2,223.94
|
| Rate for Payer: Preferred Network Access Commercial |
$3,410.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,816.21
|
| Rate for Payer: Quartz Commercial |
$2,409.26
|
| Rate for Payer: Quartz Medicare Advantage |
$2,223.94
|
| Rate for Payer: The Alliance Commercial |
$1,853.28
|
| Rate for Payer: WEA Trust Commercial |
$2,038.61
|
| Rate for Payer: WPS Commercial |
$2,745.35
|
|
|
TIGHTROPE ABS IMPLANT WITH FIBERTAG AR-1588TNT
|
Facility
|
IP
|
$3,564.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5563608
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,816.21 |
| Max. Negotiated Rate |
$3,410.04 |
| Rate for Payer: Aetna Commercial |
$3,335.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,187.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,964.48
|
| Rate for Payer: Cash Price |
$1,069.20
|
| Rate for Payer: Cigna Commercial |
$3,410.04
|
| Rate for Payer: Health EOS Commercial |
$3,298.84
|
| Rate for Payer: HFN Commercial |
$3,410.04
|
| Rate for Payer: Multiplan Commercial |
$2,965.25
|
| Rate for Payer: Preferred Network Access Commercial |
$3,410.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,816.21
|
| Rate for Payer: Quartz Commercial |
$2,223.94
|
| Rate for Payer: WEA Trust Commercial |
$2,038.61
|
| Rate for Payer: WPS Commercial |
$2,745.35
|
|
|
TIGHTROPE ACL REPAIR WITH INTERNALBRACE AR-1588R-IB
|
Facility
|
IP
|
$4,804.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6220127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,448.12 |
| Max. Negotiated Rate |
$4,596.47 |
| Rate for Payer: Aetna Commercial |
$4,496.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,296.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,647.96
|
| Rate for Payer: Cash Price |
$1,441.20
|
| Rate for Payer: Cigna Commercial |
$4,596.47
|
| Rate for Payer: Health EOS Commercial |
$4,446.58
|
| Rate for Payer: HFN Commercial |
$4,596.47
|
| Rate for Payer: Multiplan Commercial |
$3,996.93
|
| Rate for Payer: Preferred Network Access Commercial |
$4,596.47
|
| Rate for Payer: Quartz Beloit One Network |
$2,448.12
|
| Rate for Payer: Quartz Commercial |
$2,997.70
|
| Rate for Payer: WEA Trust Commercial |
$2,747.89
|
| Rate for Payer: WPS Commercial |
$3,700.52
|
|
|
TIGHTROPE ACL REPAIR WITH INTERNALBRACE AR-1588R-IB
|
Facility
|
OP
|
$4,804.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6220127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,398.92 |
| Max. Negotiated Rate |
$4,596.47 |
| Rate for Payer: Aetna Commercial |
$4,496.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,296.70
|
| Rate for Payer: Aetna Managed Medicare |
$1,398.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,247.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,498.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,398.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,647.96
|
| Rate for Payer: Cash Price |
$1,441.20
|
| Rate for Payer: Cigna Commercial |
$4,596.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,795.93
|
| Rate for Payer: Health EOS Commercial |
$4,446.58
|
| Rate for Payer: HFN Commercial |
$4,596.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,747.12
|
| Rate for Payer: Multiplan Commercial |
$3,996.93
|
| Rate for Payer: NAPHCARE Commercial |
$2,997.70
|
| Rate for Payer: Preferred Network Access Commercial |
$4,596.47
|
| Rate for Payer: Quartz Beloit One Network |
$2,448.12
|
| Rate for Payer: Quartz Commercial |
$3,247.50
|
| Rate for Payer: Quartz Medicare Advantage |
$2,997.70
|
| Rate for Payer: The Alliance Commercial |
$2,498.08
|
| Rate for Payer: WEA Trust Commercial |
$2,747.89
|
| Rate for Payer: WPS Commercial |
$3,700.52
|
|
|
TIGHTROPE BTB AR-1588BTB
|
Facility
|
IP
|
$5,775.00
|
|
| Hospital Charge Code |
3901344
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,942.94 |
| Max. Negotiated Rate |
$5,525.52 |
| Rate for Payer: Aetna Commercial |
$5,405.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,165.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,183.18
|
| Rate for Payer: Cash Price |
$1,732.50
|
| Rate for Payer: Cigna Commercial |
$5,525.52
|
| Rate for Payer: Health EOS Commercial |
$5,345.34
|
| Rate for Payer: HFN Commercial |
$5,525.52
|
| Rate for Payer: Multiplan Commercial |
$4,804.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,525.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,942.94
|
| Rate for Payer: Quartz Commercial |
$3,603.60
|
| Rate for Payer: WEA Trust Commercial |
$3,303.30
|
| Rate for Payer: WPS Commercial |
$4,448.48
|
|
|
TIGHTROPE BTB AR-1588BTB
|
Facility
|
OP
|
$5,775.00
|
|
| Hospital Charge Code |
3901344
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,681.68 |
| Max. Negotiated Rate |
$5,525.52 |
| Rate for Payer: Aetna Commercial |
$5,405.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,165.16
|
| Rate for Payer: Aetna Managed Medicare |
$1,681.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,903.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,003.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,882.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,183.18
|
| Rate for Payer: Cash Price |
$1,732.50
|
| Rate for Payer: Cigna Commercial |
$5,525.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,361.05
|
| Rate for Payer: Health EOS Commercial |
$5,345.34
|
| Rate for Payer: HFN Commercial |
$5,525.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,504.50
|
| Rate for Payer: Multiplan Commercial |
$4,804.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,525.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,942.94
|
| Rate for Payer: Quartz Commercial |
$3,903.90
|
| Rate for Payer: Quartz Medicare Advantage |
$3,603.60
|
| Rate for Payer: The Alliance Commercial |
$3,003.00
|
| Rate for Payer: WEA Trust Commercial |
$3,303.30
|
| Rate for Payer: WPS Commercial |
$4,448.48
|
|
|
TIGHTROPE BTB WITH DEPLOYING SUTURE AR-1588BTB-J
|
Facility
|
OP
|
$5,320.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5520870
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,549.18 |
| Max. Negotiated Rate |
$5,090.18 |
| Rate for Payer: Aetna Commercial |
$4,979.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,758.21
|
| Rate for Payer: Aetna Managed Medicare |
$1,549.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,596.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,766.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,655.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,932.38
|
| Rate for Payer: Cash Price |
$1,596.00
|
| Rate for Payer: Cigna Commercial |
$5,090.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,096.24
|
| Rate for Payer: Health EOS Commercial |
$4,924.19
|
| Rate for Payer: HFN Commercial |
$5,090.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,149.60
|
| Rate for Payer: Multiplan Commercial |
$4,426.24
|
| Rate for Payer: NAPHCARE Commercial |
$3,319.68
|
| Rate for Payer: Preferred Network Access Commercial |
$5,090.18
|
| Rate for Payer: Quartz Beloit One Network |
$2,711.07
|
| Rate for Payer: Quartz Commercial |
$3,596.32
|
| Rate for Payer: Quartz Medicare Advantage |
$3,319.68
|
| Rate for Payer: The Alliance Commercial |
$2,766.40
|
| Rate for Payer: WEA Trust Commercial |
$3,043.04
|
| Rate for Payer: WPS Commercial |
$4,098.00
|
|
|
TIGHTROPE BTB WITH DEPLOYING SUTURE AR-1588BTB-J
|
Facility
|
IP
|
$5,320.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5520870
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,711.07 |
| Max. Negotiated Rate |
$5,090.18 |
| Rate for Payer: Aetna Commercial |
$4,979.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,758.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,932.38
|
| Rate for Payer: Cash Price |
$1,596.00
|
| Rate for Payer: Cigna Commercial |
$5,090.18
|
| Rate for Payer: Health EOS Commercial |
$4,924.19
|
| Rate for Payer: HFN Commercial |
$5,090.18
|
| Rate for Payer: Multiplan Commercial |
$4,426.24
|
| Rate for Payer: Preferred Network Access Commercial |
$5,090.18
|
| Rate for Payer: Quartz Beloit One Network |
$2,711.07
|
| Rate for Payer: Quartz Commercial |
$3,319.68
|
| Rate for Payer: WEA Trust Commercial |
$3,043.04
|
| Rate for Payer: WPS Commercial |
$4,098.00
|
|
|
TIGHTROPE II ABS IMPLANT AR-1588TN/AR-1588TN-20
|
Facility
|
OP
|
$2,449.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5307003
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$713.15 |
| Max. Negotiated Rate |
$2,343.20 |
| Rate for Payer: Aetna Commercial |
$2,292.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,190.39
|
| Rate for Payer: Aetna Managed Medicare |
$713.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,655.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,273.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,222.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,349.89
|
| Rate for Payer: Cash Price |
$734.70
|
| Rate for Payer: Cigna Commercial |
$2,343.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,425.32
|
| Rate for Payer: Health EOS Commercial |
$2,266.79
|
| Rate for Payer: HFN Commercial |
$2,343.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,910.22
|
| Rate for Payer: Multiplan Commercial |
$2,037.57
|
| Rate for Payer: NAPHCARE Commercial |
$1,528.18
|
| Rate for Payer: Preferred Network Access Commercial |
$2,343.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,248.01
|
| Rate for Payer: Quartz Commercial |
$1,655.52
|
| Rate for Payer: Quartz Medicare Advantage |
$1,528.18
|
| Rate for Payer: The Alliance Commercial |
$1,273.48
|
| Rate for Payer: WEA Trust Commercial |
$1,400.83
|
| Rate for Payer: WPS Commercial |
$1,886.46
|
|
|
TIGHTROPE II ABS IMPLANT AR-1588TN/AR-1588TN-20
|
Facility
|
IP
|
$2,449.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5307003
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,248.01 |
| Max. Negotiated Rate |
$2,343.20 |
| Rate for Payer: Aetna Commercial |
$2,292.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,190.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,349.89
|
| Rate for Payer: Cash Price |
$734.70
|
| Rate for Payer: Cigna Commercial |
$2,343.20
|
| Rate for Payer: Health EOS Commercial |
$2,266.79
|
| Rate for Payer: HFN Commercial |
$2,343.20
|
| Rate for Payer: Multiplan Commercial |
$2,037.57
|
| Rate for Payer: Preferred Network Access Commercial |
$2,343.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,248.01
|
| Rate for Payer: Quartz Commercial |
$1,528.18
|
| Rate for Payer: WEA Trust Commercial |
$1,400.83
|
| Rate for Payer: WPS Commercial |
$1,886.46
|
|
|
TIGHTROPE II ABS IMPLANT OPEN AR-1588TN-1/AR-1588TN-21
|
Facility
|
OP
|
$2,583.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5349049
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$752.17 |
| Max. Negotiated Rate |
$2,471.41 |
| Rate for Payer: Aetna Commercial |
$2,417.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,310.24
|
| Rate for Payer: Aetna Managed Medicare |
$752.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,746.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,343.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,289.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,423.75
|
| Rate for Payer: Cash Price |
$774.90
|
| Rate for Payer: Cigna Commercial |
$2,471.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,503.31
|
| Rate for Payer: Health EOS Commercial |
$2,390.82
|
| Rate for Payer: HFN Commercial |
$2,471.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,014.74
|
| Rate for Payer: Multiplan Commercial |
$2,149.06
|
| Rate for Payer: NAPHCARE Commercial |
$1,611.79
|
| Rate for Payer: Preferred Network Access Commercial |
$2,471.41
|
| Rate for Payer: Quartz Beloit One Network |
$1,316.30
|
| Rate for Payer: Quartz Commercial |
$1,746.11
|
| Rate for Payer: Quartz Medicare Advantage |
$1,611.79
|
| Rate for Payer: The Alliance Commercial |
$1,343.16
|
| Rate for Payer: WEA Trust Commercial |
$1,477.48
|
| Rate for Payer: WPS Commercial |
$1,989.68
|
|
|
TIGHTROPE II ABS IMPLANT OPEN AR-1588TN-1/AR-1588TN-21
|
Facility
|
IP
|
$2,583.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5349049
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,316.30 |
| Max. Negotiated Rate |
$2,471.41 |
| Rate for Payer: Aetna Commercial |
$2,417.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,310.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,423.75
|
| Rate for Payer: Cash Price |
$774.90
|
| Rate for Payer: Cigna Commercial |
$2,471.41
|
| Rate for Payer: Health EOS Commercial |
$2,390.82
|
| Rate for Payer: HFN Commercial |
$2,471.41
|
| Rate for Payer: Multiplan Commercial |
$2,149.06
|
| Rate for Payer: Preferred Network Access Commercial |
$2,471.41
|
| Rate for Payer: Quartz Beloit One Network |
$1,316.30
|
| Rate for Payer: Quartz Commercial |
$1,611.79
|
| Rate for Payer: WEA Trust Commercial |
$1,477.48
|
| Rate for Payer: WPS Commercial |
$1,989.68
|
|
|
TIGHTROPE II BTB WITH INTERNALBRACE LIGAMENT AUGMENTATION IBAR AR-1588BTB-IB
|
Facility
|
IP
|
$4,757.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5993634
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,424.17 |
| Max. Negotiated Rate |
$4,551.50 |
| Rate for Payer: Aetna Commercial |
$4,452.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,254.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,622.06
|
| Rate for Payer: Cash Price |
$1,427.10
|
| Rate for Payer: Cigna Commercial |
$4,551.50
|
| Rate for Payer: Health EOS Commercial |
$4,403.08
|
| Rate for Payer: HFN Commercial |
$4,551.50
|
| Rate for Payer: Multiplan Commercial |
$3,957.82
|
| Rate for Payer: Preferred Network Access Commercial |
$4,551.50
|
| Rate for Payer: Quartz Beloit One Network |
$2,424.17
|
| Rate for Payer: Quartz Commercial |
$2,968.37
|
| Rate for Payer: WEA Trust Commercial |
$2,721.00
|
| Rate for Payer: WPS Commercial |
$3,664.32
|
|
|
TIGHTROPE II BTB WITH INTERNALBRACE LIGAMENT AUGMENTATION IBAR AR-1588BTB-IB
|
Facility
|
OP
|
$4,757.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5993634
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,385.24 |
| Max. Negotiated Rate |
$4,551.50 |
| Rate for Payer: Aetna Commercial |
$4,452.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,254.66
|
| Rate for Payer: Aetna Managed Medicare |
$1,385.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,215.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,473.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,374.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,622.06
|
| Rate for Payer: Cash Price |
$1,427.10
|
| Rate for Payer: Cigna Commercial |
$4,551.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,768.57
|
| Rate for Payer: Health EOS Commercial |
$4,403.08
|
| Rate for Payer: HFN Commercial |
$4,551.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,710.46
|
| Rate for Payer: Multiplan Commercial |
$3,957.82
|
| Rate for Payer: NAPHCARE Commercial |
$2,968.37
|
| Rate for Payer: Preferred Network Access Commercial |
$4,551.50
|
| Rate for Payer: Quartz Beloit One Network |
$2,424.17
|
| Rate for Payer: Quartz Commercial |
$3,215.73
|
| Rate for Payer: Quartz Medicare Advantage |
$2,968.37
|
| Rate for Payer: The Alliance Commercial |
$2,473.64
|
| Rate for Payer: WEA Trust Commercial |
$2,721.00
|
| Rate for Payer: WPS Commercial |
$3,664.32
|
|
|
TIGHTROPE II RT ACL WITH DEPLOYING SUTURE IBAR AR-1588RT-J/AR-1588RT-IB
|
Facility
|
IP
|
$3,936.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5520871
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,005.79 |
| Max. Negotiated Rate |
$3,765.96 |
| Rate for Payer: Aetna Commercial |
$3,684.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,520.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,169.52
|
| Rate for Payer: Cash Price |
$1,180.80
|
| Rate for Payer: Cigna Commercial |
$3,765.96
|
| Rate for Payer: Health EOS Commercial |
$3,643.16
|
| Rate for Payer: HFN Commercial |
$3,765.96
|
| Rate for Payer: Multiplan Commercial |
$3,274.75
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.79
|
| Rate for Payer: Quartz Commercial |
$2,456.06
|
| Rate for Payer: WEA Trust Commercial |
$2,251.39
|
| Rate for Payer: WPS Commercial |
$3,031.90
|
|
|
TIGHTROPE II RT ACL WITH DEPLOYING SUTURE IBAR AR-1588RT-J/AR-1588RT-IB
|
Facility
|
OP
|
$3,936.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5520871
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,146.16 |
| Max. Negotiated Rate |
$3,765.96 |
| Rate for Payer: Aetna Commercial |
$3,684.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,520.36
|
| Rate for Payer: Aetna Managed Medicare |
$1,146.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,660.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,046.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,964.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,169.52
|
| Rate for Payer: Cash Price |
$1,180.80
|
| Rate for Payer: Cigna Commercial |
$3,765.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,290.75
|
| Rate for Payer: Health EOS Commercial |
$3,643.16
|
| Rate for Payer: HFN Commercial |
$3,765.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,070.08
|
| Rate for Payer: Multiplan Commercial |
$3,274.75
|
| Rate for Payer: NAPHCARE Commercial |
$2,456.06
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.79
|
| Rate for Payer: Quartz Commercial |
$2,660.74
|
| Rate for Payer: Quartz Medicare Advantage |
$2,456.06
|
| Rate for Payer: The Alliance Commercial |
$2,046.72
|
| Rate for Payer: WEA Trust Commercial |
$2,251.39
|
| Rate for Payer: WPS Commercial |
$3,031.90
|
|
|
TIGHTROPE MINI IMPLANT SYS 1.1MM AR-8919DS
|
Facility
|
OP
|
$6,804.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5178859
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,981.32 |
| Max. Negotiated Rate |
$6,510.07 |
| Rate for Payer: Aetna Commercial |
$6,368.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,085.50
|
| Rate for Payer: Aetna Managed Medicare |
$1,981.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,599.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,538.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,396.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,750.36
|
| Rate for Payer: Cash Price |
$2,041.20
|
| Rate for Payer: Cigna Commercial |
$6,510.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,959.93
|
| Rate for Payer: Health EOS Commercial |
$6,297.78
|
| Rate for Payer: HFN Commercial |
$6,510.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,307.12
|
| Rate for Payer: Multiplan Commercial |
$5,660.93
|
| Rate for Payer: NAPHCARE Commercial |
$4,245.70
|
| Rate for Payer: Preferred Network Access Commercial |
$6,510.07
|
| Rate for Payer: Quartz Beloit One Network |
$3,467.32
|
| Rate for Payer: Quartz Commercial |
$4,599.50
|
| Rate for Payer: Quartz Medicare Advantage |
$4,245.70
|
| Rate for Payer: The Alliance Commercial |
$3,538.08
|
| Rate for Payer: WEA Trust Commercial |
$3,891.89
|
| Rate for Payer: WPS Commercial |
$5,241.12
|
|
|
TIGHTROPE MINI IMPLANT SYS 1.1MM AR-8919DS
|
Facility
|
IP
|
$6,804.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5178859
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,467.32 |
| Max. Negotiated Rate |
$6,510.07 |
| Rate for Payer: Aetna Commercial |
$6,368.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,085.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,750.36
|
| Rate for Payer: Cash Price |
$2,041.20
|
| Rate for Payer: Cigna Commercial |
$6,510.07
|
| Rate for Payer: Health EOS Commercial |
$6,297.78
|
| Rate for Payer: HFN Commercial |
$6,510.07
|
| Rate for Payer: Multiplan Commercial |
$5,660.93
|
| Rate for Payer: Preferred Network Access Commercial |
$6,510.07
|
| Rate for Payer: Quartz Beloit One Network |
$3,467.32
|
| Rate for Payer: Quartz Commercial |
$4,245.70
|
| Rate for Payer: WEA Trust Commercial |
$3,891.89
|
| Rate for Payer: WPS Commercial |
$5,241.12
|
|
|
TIGHTROPE RT ACL AR-1588RTT
|
Facility
|
OP
|
$4,750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4519923
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,383.20 |
| Max. Negotiated Rate |
$4,544.80 |
| Rate for Payer: Aetna Commercial |
$4,446.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,248.40
|
| Rate for Payer: Aetna Managed Medicare |
$1,383.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,211.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,470.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,371.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,618.20
|
| Rate for Payer: Cash Price |
$1,425.00
|
| Rate for Payer: Cigna Commercial |
$4,544.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,764.50
|
| Rate for Payer: Health EOS Commercial |
$4,396.60
|
| Rate for Payer: HFN Commercial |
$4,544.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,705.00
|
| Rate for Payer: Multiplan Commercial |
$3,952.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,964.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,544.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,420.60
|
| Rate for Payer: Quartz Commercial |
$3,211.00
|
| Rate for Payer: Quartz Medicare Advantage |
$2,964.00
|
| Rate for Payer: The Alliance Commercial |
$2,470.00
|
| Rate for Payer: WEA Trust Commercial |
$2,717.00
|
| Rate for Payer: WPS Commercial |
$3,658.93
|
|
|
TIGHTROPE RT ACL AR-1588RTT
|
Facility
|
IP
|
$4,750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4519923
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,420.60 |
| Max. Negotiated Rate |
$4,544.80 |
| Rate for Payer: Aetna Commercial |
$4,446.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,248.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,618.20
|
| Rate for Payer: Cash Price |
$1,425.00
|
| Rate for Payer: Cigna Commercial |
$4,544.80
|
| Rate for Payer: Health EOS Commercial |
$4,396.60
|
| Rate for Payer: HFN Commercial |
$4,544.80
|
| Rate for Payer: Multiplan Commercial |
$3,952.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,544.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,420.60
|
| Rate for Payer: Quartz Commercial |
$2,964.00
|
| Rate for Payer: WEA Trust Commercial |
$2,717.00
|
| Rate for Payer: WPS Commercial |
$3,658.93
|
|
|
Tilt Table Test
|
Facility
|
OP
|
$2,256.00
|
|
|
Service Code
|
CPT 93660
|
| Hospital Charge Code |
3052519
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$392.70 |
| Max. Negotiated Rate |
$2,158.54 |
| Rate for Payer: Aetna Commercial |
$2,111.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,017.77
|
| Rate for Payer: Aetna Managed Medicare |
$392.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,525.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,173.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,126.20
|
| Rate for Payer: Anthem Medicare Advantage |
$392.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,243.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$392.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$392.70
|
| Rate for Payer: Cash Price |
$676.80
|
| Rate for Payer: Cash Price |
$676.80
|
| Rate for Payer: Cigna Commercial |
$2,158.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$392.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,312.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$392.70
|
| Rate for Payer: Health EOS Commercial |
$2,088.15
|
| Rate for Payer: HFN Commercial |
$2,158.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,460.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$392.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$392.70
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$392.70
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$392.70
|
| Rate for Payer: Multiplan Commercial |
$1,876.99
|
| Rate for Payer: NAPHCARE Commercial |
$589.06
|
| Rate for Payer: Preferred Network Access Commercial |
$2,158.54
|
| Rate for Payer: Quartz Beloit One Network |
$1,149.66
|
| Rate for Payer: Quartz Commercial |
$1,525.06
|
| Rate for Payer: Quartz Medicare Advantage |
$392.70
|
| Rate for Payer: The Alliance Commercial |
$1,570.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$392.70
|
| Rate for Payer: WEA Trust Commercial |
$1,290.43
|
| Rate for Payer: Wellcare Medicare |
$392.70
|
| Rate for Payer: WPS Commercial |
$1,737.80
|
|
|
Tilt Table Test
|
Facility
|
IP
|
$2,256.00
|
|
|
Service Code
|
CPT 93660
|
| Hospital Charge Code |
3052519
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,149.66 |
| Max. Negotiated Rate |
$2,158.54 |
| Rate for Payer: Aetna Commercial |
$2,111.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,017.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,243.51
|
| Rate for Payer: Cash Price |
$676.80
|
| Rate for Payer: Cigna Commercial |
$2,158.54
|
| Rate for Payer: Health EOS Commercial |
$2,088.15
|
| Rate for Payer: HFN Commercial |
$2,158.54
|
| Rate for Payer: Multiplan Commercial |
$1,876.99
|
| Rate for Payer: Preferred Network Access Commercial |
$2,158.54
|
| Rate for Payer: Quartz Beloit One Network |
$1,149.66
|
| Rate for Payer: Quartz Commercial |
$1,407.74
|
| Rate for Payer: WEA Trust Commercial |
$1,290.43
|
| Rate for Payer: WPS Commercial |
$1,737.80
|
|
|
Timolol 0.5% Ophth Solution 5ml [Med]
|
Facility
|
OP
|
$35.00
|
|
| Hospital Charge Code |
2974988
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.19 |
| Max. Negotiated Rate |
$33.49 |
| Rate for Payer: Aetna Commercial |
$32.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$31.30
|
| Rate for Payer: Aetna Managed Medicare |
$10.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19.29
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cigna Commercial |
$33.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.37
|
| Rate for Payer: Health EOS Commercial |
$32.40
|
| Rate for Payer: HFN Commercial |
$33.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27.30
|
| Rate for Payer: Multiplan Commercial |
$29.12
|
| Rate for Payer: NAPHCARE Commercial |
$21.84
|
| Rate for Payer: Preferred Network Access Commercial |
$33.49
|
| Rate for Payer: Quartz Beloit One Network |
$17.84
|
| Rate for Payer: Quartz Commercial |
$23.66
|
| Rate for Payer: Quartz Medicare Advantage |
$21.84
|
| Rate for Payer: The Alliance Commercial |
$18.20
|
| Rate for Payer: WEA Trust Commercial |
$20.02
|
| Rate for Payer: WPS Commercial |
$26.96
|
|
|
Timolol 0.5% Ophth Solution 5ml [Med]
|
Facility
|
IP
|
$35.00
|
|
| Hospital Charge Code |
2974988
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.84 |
| Max. Negotiated Rate |
$33.49 |
| Rate for Payer: Aetna Commercial |
$32.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$31.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19.29
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cigna Commercial |
$33.49
|
| Rate for Payer: Health EOS Commercial |
$32.40
|
| Rate for Payer: HFN Commercial |
$33.49
|
| Rate for Payer: Multiplan Commercial |
$29.12
|
| Rate for Payer: Preferred Network Access Commercial |
$33.49
|
| Rate for Payer: Quartz Beloit One Network |
$17.84
|
| Rate for Payer: Quartz Commercial |
$21.84
|
| Rate for Payer: WEA Trust Commercial |
$20.02
|
| Rate for Payer: WPS Commercial |
$26.96
|
|
|
TIP 0.9MM 30DEG KELMAN PHACO 8065750263
|
Facility
|
IP
|
$1,190.00
|
|
| Hospital Charge Code |
2964181
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$606.42 |
| Max. Negotiated Rate |
$1,138.59 |
| Rate for Payer: Aetna Commercial |
$1,113.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,064.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$655.93
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cigna Commercial |
$1,138.59
|
| Rate for Payer: Health EOS Commercial |
$1,101.46
|
| Rate for Payer: HFN Commercial |
$1,138.59
|
| Rate for Payer: Multiplan Commercial |
$990.08
|
| Rate for Payer: Preferred Network Access Commercial |
$1,138.59
|
| Rate for Payer: Quartz Beloit One Network |
$606.42
|
| Rate for Payer: Quartz Commercial |
$742.56
|
| Rate for Payer: WEA Trust Commercial |
$680.68
|
| Rate for Payer: WPS Commercial |
$916.66
|
|
