|
BONE CEMENT SMARTSET GMV 5450-50-501
|
Facility
OP
|
$3,482.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5528730
|
|
Hospital Revenue Code
|
280
|
| Min. Negotiated Rate |
$974.96 |
| Max. Negotiated Rate |
$3,203.44 |
| Rate for Payer: Aetna Commercial |
$3,133.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,994.52
|
| Rate for Payer: Aetna Managed Medicare |
$974.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,263.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,741.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,671.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,845.46
|
| Rate for Payer: Cash Price |
$1,044.60
|
| Rate for Payer: Cigna Commercial |
$3,203.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,948.53
|
| Rate for Payer: Health EOS Commercial |
$3,098.98
|
| Rate for Payer: HFN Commercial |
$3,203.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,611.50
|
| Rate for Payer: Multiplan Commercial |
$2,785.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,089.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,203.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,706.18
|
| Rate for Payer: Quartz Commercial |
$2,263.30
|
| Rate for Payer: Quartz Medicare Advantage |
$2,089.20
|
| Rate for Payer: United Healthcare PPO |
$2,611.50
|
| Rate for Payer: WEA Trust Commercial |
$1,915.10
|
| Rate for Payer: WPS Commercial |
$2,579.12
|
|
|
BONE CEMENT SMARTSET GMV 5450-50-501
|
Facility
IP
|
$3,482.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5528730
|
|
Hospital Revenue Code
|
280
|
| Min. Negotiated Rate |
$1,706.18 |
| Max. Negotiated Rate |
$3,203.44 |
| Rate for Payer: Aetna Commercial |
$3,133.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,845.46
|
| Rate for Payer: Cash Price |
$1,044.60
|
| Rate for Payer: Cigna Commercial |
$3,203.44
|
| Rate for Payer: Health EOS Commercial |
$3,098.98
|
| Rate for Payer: HFN Commercial |
$3,203.44
|
| Rate for Payer: Multiplan Commercial |
$2,785.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,089.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,203.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,706.18
|
| Rate for Payer: Quartz Commercial |
$2,089.20
|
| Rate for Payer: WEA Trust Commercial |
$1,915.10
|
| Rate for Payer: WPS Commercial |
$2,579.12
|
|
|
BONE CEMENT SMARTSET MV 3122-040
|
Facility
OP
|
$1,488.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459756
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$416.64 |
| Max. Negotiated Rate |
$1,368.96 |
| Rate for Payer: Aetna Commercial |
$1,339.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,279.68
|
| Rate for Payer: Aetna Managed Medicare |
$416.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$967.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$744.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$714.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$788.64
|
| Rate for Payer: Cash Price |
$446.40
|
| Rate for Payer: Cigna Commercial |
$1,368.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$832.68
|
| Rate for Payer: Health EOS Commercial |
$1,324.32
|
| Rate for Payer: HFN Commercial |
$1,368.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,116.00
|
| Rate for Payer: Multiplan Commercial |
$1,190.40
|
| Rate for Payer: NAPHCARE Commercial |
$892.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,368.96
|
| Rate for Payer: Quartz Beloit One Network |
$729.12
|
| Rate for Payer: Quartz Commercial |
$967.20
|
| Rate for Payer: Quartz Medicare Advantage |
$892.80
|
| Rate for Payer: WEA Trust Commercial |
$818.40
|
| Rate for Payer: WPS Commercial |
$1,102.16
|
|
|
BONE CEMENT SMARTSET MV 3122-040
|
Facility
IP
|
$1,488.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459756
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$729.12 |
| Max. Negotiated Rate |
$1,368.96 |
| Rate for Payer: Aetna Commercial |
$1,339.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$788.64
|
| Rate for Payer: Cash Price |
$446.40
|
| Rate for Payer: Cigna Commercial |
$1,368.96
|
| Rate for Payer: Health EOS Commercial |
$1,324.32
|
| Rate for Payer: HFN Commercial |
$1,368.96
|
| Rate for Payer: Multiplan Commercial |
$1,190.40
|
| Rate for Payer: NAPHCARE Commercial |
$892.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,368.96
|
| Rate for Payer: Quartz Beloit One Network |
$729.12
|
| Rate for Payer: Quartz Commercial |
$892.80
|
| Rate for Payer: WEA Trust Commercial |
$818.40
|
| Rate for Payer: WPS Commercial |
$1,102.16
|
|
|
BONE DISEASES AND ARTHROPATHIES WITH MCC
|
Facility
IP
|
$36,251.00
|
|
|
Service Code
|
MS-DRG 553
|
| Min. Negotiated Rate |
$13,040.06 |
| Max. Negotiated Rate |
$36,251.00 |
| Rate for Payer: Aetna Managed Medicare |
$13,040.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$28,323.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21,709.35
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20,625.30
|
| Rate for Payer: Anthem Medicare Advantage |
$13,040.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,040.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,040.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,040.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22,895.97
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,040.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26,354.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,040.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,040.06
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,040.06
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,040.06
|
| Rate for Payer: NAPHCARE Commercial |
$19,560.09
|
| Rate for Payer: Quartz Medicare Advantage |
$13,040.06
|
| Rate for Payer: The Alliance Commercial |
$36,251.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,040.06
|
| Rate for Payer: United Healthcare PPO |
$20,517.12
|
| Rate for Payer: Wellcare Medicare |
$13,040.06
|
|
|
BONE DISEASES AND ARTHROPATHIES WITHOUT MCC
|
Facility
IP
|
$22,169.00
|
|
|
Service Code
|
MS-DRG 554
|
| Min. Negotiated Rate |
$7,974.38 |
| Max. Negotiated Rate |
$22,169.00 |
| Rate for Payer: Aetna Managed Medicare |
$7,974.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17,203.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,186.42
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,527.96
|
| Rate for Payer: Anthem Medicare Advantage |
$7,974.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,974.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,974.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,974.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13,907.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,974.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16,025.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,974.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,974.38
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,974.38
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,974.38
|
| Rate for Payer: NAPHCARE Commercial |
$11,961.57
|
| Rate for Payer: Quartz Medicare Advantage |
$7,974.38
|
| Rate for Payer: The Alliance Commercial |
$22,169.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,974.38
|
| Rate for Payer: United Healthcare PPO |
$12,475.75
|
| Rate for Payer: Wellcare Medicare |
$7,974.38
|
|
|
BONE FILLER OSTEOVATION EX
|
Facility
IP
|
$1,212.00
|
|
|
Service Code
|
HCPCS C9359
|
| Hospital Charge Code |
2965443
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$593.88 |
| Max. Negotiated Rate |
$1,115.04 |
| Rate for Payer: Aetna Commercial |
$1,090.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$642.36
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cigna Commercial |
$1,115.04
|
| Rate for Payer: Health EOS Commercial |
$1,078.68
|
| Rate for Payer: HFN Commercial |
$1,115.04
|
| Rate for Payer: Multiplan Commercial |
$969.60
|
| Rate for Payer: NAPHCARE Commercial |
$727.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,115.04
|
| Rate for Payer: Quartz Beloit One Network |
$593.88
|
| Rate for Payer: Quartz Commercial |
$727.20
|
| Rate for Payer: WEA Trust Commercial |
$666.60
|
| Rate for Payer: WPS Commercial |
$897.73
|
|
|
BONE FILLER OSTEOVATION EX
|
Facility
OP
|
$1,212.00
|
|
|
Service Code
|
HCPCS C9359
|
| Hospital Charge Code |
2965443
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.36 |
| Max. Negotiated Rate |
$1,115.04 |
| Rate for Payer: Aetna Commercial |
$1,090.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,042.32
|
| Rate for Payer: Aetna Managed Medicare |
$339.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$787.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$606.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$581.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$642.36
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cigna Commercial |
$1,115.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$678.24
|
| Rate for Payer: Health EOS Commercial |
$1,078.68
|
| Rate for Payer: HFN Commercial |
$1,115.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$909.00
|
| Rate for Payer: Multiplan Commercial |
$969.60
|
| Rate for Payer: NAPHCARE Commercial |
$727.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,115.04
|
| Rate for Payer: Quartz Beloit One Network |
$593.88
|
| Rate for Payer: Quartz Commercial |
$787.80
|
| Rate for Payer: Quartz Medicare Advantage |
$727.20
|
| Rate for Payer: WEA Trust Commercial |
$666.60
|
| Rate for Payer: WPS Commercial |
$897.73
|
|
|
BONE GRAFT, ANY DONOR AREA; MAJOR OR LARGE
|
Facility
OP
|
$26,304.57
|
|
|
Service Code
|
CPT 20902
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,440.12 |
| Max. Negotiated Rate |
$26,304.57 |
| Rate for Payer: Aetna Managed Medicare |
$7,071.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17,483.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,081.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,278.00
|
| Rate for Payer: Anthem Medicare Advantage |
$7,071.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,071.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,071.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,071.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,795.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,071.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26,304.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,071.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,071.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,071.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,071.12
|
| Rate for Payer: NAPHCARE Commercial |
$10,606.68
|
| Rate for Payer: Quartz Medicare Advantage |
$7,071.12
|
| Rate for Payer: The Alliance Commercial |
$2,440.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,071.12
|
| Rate for Payer: United Healthcare PPO |
$8,452.00
|
| Rate for Payer: Wellcare Medicare |
$7,071.12
|
|
|
BONE GRAFT, ANY DONOR AREA; MINOR OR SMALL (EG, DOWEL OR BUTTON)
|
Facility
OP
|
$26,304.57
|
|
|
Service Code
|
CPT 20900
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,894.04 |
| Max. Negotiated Rate |
$26,304.57 |
| Rate for Payer: Aetna Managed Medicare |
$7,071.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17,483.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,081.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,278.00
|
| Rate for Payer: Anthem Medicare Advantage |
$7,071.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,071.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,071.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,071.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,071.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26,304.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,071.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,071.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,071.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,071.12
|
| Rate for Payer: NAPHCARE Commercial |
$10,606.68
|
| Rate for Payer: Quartz Medicare Advantage |
$7,071.12
|
| Rate for Payer: The Alliance Commercial |
$1,894.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,071.12
|
| Rate for Payer: United Healthcare PPO |
$8,452.00
|
| Rate for Payer: Wellcare Medicare |
$7,071.12
|
|
|
BONE GRAFT DRILL 12MM BG-8030-S
|
Facility
IP
|
$5,546.00
|
|
| Hospital Charge Code |
5458681
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,717.54 |
| Max. Negotiated Rate |
$5,102.32 |
| Rate for Payer: Aetna Commercial |
$4,991.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,939.38
|
| Rate for Payer: Cash Price |
$1,663.80
|
| Rate for Payer: Cigna Commercial |
$5,102.32
|
| Rate for Payer: Health EOS Commercial |
$4,935.94
|
| Rate for Payer: HFN Commercial |
$5,102.32
|
| Rate for Payer: Multiplan Commercial |
$4,436.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,327.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,102.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,717.54
|
| Rate for Payer: Quartz Commercial |
$3,327.60
|
| Rate for Payer: WEA Trust Commercial |
$3,050.30
|
| Rate for Payer: WPS Commercial |
$4,107.92
|
|
|
BONE GRAFT DRILL 12MM BG-8030-S
|
Facility
OP
|
$5,546.00
|
|
| Hospital Charge Code |
5458681
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,552.88 |
| Max. Negotiated Rate |
$22,184.00 |
| Rate for Payer: Aetna Commercial |
$4,991.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,769.56
|
| Rate for Payer: Aetna Managed Medicare |
$1,552.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,604.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,773.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,662.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,939.38
|
| Rate for Payer: Cash Price |
$1,663.80
|
| Rate for Payer: Cigna Commercial |
$5,102.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,103.54
|
| Rate for Payer: Health EOS Commercial |
$4,935.94
|
| Rate for Payer: HFN Commercial |
$5,102.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,159.50
|
| Rate for Payer: Multiplan Commercial |
$4,436.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,327.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,102.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,717.54
|
| Rate for Payer: Quartz Commercial |
$3,604.90
|
| Rate for Payer: Quartz Medicare Advantage |
$3,327.60
|
| Rate for Payer: The Alliance Commercial |
$22,184.00
|
| Rate for Payer: WEA Trust Commercial |
$3,050.30
|
| Rate for Payer: WPS Commercial |
$4,107.92
|
|
|
BONE GRAFT DRILL 6MM BG-8006-S
|
Facility
OP
|
$5,999.00
|
|
| Hospital Charge Code |
5458712
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,679.72 |
| Max. Negotiated Rate |
$23,996.00 |
| Rate for Payer: Aetna Commercial |
$5,399.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,159.14
|
| Rate for Payer: Aetna Managed Medicare |
$1,679.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,899.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,999.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,879.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,179.47
|
| Rate for Payer: Cash Price |
$1,799.70
|
| Rate for Payer: Cigna Commercial |
$5,519.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,357.04
|
| Rate for Payer: Health EOS Commercial |
$5,339.11
|
| Rate for Payer: HFN Commercial |
$5,519.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,499.25
|
| Rate for Payer: Multiplan Commercial |
$4,799.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,599.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,519.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,939.51
|
| Rate for Payer: Quartz Commercial |
$3,899.35
|
| Rate for Payer: Quartz Medicare Advantage |
$3,599.40
|
| Rate for Payer: The Alliance Commercial |
$23,996.00
|
| Rate for Payer: WEA Trust Commercial |
$3,299.45
|
| Rate for Payer: WPS Commercial |
$4,443.46
|
|
|
BONE GRAFT DRILL 6MM BG-8006-S
|
Facility
IP
|
$5,999.00
|
|
| Hospital Charge Code |
5458712
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,939.51 |
| Max. Negotiated Rate |
$5,519.08 |
| Rate for Payer: Aetna Commercial |
$5,399.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,179.47
|
| Rate for Payer: Cash Price |
$1,799.70
|
| Rate for Payer: Cigna Commercial |
$5,519.08
|
| Rate for Payer: Health EOS Commercial |
$5,339.11
|
| Rate for Payer: HFN Commercial |
$5,519.08
|
| Rate for Payer: Multiplan Commercial |
$4,799.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,599.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,519.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,939.51
|
| Rate for Payer: Quartz Commercial |
$3,599.40
|
| Rate for Payer: WEA Trust Commercial |
$3,299.45
|
| Rate for Payer: WPS Commercial |
$4,443.46
|
|
|
BONE GRAFT DRILL 8MM BG-8010-S
|
Facility
IP
|
$5,768.00
|
|
| Hospital Charge Code |
5458682
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,826.32 |
| Max. Negotiated Rate |
$5,306.56 |
| Rate for Payer: Aetna Commercial |
$5,191.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,057.04
|
| Rate for Payer: Cash Price |
$1,730.40
|
| Rate for Payer: Cigna Commercial |
$5,306.56
|
| Rate for Payer: Health EOS Commercial |
$5,133.52
|
| Rate for Payer: HFN Commercial |
$5,306.56
|
| Rate for Payer: Multiplan Commercial |
$4,614.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,460.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,306.56
|
| Rate for Payer: Quartz Beloit One Network |
$2,826.32
|
| Rate for Payer: Quartz Commercial |
$3,460.80
|
| Rate for Payer: WEA Trust Commercial |
$3,172.40
|
| Rate for Payer: WPS Commercial |
$4,272.36
|
|
|
BONE GRAFT DRILL 8MM BG-8010-S
|
Facility
OP
|
$5,768.00
|
|
| Hospital Charge Code |
5458682
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,615.04 |
| Max. Negotiated Rate |
$23,072.00 |
| Rate for Payer: Aetna Commercial |
$5,191.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,960.48
|
| Rate for Payer: Aetna Managed Medicare |
$1,615.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,749.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,884.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,768.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,057.04
|
| Rate for Payer: Cash Price |
$1,730.40
|
| Rate for Payer: Cigna Commercial |
$5,306.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,227.77
|
| Rate for Payer: Health EOS Commercial |
$5,133.52
|
| Rate for Payer: HFN Commercial |
$5,306.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,326.00
|
| Rate for Payer: Multiplan Commercial |
$4,614.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,460.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,306.56
|
| Rate for Payer: Quartz Beloit One Network |
$2,826.32
|
| Rate for Payer: Quartz Commercial |
$3,749.20
|
| Rate for Payer: Quartz Medicare Advantage |
$3,460.80
|
| Rate for Payer: The Alliance Commercial |
$23,072.00
|
| Rate for Payer: WEA Trust Commercial |
$3,172.40
|
| Rate for Payer: WPS Commercial |
$4,272.36
|
|
|
BONE GRAFT SUBSTITUTE 2102-2201
|
Facility
IP
|
$5,548.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
5685829
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,718.52 |
| Max. Negotiated Rate |
$5,104.16 |
| Rate for Payer: Aetna Commercial |
$4,993.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,940.44
|
| Rate for Payer: Cash Price |
$1,664.40
|
| Rate for Payer: Cigna Commercial |
$5,104.16
|
| Rate for Payer: Health EOS Commercial |
$4,937.72
|
| Rate for Payer: HFN Commercial |
$5,104.16
|
| Rate for Payer: Multiplan Commercial |
$4,438.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,328.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,104.16
|
| Rate for Payer: Quartz Beloit One Network |
$2,718.52
|
| Rate for Payer: Quartz Commercial |
$3,328.80
|
| Rate for Payer: WEA Trust Commercial |
$3,051.40
|
| Rate for Payer: WPS Commercial |
$4,109.40
|
|
|
BONE GRAFT SUBSTITUTE 2102-2201
|
Facility
OP
|
$5,548.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
5685829
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,553.44 |
| Max. Negotiated Rate |
$5,104.16 |
| Rate for Payer: Aetna Commercial |
$4,993.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,771.28
|
| Rate for Payer: Aetna Managed Medicare |
$1,553.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,606.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,774.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,663.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,940.44
|
| Rate for Payer: Cash Price |
$1,664.40
|
| Rate for Payer: Cigna Commercial |
$5,104.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,104.66
|
| Rate for Payer: Health EOS Commercial |
$4,937.72
|
| Rate for Payer: HFN Commercial |
$5,104.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,161.00
|
| Rate for Payer: Multiplan Commercial |
$4,438.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,328.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,104.16
|
| Rate for Payer: Quartz Beloit One Network |
$2,718.52
|
| Rate for Payer: Quartz Commercial |
$3,606.20
|
| Rate for Payer: Quartz Medicare Advantage |
$3,328.80
|
| Rate for Payer: WEA Trust Commercial |
$3,051.40
|
| Rate for Payer: WPS Commercial |
$4,109.40
|
|
|
Bone Length Studies 77073
|
Professional
|
$86.00
|
|
|
Service Code
|
CPT 77073
|
| Hospital Charge Code |
5482710
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$37.84 |
| Max. Negotiated Rate |
$216.25 |
| Rate for Payer: Aetna Commercial |
$81.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.96
|
| Rate for Payer: Aetna Managed Medicare |
$43.25
|
| Rate for Payer: Anthem Medicare Advantage |
$43.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$43.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$43.25
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$81.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$43.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.25
|
| Rate for Payer: Health EOS Commercial |
$78.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$152.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$152.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$43.25
|
| Rate for Payer: Multiplan Commercial |
$68.80
|
| Rate for Payer: Preferred Network Access Commercial |
$81.70
|
| Rate for Payer: Quartz Beloit One Network |
$37.84
|
| Rate for Payer: Quartz Commercial |
$49.02
|
| Rate for Payer: Quartz Medicare Advantage |
$43.25
|
| Rate for Payer: The Alliance Commercial |
$164.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.25
|
| Rate for Payer: WEA Trust Commercial |
$47.30
|
| Rate for Payer: WPS Commercial |
$216.25
|
|
|
Bone Marrow, Aspiration Only
|
Professional
|
$605.00
|
|
|
Service Code
|
CPT 38220
|
| Hospital Charge Code |
1190866
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$64.26 |
| Max. Negotiated Rate |
$574.75 |
| Rate for Payer: Aetna Commercial |
$574.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$520.30
|
| Rate for Payer: Aetna Managed Medicare |
$64.26
|
| Rate for Payer: Anthem Medicare Advantage |
$64.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$64.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$64.26
|
| Rate for Payer: Cash Price |
$181.50
|
| Rate for Payer: Cash Price |
$181.50
|
| Rate for Payer: Cigna Commercial |
$574.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$302.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.26
|
| Rate for Payer: Health EOS Commercial |
$550.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$230.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$230.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$64.26
|
| Rate for Payer: Multiplan Commercial |
$484.00
|
| Rate for Payer: Preferred Network Access Commercial |
$574.75
|
| Rate for Payer: Quartz Beloit One Network |
$266.20
|
| Rate for Payer: Quartz Commercial |
$344.85
|
| Rate for Payer: Quartz Medicare Advantage |
$64.26
|
| Rate for Payer: The Alliance Commercial |
$273.10
|
| Rate for Payer: United Healthcare Medicaid |
$137.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$64.26
|
| Rate for Payer: WEA Trust Commercial |
$332.75
|
| Rate for Payer: WPS Commercial |
$289.17
|
|
|
Bone Marrow Biopsy
|
Facility
IP
|
$589.00
|
|
|
Service Code
|
CPT 38222 TC
|
| Hospital Charge Code |
6230725
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$288.61 |
| Max. Negotiated Rate |
$541.88 |
| Rate for Payer: Aetna Commercial |
$530.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$312.17
|
| Rate for Payer: Cash Price |
$176.70
|
| Rate for Payer: Cigna Commercial |
$541.88
|
| Rate for Payer: Health EOS Commercial |
$524.21
|
| Rate for Payer: HFN Commercial |
$541.88
|
| Rate for Payer: Multiplan Commercial |
$471.20
|
| Rate for Payer: NAPHCARE Commercial |
$353.40
|
| Rate for Payer: Preferred Network Access Commercial |
$541.88
|
| Rate for Payer: Quartz Beloit One Network |
$288.61
|
| Rate for Payer: Quartz Commercial |
$353.40
|
| Rate for Payer: WEA Trust Commercial |
$323.95
|
| Rate for Payer: WPS Commercial |
$436.27
|
|
|
Bone Marrow Biopsy
|
Professional
|
$589.00
|
|
|
Service Code
|
CPT 38222 TC
|
| Hospital Charge Code |
6230725
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$259.16 |
| Max. Negotiated Rate |
$559.55 |
| Rate for Payer: Aetna Commercial |
$559.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$506.54
|
| Rate for Payer: Cash Price |
$176.70
|
| Rate for Payer: Cash Price |
$176.70
|
| Rate for Payer: Cigna Commercial |
$559.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$294.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$353.40
|
| Rate for Payer: Health EOS Commercial |
$535.99
|
| Rate for Payer: Multiplan Commercial |
$471.20
|
| Rate for Payer: Preferred Network Access Commercial |
$559.55
|
| Rate for Payer: Quartz Beloit One Network |
$259.16
|
| Rate for Payer: Quartz Commercial |
$335.73
|
| Rate for Payer: The Alliance Commercial |
$294.50
|
| Rate for Payer: WEA Trust Commercial |
$323.95
|
| Rate for Payer: WPS Commercial |
$436.27
|
|
|
Bone Marrow Biopsy
|
Facility
OP
|
$589.00
|
|
|
Service Code
|
CPT 38222 TC
|
| Hospital Charge Code |
6230725
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$164.92 |
| Max. Negotiated Rate |
$3,205.00 |
| Rate for Payer: Aetna Commercial |
$530.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$506.54
|
| Rate for Payer: Aetna Managed Medicare |
$164.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$312.17
|
| Rate for Payer: Cash Price |
$176.70
|
| Rate for Payer: Cash Price |
$176.70
|
| Rate for Payer: Cash Price |
$176.70
|
| Rate for Payer: Cigna Commercial |
$541.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$329.60
|
| Rate for Payer: Health EOS Commercial |
$524.21
|
| Rate for Payer: HFN Commercial |
$541.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$441.75
|
| Rate for Payer: Multiplan Commercial |
$471.20
|
| Rate for Payer: NAPHCARE Commercial |
$353.40
|
| Rate for Payer: Preferred Network Access Commercial |
$541.88
|
| Rate for Payer: Quartz Beloit One Network |
$288.61
|
| Rate for Payer: Quartz Commercial |
$382.85
|
| Rate for Payer: Quartz Medicare Advantage |
$353.40
|
| Rate for Payer: The Alliance Commercial |
$2,356.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$323.95
|
| Rate for Payer: WPS Commercial |
$436.27
|
|
|
Bone Marrow Biopsy and Aspiration 38222
|
Professional
|
$1,273.00
|
|
|
Service Code
|
CPT 38222
|
| Hospital Charge Code |
5383338
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$71.64 |
| Max. Negotiated Rate |
$1,209.35 |
| Rate for Payer: Aetna Commercial |
$1,209.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,094.78
|
| Rate for Payer: Aetna Managed Medicare |
$71.64
|
| Rate for Payer: Anthem Medicare Advantage |
$71.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$71.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$71.64
|
| Rate for Payer: Cash Price |
$381.90
|
| Rate for Payer: Cash Price |
$381.90
|
| Rate for Payer: Cigna Commercial |
$1,209.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$636.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$71.64
|
| Rate for Payer: Health EOS Commercial |
$1,158.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$261.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$261.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$71.64
|
| Rate for Payer: Multiplan Commercial |
$1,018.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,209.35
|
| Rate for Payer: Quartz Beloit One Network |
$560.12
|
| Rate for Payer: Quartz Commercial |
$725.61
|
| Rate for Payer: Quartz Medicare Advantage |
$71.64
|
| Rate for Payer: The Alliance Commercial |
$304.47
|
| Rate for Payer: United Healthcare Medicaid |
$132.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$71.64
|
| Rate for Payer: WEA Trust Commercial |
$700.15
|
| Rate for Payer: WPS Commercial |
$322.38
|
|
|
Bone Marrow Bipsy, Needle or Trocar
|
Professional
|
$842.00
|
|
|
Service Code
|
CPT 38221
|
| Hospital Charge Code |
1190865
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$66.65 |
| Max. Negotiated Rate |
$799.90 |
| Rate for Payer: Aetna Commercial |
$799.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$724.12
|
| Rate for Payer: Aetna Managed Medicare |
$66.65
|
| Rate for Payer: Anthem Medicare Advantage |
$66.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$66.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$66.65
|
| Rate for Payer: Cash Price |
$252.60
|
| Rate for Payer: Cash Price |
$252.60
|
| Rate for Payer: Cigna Commercial |
$799.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$421.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.65
|
| Rate for Payer: Health EOS Commercial |
$766.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$237.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$237.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$66.65
|
| Rate for Payer: Multiplan Commercial |
$673.60
|
| Rate for Payer: Preferred Network Access Commercial |
$799.90
|
| Rate for Payer: Quartz Beloit One Network |
$370.48
|
| Rate for Payer: Quartz Commercial |
$479.94
|
| Rate for Payer: Quartz Medicare Advantage |
$66.65
|
| Rate for Payer: The Alliance Commercial |
$283.26
|
| Rate for Payer: United Healthcare Medicaid |
$153.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$66.65
|
| Rate for Payer: WEA Trust Commercial |
$463.10
|
| Rate for Payer: WPS Commercial |
$299.92
|
|
