|
BONE MATRIX BIO4 1CC 3102-2101
|
Facility
|
OP
|
$5,983.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
5685695
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,742.25 |
| Max. Negotiated Rate |
$5,724.53 |
| Rate for Payer: Aetna Commercial |
$5,600.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,351.20
|
| Rate for Payer: Aetna Managed Medicare |
$1,742.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,044.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,111.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,986.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,297.83
|
| Rate for Payer: Cash Price |
$1,794.90
|
| Rate for Payer: Cigna Commercial |
$5,724.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,482.11
|
| Rate for Payer: Health EOS Commercial |
$5,537.86
|
| Rate for Payer: HFN Commercial |
$5,724.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,666.74
|
| Rate for Payer: Multiplan Commercial |
$4,977.86
|
| Rate for Payer: NAPHCARE Commercial |
$3,733.39
|
| Rate for Payer: Preferred Network Access Commercial |
$5,724.53
|
| Rate for Payer: Quartz Beloit One Network |
$3,048.94
|
| Rate for Payer: Quartz Commercial |
$4,044.51
|
| Rate for Payer: Quartz Medicare Advantage |
$3,733.39
|
| Rate for Payer: The Alliance Commercial |
$3,111.16
|
| Rate for Payer: WEA Trust Commercial |
$3,422.28
|
| Rate for Payer: WPS Commercial |
$4,608.70
|
|
|
BONE MATRIX BIO4 2.5CC 3102-2102
|
Facility
|
OP
|
$8,695.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
5685696
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,531.98 |
| Max. Negotiated Rate |
$8,319.38 |
| Rate for Payer: Aetna Commercial |
$8,138.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,776.81
|
| Rate for Payer: Aetna Managed Medicare |
$2,531.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,877.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,521.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,340.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,792.68
|
| Rate for Payer: Cash Price |
$2,608.50
|
| Rate for Payer: Cigna Commercial |
$8,319.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,060.49
|
| Rate for Payer: Health EOS Commercial |
$8,048.09
|
| Rate for Payer: HFN Commercial |
$8,319.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,782.10
|
| Rate for Payer: Multiplan Commercial |
$7,234.24
|
| Rate for Payer: NAPHCARE Commercial |
$5,425.68
|
| Rate for Payer: Preferred Network Access Commercial |
$8,319.38
|
| Rate for Payer: Quartz Beloit One Network |
$4,430.97
|
| Rate for Payer: Quartz Commercial |
$5,877.82
|
| Rate for Payer: Quartz Medicare Advantage |
$5,425.68
|
| Rate for Payer: The Alliance Commercial |
$4,521.40
|
| Rate for Payer: WEA Trust Commercial |
$4,973.54
|
| Rate for Payer: WPS Commercial |
$6,697.76
|
|
|
BONE MATRIX BIO4 2.5CC 3102-2102
|
Facility
|
IP
|
$8,695.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
5685696
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,430.97 |
| Max. Negotiated Rate |
$8,319.38 |
| Rate for Payer: Aetna Commercial |
$8,138.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,776.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,792.68
|
| Rate for Payer: Cash Price |
$2,608.50
|
| Rate for Payer: Cigna Commercial |
$8,319.38
|
| Rate for Payer: Health EOS Commercial |
$8,048.09
|
| Rate for Payer: HFN Commercial |
$8,319.38
|
| Rate for Payer: Multiplan Commercial |
$7,234.24
|
| Rate for Payer: Preferred Network Access Commercial |
$8,319.38
|
| Rate for Payer: Quartz Beloit One Network |
$4,430.97
|
| Rate for Payer: Quartz Commercial |
$5,425.68
|
| Rate for Payer: WEA Trust Commercial |
$4,973.54
|
| Rate for Payer: WPS Commercial |
$6,697.76
|
|
|
BONE MATRIX BIO4 5CC 3102-2105
|
Facility
|
IP
|
$15,343.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
5685697
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,818.79 |
| Max. Negotiated Rate |
$14,680.18 |
| Rate for Payer: Aetna Commercial |
$14,361.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,722.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,457.06
|
| Rate for Payer: Cash Price |
$4,602.90
|
| Rate for Payer: Cigna Commercial |
$14,680.18
|
| Rate for Payer: Health EOS Commercial |
$14,201.48
|
| Rate for Payer: HFN Commercial |
$14,680.18
|
| Rate for Payer: Multiplan Commercial |
$12,765.38
|
| Rate for Payer: Preferred Network Access Commercial |
$14,680.18
|
| Rate for Payer: Quartz Beloit One Network |
$7,818.79
|
| Rate for Payer: Quartz Commercial |
$9,574.03
|
| Rate for Payer: WEA Trust Commercial |
$8,776.20
|
| Rate for Payer: WPS Commercial |
$11,818.71
|
|
|
BONE MATRIX BIO4 5CC 3102-2105
|
Facility
|
OP
|
$15,343.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
5685697
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,467.88 |
| Max. Negotiated Rate |
$14,680.18 |
| Rate for Payer: Aetna Commercial |
$14,361.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,722.78
|
| Rate for Payer: Aetna Managed Medicare |
$4,467.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,371.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,978.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,659.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,457.06
|
| Rate for Payer: Cash Price |
$4,602.90
|
| Rate for Payer: Cigna Commercial |
$14,680.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,929.63
|
| Rate for Payer: Health EOS Commercial |
$14,201.48
|
| Rate for Payer: HFN Commercial |
$14,680.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,967.54
|
| Rate for Payer: Multiplan Commercial |
$12,765.38
|
| Rate for Payer: NAPHCARE Commercial |
$9,574.03
|
| Rate for Payer: Preferred Network Access Commercial |
$14,680.18
|
| Rate for Payer: Quartz Beloit One Network |
$7,818.79
|
| Rate for Payer: Quartz Commercial |
$10,371.87
|
| Rate for Payer: Quartz Medicare Advantage |
$9,574.03
|
| Rate for Payer: The Alliance Commercial |
$7,978.36
|
| Rate for Payer: WEA Trust Commercial |
$8,776.20
|
| Rate for Payer: WPS Commercial |
$11,818.71
|
|
|
BONE MATRIX DBX DEMINERALIZED MIX 5CC 058050
|
Facility
|
IP
|
$7,500.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
3153468
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,822.00 |
| Max. Negotiated Rate |
$7,176.00 |
| Rate for Payer: Aetna Commercial |
$7,020.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,708.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,134.00
|
| Rate for Payer: Cash Price |
$2,250.00
|
| Rate for Payer: Cigna Commercial |
$7,176.00
|
| Rate for Payer: Health EOS Commercial |
$6,942.00
|
| Rate for Payer: HFN Commercial |
$7,176.00
|
| Rate for Payer: Multiplan Commercial |
$6,240.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,176.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,822.00
|
| Rate for Payer: Quartz Commercial |
$4,680.00
|
| Rate for Payer: WEA Trust Commercial |
$4,290.00
|
| Rate for Payer: WPS Commercial |
$5,777.25
|
|
|
BONE MATRIX DBX DEMINERALIZED MIX 5CC 058050
|
Facility
|
OP
|
$7,500.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
3153468
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,184.00 |
| Max. Negotiated Rate |
$7,176.00 |
| Rate for Payer: Aetna Commercial |
$7,020.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,708.00
|
| Rate for Payer: Aetna Managed Medicare |
$2,184.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,070.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,900.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,744.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,134.00
|
| Rate for Payer: Cash Price |
$2,250.00
|
| Rate for Payer: Cigna Commercial |
$7,176.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,365.00
|
| Rate for Payer: Health EOS Commercial |
$6,942.00
|
| Rate for Payer: HFN Commercial |
$7,176.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,850.00
|
| Rate for Payer: Multiplan Commercial |
$6,240.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,680.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,176.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,822.00
|
| Rate for Payer: Quartz Commercial |
$5,070.00
|
| Rate for Payer: Quartz Medicare Advantage |
$4,680.00
|
| Rate for Payer: The Alliance Commercial |
$3,900.00
|
| Rate for Payer: WEA Trust Commercial |
$4,290.00
|
| Rate for Payer: WPS Commercial |
$5,777.25
|
|
|
BONE OR JOINT MANIPULATION UNDER ANESTHESIA
|
Facility
|
OP
|
$663.01
|
|
|
Service Code
|
EAPG 00044
|
| Min. Negotiated Rate |
$637.51 |
| Max. Negotiated Rate |
$663.01 |
| Rate for Payer: Anthem Medicaid |
$637.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$637.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$637.51
|
| Rate for Payer: Dean Health Medicaid |
$637.51
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$637.51
|
| Rate for Payer: Managed Health Services Medicaid |
$663.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$637.51
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$637.51
|
| Rate for Payer: United Healthcare Medicaid |
$637.51
|
|
|
BONE PREPARATION KIT BIOPREP 0206-710-000
|
Facility
|
OP
|
$1,973.00
|
|
| Hospital Charge Code |
2962898
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$574.54 |
| Max. Negotiated Rate |
$1,887.77 |
| Rate for Payer: Aetna Commercial |
$1,846.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,764.65
|
| Rate for Payer: Aetna Managed Medicare |
$574.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,333.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,025.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$984.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,087.52
|
| Rate for Payer: Cash Price |
$591.90
|
| Rate for Payer: Cigna Commercial |
$1,887.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,148.29
|
| Rate for Payer: Health EOS Commercial |
$1,826.21
|
| Rate for Payer: HFN Commercial |
$1,887.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,538.94
|
| Rate for Payer: Multiplan Commercial |
$1,641.54
|
| Rate for Payer: NAPHCARE Commercial |
$1,231.15
|
| Rate for Payer: Preferred Network Access Commercial |
$1,887.77
|
| Rate for Payer: Quartz Beloit One Network |
$1,005.44
|
| Rate for Payer: Quartz Commercial |
$1,333.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,231.15
|
| Rate for Payer: The Alliance Commercial |
$1,025.96
|
| Rate for Payer: WEA Trust Commercial |
$1,128.56
|
| Rate for Payer: WPS Commercial |
$1,519.80
|
|
|
BONE PREPARATION KIT BIOPREP 0206-710-000
|
Facility
|
IP
|
$1,973.00
|
|
| Hospital Charge Code |
2962898
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,005.44 |
| Max. Negotiated Rate |
$1,887.77 |
| Rate for Payer: Aetna Commercial |
$1,846.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,764.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,087.52
|
| Rate for Payer: Cash Price |
$591.90
|
| Rate for Payer: Cigna Commercial |
$1,887.77
|
| Rate for Payer: Health EOS Commercial |
$1,826.21
|
| Rate for Payer: HFN Commercial |
$1,887.77
|
| Rate for Payer: Multiplan Commercial |
$1,641.54
|
| Rate for Payer: Preferred Network Access Commercial |
$1,887.77
|
| Rate for Payer: Quartz Beloit One Network |
$1,005.44
|
| Rate for Payer: Quartz Commercial |
$1,231.15
|
| Rate for Payer: WEA Trust Commercial |
$1,128.56
|
| Rate for Payer: WPS Commercial |
$1,519.80
|
|
|
BONE PUTTY AHBP HBP-2512
|
Facility
|
OP
|
$993.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
4048783
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$289.16 |
| Max. Negotiated Rate |
$950.10 |
| Rate for Payer: Aetna Commercial |
$929.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$888.14
|
| Rate for Payer: Aetna Managed Medicare |
$289.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$671.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$516.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$495.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$547.34
|
| Rate for Payer: Cash Price |
$297.90
|
| Rate for Payer: Cigna Commercial |
$950.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$577.93
|
| Rate for Payer: Health EOS Commercial |
$919.12
|
| Rate for Payer: HFN Commercial |
$950.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$774.54
|
| Rate for Payer: Multiplan Commercial |
$826.18
|
| Rate for Payer: NAPHCARE Commercial |
$619.63
|
| Rate for Payer: Preferred Network Access Commercial |
$950.10
|
| Rate for Payer: Quartz Beloit One Network |
$506.03
|
| Rate for Payer: Quartz Commercial |
$671.27
|
| Rate for Payer: Quartz Medicare Advantage |
$619.63
|
| Rate for Payer: The Alliance Commercial |
$516.36
|
| Rate for Payer: WEA Trust Commercial |
$568.00
|
| Rate for Payer: WPS Commercial |
$764.91
|
|
|
BONE PUTTY AHBP HBP-2512
|
Facility
|
IP
|
$993.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
4048783
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$506.03 |
| Max. Negotiated Rate |
$950.10 |
| Rate for Payer: Aetna Commercial |
$929.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$888.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$547.34
|
| Rate for Payer: Cash Price |
$297.90
|
| Rate for Payer: Cigna Commercial |
$950.10
|
| Rate for Payer: Health EOS Commercial |
$919.12
|
| Rate for Payer: HFN Commercial |
$950.10
|
| Rate for Payer: Multiplan Commercial |
$826.18
|
| Rate for Payer: Preferred Network Access Commercial |
$950.10
|
| Rate for Payer: Quartz Beloit One Network |
$506.03
|
| Rate for Payer: Quartz Commercial |
$619.63
|
| Rate for Payer: WEA Trust Commercial |
$568.00
|
| Rate for Payer: WPS Commercial |
$764.91
|
|
|
BONE PUTTY ALLOGRAFT 10CC 3102-1010
|
Facility
|
OP
|
$9,308.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
5685694
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,710.49 |
| Max. Negotiated Rate |
$8,905.89 |
| Rate for Payer: Aetna Commercial |
$8,712.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,325.08
|
| Rate for Payer: Aetna Managed Medicare |
$2,710.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,292.21
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,840.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,646.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,130.57
|
| Rate for Payer: Cash Price |
$2,792.40
|
| Rate for Payer: Cigna Commercial |
$8,905.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,417.26
|
| Rate for Payer: Health EOS Commercial |
$8,615.48
|
| Rate for Payer: HFN Commercial |
$8,905.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,260.24
|
| Rate for Payer: Multiplan Commercial |
$7,744.26
|
| Rate for Payer: NAPHCARE Commercial |
$5,808.19
|
| Rate for Payer: Preferred Network Access Commercial |
$8,905.89
|
| Rate for Payer: Quartz Beloit One Network |
$4,743.36
|
| Rate for Payer: Quartz Commercial |
$6,292.21
|
| Rate for Payer: Quartz Medicare Advantage |
$5,808.19
|
| Rate for Payer: The Alliance Commercial |
$4,840.16
|
| Rate for Payer: WEA Trust Commercial |
$5,324.18
|
| Rate for Payer: WPS Commercial |
$7,169.95
|
|
|
BONE PUTTY ALLOGRAFT 10CC 3102-1010
|
Facility
|
IP
|
$9,308.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
5685694
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,743.36 |
| Max. Negotiated Rate |
$8,905.89 |
| Rate for Payer: Aetna Commercial |
$8,712.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,325.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,130.57
|
| Rate for Payer: Cash Price |
$2,792.40
|
| Rate for Payer: Cigna Commercial |
$8,905.89
|
| Rate for Payer: Health EOS Commercial |
$8,615.48
|
| Rate for Payer: HFN Commercial |
$8,905.89
|
| Rate for Payer: Multiplan Commercial |
$7,744.26
|
| Rate for Payer: Preferred Network Access Commercial |
$8,905.89
|
| Rate for Payer: Quartz Beloit One Network |
$4,743.36
|
| Rate for Payer: Quartz Commercial |
$5,808.19
|
| Rate for Payer: WEA Trust Commercial |
$5,324.18
|
| Rate for Payer: WPS Commercial |
$7,169.95
|
|
|
BONE PUTTY ALLOGRAFT 1CC 3102-1001
|
Facility
|
OP
|
$3,936.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
5685691
|
|
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
|
|
|
BONE PUTTY ALLOGRAFT 1CC 3102-1001
|
Facility
|
IP
|
$3,936.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
5685691
|
|
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
|
|
|
BONE PUTTY ALLOGRAFT 2.5CC 3102-1002
|
Facility
|
OP
|
$6,559.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
5685692
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,909.98 |
| Max. Negotiated Rate |
$6,275.65 |
| Rate for Payer: Aetna Commercial |
$6,139.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,866.37
|
| Rate for Payer: Aetna Managed Medicare |
$1,909.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,433.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,410.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,274.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,615.32
|
| Rate for Payer: Cash Price |
$1,967.70
|
| Rate for Payer: Cigna Commercial |
$6,275.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,817.34
|
| Rate for Payer: Health EOS Commercial |
$6,071.01
|
| Rate for Payer: HFN Commercial |
$6,275.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,116.02
|
| Rate for Payer: Multiplan Commercial |
$5,457.09
|
| Rate for Payer: NAPHCARE Commercial |
$4,092.82
|
| Rate for Payer: Preferred Network Access Commercial |
$6,275.65
|
| Rate for Payer: Quartz Beloit One Network |
$3,342.47
|
| Rate for Payer: Quartz Commercial |
$4,433.88
|
| Rate for Payer: Quartz Medicare Advantage |
$4,092.82
|
| Rate for Payer: The Alliance Commercial |
$3,410.68
|
| Rate for Payer: WEA Trust Commercial |
$3,751.75
|
| Rate for Payer: WPS Commercial |
$5,052.40
|
|
|
BONE PUTTY ALLOGRAFT 2.5CC 3102-1002
|
Facility
|
IP
|
$6,559.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
5685692
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,342.47 |
| Max. Negotiated Rate |
$6,275.65 |
| Rate for Payer: Aetna Commercial |
$6,139.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,866.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,615.32
|
| Rate for Payer: Cash Price |
$1,967.70
|
| Rate for Payer: Cigna Commercial |
$6,275.65
|
| Rate for Payer: Health EOS Commercial |
$6,071.01
|
| Rate for Payer: HFN Commercial |
$6,275.65
|
| Rate for Payer: Multiplan Commercial |
$5,457.09
|
| Rate for Payer: Preferred Network Access Commercial |
$6,275.65
|
| Rate for Payer: Quartz Beloit One Network |
$3,342.47
|
| Rate for Payer: Quartz Commercial |
$4,092.82
|
| Rate for Payer: WEA Trust Commercial |
$3,751.75
|
| Rate for Payer: WPS Commercial |
$5,052.40
|
|
|
BONE PUTTY ALLOGRAFT 5CC 3102-1005
|
Facility
|
OP
|
$5,678.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
5685693
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,653.43 |
| Max. Negotiated Rate |
$5,432.71 |
| Rate for Payer: Aetna Commercial |
$5,314.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,078.40
|
| Rate for Payer: Aetna Managed Medicare |
$1,653.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,838.33
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,952.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,834.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,129.71
|
| Rate for Payer: Cash Price |
$1,703.40
|
| Rate for Payer: Cigna Commercial |
$5,432.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,304.60
|
| Rate for Payer: Health EOS Commercial |
$5,255.56
|
| Rate for Payer: HFN Commercial |
$5,432.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,428.84
|
| Rate for Payer: Multiplan Commercial |
$4,724.10
|
| Rate for Payer: NAPHCARE Commercial |
$3,543.07
|
| Rate for Payer: Preferred Network Access Commercial |
$5,432.71
|
| Rate for Payer: Quartz Beloit One Network |
$2,893.51
|
| Rate for Payer: Quartz Commercial |
$3,838.33
|
| Rate for Payer: Quartz Medicare Advantage |
$3,543.07
|
| Rate for Payer: The Alliance Commercial |
$2,952.56
|
| Rate for Payer: WEA Trust Commercial |
$3,247.82
|
| Rate for Payer: WPS Commercial |
$4,373.76
|
|
|
BONE PUTTY ALLOGRAFT 5CC 3102-1005
|
Facility
|
IP
|
$5,678.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
5685693
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,893.51 |
| Max. Negotiated Rate |
$5,432.71 |
| Rate for Payer: Aetna Commercial |
$5,314.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,078.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,129.71
|
| Rate for Payer: Cash Price |
$1,703.40
|
| Rate for Payer: Cigna Commercial |
$5,432.71
|
| Rate for Payer: Health EOS Commercial |
$5,255.56
|
| Rate for Payer: HFN Commercial |
$5,432.71
|
| Rate for Payer: Multiplan Commercial |
$4,724.10
|
| Rate for Payer: Preferred Network Access Commercial |
$5,432.71
|
| Rate for Payer: Quartz Beloit One Network |
$2,893.51
|
| Rate for Payer: Quartz Commercial |
$3,543.07
|
| Rate for Payer: WEA Trust Commercial |
$3,247.82
|
| Rate for Payer: WPS Commercial |
$4,373.76
|
|
|
BONE PUTTY ALLOMATRIX C WITH DBM & CANC CHIPS 5CC 860C0500
|
Facility
|
OP
|
$7,201.00
|
|
|
Service Code
|
HCPCS C9359
|
| Hospital Charge Code |
5248763
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,096.93 |
| Max. Negotiated Rate |
$6,889.92 |
| Rate for Payer: Aetna Commercial |
$6,740.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,440.57
|
| Rate for Payer: Aetna Managed Medicare |
$2,096.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,867.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,744.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,594.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,969.19
|
| Rate for Payer: Cash Price |
$2,160.30
|
| Rate for Payer: Cigna Commercial |
$6,889.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,190.98
|
| Rate for Payer: Health EOS Commercial |
$6,665.25
|
| Rate for Payer: HFN Commercial |
$6,889.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,616.78
|
| Rate for Payer: Multiplan Commercial |
$5,991.23
|
| Rate for Payer: NAPHCARE Commercial |
$4,493.42
|
| Rate for Payer: Preferred Network Access Commercial |
$6,889.92
|
| Rate for Payer: Quartz Beloit One Network |
$3,669.63
|
| Rate for Payer: Quartz Commercial |
$4,867.88
|
| Rate for Payer: Quartz Medicare Advantage |
$4,493.42
|
| Rate for Payer: The Alliance Commercial |
$3,744.52
|
| Rate for Payer: WEA Trust Commercial |
$4,118.97
|
| Rate for Payer: WPS Commercial |
$5,546.93
|
|
|
BONE PUTTY ALLOMATRIX C WITH DBM & CANC CHIPS 5CC 860C0500
|
Facility
|
IP
|
$7,201.00
|
|
|
Service Code
|
HCPCS C9359
|
| Hospital Charge Code |
5248763
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,669.63 |
| Max. Negotiated Rate |
$6,889.92 |
| Rate for Payer: Aetna Commercial |
$6,740.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,440.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,969.19
|
| Rate for Payer: Cash Price |
$2,160.30
|
| Rate for Payer: Cigna Commercial |
$6,889.92
|
| Rate for Payer: Health EOS Commercial |
$6,665.25
|
| Rate for Payer: HFN Commercial |
$6,889.92
|
| Rate for Payer: Multiplan Commercial |
$5,991.23
|
| Rate for Payer: Preferred Network Access Commercial |
$6,889.92
|
| Rate for Payer: Quartz Beloit One Network |
$3,669.63
|
| Rate for Payer: Quartz Commercial |
$4,493.42
|
| Rate for Payer: WEA Trust Commercial |
$4,118.97
|
| Rate for Payer: WPS Commercial |
$5,546.93
|
|
|
BONE PUTTY DBX 5CC 038050
|
Facility
|
OP
|
$3,086.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
2966144
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$898.64 |
| Max. Negotiated Rate |
$2,952.68 |
| Rate for Payer: Aetna Commercial |
$2,888.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,760.12
|
| Rate for Payer: Aetna Managed Medicare |
$898.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,086.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,604.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,540.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,701.00
|
| Rate for Payer: Cash Price |
$925.80
|
| Rate for Payer: Cigna Commercial |
$2,952.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,796.05
|
| Rate for Payer: Health EOS Commercial |
$2,856.40
|
| Rate for Payer: HFN Commercial |
$2,952.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,407.08
|
| Rate for Payer: Multiplan Commercial |
$2,567.55
|
| Rate for Payer: NAPHCARE Commercial |
$1,925.66
|
| Rate for Payer: Preferred Network Access Commercial |
$2,952.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,572.63
|
| Rate for Payer: Quartz Commercial |
$2,086.14
|
| Rate for Payer: Quartz Medicare Advantage |
$1,925.66
|
| Rate for Payer: The Alliance Commercial |
$1,604.72
|
| Rate for Payer: WEA Trust Commercial |
$1,765.19
|
| Rate for Payer: WPS Commercial |
$2,377.15
|
|
|
BONE PUTTY DBX 5CC 038050
|
Facility
|
IP
|
$3,086.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
2966144
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,572.63 |
| Max. Negotiated Rate |
$2,952.68 |
| Rate for Payer: Aetna Commercial |
$2,888.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,760.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,701.00
|
| Rate for Payer: Cash Price |
$925.80
|
| Rate for Payer: Cigna Commercial |
$2,952.68
|
| Rate for Payer: Health EOS Commercial |
$2,856.40
|
| Rate for Payer: HFN Commercial |
$2,952.68
|
| Rate for Payer: Multiplan Commercial |
$2,567.55
|
| Rate for Payer: Preferred Network Access Commercial |
$2,952.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,572.63
|
| Rate for Payer: Quartz Commercial |
$1,925.66
|
| Rate for Payer: WEA Trust Commercial |
$1,765.19
|
| Rate for Payer: WPS Commercial |
$2,377.15
|
|
|
BONE REMOVER INBONE SCREW IB200051
|
Facility
|
OP
|
$2,248.00
|
|
| Hospital Charge Code |
5831723
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$654.62 |
| Max. Negotiated Rate |
$2,150.89 |
| Rate for Payer: Aetna Commercial |
$2,104.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,010.61
|
| Rate for Payer: Aetna Managed Medicare |
$654.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,519.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,168.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,122.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,239.10
|
| Rate for Payer: Cash Price |
$674.40
|
| Rate for Payer: Cigna Commercial |
$2,150.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,308.34
|
| Rate for Payer: Health EOS Commercial |
$2,080.75
|
| Rate for Payer: HFN Commercial |
$2,150.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,753.44
|
| Rate for Payer: Multiplan Commercial |
$1,870.34
|
| Rate for Payer: NAPHCARE Commercial |
$1,402.75
|
| Rate for Payer: Preferred Network Access Commercial |
$2,150.89
|
| Rate for Payer: Quartz Beloit One Network |
$1,145.58
|
| Rate for Payer: Quartz Commercial |
$1,519.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,402.75
|
| Rate for Payer: The Alliance Commercial |
$1,168.96
|
| Rate for Payer: WEA Trust Commercial |
$1,285.86
|
| Rate for Payer: WPS Commercial |
$1,731.63
|
|
