|
DISSECTOR 3.5MM SMALL JOINT ARTHREX AR-9350DS
|
Facility
OP
|
$959.00
|
|
| Hospital Charge Code |
5348978
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$268.52 |
| Max. Negotiated Rate |
$3,836.00 |
| Rate for Payer: Aetna Commercial |
$863.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$824.74
|
| Rate for Payer: Aetna Managed Medicare |
$268.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$623.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$479.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$460.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$508.27
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cigna Commercial |
$882.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$536.66
|
| Rate for Payer: Health EOS Commercial |
$853.51
|
| Rate for Payer: HFN Commercial |
$882.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$719.25
|
| Rate for Payer: Multiplan Commercial |
$767.20
|
| Rate for Payer: NAPHCARE Commercial |
$575.40
|
| Rate for Payer: Preferred Network Access Commercial |
$882.28
|
| Rate for Payer: Quartz Beloit One Network |
$469.91
|
| Rate for Payer: Quartz Commercial |
$623.35
|
| Rate for Payer: Quartz Medicare Advantage |
$575.40
|
| Rate for Payer: The Alliance Commercial |
$3,836.00
|
| Rate for Payer: WEA Trust Commercial |
$527.45
|
| Rate for Payer: WPS Commercial |
$710.33
|
|
|
DISSECTOR 4.0MM ARTHROSCOPY ARTHREX AR-8400DS
|
Facility
IP
|
$1,078.00
|
|
| Hospital Charge Code |
5206675
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$528.22 |
| Max. Negotiated Rate |
$991.76 |
| Rate for Payer: Aetna Commercial |
$970.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$571.34
|
| Rate for Payer: Cash Price |
$323.40
|
| Rate for Payer: Cigna Commercial |
$991.76
|
| Rate for Payer: Health EOS Commercial |
$959.42
|
| Rate for Payer: HFN Commercial |
$991.76
|
| Rate for Payer: Multiplan Commercial |
$862.40
|
| Rate for Payer: NAPHCARE Commercial |
$646.80
|
| Rate for Payer: Preferred Network Access Commercial |
$991.76
|
| Rate for Payer: Quartz Beloit One Network |
$528.22
|
| Rate for Payer: Quartz Commercial |
$646.80
|
| Rate for Payer: WEA Trust Commercial |
$592.90
|
| Rate for Payer: WPS Commercial |
$798.47
|
|
|
DISSECTOR 4.0MM ARTHROSCOPY ARTHREX AR-8400DS
|
Facility
OP
|
$1,078.00
|
|
| Hospital Charge Code |
5206675
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$301.84 |
| Max. Negotiated Rate |
$4,312.00 |
| Rate for Payer: Aetna Commercial |
$970.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$927.08
|
| Rate for Payer: Aetna Managed Medicare |
$301.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$700.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$539.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$517.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$571.34
|
| Rate for Payer: Cash Price |
$323.40
|
| Rate for Payer: Cigna Commercial |
$991.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$603.25
|
| Rate for Payer: Health EOS Commercial |
$959.42
|
| Rate for Payer: HFN Commercial |
$991.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$808.50
|
| Rate for Payer: Multiplan Commercial |
$862.40
|
| Rate for Payer: NAPHCARE Commercial |
$646.80
|
| Rate for Payer: Preferred Network Access Commercial |
$991.76
|
| Rate for Payer: Quartz Beloit One Network |
$528.22
|
| Rate for Payer: Quartz Commercial |
$700.70
|
| Rate for Payer: Quartz Medicare Advantage |
$646.80
|
| Rate for Payer: The Alliance Commercial |
$4,312.00
|
| Rate for Payer: WEA Trust Commercial |
$592.90
|
| Rate for Payer: WPS Commercial |
$798.47
|
|
|
DISSECTOR 4.0MM ARTHROSCOPY ARTHREX CURVED AR-8400CDS
|
Facility
IP
|
$925.00
|
|
| Hospital Charge Code |
5348972
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$453.25 |
| Max. Negotiated Rate |
$851.00 |
| Rate for Payer: Aetna Commercial |
$832.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$490.25
|
| Rate for Payer: Cash Price |
$277.50
|
| Rate for Payer: Cigna Commercial |
$851.00
|
| Rate for Payer: Health EOS Commercial |
$823.25
|
| Rate for Payer: HFN Commercial |
$851.00
|
| Rate for Payer: Multiplan Commercial |
$740.00
|
| Rate for Payer: NAPHCARE Commercial |
$555.00
|
| Rate for Payer: Preferred Network Access Commercial |
$851.00
|
| Rate for Payer: Quartz Beloit One Network |
$453.25
|
| Rate for Payer: Quartz Commercial |
$555.00
|
| Rate for Payer: WEA Trust Commercial |
$508.75
|
| Rate for Payer: WPS Commercial |
$685.15
|
|
|
DISSECTOR 4.0MM ARTHROSCOPY ARTHREX CURVED AR-8400CDS
|
Facility
OP
|
$925.00
|
|
| Hospital Charge Code |
5348972
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$259.00 |
| Max. Negotiated Rate |
$3,700.00 |
| Rate for Payer: Aetna Commercial |
$832.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$795.50
|
| Rate for Payer: Aetna Managed Medicare |
$259.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$601.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$462.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$444.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$490.25
|
| Rate for Payer: Cash Price |
$277.50
|
| Rate for Payer: Cigna Commercial |
$851.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$517.63
|
| Rate for Payer: Health EOS Commercial |
$823.25
|
| Rate for Payer: HFN Commercial |
$851.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$693.75
|
| Rate for Payer: Multiplan Commercial |
$740.00
|
| Rate for Payer: NAPHCARE Commercial |
$555.00
|
| Rate for Payer: Preferred Network Access Commercial |
$851.00
|
| Rate for Payer: Quartz Beloit One Network |
$453.25
|
| Rate for Payer: Quartz Commercial |
$601.25
|
| Rate for Payer: Quartz Medicare Advantage |
$555.00
|
| Rate for Payer: The Alliance Commercial |
$3,700.00
|
| Rate for Payer: WEA Trust Commercial |
$508.75
|
| Rate for Payer: WPS Commercial |
$685.15
|
|
|
DISSECTOR 5.0MM ARTHROSCOPY ARTHREX AR-8500DS
|
Facility
IP
|
$1,039.00
|
|
| Hospital Charge Code |
5206676
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$509.11 |
| Max. Negotiated Rate |
$955.88 |
| Rate for Payer: Aetna Commercial |
$935.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$550.67
|
| Rate for Payer: Cash Price |
$311.70
|
| Rate for Payer: Cigna Commercial |
$955.88
|
| Rate for Payer: Health EOS Commercial |
$924.71
|
| Rate for Payer: HFN Commercial |
$955.88
|
| Rate for Payer: Multiplan Commercial |
$831.20
|
| Rate for Payer: NAPHCARE Commercial |
$623.40
|
| Rate for Payer: Preferred Network Access Commercial |
$955.88
|
| Rate for Payer: Quartz Beloit One Network |
$509.11
|
| Rate for Payer: Quartz Commercial |
$623.40
|
| Rate for Payer: WEA Trust Commercial |
$571.45
|
| Rate for Payer: WPS Commercial |
$769.59
|
|
|
DISSECTOR 5.0MM ARTHROSCOPY ARTHREX AR-8500DS
|
Facility
OP
|
$1,039.00
|
|
| Hospital Charge Code |
5206676
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$290.92 |
| Max. Negotiated Rate |
$4,156.00 |
| Rate for Payer: Aetna Commercial |
$935.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$893.54
|
| Rate for Payer: Aetna Managed Medicare |
$290.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$675.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$519.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$498.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$550.67
|
| Rate for Payer: Cash Price |
$311.70
|
| Rate for Payer: Cigna Commercial |
$955.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$581.42
|
| Rate for Payer: Health EOS Commercial |
$924.71
|
| Rate for Payer: HFN Commercial |
$955.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$779.25
|
| Rate for Payer: Multiplan Commercial |
$831.20
|
| Rate for Payer: NAPHCARE Commercial |
$623.40
|
| Rate for Payer: Preferred Network Access Commercial |
$955.88
|
| Rate for Payer: Quartz Beloit One Network |
$509.11
|
| Rate for Payer: Quartz Commercial |
$675.35
|
| Rate for Payer: Quartz Medicare Advantage |
$623.40
|
| Rate for Payer: The Alliance Commercial |
$4,156.00
|
| Rate for Payer: WEA Trust Commercial |
$571.45
|
| Rate for Payer: WPS Commercial |
$769.59
|
|
|
DISSECTOR ENDO PEANUT 5MM 173019
|
Facility
IP
|
$204.00
|
|
| Hospital Charge Code |
2963715
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$99.96 |
| Max. Negotiated Rate |
$187.68 |
| Rate for Payer: Aetna Commercial |
$183.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$108.12
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna Commercial |
$187.68
|
| Rate for Payer: Health EOS Commercial |
$181.56
|
| Rate for Payer: HFN Commercial |
$187.68
|
| Rate for Payer: Multiplan Commercial |
$163.20
|
| Rate for Payer: NAPHCARE Commercial |
$122.40
|
| Rate for Payer: Preferred Network Access Commercial |
$187.68
|
| Rate for Payer: Quartz Beloit One Network |
$99.96
|
| Rate for Payer: Quartz Commercial |
$122.40
|
| Rate for Payer: WEA Trust Commercial |
$112.20
|
| Rate for Payer: WPS Commercial |
$151.10
|
|
|
DISSECTOR ENDO PEANUT 5MM 173019
|
Facility
OP
|
$204.00
|
|
| Hospital Charge Code |
2963715
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.12 |
| Max. Negotiated Rate |
$816.00 |
| Rate for Payer: Aetna Commercial |
$183.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$175.44
|
| Rate for Payer: Aetna Managed Medicare |
$57.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$132.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$102.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$97.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$108.12
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna Commercial |
$187.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$114.16
|
| Rate for Payer: Health EOS Commercial |
$181.56
|
| Rate for Payer: HFN Commercial |
$187.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$153.00
|
| Rate for Payer: Multiplan Commercial |
$163.20
|
| Rate for Payer: NAPHCARE Commercial |
$122.40
|
| Rate for Payer: Preferred Network Access Commercial |
$187.68
|
| Rate for Payer: Quartz Beloit One Network |
$99.96
|
| Rate for Payer: Quartz Commercial |
$132.60
|
| Rate for Payer: Quartz Medicare Advantage |
$122.40
|
| Rate for Payer: The Alliance Commercial |
$816.00
|
| Rate for Payer: WEA Trust Commercial |
$112.20
|
| Rate for Payer: WPS Commercial |
$151.10
|
|
|
DISSECTOR SEPS BALLOON
|
Facility
OP
|
$5,845.00
|
|
| Hospital Charge Code |
2967372
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,636.60 |
| Max. Negotiated Rate |
$23,380.00 |
| Rate for Payer: Aetna Commercial |
$5,260.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,026.70
|
| Rate for Payer: Aetna Managed Medicare |
$1,636.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,799.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,922.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,805.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,097.85
|
| Rate for Payer: Cash Price |
$1,753.50
|
| Rate for Payer: Cigna Commercial |
$5,377.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,270.86
|
| Rate for Payer: Health EOS Commercial |
$5,202.05
|
| Rate for Payer: HFN Commercial |
$5,377.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,383.75
|
| Rate for Payer: Multiplan Commercial |
$4,676.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,507.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,377.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,864.05
|
| Rate for Payer: Quartz Commercial |
$3,799.25
|
| Rate for Payer: Quartz Medicare Advantage |
$3,507.00
|
| Rate for Payer: The Alliance Commercial |
$23,380.00
|
| Rate for Payer: WEA Trust Commercial |
$3,214.75
|
| Rate for Payer: WPS Commercial |
$4,329.39
|
|
|
DISSECTOR SEPS BALLOON
|
Facility
IP
|
$5,845.00
|
|
| Hospital Charge Code |
2967372
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,864.05 |
| Max. Negotiated Rate |
$5,377.40 |
| Rate for Payer: Aetna Commercial |
$5,260.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,097.85
|
| Rate for Payer: Cash Price |
$1,753.50
|
| Rate for Payer: Cigna Commercial |
$5,377.40
|
| Rate for Payer: Health EOS Commercial |
$5,202.05
|
| Rate for Payer: HFN Commercial |
$5,377.40
|
| Rate for Payer: Multiplan Commercial |
$4,676.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,507.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,377.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,864.05
|
| Rate for Payer: Quartz Commercial |
$3,507.00
|
| Rate for Payer: WEA Trust Commercial |
$3,214.75
|
| Rate for Payer: WPS Commercial |
$4,329.39
|
|
|
DISSECTOR SYSTEM SPACEMAKER PLUS OVAL BALLOON/TROCAR SMBTTOVLX
|
Facility
OP
|
$5,309.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
4508954
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,486.52 |
| Max. Negotiated Rate |
$4,884.28 |
| Rate for Payer: Aetna Commercial |
$4,778.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,565.74
|
| Rate for Payer: Aetna Managed Medicare |
$1,486.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,450.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,654.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,548.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,813.77
|
| Rate for Payer: Cash Price |
$1,592.70
|
| Rate for Payer: Cigna Commercial |
$4,884.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,970.92
|
| Rate for Payer: Health EOS Commercial |
$4,725.01
|
| Rate for Payer: HFN Commercial |
$4,884.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,981.75
|
| Rate for Payer: Multiplan Commercial |
$4,247.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,185.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,884.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,601.41
|
| Rate for Payer: Quartz Commercial |
$3,450.85
|
| Rate for Payer: Quartz Medicare Advantage |
$3,185.40
|
| Rate for Payer: WEA Trust Commercial |
$2,919.95
|
| Rate for Payer: WPS Commercial |
$3,932.38
|
|
|
DISSECTOR SYSTEM SPACEMAKER PLUS OVAL BALLOON/TROCAR SMBTTOVLX
|
Facility
IP
|
$5,309.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
4508954
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,601.41 |
| Max. Negotiated Rate |
$4,884.28 |
| Rate for Payer: Aetna Commercial |
$4,778.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,813.77
|
| Rate for Payer: Cash Price |
$1,592.70
|
| Rate for Payer: Cigna Commercial |
$4,884.28
|
| Rate for Payer: Health EOS Commercial |
$4,725.01
|
| Rate for Payer: HFN Commercial |
$4,884.28
|
| Rate for Payer: Multiplan Commercial |
$4,247.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,185.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,884.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,601.41
|
| Rate for Payer: Quartz Commercial |
$3,185.40
|
| Rate for Payer: WEA Trust Commercial |
$2,919.95
|
| Rate for Payer: WPS Commercial |
$3,932.38
|
|
|
DISTAL CEMENT SPACER OMNIFIT 10MM 1067-0010
|
Facility
IP
|
$860.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3431505
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$421.40 |
| Max. Negotiated Rate |
$791.20 |
| Rate for Payer: Aetna Commercial |
$774.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$455.80
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cigna Commercial |
$791.20
|
| Rate for Payer: Health EOS Commercial |
$765.40
|
| Rate for Payer: HFN Commercial |
$791.20
|
| Rate for Payer: Multiplan Commercial |
$688.00
|
| Rate for Payer: NAPHCARE Commercial |
$516.00
|
| Rate for Payer: Preferred Network Access Commercial |
$791.20
|
| Rate for Payer: Quartz Beloit One Network |
$421.40
|
| Rate for Payer: Quartz Commercial |
$516.00
|
| Rate for Payer: WEA Trust Commercial |
$473.00
|
| Rate for Payer: WPS Commercial |
$637.00
|
|
|
DISTAL CEMENT SPACER OMNIFIT 10MM 1067-0010
|
Facility
OP
|
$860.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3431505
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$240.80 |
| Max. Negotiated Rate |
$791.20 |
| Rate for Payer: Aetna Commercial |
$774.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$739.60
|
| Rate for Payer: Aetna Managed Medicare |
$240.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$559.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$430.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$412.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$455.80
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cigna Commercial |
$791.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$481.26
|
| Rate for Payer: Health EOS Commercial |
$765.40
|
| Rate for Payer: HFN Commercial |
$791.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$645.00
|
| Rate for Payer: Multiplan Commercial |
$688.00
|
| Rate for Payer: NAPHCARE Commercial |
$516.00
|
| Rate for Payer: Preferred Network Access Commercial |
$791.20
|
| Rate for Payer: Quartz Beloit One Network |
$421.40
|
| Rate for Payer: Quartz Commercial |
$559.00
|
| Rate for Payer: Quartz Medicare Advantage |
$516.00
|
| Rate for Payer: WEA Trust Commercial |
$473.00
|
| Rate for Payer: WPS Commercial |
$637.00
|
|
|
DISTAL CEMENT SPACER OMNIFIT 11MM 1067-0011
|
Facility
OP
|
$860.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5729748
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$240.80 |
| Max. Negotiated Rate |
$791.20 |
| Rate for Payer: Aetna Commercial |
$774.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$739.60
|
| Rate for Payer: Aetna Managed Medicare |
$240.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$559.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$430.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$412.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$455.80
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cigna Commercial |
$791.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$481.26
|
| Rate for Payer: Health EOS Commercial |
$765.40
|
| Rate for Payer: HFN Commercial |
$791.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$645.00
|
| Rate for Payer: Multiplan Commercial |
$688.00
|
| Rate for Payer: NAPHCARE Commercial |
$516.00
|
| Rate for Payer: Preferred Network Access Commercial |
$791.20
|
| Rate for Payer: Quartz Beloit One Network |
$421.40
|
| Rate for Payer: Quartz Commercial |
$559.00
|
| Rate for Payer: Quartz Medicare Advantage |
$516.00
|
| Rate for Payer: WEA Trust Commercial |
$473.00
|
| Rate for Payer: WPS Commercial |
$637.00
|
|
|
DISTAL CEMENT SPACER OMNIFIT 11MM 1067-0011
|
Facility
IP
|
$860.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5729748
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$421.40 |
| Max. Negotiated Rate |
$791.20 |
| Rate for Payer: Aetna Commercial |
$774.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$455.80
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cigna Commercial |
$791.20
|
| Rate for Payer: Health EOS Commercial |
$765.40
|
| Rate for Payer: HFN Commercial |
$791.20
|
| Rate for Payer: Multiplan Commercial |
$688.00
|
| Rate for Payer: NAPHCARE Commercial |
$516.00
|
| Rate for Payer: Preferred Network Access Commercial |
$791.20
|
| Rate for Payer: Quartz Beloit One Network |
$421.40
|
| Rate for Payer: Quartz Commercial |
$516.00
|
| Rate for Payer: WEA Trust Commercial |
$473.00
|
| Rate for Payer: WPS Commercial |
$637.00
|
|
|
DISTAL CENTRALIZER VERSYS SZ 10 7859-10
|
Facility
IP
|
$582.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967876
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$285.18 |
| Max. Negotiated Rate |
$535.44 |
| Rate for Payer: Aetna Commercial |
$523.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$308.46
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cigna Commercial |
$535.44
|
| Rate for Payer: Health EOS Commercial |
$517.98
|
| Rate for Payer: HFN Commercial |
$535.44
|
| Rate for Payer: Multiplan Commercial |
$465.60
|
| Rate for Payer: NAPHCARE Commercial |
$349.20
|
| Rate for Payer: Preferred Network Access Commercial |
$535.44
|
| Rate for Payer: Quartz Beloit One Network |
$285.18
|
| Rate for Payer: Quartz Commercial |
$349.20
|
| Rate for Payer: WEA Trust Commercial |
$320.10
|
| Rate for Payer: WPS Commercial |
$431.09
|
|
|
DISTAL CENTRALIZER VERSYS SZ 10 7859-10
|
Facility
OP
|
$582.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967876
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$162.96 |
| Max. Negotiated Rate |
$535.44 |
| Rate for Payer: Aetna Commercial |
$523.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$500.52
|
| Rate for Payer: Aetna Managed Medicare |
$162.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$378.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$291.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$279.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$308.46
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cigna Commercial |
$535.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$325.69
|
| Rate for Payer: Health EOS Commercial |
$517.98
|
| Rate for Payer: HFN Commercial |
$535.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$436.50
|
| Rate for Payer: Multiplan Commercial |
$465.60
|
| Rate for Payer: NAPHCARE Commercial |
$349.20
|
| Rate for Payer: Preferred Network Access Commercial |
$535.44
|
| Rate for Payer: Quartz Beloit One Network |
$285.18
|
| Rate for Payer: Quartz Commercial |
$378.30
|
| Rate for Payer: Quartz Medicare Advantage |
$349.20
|
| Rate for Payer: WEA Trust Commercial |
$320.10
|
| Rate for Payer: WPS Commercial |
$431.09
|
|
|
DISTAL CENTRALIZER VERSYS SZ 11 7859-11
|
Facility
OP
|
$582.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967877
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$162.96 |
| Max. Negotiated Rate |
$535.44 |
| Rate for Payer: Aetna Commercial |
$523.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$500.52
|
| Rate for Payer: Aetna Managed Medicare |
$162.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$378.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$291.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$279.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$308.46
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cigna Commercial |
$535.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$325.69
|
| Rate for Payer: Health EOS Commercial |
$517.98
|
| Rate for Payer: HFN Commercial |
$535.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$436.50
|
| Rate for Payer: Multiplan Commercial |
$465.60
|
| Rate for Payer: NAPHCARE Commercial |
$349.20
|
| Rate for Payer: Preferred Network Access Commercial |
$535.44
|
| Rate for Payer: Quartz Beloit One Network |
$285.18
|
| Rate for Payer: Quartz Commercial |
$378.30
|
| Rate for Payer: Quartz Medicare Advantage |
$349.20
|
| Rate for Payer: WEA Trust Commercial |
$320.10
|
| Rate for Payer: WPS Commercial |
$431.09
|
|
|
DISTAL CENTRALIZER VERSYS SZ 11 7859-11
|
Facility
IP
|
$582.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967877
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$285.18 |
| Max. Negotiated Rate |
$535.44 |
| Rate for Payer: Aetna Commercial |
$523.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$308.46
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cigna Commercial |
$535.44
|
| Rate for Payer: Health EOS Commercial |
$517.98
|
| Rate for Payer: HFN Commercial |
$535.44
|
| Rate for Payer: Multiplan Commercial |
$465.60
|
| Rate for Payer: NAPHCARE Commercial |
$349.20
|
| Rate for Payer: Preferred Network Access Commercial |
$535.44
|
| Rate for Payer: Quartz Beloit One Network |
$285.18
|
| Rate for Payer: Quartz Commercial |
$349.20
|
| Rate for Payer: WEA Trust Commercial |
$320.10
|
| Rate for Payer: WPS Commercial |
$431.09
|
|
|
DISTAL CENTRALIZER VERSYS SZ 12 7859-12
|
Facility
IP
|
$582.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967878
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$285.18 |
| Max. Negotiated Rate |
$535.44 |
| Rate for Payer: Aetna Commercial |
$523.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$308.46
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cigna Commercial |
$535.44
|
| Rate for Payer: Health EOS Commercial |
$517.98
|
| Rate for Payer: HFN Commercial |
$535.44
|
| Rate for Payer: Multiplan Commercial |
$465.60
|
| Rate for Payer: NAPHCARE Commercial |
$349.20
|
| Rate for Payer: Preferred Network Access Commercial |
$535.44
|
| Rate for Payer: Quartz Beloit One Network |
$285.18
|
| Rate for Payer: Quartz Commercial |
$349.20
|
| Rate for Payer: WEA Trust Commercial |
$320.10
|
| Rate for Payer: WPS Commercial |
$431.09
|
|
|
DISTAL CENTRALIZER VERSYS SZ 12 7859-12
|
Facility
OP
|
$582.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967878
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$162.96 |
| Max. Negotiated Rate |
$535.44 |
| Rate for Payer: Aetna Commercial |
$523.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$500.52
|
| Rate for Payer: Aetna Managed Medicare |
$162.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$378.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$291.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$279.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$308.46
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cigna Commercial |
$535.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$325.69
|
| Rate for Payer: Health EOS Commercial |
$517.98
|
| Rate for Payer: HFN Commercial |
$535.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$436.50
|
| Rate for Payer: Multiplan Commercial |
$465.60
|
| Rate for Payer: NAPHCARE Commercial |
$349.20
|
| Rate for Payer: Preferred Network Access Commercial |
$535.44
|
| Rate for Payer: Quartz Beloit One Network |
$285.18
|
| Rate for Payer: Quartz Commercial |
$378.30
|
| Rate for Payer: Quartz Medicare Advantage |
$349.20
|
| Rate for Payer: WEA Trust Commercial |
$320.10
|
| Rate for Payer: WPS Commercial |
$431.09
|
|
|
DISTAL CENTRALIZER VERSYS SZ 13 7859-13
|
Facility
IP
|
$561.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967879
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$274.89 |
| Max. Negotiated Rate |
$516.12 |
| Rate for Payer: Aetna Commercial |
$504.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$297.33
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Cigna Commercial |
$516.12
|
| Rate for Payer: Health EOS Commercial |
$499.29
|
| Rate for Payer: HFN Commercial |
$516.12
|
| Rate for Payer: Multiplan Commercial |
$448.80
|
| Rate for Payer: NAPHCARE Commercial |
$336.60
|
| Rate for Payer: Preferred Network Access Commercial |
$516.12
|
| Rate for Payer: Quartz Beloit One Network |
$274.89
|
| Rate for Payer: Quartz Commercial |
$336.60
|
| Rate for Payer: WEA Trust Commercial |
$308.55
|
| Rate for Payer: WPS Commercial |
$415.53
|
|
|
DISTAL CENTRALIZER VERSYS SZ 13 7859-13
|
Facility
OP
|
$561.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967879
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$157.08 |
| Max. Negotiated Rate |
$516.12 |
| Rate for Payer: Aetna Commercial |
$504.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$482.46
|
| Rate for Payer: Aetna Managed Medicare |
$157.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$364.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$280.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$269.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$297.33
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Cigna Commercial |
$516.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$313.94
|
| Rate for Payer: Health EOS Commercial |
$499.29
|
| Rate for Payer: HFN Commercial |
$516.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$420.75
|
| Rate for Payer: Multiplan Commercial |
$448.80
|
| Rate for Payer: NAPHCARE Commercial |
$336.60
|
| Rate for Payer: Preferred Network Access Commercial |
$516.12
|
| Rate for Payer: Quartz Beloit One Network |
$274.89
|
| Rate for Payer: Quartz Commercial |
$364.65
|
| Rate for Payer: Quartz Medicare Advantage |
$336.60
|
| Rate for Payer: WEA Trust Commercial |
$308.55
|
| Rate for Payer: WPS Commercial |
$415.53
|
|
