|
FIBERSTITCH IMPLANT CURVED 24 DEG AR-4570-24
|
Facility
|
IP
|
$5,266.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767727
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,580.34 |
| Max. Negotiated Rate |
$4,844.72 |
| Rate for Payer: Aetna Commercial |
$4,739.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,528.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,790.98
|
| Rate for Payer: Cash Price |
$1,579.80
|
| Rate for Payer: Cigna Commercial |
$4,844.72
|
| Rate for Payer: Health EOS Commercial |
$4,686.74
|
| Rate for Payer: HFN Commercial |
$4,844.72
|
| Rate for Payer: Multiplan Commercial |
$4,212.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,159.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,844.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,580.34
|
| Rate for Payer: Quartz Commercial |
$3,159.60
|
| Rate for Payer: WEA Trust Commercial |
$2,896.30
|
| Rate for Payer: WPS Commercial |
$3,900.53
|
|
|
FIBERSTITCH IMPLANT CURVED 24 DEG AR-4570-24
|
Facility
|
OP
|
$5,266.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767727
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,474.48 |
| Max. Negotiated Rate |
$21,064.00 |
| Rate for Payer: Aetna Commercial |
$4,739.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,528.76
|
| Rate for Payer: Aetna Managed Medicare |
$1,474.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,422.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,633.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,527.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,790.98
|
| Rate for Payer: Cash Price |
$1,579.80
|
| Rate for Payer: Cigna Commercial |
$4,844.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,946.85
|
| Rate for Payer: Health EOS Commercial |
$4,686.74
|
| Rate for Payer: HFN Commercial |
$4,844.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,949.50
|
| Rate for Payer: Multiplan Commercial |
$4,212.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,159.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,844.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,580.34
|
| Rate for Payer: Quartz Commercial |
$3,422.90
|
| Rate for Payer: Quartz Medicare Advantage |
$3,159.60
|
| Rate for Payer: The Alliance Commercial |
$21,064.00
|
| Rate for Payer: WEA Trust Commercial |
$2,896.30
|
| Rate for Payer: WPS Commercial |
$3,900.53
|
|
|
FIBERSTITCH IMPLANT CURVED RC AR-19032C
|
Facility
|
OP
|
$3,751.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6246220
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,050.28 |
| Max. Negotiated Rate |
$15,004.00 |
| Rate for Payer: Aetna Commercial |
$3,375.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,225.86
|
| Rate for Payer: Aetna Managed Medicare |
$1,050.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,438.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,875.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,800.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,988.03
|
| Rate for Payer: Cash Price |
$1,125.30
|
| Rate for Payer: Cigna Commercial |
$3,450.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,099.06
|
| Rate for Payer: Health EOS Commercial |
$3,338.39
|
| Rate for Payer: HFN Commercial |
$3,450.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,813.25
|
| Rate for Payer: Multiplan Commercial |
$3,000.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,250.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,450.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,837.99
|
| Rate for Payer: Quartz Commercial |
$2,438.15
|
| Rate for Payer: Quartz Medicare Advantage |
$2,250.60
|
| Rate for Payer: The Alliance Commercial |
$15,004.00
|
| Rate for Payer: WEA Trust Commercial |
$2,063.05
|
| Rate for Payer: WPS Commercial |
$2,778.37
|
|
|
FIBERSTITCH IMPLANT CURVED RC AR-19032C
|
Facility
|
IP
|
$3,751.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6246220
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,837.99 |
| Max. Negotiated Rate |
$3,450.92 |
| Rate for Payer: Aetna Commercial |
$3,375.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,225.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,988.03
|
| Rate for Payer: Cash Price |
$1,125.30
|
| Rate for Payer: Cigna Commercial |
$3,450.92
|
| Rate for Payer: Health EOS Commercial |
$3,338.39
|
| Rate for Payer: HFN Commercial |
$3,450.92
|
| Rate for Payer: Multiplan Commercial |
$3,000.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,250.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,450.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,837.99
|
| Rate for Payer: Quartz Commercial |
$2,250.60
|
| Rate for Payer: WEA Trust Commercial |
$2,063.05
|
| Rate for Payer: WPS Commercial |
$2,778.37
|
|
|
FIBERSTITCH IMPLANT, REVERSE CURVED AR-4570R
|
Facility
|
IP
|
$5,063.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685819
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,480.87 |
| Max. Negotiated Rate |
$4,657.96 |
| Rate for Payer: Aetna Commercial |
$4,556.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,354.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,683.39
|
| Rate for Payer: Cash Price |
$1,518.90
|
| Rate for Payer: Cigna Commercial |
$4,657.96
|
| Rate for Payer: Health EOS Commercial |
$4,506.07
|
| Rate for Payer: HFN Commercial |
$4,657.96
|
| Rate for Payer: Multiplan Commercial |
$4,050.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,037.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,657.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,480.87
|
| Rate for Payer: Quartz Commercial |
$3,037.80
|
| Rate for Payer: WEA Trust Commercial |
$2,784.65
|
| Rate for Payer: WPS Commercial |
$3,750.16
|
|
|
FIBERSTITCH IMPLANT, REVERSE CURVED AR-4570R
|
Facility
|
OP
|
$5,063.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685819
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,417.64 |
| Max. Negotiated Rate |
$20,252.00 |
| Rate for Payer: Aetna Commercial |
$4,556.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,354.18
|
| Rate for Payer: Aetna Managed Medicare |
$1,417.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,290.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,531.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,430.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,683.39
|
| Rate for Payer: Cash Price |
$1,518.90
|
| Rate for Payer: Cigna Commercial |
$4,657.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,833.25
|
| Rate for Payer: Health EOS Commercial |
$4,506.07
|
| Rate for Payer: HFN Commercial |
$4,657.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,797.25
|
| Rate for Payer: Multiplan Commercial |
$4,050.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,037.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,657.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,480.87
|
| Rate for Payer: Quartz Commercial |
$3,290.95
|
| Rate for Payer: Quartz Medicare Advantage |
$3,037.80
|
| Rate for Payer: The Alliance Commercial |
$20,252.00
|
| Rate for Payer: WEA Trust Commercial |
$2,784.65
|
| Rate for Payer: WPS Commercial |
$3,750.16
|
|
|
FIBERSTITCH IMPLANT STRAIGHT AR-4570S
|
Facility
|
IP
|
$5,266.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767728
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,580.34 |
| Max. Negotiated Rate |
$4,844.72 |
| Rate for Payer: Aetna Commercial |
$4,739.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,528.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,790.98
|
| Rate for Payer: Cash Price |
$1,579.80
|
| Rate for Payer: Cigna Commercial |
$4,844.72
|
| Rate for Payer: Health EOS Commercial |
$4,686.74
|
| Rate for Payer: HFN Commercial |
$4,844.72
|
| Rate for Payer: Multiplan Commercial |
$4,212.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,159.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,844.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,580.34
|
| Rate for Payer: Quartz Commercial |
$3,159.60
|
| Rate for Payer: WEA Trust Commercial |
$2,896.30
|
| Rate for Payer: WPS Commercial |
$3,900.53
|
|
|
FIBERSTITCH IMPLANT STRAIGHT AR-4570S
|
Facility
|
OP
|
$5,266.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767728
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,474.48 |
| Max. Negotiated Rate |
$21,064.00 |
| Rate for Payer: Aetna Commercial |
$4,739.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,528.76
|
| Rate for Payer: Aetna Managed Medicare |
$1,474.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,422.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,633.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,527.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,790.98
|
| Rate for Payer: Cash Price |
$1,579.80
|
| Rate for Payer: Cigna Commercial |
$4,844.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,946.85
|
| Rate for Payer: Health EOS Commercial |
$4,686.74
|
| Rate for Payer: HFN Commercial |
$4,844.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,949.50
|
| Rate for Payer: Multiplan Commercial |
$4,212.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,159.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,844.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,580.34
|
| Rate for Payer: Quartz Commercial |
$3,422.90
|
| Rate for Payer: Quartz Medicare Advantage |
$3,159.60
|
| Rate for Payer: The Alliance Commercial |
$21,064.00
|
| Rate for Payer: WEA Trust Commercial |
$2,896.30
|
| Rate for Payer: WPS Commercial |
$3,900.53
|
|
|
***FIBERSTITCH IMPLANT STRAIGHT *** DO NOT USE ***
|
Facility
|
IP
|
$5,063.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685683
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,480.87 |
| Max. Negotiated Rate |
$4,657.96 |
| Rate for Payer: Aetna Commercial |
$4,556.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,354.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,683.39
|
| Rate for Payer: Cash Price |
$1,518.90
|
| Rate for Payer: Cigna Commercial |
$4,657.96
|
| Rate for Payer: Health EOS Commercial |
$4,506.07
|
| Rate for Payer: HFN Commercial |
$4,657.96
|
| Rate for Payer: Multiplan Commercial |
$4,050.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,037.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,657.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,480.87
|
| Rate for Payer: Quartz Commercial |
$3,037.80
|
| Rate for Payer: WEA Trust Commercial |
$2,784.65
|
| Rate for Payer: WPS Commercial |
$3,750.16
|
|
|
***FIBERSTITCH IMPLANT STRAIGHT *** DO NOT USE ***
|
Facility
|
OP
|
$5,063.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685683
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,417.64 |
| Max. Negotiated Rate |
$20,252.00 |
| Rate for Payer: Aetna Commercial |
$4,556.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,354.18
|
| Rate for Payer: Aetna Managed Medicare |
$1,417.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,290.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,531.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,430.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,683.39
|
| Rate for Payer: Cash Price |
$1,518.90
|
| Rate for Payer: Cigna Commercial |
$4,657.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,833.25
|
| Rate for Payer: Health EOS Commercial |
$4,506.07
|
| Rate for Payer: HFN Commercial |
$4,657.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,797.25
|
| Rate for Payer: Multiplan Commercial |
$4,050.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,037.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,657.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,480.87
|
| Rate for Payer: Quartz Commercial |
$3,290.95
|
| Rate for Payer: Quartz Medicare Advantage |
$3,037.80
|
| Rate for Payer: The Alliance Commercial |
$20,252.00
|
| Rate for Payer: WEA Trust Commercial |
$2,784.65
|
| Rate for Payer: WPS Commercial |
$3,750.16
|
|
|
FIBERTAG TIGHTROPE II ABS AR-1588TNT2
|
Facility
|
IP
|
$3,830.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6216983
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,876.70 |
| Max. Negotiated Rate |
$3,523.60 |
| Rate for Payer: Aetna Commercial |
$3,447.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,293.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,029.90
|
| Rate for Payer: Cash Price |
$1,149.00
|
| Rate for Payer: Cigna Commercial |
$3,523.60
|
| Rate for Payer: Health EOS Commercial |
$3,408.70
|
| Rate for Payer: HFN Commercial |
$3,523.60
|
| Rate for Payer: Multiplan Commercial |
$3,064.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,298.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,523.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,876.70
|
| Rate for Payer: Quartz Commercial |
$2,298.00
|
| Rate for Payer: WEA Trust Commercial |
$2,106.50
|
| Rate for Payer: WPS Commercial |
$2,836.88
|
|
|
FIBERTAG TIGHTROPE II ABS AR-1588TNT2
|
Facility
|
OP
|
$3,830.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6216983
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,072.40 |
| Max. Negotiated Rate |
$15,320.00 |
| Rate for Payer: Aetna Commercial |
$3,447.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,293.80
|
| Rate for Payer: Aetna Managed Medicare |
$1,072.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,489.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,915.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,838.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,029.90
|
| Rate for Payer: Cash Price |
$1,149.00
|
| Rate for Payer: Cigna Commercial |
$3,523.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,143.27
|
| Rate for Payer: Health EOS Commercial |
$3,408.70
|
| Rate for Payer: HFN Commercial |
$3,523.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,872.50
|
| Rate for Payer: Multiplan Commercial |
$3,064.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,298.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,523.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,876.70
|
| Rate for Payer: Quartz Commercial |
$2,489.50
|
| Rate for Payer: Quartz Medicare Advantage |
$2,298.00
|
| Rate for Payer: The Alliance Commercial |
$15,320.00
|
| Rate for Payer: WEA Trust Commercial |
$2,106.50
|
| Rate for Payer: WPS Commercial |
$2,836.88
|
|
|
FIBERTAG TIGHTROPE II WITH ATTACHED NEEDLE AR-1588RTT2
|
Facility
|
IP
|
$4,220.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6220211
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,067.80 |
| Max. Negotiated Rate |
$3,882.40 |
| Rate for Payer: Aetna Commercial |
$3,798.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,629.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,236.60
|
| Rate for Payer: Cash Price |
$1,266.00
|
| Rate for Payer: Cigna Commercial |
$3,882.40
|
| Rate for Payer: Health EOS Commercial |
$3,755.80
|
| Rate for Payer: HFN Commercial |
$3,882.40
|
| Rate for Payer: Multiplan Commercial |
$3,376.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,532.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,882.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,067.80
|
| Rate for Payer: Quartz Commercial |
$2,532.00
|
| Rate for Payer: WEA Trust Commercial |
$2,321.00
|
| Rate for Payer: WPS Commercial |
$3,125.75
|
|
|
FIBERTAG TIGHTROPE II WITH ATTACHED NEEDLE AR-1588RTT2
|
Facility
|
OP
|
$4,220.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6220211
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,181.60 |
| Max. Negotiated Rate |
$16,880.00 |
| Rate for Payer: Aetna Commercial |
$3,798.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,629.20
|
| Rate for Payer: Aetna Managed Medicare |
$1,181.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,743.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,110.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,025.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,236.60
|
| Rate for Payer: Cash Price |
$1,266.00
|
| Rate for Payer: Cigna Commercial |
$3,882.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,361.51
|
| Rate for Payer: Health EOS Commercial |
$3,755.80
|
| Rate for Payer: HFN Commercial |
$3,882.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,165.00
|
| Rate for Payer: Multiplan Commercial |
$3,376.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,532.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,882.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,067.80
|
| Rate for Payer: Quartz Commercial |
$2,743.00
|
| Rate for Payer: Quartz Medicare Advantage |
$2,532.00
|
| Rate for Payer: The Alliance Commercial |
$16,880.00
|
| Rate for Payer: WEA Trust Commercial |
$2,321.00
|
| Rate for Payer: WPS Commercial |
$3,125.75
|
|
|
FIBERTAG TIGHTROPE II WITH INTERNALBRACE AR-1588RTT2-IB
|
Facility
|
OP
|
$5,142.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6216982
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,439.76 |
| Max. Negotiated Rate |
$20,568.00 |
| Rate for Payer: Aetna Commercial |
$4,627.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,422.12
|
| Rate for Payer: Aetna Managed Medicare |
$1,439.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,342.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,571.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,468.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,725.26
|
| Rate for Payer: Cash Price |
$1,542.60
|
| Rate for Payer: Cigna Commercial |
$4,730.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,877.46
|
| Rate for Payer: Health EOS Commercial |
$4,576.38
|
| Rate for Payer: HFN Commercial |
$4,730.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,856.50
|
| Rate for Payer: Multiplan Commercial |
$4,113.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,085.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,730.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,519.58
|
| Rate for Payer: Quartz Commercial |
$3,342.30
|
| Rate for Payer: Quartz Medicare Advantage |
$3,085.20
|
| Rate for Payer: The Alliance Commercial |
$20,568.00
|
| Rate for Payer: WEA Trust Commercial |
$2,828.10
|
| Rate for Payer: WPS Commercial |
$3,808.68
|
|
|
FIBERTAG TIGHTROPE II WITH INTERNALBRACE AR-1588RTT2-IB
|
Facility
|
IP
|
$5,142.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6216982
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,519.58 |
| Max. Negotiated Rate |
$4,730.64 |
| Rate for Payer: Aetna Commercial |
$4,627.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,422.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,725.26
|
| Rate for Payer: Cash Price |
$1,542.60
|
| Rate for Payer: Cigna Commercial |
$4,730.64
|
| Rate for Payer: Health EOS Commercial |
$4,576.38
|
| Rate for Payer: HFN Commercial |
$4,730.64
|
| Rate for Payer: Multiplan Commercial |
$4,113.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,085.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,730.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,519.58
|
| Rate for Payer: Quartz Commercial |
$3,085.20
|
| Rate for Payer: WEA Trust Commercial |
$2,828.10
|
| Rate for Payer: WPS Commercial |
$3,808.68
|
|
|
FIBERTAPE 2MM WITH BRAIDED SUTURE BLUE LONG NEEDLE AR-7237-17LN
|
Facility
|
OP
|
$2,969.00
|
|
| Hospital Charge Code |
5459424
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$831.32 |
| Max. Negotiated Rate |
$11,876.00 |
| Rate for Payer: Aetna Commercial |
$2,672.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,553.34
|
| Rate for Payer: Aetna Managed Medicare |
$831.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,929.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,484.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,425.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,573.57
|
| Rate for Payer: Cash Price |
$890.70
|
| Rate for Payer: Cigna Commercial |
$2,731.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,661.45
|
| Rate for Payer: Health EOS Commercial |
$2,642.41
|
| Rate for Payer: HFN Commercial |
$2,731.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,226.75
|
| Rate for Payer: Multiplan Commercial |
$2,375.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,781.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,731.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,454.81
|
| Rate for Payer: Quartz Commercial |
$1,929.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,781.40
|
| Rate for Payer: The Alliance Commercial |
$11,876.00
|
| Rate for Payer: WEA Trust Commercial |
$1,632.95
|
| Rate for Payer: WPS Commercial |
$2,199.14
|
|
|
FIBERTAPE 2MM WITH BRAIDED SUTURE BLUE LONG NEEDLE AR-7237-17LN
|
Facility
|
IP
|
$2,969.00
|
|
| Hospital Charge Code |
5459424
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,454.81 |
| Max. Negotiated Rate |
$2,731.48 |
| Rate for Payer: Aetna Commercial |
$2,672.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,553.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,573.57
|
| Rate for Payer: Cash Price |
$890.70
|
| Rate for Payer: Cigna Commercial |
$2,731.48
|
| Rate for Payer: Health EOS Commercial |
$2,642.41
|
| Rate for Payer: HFN Commercial |
$2,731.48
|
| Rate for Payer: Multiplan Commercial |
$2,375.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,781.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,731.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,454.81
|
| Rate for Payer: Quartz Commercial |
$1,781.40
|
| Rate for Payer: WEA Trust Commercial |
$1,632.95
|
| Rate for Payer: WPS Commercial |
$2,199.14
|
|
|
Fibrinogen
|
Professional
|
Both
|
$130.00
|
|
|
Service Code
|
CPT 85384
|
| Hospital Charge Code |
633728
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.31 |
| Max. Negotiated Rate |
$123.50 |
| Rate for Payer: Aetna Commercial |
$123.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$111.80
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$123.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$65.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$78.00
|
| Rate for Payer: Health EOS Commercial |
$118.30
|
| Rate for Payer: HFN Commercial |
$123.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$34.31
|
| Rate for Payer: Multiplan Commercial |
$104.00
|
| Rate for Payer: Preferred Network Access Commercial |
$123.50
|
| Rate for Payer: Quartz Beloit One Network |
$57.20
|
| Rate for Payer: Quartz Commercial |
$74.10
|
| Rate for Payer: The Alliance Commercial |
$65.00
|
| Rate for Payer: WEA Trust Commercial |
$71.50
|
| Rate for Payer: WPS Commercial |
$96.29
|
|
|
Fibrinogen
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
CPT 85384
|
| Hospital Charge Code |
633728
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.72 |
| Max. Negotiated Rate |
$119.60 |
| Rate for Payer: Aetna Commercial |
$117.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$111.80
|
| Rate for Payer: Aetna Managed Medicare |
$9.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$36.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16.14
|
| Rate for Payer: Anthem Medicaid |
$10.04
|
| Rate for Payer: Anthem Medicare Advantage |
$9.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$68.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.72
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$119.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$72.75
|
| Rate for Payer: Dean Health Medicaid |
$10.04
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9.72
|
| Rate for Payer: Health EOS Commercial |
$115.70
|
| Rate for Payer: HFN Commercial |
$119.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9.72
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$10.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.72
|
| Rate for Payer: Managed Health Services Medicaid |
$10.44
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9.72
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9.72
|
| Rate for Payer: Multiplan Commercial |
$104.00
|
| Rate for Payer: NAPHCARE Commercial |
$14.58
|
| Rate for Payer: Preferred Network Access Commercial |
$119.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$10.04
|
| Rate for Payer: Quartz Beloit One Network |
$63.70
|
| Rate for Payer: Quartz Commercial |
$84.50
|
| Rate for Payer: Quartz Medicare Advantage |
$9.72
|
| Rate for Payer: The Alliance Commercial |
$38.88
|
| Rate for Payer: United Healthcare Medicaid |
$10.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.72
|
| Rate for Payer: United Healthcare PPO |
$97.50
|
| Rate for Payer: WEA Trust Commercial |
$71.50
|
| Rate for Payer: Wellcare Medicare |
$9.72
|
| Rate for Payer: WMAP Medicaid |
$10.04
|
| Rate for Payer: WPS Commercial |
$96.29
|
|
|
Fibrinogen
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
CPT 85384
|
| Hospital Charge Code |
633728
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.70 |
| Max. Negotiated Rate |
$119.60 |
| Rate for Payer: Aetna Commercial |
$117.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$111.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$68.90
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$119.60
|
| Rate for Payer: Health EOS Commercial |
$115.70
|
| Rate for Payer: HFN Commercial |
$119.60
|
| Rate for Payer: Multiplan Commercial |
$104.00
|
| Rate for Payer: NAPHCARE Commercial |
$78.00
|
| Rate for Payer: Preferred Network Access Commercial |
$119.60
|
| Rate for Payer: Quartz Beloit One Network |
$63.70
|
| Rate for Payer: Quartz Commercial |
$78.00
|
| Rate for Payer: WEA Trust Commercial |
$71.50
|
| Rate for Payer: WPS Commercial |
$96.29
|
|
|
Fibrinogen Degradation Products, Semi Quantitative
|
Professional
|
Both
|
$111.00
|
|
|
Service Code
|
CPT 85362
|
| Hospital Charge Code |
3949340
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.32 |
| Max. Negotiated Rate |
$105.45 |
| Rate for Payer: Aetna Commercial |
$105.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.46
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$105.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$55.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.60
|
| Rate for Payer: Health EOS Commercial |
$101.01
|
| Rate for Payer: HFN Commercial |
$105.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$24.32
|
| Rate for Payer: Multiplan Commercial |
$88.80
|
| Rate for Payer: Preferred Network Access Commercial |
$105.45
|
| Rate for Payer: Quartz Beloit One Network |
$48.84
|
| Rate for Payer: Quartz Commercial |
$63.27
|
| Rate for Payer: The Alliance Commercial |
$55.50
|
| Rate for Payer: WEA Trust Commercial |
$61.05
|
| Rate for Payer: WPS Commercial |
$82.22
|
|
|
Fibrinogen Degradation Products, Semi Quantitative
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
CPT 85362
|
| Hospital Charge Code |
3949340
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.39 |
| Max. Negotiated Rate |
$102.12 |
| Rate for Payer: Aetna Commercial |
$99.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.83
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$102.12
|
| Rate for Payer: Health EOS Commercial |
$98.79
|
| Rate for Payer: HFN Commercial |
$102.12
|
| Rate for Payer: Multiplan Commercial |
$88.80
|
| Rate for Payer: NAPHCARE Commercial |
$66.60
|
| Rate for Payer: Preferred Network Access Commercial |
$102.12
|
| Rate for Payer: Quartz Beloit One Network |
$54.39
|
| Rate for Payer: Quartz Commercial |
$66.60
|
| Rate for Payer: WEA Trust Commercial |
$61.05
|
| Rate for Payer: WPS Commercial |
$82.22
|
|
|
Fibrinogen Degradation Products, Semi Quantitative
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
CPT 85362
|
| Hospital Charge Code |
3949340
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.89 |
| Max. Negotiated Rate |
$102.12 |
| Rate for Payer: Aetna Commercial |
$99.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.46
|
| Rate for Payer: Aetna Managed Medicare |
$6.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12.06
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.44
|
| Rate for Payer: Anthem Medicaid |
$7.12
|
| Rate for Payer: Anthem Medicare Advantage |
$6.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.89
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$102.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$62.12
|
| Rate for Payer: Dean Health Medicaid |
$7.12
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.89
|
| Rate for Payer: Health EOS Commercial |
$98.79
|
| Rate for Payer: HFN Commercial |
$102.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.89
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$7.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.89
|
| Rate for Payer: Managed Health Services Medicaid |
$7.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.89
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.89
|
| Rate for Payer: Multiplan Commercial |
$88.80
|
| Rate for Payer: NAPHCARE Commercial |
$10.34
|
| Rate for Payer: Preferred Network Access Commercial |
$102.12
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$7.12
|
| Rate for Payer: Quartz Beloit One Network |
$54.39
|
| Rate for Payer: Quartz Commercial |
$72.15
|
| Rate for Payer: Quartz Medicare Advantage |
$6.89
|
| Rate for Payer: The Alliance Commercial |
$27.56
|
| Rate for Payer: United Healthcare Medicaid |
$7.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.89
|
| Rate for Payer: United Healthcare PPO |
$83.25
|
| Rate for Payer: WEA Trust Commercial |
$61.05
|
| Rate for Payer: Wellcare Medicare |
$6.89
|
| Rate for Payer: WMAP Medicaid |
$7.12
|
| Rate for Payer: WPS Commercial |
$82.22
|
|
|
FIBULA BONE GRAFTING
|
Facility
|
OP
|
$4,170.00
|
|
| Hospital Charge Code |
2959859
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,167.60 |
| Max. Negotiated Rate |
$16,680.00 |
| Rate for Payer: Aetna Commercial |
$3,753.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,586.20
|
| Rate for Payer: Aetna Managed Medicare |
$1,167.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,710.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,085.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,001.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,210.10
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cigna Commercial |
$3,836.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,333.53
|
| Rate for Payer: Health EOS Commercial |
$3,711.30
|
| Rate for Payer: HFN Commercial |
$3,836.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,127.50
|
| Rate for Payer: Multiplan Commercial |
$3,336.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,502.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,836.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,043.30
|
| Rate for Payer: Quartz Commercial |
$2,710.50
|
| Rate for Payer: Quartz Medicare Advantage |
$2,502.00
|
| Rate for Payer: The Alliance Commercial |
$16,680.00
|
| Rate for Payer: WEA Trust Commercial |
$2,293.50
|
| Rate for Payer: WPS Commercial |
$3,088.72
|
|
