|
ALLOGRAFT BIOCLEANSE SEMI-TENDINOSUS TENDON 453015
|
Facility
|
OP
|
$10,449.00
|
|
|
Service Code
|
HCPCS C1763
|
| Hospital Charge Code |
4640836
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,042.75 |
| Max. Negotiated Rate |
$9,997.60 |
| Rate for Payer: Aetna Commercial |
$9,780.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,345.59
|
| Rate for Payer: Aetna Managed Medicare |
$3,042.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,063.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,433.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,216.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,759.49
|
| Rate for Payer: Cash Price |
$3,134.70
|
| Rate for Payer: Cigna Commercial |
$9,997.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,081.32
|
| Rate for Payer: Health EOS Commercial |
$9,671.59
|
| Rate for Payer: HFN Commercial |
$9,997.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,150.22
|
| Rate for Payer: Multiplan Commercial |
$8,693.57
|
| Rate for Payer: NAPHCARE Commercial |
$6,520.18
|
| Rate for Payer: Preferred Network Access Commercial |
$9,997.60
|
| Rate for Payer: Quartz Beloit One Network |
$5,324.81
|
| Rate for Payer: Quartz Commercial |
$7,063.52
|
| Rate for Payer: Quartz Medicare Advantage |
$6,520.18
|
| Rate for Payer: The Alliance Commercial |
$5,433.48
|
| Rate for Payer: WEA Trust Commercial |
$5,976.83
|
| Rate for Payer: WPS Commercial |
$8,048.86
|
|
|
ALLOGRAFT CONNECT TENDON FLEXIGRAFT PRE-SUTURED 4.5 X 190MM FCON
|
Facility
|
OP
|
$9,012.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
5917639
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,624.29 |
| Max. Negotiated Rate |
$8,622.68 |
| Rate for Payer: Aetna Commercial |
$8,435.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,060.33
|
| Rate for Payer: Aetna Managed Medicare |
$2,624.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,092.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,686.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,498.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,967.41
|
| Rate for Payer: Cash Price |
$2,703.60
|
| Rate for Payer: Cigna Commercial |
$8,622.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,244.98
|
| Rate for Payer: Health EOS Commercial |
$8,341.51
|
| Rate for Payer: HFN Commercial |
$8,622.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,029.36
|
| Rate for Payer: Multiplan Commercial |
$7,497.98
|
| Rate for Payer: NAPHCARE Commercial |
$5,623.49
|
| Rate for Payer: Preferred Network Access Commercial |
$8,622.68
|
| Rate for Payer: Quartz Beloit One Network |
$4,592.52
|
| Rate for Payer: Quartz Commercial |
$6,092.11
|
| Rate for Payer: Quartz Medicare Advantage |
$5,623.49
|
| Rate for Payer: The Alliance Commercial |
$4,686.24
|
| Rate for Payer: WEA Trust Commercial |
$5,154.86
|
| Rate for Payer: WPS Commercial |
$6,941.94
|
|
|
ALLOGRAFT CONNECT TENDON FLEXIGRAFT PRE-SUTURED 4.5 X 190MM FCON
|
Facility
|
IP
|
$9,012.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
5917639
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,592.52 |
| Max. Negotiated Rate |
$8,622.68 |
| Rate for Payer: Aetna Commercial |
$8,435.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,060.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,967.41
|
| Rate for Payer: Cash Price |
$2,703.60
|
| Rate for Payer: Cigna Commercial |
$8,622.68
|
| Rate for Payer: Health EOS Commercial |
$8,341.51
|
| Rate for Payer: HFN Commercial |
$8,622.68
|
| Rate for Payer: Multiplan Commercial |
$7,497.98
|
| Rate for Payer: Preferred Network Access Commercial |
$8,622.68
|
| Rate for Payer: Quartz Beloit One Network |
$4,592.52
|
| Rate for Payer: Quartz Commercial |
$5,623.49
|
| Rate for Payer: WEA Trust Commercial |
$5,154.86
|
| Rate for Payer: WPS Commercial |
$6,941.94
|
|
|
ALLOGRAFT COSTAL CARTILAGE L60MM D1=9MM D2=10MM FROZEN CCART60
|
Facility
|
IP
|
$5,179.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
5831642
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,639.22 |
| Max. Negotiated Rate |
$4,955.27 |
| Rate for Payer: Aetna Commercial |
$4,847.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,632.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,854.66
|
| Rate for Payer: Cash Price |
$1,553.70
|
| Rate for Payer: Cigna Commercial |
$4,955.27
|
| Rate for Payer: Health EOS Commercial |
$4,793.68
|
| Rate for Payer: HFN Commercial |
$4,955.27
|
| Rate for Payer: Multiplan Commercial |
$4,308.93
|
| Rate for Payer: Preferred Network Access Commercial |
$4,955.27
|
| Rate for Payer: Quartz Beloit One Network |
$2,639.22
|
| Rate for Payer: Quartz Commercial |
$3,231.70
|
| Rate for Payer: WEA Trust Commercial |
$2,962.39
|
| Rate for Payer: WPS Commercial |
$3,989.38
|
|
|
ALLOGRAFT COSTAL CARTILAGE L60MM D1=9MM D2=10MM FROZEN CCART60
|
Facility
|
OP
|
$5,179.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
5831642
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,508.12 |
| Max. Negotiated Rate |
$4,955.27 |
| Rate for Payer: Aetna Commercial |
$4,847.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,632.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,508.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,501.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,693.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,585.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,854.66
|
| Rate for Payer: Cash Price |
$1,553.70
|
| Rate for Payer: Cigna Commercial |
$4,955.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,014.18
|
| Rate for Payer: Health EOS Commercial |
$4,793.68
|
| Rate for Payer: HFN Commercial |
$4,955.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,039.62
|
| Rate for Payer: Multiplan Commercial |
$4,308.93
|
| Rate for Payer: NAPHCARE Commercial |
$3,231.70
|
| Rate for Payer: Preferred Network Access Commercial |
$4,955.27
|
| Rate for Payer: Quartz Beloit One Network |
$2,639.22
|
| Rate for Payer: Quartz Commercial |
$3,501.00
|
| Rate for Payer: Quartz Medicare Advantage |
$3,231.70
|
| Rate for Payer: The Alliance Commercial |
$2,693.08
|
| Rate for Payer: WEA Trust Commercial |
$2,962.39
|
| Rate for Payer: WPS Commercial |
$3,989.38
|
|
|
ALLOGRAFT COSTAL CARTILAGE LENGTH < 6CM L1: 4.5CM W: 1.5CM (ROOM TEMP) 12420059
|
Facility
|
IP
|
$5,320.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
5831697
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,711.07 |
| Max. Negotiated Rate |
$5,090.18 |
| Rate for Payer: Aetna Commercial |
$4,979.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,758.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,932.38
|
| Rate for Payer: Cash Price |
$1,596.00
|
| Rate for Payer: Cigna Commercial |
$5,090.18
|
| Rate for Payer: Health EOS Commercial |
$4,924.19
|
| Rate for Payer: HFN Commercial |
$5,090.18
|
| Rate for Payer: Multiplan Commercial |
$4,426.24
|
| Rate for Payer: Preferred Network Access Commercial |
$5,090.18
|
| Rate for Payer: Quartz Beloit One Network |
$2,711.07
|
| Rate for Payer: Quartz Commercial |
$3,319.68
|
| Rate for Payer: WEA Trust Commercial |
$3,043.04
|
| Rate for Payer: WPS Commercial |
$4,098.00
|
|
|
ALLOGRAFT COSTAL CARTILAGE LENGTH < 6CM L1: 4.5CM W: 1.5CM (ROOM TEMP) 12420059
|
Facility
|
OP
|
$5,320.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
5831697
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,549.18 |
| Max. Negotiated Rate |
$5,090.18 |
| Rate for Payer: Aetna Commercial |
$4,979.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,758.21
|
| Rate for Payer: Aetna Managed Medicare |
$1,549.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,596.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,766.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,655.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,932.38
|
| Rate for Payer: Cash Price |
$1,596.00
|
| Rate for Payer: Cigna Commercial |
$5,090.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,096.24
|
| Rate for Payer: Health EOS Commercial |
$4,924.19
|
| Rate for Payer: HFN Commercial |
$5,090.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,149.60
|
| Rate for Payer: Multiplan Commercial |
$4,426.24
|
| Rate for Payer: NAPHCARE Commercial |
$3,319.68
|
| Rate for Payer: Preferred Network Access Commercial |
$5,090.18
|
| Rate for Payer: Quartz Beloit One Network |
$2,711.07
|
| Rate for Payer: Quartz Commercial |
$3,596.32
|
| Rate for Payer: Quartz Medicare Advantage |
$3,319.68
|
| Rate for Payer: The Alliance Commercial |
$2,766.40
|
| Rate for Payer: WEA Trust Commercial |
$3,043.04
|
| Rate for Payer: WPS Commercial |
$4,098.00
|
|
|
ALLOGRAFT COTTON WEDGE 6MM (H) X 14MM (W) X 24MM (L) 3102-1900
|
Facility
|
OP
|
$9,001.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
5627706
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,621.09 |
| Max. Negotiated Rate |
$8,612.16 |
| Rate for Payer: Aetna Commercial |
$8,424.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,050.49
|
| Rate for Payer: Aetna Managed Medicare |
$2,621.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,084.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,680.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,493.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,961.35
|
| Rate for Payer: Cash Price |
$2,700.30
|
| Rate for Payer: Cigna Commercial |
$8,612.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,238.58
|
| Rate for Payer: Health EOS Commercial |
$8,331.33
|
| Rate for Payer: HFN Commercial |
$8,612.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,020.78
|
| Rate for Payer: Multiplan Commercial |
$7,488.83
|
| Rate for Payer: NAPHCARE Commercial |
$5,616.62
|
| Rate for Payer: Preferred Network Access Commercial |
$8,612.16
|
| Rate for Payer: Quartz Beloit One Network |
$4,586.91
|
| Rate for Payer: Quartz Commercial |
$6,084.68
|
| Rate for Payer: Quartz Medicare Advantage |
$5,616.62
|
| Rate for Payer: The Alliance Commercial |
$4,680.52
|
| Rate for Payer: WEA Trust Commercial |
$5,148.57
|
| Rate for Payer: WPS Commercial |
$6,933.47
|
|
|
ALLOGRAFT COTTON WEDGE 6MM (H) X 14MM (W) X 24MM (L) 3102-1900
|
Facility
|
IP
|
$9,001.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
5627706
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,586.91 |
| Max. Negotiated Rate |
$8,612.16 |
| Rate for Payer: Aetna Commercial |
$8,424.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,050.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,961.35
|
| Rate for Payer: Cash Price |
$2,700.30
|
| Rate for Payer: Cigna Commercial |
$8,612.16
|
| Rate for Payer: Health EOS Commercial |
$8,331.33
|
| Rate for Payer: HFN Commercial |
$8,612.16
|
| Rate for Payer: Multiplan Commercial |
$7,488.83
|
| Rate for Payer: Preferred Network Access Commercial |
$8,612.16
|
| Rate for Payer: Quartz Beloit One Network |
$4,586.91
|
| Rate for Payer: Quartz Commercial |
$5,616.62
|
| Rate for Payer: WEA Trust Commercial |
$5,148.57
|
| Rate for Payer: WPS Commercial |
$6,933.47
|
|
|
ALLOGRAFT COTTON WEDGE ALLOPURE BICORTICAL 6MM X 6MM (FREEZE DRIED ) 8666-0006
|
Facility
|
OP
|
$9,478.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
6179807
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,759.99 |
| Max. Negotiated Rate |
$9,068.55 |
| Rate for Payer: Aetna Commercial |
$8,871.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,477.12
|
| Rate for Payer: Aetna Managed Medicare |
$2,759.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,407.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,928.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,731.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,224.27
|
| Rate for Payer: Cash Price |
$2,843.40
|
| Rate for Payer: Cigna Commercial |
$9,068.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,516.20
|
| Rate for Payer: Health EOS Commercial |
$8,772.84
|
| Rate for Payer: HFN Commercial |
$9,068.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,392.84
|
| Rate for Payer: Multiplan Commercial |
$7,885.70
|
| Rate for Payer: NAPHCARE Commercial |
$5,914.27
|
| Rate for Payer: Preferred Network Access Commercial |
$9,068.55
|
| Rate for Payer: Quartz Beloit One Network |
$4,829.99
|
| Rate for Payer: Quartz Commercial |
$6,407.13
|
| Rate for Payer: Quartz Medicare Advantage |
$5,914.27
|
| Rate for Payer: The Alliance Commercial |
$4,928.56
|
| Rate for Payer: WEA Trust Commercial |
$5,421.42
|
| Rate for Payer: WPS Commercial |
$7,300.90
|
|
|
ALLOGRAFT COTTON WEDGE ALLOPURE BICORTICAL 6MM X 6MM (FREEZE DRIED ) 8666-0006
|
Facility
|
IP
|
$9,478.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
6179807
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,829.99 |
| Max. Negotiated Rate |
$9,068.55 |
| Rate for Payer: Aetna Commercial |
$8,871.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,477.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,224.27
|
| Rate for Payer: Cash Price |
$2,843.40
|
| Rate for Payer: Cigna Commercial |
$9,068.55
|
| Rate for Payer: Health EOS Commercial |
$8,772.84
|
| Rate for Payer: HFN Commercial |
$9,068.55
|
| Rate for Payer: Multiplan Commercial |
$7,885.70
|
| Rate for Payer: Preferred Network Access Commercial |
$9,068.55
|
| Rate for Payer: Quartz Beloit One Network |
$4,829.99
|
| Rate for Payer: Quartz Commercial |
$5,914.27
|
| Rate for Payer: WEA Trust Commercial |
$5,421.42
|
| Rate for Payer: WPS Commercial |
$7,300.90
|
|
|
ALLOGRAFT CRUSHED CANCELLOUS CHIPS 5CC 3102-1505
|
Facility
|
OP
|
$2,026.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
6167717
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$589.97 |
| Max. Negotiated Rate |
$1,938.48 |
| Rate for Payer: Aetna Commercial |
$1,896.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,812.05
|
| Rate for Payer: Aetna Managed Medicare |
$589.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,369.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,053.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,011.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,116.73
|
| Rate for Payer: Cash Price |
$607.80
|
| Rate for Payer: Cigna Commercial |
$1,938.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,179.13
|
| Rate for Payer: Health EOS Commercial |
$1,875.27
|
| Rate for Payer: HFN Commercial |
$1,938.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,580.28
|
| Rate for Payer: Multiplan Commercial |
$1,685.63
|
| Rate for Payer: NAPHCARE Commercial |
$1,264.22
|
| Rate for Payer: Preferred Network Access Commercial |
$1,938.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,032.45
|
| Rate for Payer: Quartz Commercial |
$1,369.58
|
| Rate for Payer: Quartz Medicare Advantage |
$1,264.22
|
| Rate for Payer: The Alliance Commercial |
$1,053.52
|
| Rate for Payer: WEA Trust Commercial |
$1,158.87
|
| Rate for Payer: WPS Commercial |
$1,560.63
|
|
|
ALLOGRAFT CRUSHED CANCELLOUS CHIPS 5CC 3102-1505
|
Facility
|
IP
|
$2,026.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
6167717
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,032.45 |
| Max. Negotiated Rate |
$1,938.48 |
| Rate for Payer: Aetna Commercial |
$1,896.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,812.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,116.73
|
| Rate for Payer: Cash Price |
$607.80
|
| Rate for Payer: Cigna Commercial |
$1,938.48
|
| Rate for Payer: Health EOS Commercial |
$1,875.27
|
| Rate for Payer: HFN Commercial |
$1,938.48
|
| Rate for Payer: Multiplan Commercial |
$1,685.63
|
| Rate for Payer: Preferred Network Access Commercial |
$1,938.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,032.45
|
| Rate for Payer: Quartz Commercial |
$1,264.22
|
| Rate for Payer: WEA Trust Commercial |
$1,158.87
|
| Rate for Payer: WPS Commercial |
$1,560.63
|
|
|
ALLOGRAFT DISTAL FEMUR SHORT RT 150-250MM 640208
|
Facility
|
IP
|
$11,287.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
2967969
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,751.86 |
| Max. Negotiated Rate |
$10,799.40 |
| Rate for Payer: Aetna Commercial |
$10,564.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,095.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,221.39
|
| Rate for Payer: Cash Price |
$3,386.10
|
| Rate for Payer: Cigna Commercial |
$10,799.40
|
| Rate for Payer: Health EOS Commercial |
$10,447.25
|
| Rate for Payer: HFN Commercial |
$10,799.40
|
| Rate for Payer: Multiplan Commercial |
$9,390.78
|
| Rate for Payer: Preferred Network Access Commercial |
$10,799.40
|
| Rate for Payer: Quartz Beloit One Network |
$5,751.86
|
| Rate for Payer: Quartz Commercial |
$7,043.09
|
| Rate for Payer: WEA Trust Commercial |
$6,456.16
|
| Rate for Payer: WPS Commercial |
$8,694.38
|
|
|
ALLOGRAFT DISTAL FEMUR SHORT RT 150-250MM 640208
|
Facility
|
OP
|
$11,287.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
2967969
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,286.77 |
| Max. Negotiated Rate |
$10,799.40 |
| Rate for Payer: Aetna Commercial |
$10,564.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,095.09
|
| Rate for Payer: Aetna Managed Medicare |
$3,286.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,630.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,869.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,634.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,221.39
|
| Rate for Payer: Cash Price |
$3,386.10
|
| Rate for Payer: Cigna Commercial |
$10,799.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,569.03
|
| Rate for Payer: Health EOS Commercial |
$10,447.25
|
| Rate for Payer: HFN Commercial |
$10,799.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,803.86
|
| Rate for Payer: Multiplan Commercial |
$9,390.78
|
| Rate for Payer: NAPHCARE Commercial |
$7,043.09
|
| Rate for Payer: Preferred Network Access Commercial |
$10,799.40
|
| Rate for Payer: Quartz Beloit One Network |
$5,751.86
|
| Rate for Payer: Quartz Commercial |
$7,630.01
|
| Rate for Payer: Quartz Medicare Advantage |
$7,043.09
|
| Rate for Payer: The Alliance Commercial |
$5,869.24
|
| Rate for Payer: WEA Trust Commercial |
$6,456.16
|
| Rate for Payer: WPS Commercial |
$8,694.38
|
|
|
ALLOGRAFT EVANS WEDGE 10MM (H) X 20MM (W) X 22MM (L) 3102-1910
|
Facility
|
IP
|
$9,001.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
5627708
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,586.91 |
| Max. Negotiated Rate |
$8,612.16 |
| Rate for Payer: Aetna Commercial |
$8,424.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,050.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,961.35
|
| Rate for Payer: Cash Price |
$2,700.30
|
| Rate for Payer: Cigna Commercial |
$8,612.16
|
| Rate for Payer: Health EOS Commercial |
$8,331.33
|
| Rate for Payer: HFN Commercial |
$8,612.16
|
| Rate for Payer: Multiplan Commercial |
$7,488.83
|
| Rate for Payer: Preferred Network Access Commercial |
$8,612.16
|
| Rate for Payer: Quartz Beloit One Network |
$4,586.91
|
| Rate for Payer: Quartz Commercial |
$5,616.62
|
| Rate for Payer: WEA Trust Commercial |
$5,148.57
|
| Rate for Payer: WPS Commercial |
$6,933.47
|
|
|
ALLOGRAFT EVANS WEDGE 10MM (H) X 20MM (W) X 22MM (L) 3102-1910
|
Facility
|
OP
|
$9,001.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
5627708
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,621.09 |
| Max. Negotiated Rate |
$8,612.16 |
| Rate for Payer: Aetna Commercial |
$8,424.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,050.49
|
| Rate for Payer: Aetna Managed Medicare |
$2,621.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,084.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,680.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,493.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,961.35
|
| Rate for Payer: Cash Price |
$2,700.30
|
| Rate for Payer: Cigna Commercial |
$8,612.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,238.58
|
| Rate for Payer: Health EOS Commercial |
$8,331.33
|
| Rate for Payer: HFN Commercial |
$8,612.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,020.78
|
| Rate for Payer: Multiplan Commercial |
$7,488.83
|
| Rate for Payer: NAPHCARE Commercial |
$5,616.62
|
| Rate for Payer: Preferred Network Access Commercial |
$8,612.16
|
| Rate for Payer: Quartz Beloit One Network |
$4,586.91
|
| Rate for Payer: Quartz Commercial |
$6,084.68
|
| Rate for Payer: Quartz Medicare Advantage |
$5,616.62
|
| Rate for Payer: The Alliance Commercial |
$4,680.52
|
| Rate for Payer: WEA Trust Commercial |
$5,148.57
|
| Rate for Payer: WPS Commercial |
$6,933.47
|
|
|
ALLOGRAFT EVANS WEDGE 12MM (H) X 20MM (W) X 22MM (L) 3102-1912
|
Facility
|
OP
|
$9,001.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
5627709
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,621.09 |
| Max. Negotiated Rate |
$8,612.16 |
| Rate for Payer: Aetna Commercial |
$8,424.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,050.49
|
| Rate for Payer: Aetna Managed Medicare |
$2,621.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,084.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,680.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,493.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,961.35
|
| Rate for Payer: Cash Price |
$2,700.30
|
| Rate for Payer: Cigna Commercial |
$8,612.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,238.58
|
| Rate for Payer: Health EOS Commercial |
$8,331.33
|
| Rate for Payer: HFN Commercial |
$8,612.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,020.78
|
| Rate for Payer: Multiplan Commercial |
$7,488.83
|
| Rate for Payer: NAPHCARE Commercial |
$5,616.62
|
| Rate for Payer: Preferred Network Access Commercial |
$8,612.16
|
| Rate for Payer: Quartz Beloit One Network |
$4,586.91
|
| Rate for Payer: Quartz Commercial |
$6,084.68
|
| Rate for Payer: Quartz Medicare Advantage |
$5,616.62
|
| Rate for Payer: The Alliance Commercial |
$4,680.52
|
| Rate for Payer: WEA Trust Commercial |
$5,148.57
|
| Rate for Payer: WPS Commercial |
$6,933.47
|
|
|
ALLOGRAFT EVANS WEDGE 12MM (H) X 20MM (W) X 22MM (L) 3102-1912
|
Facility
|
IP
|
$9,001.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
5627709
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,586.91 |
| Max. Negotiated Rate |
$8,612.16 |
| Rate for Payer: Aetna Commercial |
$8,424.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,050.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,961.35
|
| Rate for Payer: Cash Price |
$2,700.30
|
| Rate for Payer: Cigna Commercial |
$8,612.16
|
| Rate for Payer: Health EOS Commercial |
$8,331.33
|
| Rate for Payer: HFN Commercial |
$8,612.16
|
| Rate for Payer: Multiplan Commercial |
$7,488.83
|
| Rate for Payer: Preferred Network Access Commercial |
$8,612.16
|
| Rate for Payer: Quartz Beloit One Network |
$4,586.91
|
| Rate for Payer: Quartz Commercial |
$5,616.62
|
| Rate for Payer: WEA Trust Commercial |
$5,148.57
|
| Rate for Payer: WPS Commercial |
$6,933.47
|
|
|
ALLOGRAFT EVANS WEDGE 8MM (H) X 20MM (W) X 22 (L) 3102-1908
|
Facility
|
IP
|
$9,001.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
5627707
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,586.91 |
| Max. Negotiated Rate |
$8,612.16 |
| Rate for Payer: Aetna Commercial |
$8,424.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,050.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,961.35
|
| Rate for Payer: Cash Price |
$2,700.30
|
| Rate for Payer: Cigna Commercial |
$8,612.16
|
| Rate for Payer: Health EOS Commercial |
$8,331.33
|
| Rate for Payer: HFN Commercial |
$8,612.16
|
| Rate for Payer: Multiplan Commercial |
$7,488.83
|
| Rate for Payer: Preferred Network Access Commercial |
$8,612.16
|
| Rate for Payer: Quartz Beloit One Network |
$4,586.91
|
| Rate for Payer: Quartz Commercial |
$5,616.62
|
| Rate for Payer: WEA Trust Commercial |
$5,148.57
|
| Rate for Payer: WPS Commercial |
$6,933.47
|
|
|
ALLOGRAFT EVANS WEDGE 8MM (H) X 20MM (W) X 22 (L) 3102-1908
|
Facility
|
OP
|
$9,001.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
5627707
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,621.09 |
| Max. Negotiated Rate |
$8,612.16 |
| Rate for Payer: Aetna Commercial |
$8,424.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,050.49
|
| Rate for Payer: Aetna Managed Medicare |
$2,621.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,084.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,680.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,493.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,961.35
|
| Rate for Payer: Cash Price |
$2,700.30
|
| Rate for Payer: Cigna Commercial |
$8,612.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,238.58
|
| Rate for Payer: Health EOS Commercial |
$8,331.33
|
| Rate for Payer: HFN Commercial |
$8,612.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,020.78
|
| Rate for Payer: Multiplan Commercial |
$7,488.83
|
| Rate for Payer: NAPHCARE Commercial |
$5,616.62
|
| Rate for Payer: Preferred Network Access Commercial |
$8,612.16
|
| Rate for Payer: Quartz Beloit One Network |
$4,586.91
|
| Rate for Payer: Quartz Commercial |
$6,084.68
|
| Rate for Payer: Quartz Medicare Advantage |
$5,616.62
|
| Rate for Payer: The Alliance Commercial |
$4,680.52
|
| Rate for Payer: WEA Trust Commercial |
$5,148.57
|
| Rate for Payer: WPS Commercial |
$6,933.47
|
|
|
ALLOGRAFT EVANS WEDGE ALLOPURE BICORTICAL 8MM X 8MM (FREEZE DRIED) 8666-0800
|
Facility
|
OP
|
$10,062.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
6179806
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,930.05 |
| Max. Negotiated Rate |
$9,627.32 |
| Rate for Payer: Aetna Commercial |
$9,418.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,999.45
|
| Rate for Payer: Aetna Managed Medicare |
$2,930.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,801.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,232.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,022.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,546.17
|
| Rate for Payer: Cash Price |
$3,018.60
|
| Rate for Payer: Cigna Commercial |
$9,627.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,856.08
|
| Rate for Payer: Health EOS Commercial |
$9,313.39
|
| Rate for Payer: HFN Commercial |
$9,627.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,848.36
|
| Rate for Payer: Multiplan Commercial |
$8,371.58
|
| Rate for Payer: NAPHCARE Commercial |
$6,278.69
|
| Rate for Payer: Preferred Network Access Commercial |
$9,627.32
|
| Rate for Payer: Quartz Beloit One Network |
$5,127.60
|
| Rate for Payer: Quartz Commercial |
$6,801.91
|
| Rate for Payer: Quartz Medicare Advantage |
$6,278.69
|
| Rate for Payer: The Alliance Commercial |
$5,232.24
|
| Rate for Payer: WEA Trust Commercial |
$5,755.46
|
| Rate for Payer: WPS Commercial |
$7,750.76
|
|
|
ALLOGRAFT EVANS WEDGE ALLOPURE BICORTICAL 8MM X 8MM (FREEZE DRIED) 8666-0800
|
Facility
|
IP
|
$10,062.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
6179806
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,127.60 |
| Max. Negotiated Rate |
$9,627.32 |
| Rate for Payer: Aetna Commercial |
$9,418.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,999.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,546.17
|
| Rate for Payer: Cash Price |
$3,018.60
|
| Rate for Payer: Cigna Commercial |
$9,627.32
|
| Rate for Payer: Health EOS Commercial |
$9,313.39
|
| Rate for Payer: HFN Commercial |
$9,627.32
|
| Rate for Payer: Multiplan Commercial |
$8,371.58
|
| Rate for Payer: Preferred Network Access Commercial |
$9,627.32
|
| Rate for Payer: Quartz Beloit One Network |
$5,127.60
|
| Rate for Payer: Quartz Commercial |
$6,278.69
|
| Rate for Payer: WEA Trust Commercial |
$5,755.46
|
| Rate for Payer: WPS Commercial |
$7,750.76
|
|
|
ALLOGRAFT FASCIALOTA 8x20
|
Facility
|
IP
|
$11,530.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
2965941
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,875.69 |
| Max. Negotiated Rate |
$11,031.90 |
| Rate for Payer: Aetna Commercial |
$10,792.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,312.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,355.34
|
| Rate for Payer: Cash Price |
$3,459.00
|
| Rate for Payer: Cigna Commercial |
$11,031.90
|
| Rate for Payer: Health EOS Commercial |
$10,672.17
|
| Rate for Payer: HFN Commercial |
$11,031.90
|
| Rate for Payer: Multiplan Commercial |
$9,592.96
|
| Rate for Payer: Preferred Network Access Commercial |
$11,031.90
|
| Rate for Payer: Quartz Beloit One Network |
$5,875.69
|
| Rate for Payer: Quartz Commercial |
$7,194.72
|
| Rate for Payer: WEA Trust Commercial |
$6,595.16
|
| Rate for Payer: WPS Commercial |
$8,881.56
|
|
|
ALLOGRAFT FASCIALOTA 8x20
|
Facility
|
OP
|
$11,530.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
2965941
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,357.54 |
| Max. Negotiated Rate |
$11,031.90 |
| Rate for Payer: Aetna Commercial |
$10,792.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,312.43
|
| Rate for Payer: Aetna Managed Medicare |
$3,357.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,794.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,995.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,755.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,355.34
|
| Rate for Payer: Cash Price |
$3,459.00
|
| Rate for Payer: Cigna Commercial |
$11,031.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,710.46
|
| Rate for Payer: Health EOS Commercial |
$10,672.17
|
| Rate for Payer: HFN Commercial |
$11,031.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,993.40
|
| Rate for Payer: Multiplan Commercial |
$9,592.96
|
| Rate for Payer: NAPHCARE Commercial |
$7,194.72
|
| Rate for Payer: Preferred Network Access Commercial |
$11,031.90
|
| Rate for Payer: Quartz Beloit One Network |
$5,875.69
|
| Rate for Payer: Quartz Commercial |
$7,794.28
|
| Rate for Payer: Quartz Medicare Advantage |
$7,194.72
|
| Rate for Payer: The Alliance Commercial |
$5,995.60
|
| Rate for Payer: WEA Trust Commercial |
$6,595.16
|
| Rate for Payer: WPS Commercial |
$8,881.56
|
|
