|
ALLOGRAFT GRAFTLINK FGL
|
Facility
|
IP
|
$12,979.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
5308125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,614.10 |
| Max. Negotiated Rate |
$12,418.31 |
| Rate for Payer: Aetna Commercial |
$12,148.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,608.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,154.02
|
| Rate for Payer: Cash Price |
$3,893.70
|
| Rate for Payer: Cigna Commercial |
$12,418.31
|
| Rate for Payer: Health EOS Commercial |
$12,013.36
|
| Rate for Payer: HFN Commercial |
$12,418.31
|
| Rate for Payer: Multiplan Commercial |
$10,798.53
|
| Rate for Payer: Preferred Network Access Commercial |
$12,418.31
|
| Rate for Payer: Quartz Beloit One Network |
$6,614.10
|
| Rate for Payer: Quartz Commercial |
$8,098.90
|
| Rate for Payer: WEA Trust Commercial |
$7,423.99
|
| Rate for Payer: WPS Commercial |
$9,997.72
|
|
|
ALLOGRAFT GRAFTLINK FGL
|
Facility
|
OP
|
$12,979.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
5308125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,779.48 |
| Max. Negotiated Rate |
$12,418.31 |
| Rate for Payer: Aetna Commercial |
$12,148.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,608.42
|
| Rate for Payer: Aetna Managed Medicare |
$3,779.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,773.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,749.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,479.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,154.02
|
| Rate for Payer: Cash Price |
$3,893.70
|
| Rate for Payer: Cigna Commercial |
$12,418.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,553.78
|
| Rate for Payer: Health EOS Commercial |
$12,013.36
|
| Rate for Payer: HFN Commercial |
$12,418.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,123.62
|
| Rate for Payer: Multiplan Commercial |
$10,798.53
|
| Rate for Payer: NAPHCARE Commercial |
$8,098.90
|
| Rate for Payer: Preferred Network Access Commercial |
$12,418.31
|
| Rate for Payer: Quartz Beloit One Network |
$6,614.10
|
| Rate for Payer: Quartz Commercial |
$8,773.80
|
| Rate for Payer: Quartz Medicare Advantage |
$8,098.90
|
| Rate for Payer: The Alliance Commercial |
$6,749.08
|
| Rate for Payer: WEA Trust Commercial |
$7,423.99
|
| Rate for Payer: WPS Commercial |
$9,997.72
|
|
|
ALLOGRAFT GRAFTLINK TRIPLE STRAND FGLTS
|
Facility
|
IP
|
$12,117.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
5611646
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,174.82 |
| Max. Negotiated Rate |
$11,593.55 |
| Rate for Payer: Aetna Commercial |
$11,341.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,837.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,678.89
|
| Rate for Payer: Cash Price |
$3,635.10
|
| Rate for Payer: Cigna Commercial |
$11,593.55
|
| Rate for Payer: Health EOS Commercial |
$11,215.50
|
| Rate for Payer: HFN Commercial |
$11,593.55
|
| Rate for Payer: Multiplan Commercial |
$10,081.34
|
| Rate for Payer: Preferred Network Access Commercial |
$11,593.55
|
| Rate for Payer: Quartz Beloit One Network |
$6,174.82
|
| Rate for Payer: Quartz Commercial |
$7,561.01
|
| Rate for Payer: WEA Trust Commercial |
$6,930.92
|
| Rate for Payer: WPS Commercial |
$9,333.73
|
|
|
ALLOGRAFT GRAFTLINK TRIPLE STRAND FGLTS
|
Facility
|
OP
|
$12,117.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
5611646
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,528.47 |
| Max. Negotiated Rate |
$11,593.55 |
| Rate for Payer: Aetna Commercial |
$11,341.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,837.44
|
| Rate for Payer: Aetna Managed Medicare |
$3,528.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,191.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,300.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,048.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,678.89
|
| Rate for Payer: Cash Price |
$3,635.10
|
| Rate for Payer: Cigna Commercial |
$11,593.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,052.09
|
| Rate for Payer: Health EOS Commercial |
$11,215.50
|
| Rate for Payer: HFN Commercial |
$11,593.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,451.26
|
| Rate for Payer: Multiplan Commercial |
$10,081.34
|
| Rate for Payer: NAPHCARE Commercial |
$7,561.01
|
| Rate for Payer: Preferred Network Access Commercial |
$11,593.55
|
| Rate for Payer: Quartz Beloit One Network |
$6,174.82
|
| Rate for Payer: Quartz Commercial |
$8,191.09
|
| Rate for Payer: Quartz Medicare Advantage |
$7,561.01
|
| Rate for Payer: The Alliance Commercial |
$6,300.84
|
| Rate for Payer: WEA Trust Commercial |
$6,930.92
|
| Rate for Payer: WPS Commercial |
$9,333.73
|
|
|
ALLOGRAFT HUMAN DBM 2.5CC
|
Facility
|
IP
|
$4,713.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
2965924
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,401.74 |
| Max. Negotiated Rate |
$4,509.40 |
| Rate for Payer: Aetna Commercial |
$4,411.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,215.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,597.81
|
| Rate for Payer: Cash Price |
$1,413.90
|
| Rate for Payer: Cigna Commercial |
$4,509.40
|
| Rate for Payer: Health EOS Commercial |
$4,362.35
|
| Rate for Payer: HFN Commercial |
$4,509.40
|
| Rate for Payer: Multiplan Commercial |
$3,921.22
|
| Rate for Payer: Preferred Network Access Commercial |
$4,509.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,401.74
|
| Rate for Payer: Quartz Commercial |
$2,940.91
|
| Rate for Payer: WEA Trust Commercial |
$2,695.84
|
| Rate for Payer: WPS Commercial |
$3,630.42
|
|
|
ALLOGRAFT HUMAN DBM 2.5CC
|
Facility
|
OP
|
$4,713.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
2965924
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,372.43 |
| Max. Negotiated Rate |
$4,509.40 |
| Rate for Payer: Aetna Commercial |
$4,411.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,215.31
|
| Rate for Payer: Aetna Managed Medicare |
$1,372.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,185.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,450.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,352.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,597.81
|
| Rate for Payer: Cash Price |
$1,413.90
|
| Rate for Payer: Cigna Commercial |
$4,509.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,742.97
|
| Rate for Payer: Health EOS Commercial |
$4,362.35
|
| Rate for Payer: HFN Commercial |
$4,509.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,676.14
|
| Rate for Payer: Multiplan Commercial |
$3,921.22
|
| Rate for Payer: NAPHCARE Commercial |
$2,940.91
|
| Rate for Payer: Preferred Network Access Commercial |
$4,509.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,401.74
|
| Rate for Payer: Quartz Commercial |
$3,185.99
|
| Rate for Payer: Quartz Medicare Advantage |
$2,940.91
|
| Rate for Payer: The Alliance Commercial |
$2,450.76
|
| Rate for Payer: WEA Trust Commercial |
$2,695.84
|
| Rate for Payer: WPS Commercial |
$3,630.42
|
|
|
ALLOGRAFT NUSHIELD DEHYDRATED PLACENTAL 1.6SQ CM DISC NO-1160c
|
Facility
|
IP
|
$2,895.00
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
5298725
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,475.29 |
| Max. Negotiated Rate |
$2,769.94 |
| Rate for Payer: Aetna Commercial |
$2,709.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,589.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,595.72
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Cigna Commercial |
$2,769.94
|
| Rate for Payer: Health EOS Commercial |
$2,679.61
|
| Rate for Payer: HFN Commercial |
$2,769.94
|
| Rate for Payer: Multiplan Commercial |
$2,408.64
|
| Rate for Payer: Preferred Network Access Commercial |
$2,769.94
|
| Rate for Payer: Quartz Beloit One Network |
$1,475.29
|
| Rate for Payer: Quartz Commercial |
$1,806.48
|
| Rate for Payer: WEA Trust Commercial |
$1,655.94
|
| Rate for Payer: WPS Commercial |
$2,230.02
|
|
|
ALLOGRAFT NUSHIELD DEHYDRATED PLACENTAL 1.6SQ CM DISC NO-1160c
|
Facility
|
OP
|
$2,895.00
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
5298725
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$130.60 |
| Max. Negotiated Rate |
$2,769.94 |
| Rate for Payer: Aetna Commercial |
$2,709.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,589.29
|
| Rate for Payer: Aetna Managed Medicare |
$130.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,957.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,505.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,445.18
|
| Rate for Payer: Anthem Medicare Advantage |
$130.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,595.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$130.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$130.97
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Cigna Commercial |
$2,769.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$130.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$130.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$130.97
|
| Rate for Payer: Health EOS Commercial |
$2,679.61
|
| Rate for Payer: HFN Commercial |
$2,769.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$487.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$130.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$130.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$130.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$130.97
|
| Rate for Payer: Multiplan Commercial |
$2,408.64
|
| Rate for Payer: NAPHCARE Commercial |
$196.45
|
| Rate for Payer: Preferred Network Access Commercial |
$2,769.94
|
| Rate for Payer: Quartz Beloit One Network |
$1,475.29
|
| Rate for Payer: Quartz Commercial |
$1,957.02
|
| Rate for Payer: Quartz Medicare Advantage |
$130.97
|
| Rate for Payer: The Alliance Commercial |
$523.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$130.97
|
| Rate for Payer: WEA Trust Commercial |
$1,655.94
|
| Rate for Payer: Wellcare Medicare |
$130.97
|
| Rate for Payer: WPS Commercial |
$2,230.02
|
|
|
ALLOGRAFT NUSHIELD DEHYDRATED PLACENTAL (2 X 3) 6SQ CM NO-1230
|
Facility
|
IP
|
$1,165.00
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
5298719
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$593.68 |
| Max. Negotiated Rate |
$1,114.67 |
| Rate for Payer: Aetna Commercial |
$1,090.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,041.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$642.15
|
| Rate for Payer: Cash Price |
$349.50
|
| Rate for Payer: Cigna Commercial |
$1,114.67
|
| Rate for Payer: Health EOS Commercial |
$1,078.32
|
| Rate for Payer: HFN Commercial |
$1,114.67
|
| Rate for Payer: Multiplan Commercial |
$969.28
|
| Rate for Payer: Preferred Network Access Commercial |
$1,114.67
|
| Rate for Payer: Quartz Beloit One Network |
$593.68
|
| Rate for Payer: Quartz Commercial |
$726.96
|
| Rate for Payer: WEA Trust Commercial |
$666.38
|
| Rate for Payer: WPS Commercial |
$897.40
|
|
|
ALLOGRAFT NUSHIELD DEHYDRATED PLACENTAL (2 X 3) 6SQ CM NO-1230
|
Facility
|
OP
|
$1,165.00
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
5298719
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$130.60 |
| Max. Negotiated Rate |
$1,114.67 |
| Rate for Payer: Aetna Commercial |
$1,090.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,041.98
|
| Rate for Payer: Aetna Managed Medicare |
$130.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$787.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$605.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$581.57
|
| Rate for Payer: Anthem Medicare Advantage |
$130.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$642.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$130.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$130.97
|
| Rate for Payer: Cash Price |
$349.50
|
| Rate for Payer: Cash Price |
$349.50
|
| Rate for Payer: Cigna Commercial |
$1,114.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$130.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$130.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$130.97
|
| Rate for Payer: Health EOS Commercial |
$1,078.32
|
| Rate for Payer: HFN Commercial |
$1,114.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$487.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$130.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$130.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$130.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$130.97
|
| Rate for Payer: Multiplan Commercial |
$969.28
|
| Rate for Payer: NAPHCARE Commercial |
$196.45
|
| Rate for Payer: Preferred Network Access Commercial |
$1,114.67
|
| Rate for Payer: Quartz Beloit One Network |
$593.68
|
| Rate for Payer: Quartz Commercial |
$787.54
|
| Rate for Payer: Quartz Medicare Advantage |
$130.97
|
| Rate for Payer: The Alliance Commercial |
$523.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$130.97
|
| Rate for Payer: WEA Trust Commercial |
$666.38
|
| Rate for Payer: Wellcare Medicare |
$130.97
|
| Rate for Payer: WPS Commercial |
$897.40
|
|
|
ALLOGRAFT NUSHIELD DEHYDRATED PLACENTAL (2 X 4) 8SQ CM NO-1240
|
Facility
|
OP
|
$1,044.00
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
5298720
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$130.60 |
| Max. Negotiated Rate |
$998.90 |
| Rate for Payer: Aetna Commercial |
$977.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$933.75
|
| Rate for Payer: Aetna Managed Medicare |
$130.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$705.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$542.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$521.16
|
| Rate for Payer: Anthem Medicare Advantage |
$130.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$575.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$130.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$130.97
|
| Rate for Payer: Cash Price |
$313.20
|
| Rate for Payer: Cash Price |
$313.20
|
| Rate for Payer: Cigna Commercial |
$998.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$130.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$130.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$130.97
|
| Rate for Payer: Health EOS Commercial |
$966.33
|
| Rate for Payer: HFN Commercial |
$998.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$487.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$130.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$130.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$130.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$130.97
|
| Rate for Payer: Multiplan Commercial |
$868.61
|
| Rate for Payer: NAPHCARE Commercial |
$196.45
|
| Rate for Payer: Preferred Network Access Commercial |
$998.90
|
| Rate for Payer: Quartz Beloit One Network |
$532.02
|
| Rate for Payer: Quartz Commercial |
$705.74
|
| Rate for Payer: Quartz Medicare Advantage |
$130.97
|
| Rate for Payer: The Alliance Commercial |
$523.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$130.97
|
| Rate for Payer: WEA Trust Commercial |
$597.17
|
| Rate for Payer: Wellcare Medicare |
$130.97
|
| Rate for Payer: WPS Commercial |
$804.19
|
|
|
ALLOGRAFT NUSHIELD DEHYDRATED PLACENTAL (2 X 4) 8SQ CM NO-1240
|
Facility
|
IP
|
$1,044.00
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
5298720
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$532.02 |
| Max. Negotiated Rate |
$998.90 |
| Rate for Payer: Aetna Commercial |
$977.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$933.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$575.45
|
| Rate for Payer: Cash Price |
$313.20
|
| Rate for Payer: Cigna Commercial |
$998.90
|
| Rate for Payer: Health EOS Commercial |
$966.33
|
| Rate for Payer: HFN Commercial |
$998.90
|
| Rate for Payer: Multiplan Commercial |
$868.61
|
| Rate for Payer: Preferred Network Access Commercial |
$998.90
|
| Rate for Payer: Quartz Beloit One Network |
$532.02
|
| Rate for Payer: Quartz Commercial |
$651.46
|
| Rate for Payer: WEA Trust Commercial |
$597.17
|
| Rate for Payer: WPS Commercial |
$804.19
|
|
|
ALLOGRAFT NUSHIELD DEHYDRATED PLACENTAL (3 X 4) 12SQ CM NO-1340
|
Facility
|
IP
|
$682.00
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
5298721
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$347.55 |
| Max. Negotiated Rate |
$652.54 |
| Rate for Payer: Aetna Commercial |
$638.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$609.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$375.92
|
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cigna Commercial |
$652.54
|
| Rate for Payer: Health EOS Commercial |
$631.26
|
| Rate for Payer: HFN Commercial |
$652.54
|
| Rate for Payer: Multiplan Commercial |
$567.42
|
| Rate for Payer: Preferred Network Access Commercial |
$652.54
|
| Rate for Payer: Quartz Beloit One Network |
$347.55
|
| Rate for Payer: Quartz Commercial |
$425.57
|
| Rate for Payer: WEA Trust Commercial |
$390.10
|
| Rate for Payer: WPS Commercial |
$525.34
|
|
|
ALLOGRAFT NUSHIELD DEHYDRATED PLACENTAL (3 X 4) 12SQ CM NO-1340
|
Facility
|
OP
|
$682.00
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
5298721
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$130.60 |
| Max. Negotiated Rate |
$652.54 |
| Rate for Payer: Aetna Commercial |
$638.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$609.98
|
| Rate for Payer: Aetna Managed Medicare |
$130.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$461.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$354.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$340.45
|
| Rate for Payer: Anthem Medicare Advantage |
$130.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$375.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$130.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$130.97
|
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cigna Commercial |
$652.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$130.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$130.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$130.97
|
| Rate for Payer: Health EOS Commercial |
$631.26
|
| Rate for Payer: HFN Commercial |
$652.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$487.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$130.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$130.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$130.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$130.97
|
| Rate for Payer: Multiplan Commercial |
$567.42
|
| Rate for Payer: NAPHCARE Commercial |
$196.45
|
| Rate for Payer: Preferred Network Access Commercial |
$652.54
|
| Rate for Payer: Quartz Beloit One Network |
$347.55
|
| Rate for Payer: Quartz Commercial |
$461.03
|
| Rate for Payer: Quartz Medicare Advantage |
$130.97
|
| Rate for Payer: The Alliance Commercial |
$523.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$130.97
|
| Rate for Payer: WEA Trust Commercial |
$390.10
|
| Rate for Payer: Wellcare Medicare |
$130.97
|
| Rate for Payer: WPS Commercial |
$525.34
|
|
|
ALLOGRAFT NUSHIELD DEHYDRATED PLACENTAL (4 X 4) 16SQ CM NO-1440
|
Facility
|
IP
|
$680.00
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
5298722
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$346.53 |
| Max. Negotiated Rate |
$650.62 |
| Rate for Payer: Aetna Commercial |
$636.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$608.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$374.82
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cigna Commercial |
$650.62
|
| Rate for Payer: Health EOS Commercial |
$629.41
|
| Rate for Payer: HFN Commercial |
$650.62
|
| Rate for Payer: Multiplan Commercial |
$565.76
|
| Rate for Payer: Preferred Network Access Commercial |
$650.62
|
| Rate for Payer: Quartz Beloit One Network |
$346.53
|
| Rate for Payer: Quartz Commercial |
$424.32
|
| Rate for Payer: WEA Trust Commercial |
$388.96
|
| Rate for Payer: WPS Commercial |
$523.80
|
|
|
ALLOGRAFT NUSHIELD DEHYDRATED PLACENTAL (4 X 4) 16SQ CM NO-1440
|
Facility
|
OP
|
$680.00
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
5298722
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$130.60 |
| Max. Negotiated Rate |
$650.62 |
| Rate for Payer: Aetna Commercial |
$636.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$608.19
|
| Rate for Payer: Aetna Managed Medicare |
$130.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$459.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$353.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$339.46
|
| Rate for Payer: Anthem Medicare Advantage |
$130.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$374.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$130.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$130.97
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cigna Commercial |
$650.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$130.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$130.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$130.97
|
| Rate for Payer: Health EOS Commercial |
$629.41
|
| Rate for Payer: HFN Commercial |
$650.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$487.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$130.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$130.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$130.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$130.97
|
| Rate for Payer: Multiplan Commercial |
$565.76
|
| Rate for Payer: NAPHCARE Commercial |
$196.45
|
| Rate for Payer: Preferred Network Access Commercial |
$650.62
|
| Rate for Payer: Quartz Beloit One Network |
$346.53
|
| Rate for Payer: Quartz Commercial |
$459.68
|
| Rate for Payer: Quartz Medicare Advantage |
$130.97
|
| Rate for Payer: The Alliance Commercial |
$523.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$130.97
|
| Rate for Payer: WEA Trust Commercial |
$388.96
|
| Rate for Payer: Wellcare Medicare |
$130.97
|
| Rate for Payer: WPS Commercial |
$523.80
|
|
|
ALLOGRAFT NUSHIELD DEHYDRATED PLACENTAL (4 X 6) 36SQ CM NO-1460
|
Facility
|
IP
|
$636.00
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
5298723
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$324.11 |
| Max. Negotiated Rate |
$608.52 |
| Rate for Payer: Aetna Commercial |
$595.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$568.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$350.56
|
| Rate for Payer: Cash Price |
$190.80
|
| Rate for Payer: Cigna Commercial |
$608.52
|
| Rate for Payer: Health EOS Commercial |
$588.68
|
| Rate for Payer: HFN Commercial |
$608.52
|
| Rate for Payer: Multiplan Commercial |
$529.15
|
| Rate for Payer: Preferred Network Access Commercial |
$608.52
|
| Rate for Payer: Quartz Beloit One Network |
$324.11
|
| Rate for Payer: Quartz Commercial |
$396.86
|
| Rate for Payer: WEA Trust Commercial |
$363.79
|
| Rate for Payer: WPS Commercial |
$489.91
|
|
|
ALLOGRAFT NUSHIELD DEHYDRATED PLACENTAL (4 X 6) 36SQ CM NO-1460
|
Facility
|
OP
|
$636.00
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
5298723
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$130.60 |
| Max. Negotiated Rate |
$608.52 |
| Rate for Payer: Aetna Commercial |
$595.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$568.84
|
| Rate for Payer: Aetna Managed Medicare |
$130.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$429.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$330.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$317.49
|
| Rate for Payer: Anthem Medicare Advantage |
$130.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$350.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$130.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$130.97
|
| Rate for Payer: Cash Price |
$190.80
|
| Rate for Payer: Cash Price |
$190.80
|
| Rate for Payer: Cigna Commercial |
$608.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$130.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$130.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$130.97
|
| Rate for Payer: Health EOS Commercial |
$588.68
|
| Rate for Payer: HFN Commercial |
$608.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$487.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$130.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$130.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$130.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$130.97
|
| Rate for Payer: Multiplan Commercial |
$529.15
|
| Rate for Payer: NAPHCARE Commercial |
$196.45
|
| Rate for Payer: Preferred Network Access Commercial |
$608.52
|
| Rate for Payer: Quartz Beloit One Network |
$324.11
|
| Rate for Payer: Quartz Commercial |
$429.94
|
| Rate for Payer: Quartz Medicare Advantage |
$130.97
|
| Rate for Payer: The Alliance Commercial |
$523.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$130.97
|
| Rate for Payer: WEA Trust Commercial |
$363.79
|
| Rate for Payer: Wellcare Medicare |
$130.97
|
| Rate for Payer: WPS Commercial |
$489.91
|
|
|
ALLOGRAFT NUSHIELD DEHYDRATED PLACENTAL (6 X 6) 36SQ CM NO-1660
|
Facility
|
OP
|
$578.00
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
5298724
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$130.60 |
| Max. Negotiated Rate |
$553.03 |
| Rate for Payer: Aetna Commercial |
$541.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$516.96
|
| Rate for Payer: Aetna Managed Medicare |
$130.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$390.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$300.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$288.54
|
| Rate for Payer: Anthem Medicare Advantage |
$130.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$318.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$130.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$130.97
|
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Cigna Commercial |
$553.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$130.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$130.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$130.97
|
| Rate for Payer: Health EOS Commercial |
$535.00
|
| Rate for Payer: HFN Commercial |
$553.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$487.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$130.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$130.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$130.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$130.97
|
| Rate for Payer: Multiplan Commercial |
$480.90
|
| Rate for Payer: NAPHCARE Commercial |
$196.45
|
| Rate for Payer: Preferred Network Access Commercial |
$553.03
|
| Rate for Payer: Quartz Beloit One Network |
$294.55
|
| Rate for Payer: Quartz Commercial |
$390.73
|
| Rate for Payer: Quartz Medicare Advantage |
$130.97
|
| Rate for Payer: The Alliance Commercial |
$523.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$130.97
|
| Rate for Payer: WEA Trust Commercial |
$330.62
|
| Rate for Payer: Wellcare Medicare |
$130.97
|
| Rate for Payer: WPS Commercial |
$445.23
|
|
|
ALLOGRAFT NUSHIELD DEHYDRATED PLACENTAL (6 X 6) 36SQ CM NO-1660
|
Facility
|
IP
|
$578.00
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
5298724
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$294.55 |
| Max. Negotiated Rate |
$553.03 |
| Rate for Payer: Aetna Commercial |
$541.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$516.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$318.59
|
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Cigna Commercial |
$553.03
|
| Rate for Payer: Health EOS Commercial |
$535.00
|
| Rate for Payer: HFN Commercial |
$553.03
|
| Rate for Payer: Multiplan Commercial |
$480.90
|
| Rate for Payer: Preferred Network Access Commercial |
$553.03
|
| Rate for Payer: Quartz Beloit One Network |
$294.55
|
| Rate for Payer: Quartz Commercial |
$360.67
|
| Rate for Payer: WEA Trust Commercial |
$330.62
|
| Rate for Payer: WPS Commercial |
$445.23
|
|
|
ALLOGRAFT PATELLAR PRE-SHAPE BTB 10/10MM 453001
|
Facility
|
OP
|
$21,954.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4519825
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,393.00 |
| Max. Negotiated Rate |
$21,005.59 |
| Rate for Payer: Aetna Commercial |
$20,548.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19,635.66
|
| Rate for Payer: Aetna Managed Medicare |
$6,393.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14,840.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,416.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,959.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12,101.04
|
| Rate for Payer: Cash Price |
$6,586.20
|
| Rate for Payer: Cigna Commercial |
$21,005.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,777.23
|
| Rate for Payer: Health EOS Commercial |
$20,320.62
|
| Rate for Payer: HFN Commercial |
$21,005.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17,124.12
|
| Rate for Payer: Multiplan Commercial |
$18,265.73
|
| Rate for Payer: NAPHCARE Commercial |
$13,699.30
|
| Rate for Payer: Preferred Network Access Commercial |
$21,005.59
|
| Rate for Payer: Quartz Beloit One Network |
$11,187.76
|
| Rate for Payer: Quartz Commercial |
$14,840.90
|
| Rate for Payer: Quartz Medicare Advantage |
$13,699.30
|
| Rate for Payer: The Alliance Commercial |
$11,416.08
|
| Rate for Payer: WEA Trust Commercial |
$12,557.69
|
| Rate for Payer: WPS Commercial |
$16,911.17
|
|
|
ALLOGRAFT PATELLAR PRE-SHAPE BTB 10/10MM 453001
|
Facility
|
IP
|
$21,954.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4519825
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,187.76 |
| Max. Negotiated Rate |
$21,005.59 |
| Rate for Payer: Aetna Commercial |
$20,548.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19,635.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12,101.04
|
| Rate for Payer: Cash Price |
$6,586.20
|
| Rate for Payer: Cigna Commercial |
$21,005.59
|
| Rate for Payer: Health EOS Commercial |
$20,320.62
|
| Rate for Payer: HFN Commercial |
$21,005.59
|
| Rate for Payer: Multiplan Commercial |
$18,265.73
|
| Rate for Payer: Preferred Network Access Commercial |
$21,005.59
|
| Rate for Payer: Quartz Beloit One Network |
$11,187.76
|
| Rate for Payer: Quartz Commercial |
$13,699.30
|
| Rate for Payer: WEA Trust Commercial |
$12,557.69
|
| Rate for Payer: WPS Commercial |
$16,911.17
|
|
|
ALLOGRAFT PATELLAR PRE-SHAPE BTB 10MM REG 453002
|
Facility
|
IP
|
$21,954.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967964
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,187.76 |
| Max. Negotiated Rate |
$21,005.59 |
| Rate for Payer: Aetna Commercial |
$20,548.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19,635.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12,101.04
|
| Rate for Payer: Cash Price |
$6,586.20
|
| Rate for Payer: Cigna Commercial |
$21,005.59
|
| Rate for Payer: Health EOS Commercial |
$20,320.62
|
| Rate for Payer: HFN Commercial |
$21,005.59
|
| Rate for Payer: Multiplan Commercial |
$18,265.73
|
| Rate for Payer: Preferred Network Access Commercial |
$21,005.59
|
| Rate for Payer: Quartz Beloit One Network |
$11,187.76
|
| Rate for Payer: Quartz Commercial |
$13,699.30
|
| Rate for Payer: WEA Trust Commercial |
$12,557.69
|
| Rate for Payer: WPS Commercial |
$16,911.17
|
|
|
ALLOGRAFT PATELLAR PRE-SHAPE BTB 10MM REG 453002
|
Facility
|
OP
|
$21,954.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967964
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,393.00 |
| Max. Negotiated Rate |
$21,005.59 |
| Rate for Payer: Aetna Commercial |
$20,548.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19,635.66
|
| Rate for Payer: Aetna Managed Medicare |
$6,393.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14,840.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,416.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,959.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12,101.04
|
| Rate for Payer: Cash Price |
$6,586.20
|
| Rate for Payer: Cigna Commercial |
$21,005.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,777.23
|
| Rate for Payer: Health EOS Commercial |
$20,320.62
|
| Rate for Payer: HFN Commercial |
$21,005.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17,124.12
|
| Rate for Payer: Multiplan Commercial |
$18,265.73
|
| Rate for Payer: NAPHCARE Commercial |
$13,699.30
|
| Rate for Payer: Preferred Network Access Commercial |
$21,005.59
|
| Rate for Payer: Quartz Beloit One Network |
$11,187.76
|
| Rate for Payer: Quartz Commercial |
$14,840.90
|
| Rate for Payer: Quartz Medicare Advantage |
$13,699.30
|
| Rate for Payer: The Alliance Commercial |
$11,416.08
|
| Rate for Payer: WEA Trust Commercial |
$12,557.69
|
| Rate for Payer: WPS Commercial |
$16,911.17
|
|
|
ALLOGRAFT PATELLAR PRE-SHAPE BTB 10MM SHORT 443002
|
Facility
|
OP
|
$21,954.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3887354
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,393.00 |
| Max. Negotiated Rate |
$21,005.59 |
| Rate for Payer: Aetna Commercial |
$20,548.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19,635.66
|
| Rate for Payer: Aetna Managed Medicare |
$6,393.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14,840.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,416.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,959.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12,101.04
|
| Rate for Payer: Cash Price |
$6,586.20
|
| Rate for Payer: Cigna Commercial |
$21,005.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,777.23
|
| Rate for Payer: Health EOS Commercial |
$20,320.62
|
| Rate for Payer: HFN Commercial |
$21,005.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17,124.12
|
| Rate for Payer: Multiplan Commercial |
$18,265.73
|
| Rate for Payer: NAPHCARE Commercial |
$13,699.30
|
| Rate for Payer: Preferred Network Access Commercial |
$21,005.59
|
| Rate for Payer: Quartz Beloit One Network |
$11,187.76
|
| Rate for Payer: Quartz Commercial |
$14,840.90
|
| Rate for Payer: Quartz Medicare Advantage |
$13,699.30
|
| Rate for Payer: The Alliance Commercial |
$11,416.08
|
| Rate for Payer: WEA Trust Commercial |
$12,557.69
|
| Rate for Payer: WPS Commercial |
$16,911.17
|
|
