|
IMPLANT BREAST 421CC SILICONE
|
Facility
|
IP
|
$8,239.00
|
|
| Hospital Charge Code |
2964633
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,037.11 |
| Max. Negotiated Rate |
$7,579.88 |
| Rate for Payer: Aetna Commercial |
$7,415.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,085.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,366.67
|
| Rate for Payer: Cash Price |
$2,471.70
|
| Rate for Payer: Cigna Commercial |
$7,579.88
|
| Rate for Payer: Health EOS Commercial |
$7,332.71
|
| Rate for Payer: HFN Commercial |
$7,579.88
|
| Rate for Payer: Multiplan Commercial |
$6,591.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,943.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,579.88
|
| Rate for Payer: Quartz Beloit One Network |
$4,037.11
|
| Rate for Payer: Quartz Commercial |
$4,943.40
|
| Rate for Payer: WEA Trust Commercial |
$4,531.45
|
| Rate for Payer: WPS Commercial |
$6,102.63
|
|
|
IMPLANT BREAST 575CC SILICONE
|
Facility
|
IP
|
$8,239.00
|
|
| Hospital Charge Code |
2964634
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,037.11 |
| Max. Negotiated Rate |
$7,579.88 |
| Rate for Payer: Aetna Commercial |
$7,415.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,085.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,366.67
|
| Rate for Payer: Cash Price |
$2,471.70
|
| Rate for Payer: Cigna Commercial |
$7,579.88
|
| Rate for Payer: Health EOS Commercial |
$7,332.71
|
| Rate for Payer: HFN Commercial |
$7,579.88
|
| Rate for Payer: Multiplan Commercial |
$6,591.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,943.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,579.88
|
| Rate for Payer: Quartz Beloit One Network |
$4,037.11
|
| Rate for Payer: Quartz Commercial |
$4,943.40
|
| Rate for Payer: WEA Trust Commercial |
$4,531.45
|
| Rate for Payer: WPS Commercial |
$6,102.63
|
|
|
IMPLANT BREAST 575CC SILICONE
|
Facility
|
OP
|
$8,239.00
|
|
| Hospital Charge Code |
2964634
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,306.92 |
| Max. Negotiated Rate |
$32,956.00 |
| Rate for Payer: Aetna Commercial |
$7,415.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,085.54
|
| Rate for Payer: Aetna Managed Medicare |
$2,306.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,355.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,119.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,954.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,366.67
|
| Rate for Payer: Cash Price |
$2,471.70
|
| Rate for Payer: Cigna Commercial |
$7,579.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,610.54
|
| Rate for Payer: Health EOS Commercial |
$7,332.71
|
| Rate for Payer: HFN Commercial |
$7,579.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,179.25
|
| Rate for Payer: Multiplan Commercial |
$6,591.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,943.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,579.88
|
| Rate for Payer: Quartz Beloit One Network |
$4,037.11
|
| Rate for Payer: Quartz Commercial |
$5,355.35
|
| Rate for Payer: Quartz Medicare Advantage |
$4,943.40
|
| Rate for Payer: The Alliance Commercial |
$32,956.00
|
| Rate for Payer: WEA Trust Commercial |
$4,531.45
|
| Rate for Payer: WPS Commercial |
$6,102.63
|
|
|
IMPLANT BREAST 700CC SILICONE
|
Facility
|
IP
|
$1,212.00
|
|
| Hospital Charge Code |
2964635
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$593.88 |
| Max. Negotiated Rate |
$1,115.04 |
| Rate for Payer: Aetna Commercial |
$1,090.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,042.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$642.36
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cigna Commercial |
$1,115.04
|
| Rate for Payer: Health EOS Commercial |
$1,078.68
|
| Rate for Payer: HFN Commercial |
$1,115.04
|
| Rate for Payer: Multiplan Commercial |
$969.60
|
| Rate for Payer: NAPHCARE Commercial |
$727.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,115.04
|
| Rate for Payer: Quartz Beloit One Network |
$593.88
|
| Rate for Payer: Quartz Commercial |
$727.20
|
| Rate for Payer: WEA Trust Commercial |
$666.60
|
| Rate for Payer: WPS Commercial |
$897.73
|
|
|
IMPLANT BREAST 700CC SILICONE
|
Facility
|
OP
|
$1,212.00
|
|
| Hospital Charge Code |
2964635
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.36 |
| Max. Negotiated Rate |
$4,848.00 |
| Rate for Payer: Aetna Commercial |
$1,090.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,042.32
|
| Rate for Payer: Aetna Managed Medicare |
$339.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$787.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$606.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$581.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$642.36
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cigna Commercial |
$1,115.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$678.24
|
| Rate for Payer: Health EOS Commercial |
$1,078.68
|
| Rate for Payer: HFN Commercial |
$1,115.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$909.00
|
| Rate for Payer: Multiplan Commercial |
$969.60
|
| Rate for Payer: NAPHCARE Commercial |
$727.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,115.04
|
| Rate for Payer: Quartz Beloit One Network |
$593.88
|
| Rate for Payer: Quartz Commercial |
$787.80
|
| Rate for Payer: Quartz Medicare Advantage |
$727.20
|
| Rate for Payer: The Alliance Commercial |
$4,848.00
|
| Rate for Payer: WEA Trust Commercial |
$666.60
|
| Rate for Payer: WPS Commercial |
$897.73
|
|
|
IMPLANT BREAST 752CC SILICONE
|
Facility
|
IP
|
$1,212.00
|
|
| Hospital Charge Code |
2967898
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$593.88 |
| Max. Negotiated Rate |
$1,115.04 |
| Rate for Payer: Aetna Commercial |
$1,090.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,042.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$642.36
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cigna Commercial |
$1,115.04
|
| Rate for Payer: Health EOS Commercial |
$1,078.68
|
| Rate for Payer: HFN Commercial |
$1,115.04
|
| Rate for Payer: Multiplan Commercial |
$969.60
|
| Rate for Payer: NAPHCARE Commercial |
$727.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,115.04
|
| Rate for Payer: Quartz Beloit One Network |
$593.88
|
| Rate for Payer: Quartz Commercial |
$727.20
|
| Rate for Payer: WEA Trust Commercial |
$666.60
|
| Rate for Payer: WPS Commercial |
$897.73
|
|
|
IMPLANT BREAST 752CC SILICONE
|
Facility
|
OP
|
$1,212.00
|
|
| Hospital Charge Code |
2967898
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.36 |
| Max. Negotiated Rate |
$4,848.00 |
| Rate for Payer: Aetna Commercial |
$1,090.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,042.32
|
| Rate for Payer: Aetna Managed Medicare |
$339.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$787.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$606.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$581.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$642.36
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cigna Commercial |
$1,115.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$678.24
|
| Rate for Payer: Health EOS Commercial |
$1,078.68
|
| Rate for Payer: HFN Commercial |
$1,115.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$909.00
|
| Rate for Payer: Multiplan Commercial |
$969.60
|
| Rate for Payer: NAPHCARE Commercial |
$727.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,115.04
|
| Rate for Payer: Quartz Beloit One Network |
$593.88
|
| Rate for Payer: Quartz Commercial |
$787.80
|
| Rate for Payer: Quartz Medicare Advantage |
$727.20
|
| Rate for Payer: The Alliance Commercial |
$4,848.00
|
| Rate for Payer: WEA Trust Commercial |
$666.60
|
| Rate for Payer: WPS Commercial |
$897.73
|
|
|
IMPLANT BREAST 800CC SILICON
|
Facility
|
IP
|
$1,212.00
|
|
| Hospital Charge Code |
2964636
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$593.88 |
| Max. Negotiated Rate |
$1,115.04 |
| Rate for Payer: Aetna Commercial |
$1,090.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,042.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$642.36
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cigna Commercial |
$1,115.04
|
| Rate for Payer: Health EOS Commercial |
$1,078.68
|
| Rate for Payer: HFN Commercial |
$1,115.04
|
| Rate for Payer: Multiplan Commercial |
$969.60
|
| Rate for Payer: NAPHCARE Commercial |
$727.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,115.04
|
| Rate for Payer: Quartz Beloit One Network |
$593.88
|
| Rate for Payer: Quartz Commercial |
$727.20
|
| Rate for Payer: WEA Trust Commercial |
$666.60
|
| Rate for Payer: WPS Commercial |
$897.73
|
|
|
IMPLANT BREAST 800CC SILICON
|
Facility
|
OP
|
$1,212.00
|
|
| Hospital Charge Code |
2964636
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.36 |
| Max. Negotiated Rate |
$4,848.00 |
| Rate for Payer: Aetna Commercial |
$1,090.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,042.32
|
| Rate for Payer: Aetna Managed Medicare |
$339.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$787.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$606.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$581.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$642.36
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cigna Commercial |
$1,115.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$678.24
|
| Rate for Payer: Health EOS Commercial |
$1,078.68
|
| Rate for Payer: HFN Commercial |
$1,115.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$909.00
|
| Rate for Payer: Multiplan Commercial |
$969.60
|
| Rate for Payer: NAPHCARE Commercial |
$727.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,115.04
|
| Rate for Payer: Quartz Beloit One Network |
$593.88
|
| Rate for Payer: Quartz Commercial |
$787.80
|
| Rate for Payer: Quartz Medicare Advantage |
$727.20
|
| Rate for Payer: The Alliance Commercial |
$4,848.00
|
| Rate for Payer: WEA Trust Commercial |
$666.60
|
| Rate for Payer: WPS Commercial |
$897.73
|
|
|
IMPLANT CHANDRAL DART 1.3 X 18MM AR-4005B-18
|
Facility
|
IP
|
$2,214.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5885643
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,084.86 |
| Max. Negotiated Rate |
$2,036.88 |
| Rate for Payer: Aetna Commercial |
$1,992.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,904.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,173.42
|
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Cigna Commercial |
$2,036.88
|
| Rate for Payer: Health EOS Commercial |
$1,970.46
|
| Rate for Payer: HFN Commercial |
$2,036.88
|
| Rate for Payer: Multiplan Commercial |
$1,771.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,328.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,036.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,084.86
|
| Rate for Payer: Quartz Commercial |
$1,328.40
|
| Rate for Payer: WEA Trust Commercial |
$1,217.70
|
| Rate for Payer: WPS Commercial |
$1,639.91
|
|
|
IMPLANT CHANDRAL DART 1.3 X 18MM AR-4005B-18
|
Facility
|
OP
|
$2,214.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5885643
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$619.92 |
| Max. Negotiated Rate |
$8,856.00 |
| Rate for Payer: Aetna Commercial |
$1,992.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,904.04
|
| Rate for Payer: Aetna Managed Medicare |
$619.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,439.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,107.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,062.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,173.42
|
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Cigna Commercial |
$2,036.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,238.95
|
| Rate for Payer: Health EOS Commercial |
$1,970.46
|
| Rate for Payer: HFN Commercial |
$2,036.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,660.50
|
| Rate for Payer: Multiplan Commercial |
$1,771.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,328.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,036.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,084.86
|
| Rate for Payer: Quartz Commercial |
$1,439.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,328.40
|
| Rate for Payer: The Alliance Commercial |
$8,856.00
|
| Rate for Payer: WEA Trust Commercial |
$1,217.70
|
| Rate for Payer: WPS Commercial |
$1,639.91
|
|
|
IMPLANT DELIVERY SYSTEM DISTAL BICEPS REPAIR AR-2260
|
Facility
|
IP
|
$7,699.00
|
|
| Hospital Charge Code |
2964682
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,772.51 |
| Max. Negotiated Rate |
$7,083.08 |
| Rate for Payer: Aetna Commercial |
$6,929.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,621.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,080.47
|
| Rate for Payer: Cash Price |
$2,309.70
|
| Rate for Payer: Cigna Commercial |
$7,083.08
|
| Rate for Payer: Health EOS Commercial |
$6,852.11
|
| Rate for Payer: HFN Commercial |
$7,083.08
|
| Rate for Payer: Multiplan Commercial |
$6,159.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,619.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,083.08
|
| Rate for Payer: Quartz Beloit One Network |
$3,772.51
|
| Rate for Payer: Quartz Commercial |
$4,619.40
|
| Rate for Payer: WEA Trust Commercial |
$4,234.45
|
| Rate for Payer: WPS Commercial |
$5,702.65
|
|
|
IMPLANT DELIVERY SYSTEM DISTAL BICEPS REPAIR AR-2260
|
Facility
|
OP
|
$7,699.00
|
|
| Hospital Charge Code |
2964682
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,155.72 |
| Max. Negotiated Rate |
$30,796.00 |
| Rate for Payer: Aetna Commercial |
$6,929.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,621.14
|
| Rate for Payer: Aetna Managed Medicare |
$2,155.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,004.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,849.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,695.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,080.47
|
| Rate for Payer: Cash Price |
$2,309.70
|
| Rate for Payer: Cigna Commercial |
$7,083.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,308.36
|
| Rate for Payer: Health EOS Commercial |
$6,852.11
|
| Rate for Payer: HFN Commercial |
$7,083.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,774.25
|
| Rate for Payer: Multiplan Commercial |
$6,159.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,619.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,083.08
|
| Rate for Payer: Quartz Beloit One Network |
$3,772.51
|
| Rate for Payer: Quartz Commercial |
$5,004.35
|
| Rate for Payer: Quartz Medicare Advantage |
$4,619.40
|
| Rate for Payer: The Alliance Commercial |
$30,796.00
|
| Rate for Payer: WEA Trust Commercial |
$4,234.45
|
| Rate for Payer: WPS Commercial |
$5,702.65
|
|
|
IMPLANT DELIVERY SYSTEM DISTAL BICEPS REPAIR BC AR-2260BC
|
Facility
|
OP
|
$8,695.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5520889
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,434.60 |
| Max. Negotiated Rate |
$34,780.00 |
| Rate for Payer: Aetna Commercial |
$7,825.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,477.70
|
| Rate for Payer: Aetna Managed Medicare |
$2,434.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,651.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,347.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,173.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,608.35
|
| Rate for Payer: Cash Price |
$2,608.50
|
| Rate for Payer: Cigna Commercial |
$7,999.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,865.72
|
| Rate for Payer: Health EOS Commercial |
$7,738.55
|
| Rate for Payer: HFN Commercial |
$7,999.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,521.25
|
| Rate for Payer: Multiplan Commercial |
$6,956.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,217.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,999.40
|
| Rate for Payer: Quartz Beloit One Network |
$4,260.55
|
| Rate for Payer: Quartz Commercial |
$5,651.75
|
| Rate for Payer: Quartz Medicare Advantage |
$5,217.00
|
| Rate for Payer: The Alliance Commercial |
$34,780.00
|
| Rate for Payer: WEA Trust Commercial |
$4,782.25
|
| Rate for Payer: WPS Commercial |
$6,440.39
|
|
|
IMPLANT DELIVERY SYSTEM DISTAL BICEPS REPAIR BC AR-2260BC
|
Facility
|
IP
|
$8,695.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5520889
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,260.55 |
| Max. Negotiated Rate |
$7,999.40 |
| Rate for Payer: Aetna Commercial |
$7,825.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,477.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,608.35
|
| Rate for Payer: Cash Price |
$2,608.50
|
| Rate for Payer: Cigna Commercial |
$7,999.40
|
| Rate for Payer: Health EOS Commercial |
$7,738.55
|
| Rate for Payer: HFN Commercial |
$7,999.40
|
| Rate for Payer: Multiplan Commercial |
$6,956.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,217.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,999.40
|
| Rate for Payer: Quartz Beloit One Network |
$4,260.55
|
| Rate for Payer: Quartz Commercial |
$5,217.00
|
| Rate for Payer: WEA Trust Commercial |
$4,782.25
|
| Rate for Payer: WPS Commercial |
$6,440.39
|
|
|
IMPLANT DIGIFUSE 2.0MM X 10 DEG ANGLE DF2010
|
Facility
|
OP
|
$11,306.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729623
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,165.68 |
| Max. Negotiated Rate |
$45,224.00 |
| Rate for Payer: Aetna Commercial |
$10,175.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,723.16
|
| Rate for Payer: Aetna Managed Medicare |
$3,165.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,348.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,653.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,426.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,992.18
|
| Rate for Payer: Cash Price |
$3,391.80
|
| Rate for Payer: Cigna Commercial |
$10,401.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,326.84
|
| Rate for Payer: Health EOS Commercial |
$10,062.34
|
| Rate for Payer: HFN Commercial |
$10,401.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,479.50
|
| Rate for Payer: Multiplan Commercial |
$9,044.80
|
| Rate for Payer: NAPHCARE Commercial |
$6,783.60
|
| Rate for Payer: Preferred Network Access Commercial |
$10,401.52
|
| Rate for Payer: Quartz Beloit One Network |
$5,539.94
|
| Rate for Payer: Quartz Commercial |
$7,348.90
|
| Rate for Payer: Quartz Medicare Advantage |
$6,783.60
|
| Rate for Payer: The Alliance Commercial |
$45,224.00
|
| Rate for Payer: WEA Trust Commercial |
$6,218.30
|
| Rate for Payer: WPS Commercial |
$8,374.35
|
|
|
IMPLANT DIGIFUSE 2.0MM X 10 DEG ANGLE DF2010
|
Facility
|
IP
|
$11,306.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729623
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,539.94 |
| Max. Negotiated Rate |
$10,401.52 |
| Rate for Payer: Aetna Commercial |
$10,175.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,723.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,992.18
|
| Rate for Payer: Cash Price |
$3,391.80
|
| Rate for Payer: Cigna Commercial |
$10,401.52
|
| Rate for Payer: Health EOS Commercial |
$10,062.34
|
| Rate for Payer: HFN Commercial |
$10,401.52
|
| Rate for Payer: Multiplan Commercial |
$9,044.80
|
| Rate for Payer: NAPHCARE Commercial |
$6,783.60
|
| Rate for Payer: Preferred Network Access Commercial |
$10,401.52
|
| Rate for Payer: Quartz Beloit One Network |
$5,539.94
|
| Rate for Payer: Quartz Commercial |
$6,783.60
|
| Rate for Payer: WEA Trust Commercial |
$6,218.30
|
| Rate for Payer: WPS Commercial |
$8,374.35
|
|
|
IMPLANT DIGIFUSE 2.5MM 10 DEGREE DF2510
|
Facility
|
IP
|
$6,393.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5627642
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,132.57 |
| Max. Negotiated Rate |
$5,881.56 |
| Rate for Payer: Aetna Commercial |
$5,753.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,497.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,388.29
|
| Rate for Payer: Cash Price |
$1,917.90
|
| Rate for Payer: Cigna Commercial |
$5,881.56
|
| Rate for Payer: Health EOS Commercial |
$5,689.77
|
| Rate for Payer: HFN Commercial |
$5,881.56
|
| Rate for Payer: Multiplan Commercial |
$5,114.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,835.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,881.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,132.57
|
| Rate for Payer: Quartz Commercial |
$3,835.80
|
| Rate for Payer: WEA Trust Commercial |
$3,516.15
|
| Rate for Payer: WPS Commercial |
$4,735.30
|
|
|
IMPLANT DIGIFUSE 2.5MM 10 DEGREE DF2510
|
Facility
|
OP
|
$6,393.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5627642
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,790.04 |
| Max. Negotiated Rate |
$25,572.00 |
| Rate for Payer: Aetna Commercial |
$5,753.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,497.98
|
| Rate for Payer: Aetna Managed Medicare |
$1,790.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,155.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,196.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,068.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,388.29
|
| Rate for Payer: Cash Price |
$1,917.90
|
| Rate for Payer: Cigna Commercial |
$5,881.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,577.52
|
| Rate for Payer: Health EOS Commercial |
$5,689.77
|
| Rate for Payer: HFN Commercial |
$5,881.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,794.75
|
| Rate for Payer: Multiplan Commercial |
$5,114.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,835.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,881.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,132.57
|
| Rate for Payer: Quartz Commercial |
$4,155.45
|
| Rate for Payer: Quartz Medicare Advantage |
$3,835.80
|
| Rate for Payer: The Alliance Commercial |
$25,572.00
|
| Rate for Payer: WEA Trust Commercial |
$3,516.15
|
| Rate for Payer: WPS Commercial |
$4,735.30
|
|
|
IMPLANT EAR KURZ ANGULAR PLESTER 2.25MM 1002 610
|
Facility
|
OP
|
$4,793.00
|
|
| Hospital Charge Code |
3713506
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,342.04 |
| Max. Negotiated Rate |
$19,172.00 |
| Rate for Payer: Aetna Commercial |
$4,313.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,121.98
|
| Rate for Payer: Aetna Managed Medicare |
$1,342.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,115.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,396.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,300.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,540.29
|
| Rate for Payer: Cash Price |
$1,437.90
|
| Rate for Payer: Cigna Commercial |
$4,409.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,682.16
|
| Rate for Payer: Health EOS Commercial |
$4,265.77
|
| Rate for Payer: HFN Commercial |
$4,409.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,594.75
|
| Rate for Payer: Multiplan Commercial |
$3,834.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,875.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,409.56
|
| Rate for Payer: Quartz Beloit One Network |
$2,348.57
|
| Rate for Payer: Quartz Commercial |
$3,115.45
|
| Rate for Payer: Quartz Medicare Advantage |
$2,875.80
|
| Rate for Payer: The Alliance Commercial |
$19,172.00
|
| Rate for Payer: WEA Trust Commercial |
$2,636.15
|
| Rate for Payer: WPS Commercial |
$3,550.18
|
|
|
IMPLANT EAR KURZ ANGULAR PLESTER 2.25MM 1002 610
|
Facility
|
IP
|
$4,793.00
|
|
| Hospital Charge Code |
3713506
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,348.57 |
| Max. Negotiated Rate |
$4,409.56 |
| Rate for Payer: Aetna Commercial |
$4,313.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,121.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,540.29
|
| Rate for Payer: Cash Price |
$1,437.90
|
| Rate for Payer: Cigna Commercial |
$4,409.56
|
| Rate for Payer: Health EOS Commercial |
$4,265.77
|
| Rate for Payer: HFN Commercial |
$4,409.56
|
| Rate for Payer: Multiplan Commercial |
$3,834.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,875.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,409.56
|
| Rate for Payer: Quartz Beloit One Network |
$2,348.57
|
| Rate for Payer: Quartz Commercial |
$2,875.80
|
| Rate for Payer: WEA Trust Commercial |
$2,636.15
|
| Rate for Payer: WPS Commercial |
$3,550.18
|
|
|
IMPLANT EAR KURZ ANGULAR PLESTER 3.25MM 1002 612
|
Facility
|
OP
|
$4,793.00
|
|
| Hospital Charge Code |
3713507
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,342.04 |
| Max. Negotiated Rate |
$19,172.00 |
| Rate for Payer: Aetna Commercial |
$4,313.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,121.98
|
| Rate for Payer: Aetna Managed Medicare |
$1,342.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,115.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,396.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,300.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,540.29
|
| Rate for Payer: Cash Price |
$1,437.90
|
| Rate for Payer: Cigna Commercial |
$4,409.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,682.16
|
| Rate for Payer: Health EOS Commercial |
$4,265.77
|
| Rate for Payer: HFN Commercial |
$4,409.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,594.75
|
| Rate for Payer: Multiplan Commercial |
$3,834.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,875.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,409.56
|
| Rate for Payer: Quartz Beloit One Network |
$2,348.57
|
| Rate for Payer: Quartz Commercial |
$3,115.45
|
| Rate for Payer: Quartz Medicare Advantage |
$2,875.80
|
| Rate for Payer: The Alliance Commercial |
$19,172.00
|
| Rate for Payer: WEA Trust Commercial |
$2,636.15
|
| Rate for Payer: WPS Commercial |
$3,550.18
|
|
|
IMPLANT EAR KURZ ANGULAR PLESTER 3.25MM 1002 612
|
Facility
|
IP
|
$4,793.00
|
|
| Hospital Charge Code |
3713507
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,348.57 |
| Max. Negotiated Rate |
$4,409.56 |
| Rate for Payer: Aetna Commercial |
$4,313.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,121.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,540.29
|
| Rate for Payer: Cash Price |
$1,437.90
|
| Rate for Payer: Cigna Commercial |
$4,409.56
|
| Rate for Payer: Health EOS Commercial |
$4,265.77
|
| Rate for Payer: HFN Commercial |
$4,409.56
|
| Rate for Payer: Multiplan Commercial |
$3,834.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,875.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,409.56
|
| Rate for Payer: Quartz Beloit One Network |
$2,348.57
|
| Rate for Payer: Quartz Commercial |
$2,875.80
|
| Rate for Payer: WEA Trust Commercial |
$2,636.15
|
| Rate for Payer: WPS Commercial |
$3,550.18
|
|
|
IMPLANT EAR KURZ TTP VARIAC PARTIAL (1.75 - 4.5MM) 1002 020
|
Facility
|
OP
|
$4,856.00
|
|
| Hospital Charge Code |
3583499
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,359.68 |
| Max. Negotiated Rate |
$19,424.00 |
| Rate for Payer: Aetna Commercial |
$4,370.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,176.16
|
| Rate for Payer: Aetna Managed Medicare |
$1,359.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,156.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,428.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,330.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,573.68
|
| Rate for Payer: Cash Price |
$1,456.80
|
| Rate for Payer: Cigna Commercial |
$4,467.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,717.42
|
| Rate for Payer: Health EOS Commercial |
$4,321.84
|
| Rate for Payer: HFN Commercial |
$4,467.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,642.00
|
| Rate for Payer: Multiplan Commercial |
$3,884.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,913.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,467.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,379.44
|
| Rate for Payer: Quartz Commercial |
$3,156.40
|
| Rate for Payer: Quartz Medicare Advantage |
$2,913.60
|
| Rate for Payer: The Alliance Commercial |
$19,424.00
|
| Rate for Payer: WEA Trust Commercial |
$2,670.80
|
| Rate for Payer: WPS Commercial |
$3,596.84
|
|
|
IMPLANT EAR KURZ TTP VARIAC PARTIAL (1.75 - 4.5MM) 1002 020
|
Facility
|
IP
|
$4,856.00
|
|
| Hospital Charge Code |
3583499
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,379.44 |
| Max. Negotiated Rate |
$4,467.52 |
| Rate for Payer: Aetna Commercial |
$4,370.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,176.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,573.68
|
| Rate for Payer: Cash Price |
$1,456.80
|
| Rate for Payer: Cigna Commercial |
$4,467.52
|
| Rate for Payer: Health EOS Commercial |
$4,321.84
|
| Rate for Payer: HFN Commercial |
$4,467.52
|
| Rate for Payer: Multiplan Commercial |
$3,884.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,913.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,467.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,379.44
|
| Rate for Payer: Quartz Commercial |
$2,913.60
|
| Rate for Payer: WEA Trust Commercial |
$2,670.80
|
| Rate for Payer: WPS Commercial |
$3,596.84
|
|
