|
IMPLANT EAR KURZ TTP VARIAC TOTAL (3.0 - 7.0MM) 1004 020
|
Facility
|
IP
|
$4,856.00
|
|
| Hospital Charge Code |
3591496
|
|
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
|
|
|
IMPLANT EAR KURZ TTP VARIAC TOTAL (3.0 - 7.0MM) 1004 020
|
Facility
|
OP
|
$4,856.00
|
|
| Hospital Charge Code |
3591496
|
|
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 MEDPOR EAR BASE EXTENDED LT 30MM X 59MM 8331
|
Facility
|
OP
|
$7,197.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6200990
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,015.16 |
| Max. Negotiated Rate |
$28,788.00 |
| Rate for Payer: Aetna Commercial |
$6,477.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,189.42
|
| Rate for Payer: Aetna Managed Medicare |
$2,015.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,678.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,598.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,454.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,814.41
|
| Rate for Payer: Cash Price |
$2,159.10
|
| Rate for Payer: Cigna Commercial |
$6,621.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,027.44
|
| Rate for Payer: Health EOS Commercial |
$6,405.33
|
| Rate for Payer: HFN Commercial |
$6,621.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,397.75
|
| Rate for Payer: Multiplan Commercial |
$5,757.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,318.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,621.24
|
| Rate for Payer: Quartz Beloit One Network |
$3,526.53
|
| Rate for Payer: Quartz Commercial |
$4,678.05
|
| Rate for Payer: Quartz Medicare Advantage |
$4,318.20
|
| Rate for Payer: The Alliance Commercial |
$28,788.00
|
| Rate for Payer: WEA Trust Commercial |
$3,958.35
|
| Rate for Payer: WPS Commercial |
$5,330.82
|
|
|
IMPLANT EAR MEDPOR EAR BASE EXTENDED LT 30MM X 59MM 8331
|
Facility
|
IP
|
$7,197.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6200990
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,526.53 |
| Max. Negotiated Rate |
$6,621.24 |
| Rate for Payer: Aetna Commercial |
$6,477.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,189.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,814.41
|
| Rate for Payer: Cash Price |
$2,159.10
|
| Rate for Payer: Cigna Commercial |
$6,621.24
|
| Rate for Payer: Health EOS Commercial |
$6,405.33
|
| Rate for Payer: HFN Commercial |
$6,621.24
|
| Rate for Payer: Multiplan Commercial |
$5,757.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,318.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,621.24
|
| Rate for Payer: Quartz Beloit One Network |
$3,526.53
|
| Rate for Payer: Quartz Commercial |
$4,318.20
|
| Rate for Payer: WEA Trust Commercial |
$3,958.35
|
| Rate for Payer: WPS Commercial |
$5,330.82
|
|
|
IMPLANT EAR MEDPOR EAR BASE EXTENDED RT 30MM X 59MM 8330
|
Facility
|
OP
|
$7,197.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6200986
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,015.16 |
| Max. Negotiated Rate |
$28,788.00 |
| Rate for Payer: Aetna Commercial |
$6,477.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,189.42
|
| Rate for Payer: Aetna Managed Medicare |
$2,015.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,678.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,598.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,454.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,814.41
|
| Rate for Payer: Cash Price |
$2,159.10
|
| Rate for Payer: Cigna Commercial |
$6,621.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,027.44
|
| Rate for Payer: Health EOS Commercial |
$6,405.33
|
| Rate for Payer: HFN Commercial |
$6,621.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,397.75
|
| Rate for Payer: Multiplan Commercial |
$5,757.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,318.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,621.24
|
| Rate for Payer: Quartz Beloit One Network |
$3,526.53
|
| Rate for Payer: Quartz Commercial |
$4,678.05
|
| Rate for Payer: Quartz Medicare Advantage |
$4,318.20
|
| Rate for Payer: The Alliance Commercial |
$28,788.00
|
| Rate for Payer: WEA Trust Commercial |
$3,958.35
|
| Rate for Payer: WPS Commercial |
$5,330.82
|
|
|
IMPLANT EAR MEDPOR EAR BASE EXTENDED RT 30MM X 59MM 8330
|
Facility
|
IP
|
$7,197.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6200986
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,526.53 |
| Max. Negotiated Rate |
$6,621.24 |
| Rate for Payer: Aetna Commercial |
$6,477.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,189.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,814.41
|
| Rate for Payer: Cash Price |
$2,159.10
|
| Rate for Payer: Cigna Commercial |
$6,621.24
|
| Rate for Payer: Health EOS Commercial |
$6,405.33
|
| Rate for Payer: HFN Commercial |
$6,621.24
|
| Rate for Payer: Multiplan Commercial |
$5,757.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,318.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,621.24
|
| Rate for Payer: Quartz Beloit One Network |
$3,526.53
|
| Rate for Payer: Quartz Commercial |
$4,318.20
|
| Rate for Payer: WEA Trust Commercial |
$3,958.35
|
| Rate for Payer: WPS Commercial |
$5,330.82
|
|
|
IMPLANT EAR MEDPOR HELICAL RIM LT 37MM X 62MM 8329
|
Facility
|
OP
|
$5,894.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6200984
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,650.32 |
| Max. Negotiated Rate |
$23,576.00 |
| Rate for Payer: Aetna Commercial |
$5,304.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,068.84
|
| Rate for Payer: Aetna Managed Medicare |
$1,650.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,831.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,947.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,829.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,123.82
|
| Rate for Payer: Cash Price |
$1,768.20
|
| Rate for Payer: Cigna Commercial |
$5,422.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,298.28
|
| Rate for Payer: Health EOS Commercial |
$5,245.66
|
| Rate for Payer: HFN Commercial |
$5,422.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,420.50
|
| Rate for Payer: Multiplan Commercial |
$4,715.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,536.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,422.48
|
| Rate for Payer: Quartz Beloit One Network |
$2,888.06
|
| Rate for Payer: Quartz Commercial |
$3,831.10
|
| Rate for Payer: Quartz Medicare Advantage |
$3,536.40
|
| Rate for Payer: The Alliance Commercial |
$23,576.00
|
| Rate for Payer: WEA Trust Commercial |
$3,241.70
|
| Rate for Payer: WPS Commercial |
$4,365.69
|
|
|
IMPLANT EAR MEDPOR HELICAL RIM LT 37MM X 62MM 8329
|
Facility
|
IP
|
$5,894.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6200984
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,888.06 |
| Max. Negotiated Rate |
$5,422.48 |
| Rate for Payer: Aetna Commercial |
$5,304.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,068.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,123.82
|
| Rate for Payer: Cash Price |
$1,768.20
|
| Rate for Payer: Cigna Commercial |
$5,422.48
|
| Rate for Payer: Health EOS Commercial |
$5,245.66
|
| Rate for Payer: HFN Commercial |
$5,422.48
|
| Rate for Payer: Multiplan Commercial |
$4,715.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,536.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,422.48
|
| Rate for Payer: Quartz Beloit One Network |
$2,888.06
|
| Rate for Payer: Quartz Commercial |
$3,536.40
|
| Rate for Payer: WEA Trust Commercial |
$3,241.70
|
| Rate for Payer: WPS Commercial |
$4,365.69
|
|
|
IMPLANT EAR MEDPOR HELICAL RIM RT 37MM X 62MM 8328
|
Facility
|
OP
|
$5,894.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6200982
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,650.32 |
| Max. Negotiated Rate |
$23,576.00 |
| Rate for Payer: Aetna Commercial |
$5,304.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,068.84
|
| Rate for Payer: Aetna Managed Medicare |
$1,650.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,831.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,947.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,829.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,123.82
|
| Rate for Payer: Cash Price |
$1,768.20
|
| Rate for Payer: Cigna Commercial |
$5,422.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,298.28
|
| Rate for Payer: Health EOS Commercial |
$5,245.66
|
| Rate for Payer: HFN Commercial |
$5,422.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,420.50
|
| Rate for Payer: Multiplan Commercial |
$4,715.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,536.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,422.48
|
| Rate for Payer: Quartz Beloit One Network |
$2,888.06
|
| Rate for Payer: Quartz Commercial |
$3,831.10
|
| Rate for Payer: Quartz Medicare Advantage |
$3,536.40
|
| Rate for Payer: The Alliance Commercial |
$23,576.00
|
| Rate for Payer: WEA Trust Commercial |
$3,241.70
|
| Rate for Payer: WPS Commercial |
$4,365.69
|
|
|
IMPLANT EAR MEDPOR HELICAL RIM RT 37MM X 62MM 8328
|
Facility
|
IP
|
$5,894.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6200982
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,888.06 |
| Max. Negotiated Rate |
$5,422.48 |
| Rate for Payer: Aetna Commercial |
$5,304.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,068.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,123.82
|
| Rate for Payer: Cash Price |
$1,768.20
|
| Rate for Payer: Cigna Commercial |
$5,422.48
|
| Rate for Payer: Health EOS Commercial |
$5,245.66
|
| Rate for Payer: HFN Commercial |
$5,422.48
|
| Rate for Payer: Multiplan Commercial |
$4,715.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,536.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,422.48
|
| Rate for Payer: Quartz Beloit One Network |
$2,888.06
|
| Rate for Payer: Quartz Commercial |
$3,536.40
|
| Rate for Payer: WEA Trust Commercial |
$3,241.70
|
| Rate for Payer: WPS Commercial |
$4,365.69
|
|
|
Implanted port - accessed - Central IV Activity:
|
Facility
|
IP
|
$597.00
|
|
| Hospital Charge Code |
3025898
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$292.53 |
| Max. Negotiated Rate |
$549.24 |
| Rate for Payer: Aetna Commercial |
$537.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$513.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$316.41
|
| Rate for Payer: Cash Price |
$179.10
|
| Rate for Payer: Cigna Commercial |
$549.24
|
| Rate for Payer: Health EOS Commercial |
$531.33
|
| Rate for Payer: HFN Commercial |
$549.24
|
| Rate for Payer: Multiplan Commercial |
$477.60
|
| Rate for Payer: NAPHCARE Commercial |
$358.20
|
| Rate for Payer: Preferred Network Access Commercial |
$549.24
|
| Rate for Payer: Quartz Beloit One Network |
$292.53
|
| Rate for Payer: Quartz Commercial |
$358.20
|
| Rate for Payer: WEA Trust Commercial |
$328.35
|
| Rate for Payer: WPS Commercial |
$442.20
|
|
|
Implanted port - accessed - Central IV Activity:
|
Facility
|
OP
|
$597.00
|
|
| Hospital Charge Code |
3025898
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$167.16 |
| Max. Negotiated Rate |
$2,388.00 |
| Rate for Payer: Aetna Commercial |
$537.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$513.42
|
| Rate for Payer: Aetna Managed Medicare |
$167.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$388.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$298.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$286.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$316.41
|
| Rate for Payer: Cash Price |
$179.10
|
| Rate for Payer: Cigna Commercial |
$549.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$334.08
|
| Rate for Payer: Health EOS Commercial |
$531.33
|
| Rate for Payer: HFN Commercial |
$549.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$447.75
|
| Rate for Payer: Multiplan Commercial |
$477.60
|
| Rate for Payer: NAPHCARE Commercial |
$358.20
|
| Rate for Payer: Preferred Network Access Commercial |
$549.24
|
| Rate for Payer: Quartz Beloit One Network |
$292.53
|
| Rate for Payer: Quartz Commercial |
$388.05
|
| Rate for Payer: Quartz Medicare Advantage |
$358.20
|
| Rate for Payer: The Alliance Commercial |
$2,388.00
|
| Rate for Payer: WEA Trust Commercial |
$328.35
|
| Rate for Payer: WPS Commercial |
$442.20
|
|
|
Implanted port - blood drawn - Central IV Activity:
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT 36591
|
| Hospital Charge Code |
3025899
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$87.22 |
| Max. Negotiated Rate |
$163.76 |
| Rate for Payer: Aetna Commercial |
$160.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$153.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$94.34
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$163.76
|
| Rate for Payer: Health EOS Commercial |
$158.42
|
| Rate for Payer: HFN Commercial |
$163.76
|
| Rate for Payer: Multiplan Commercial |
$142.40
|
| Rate for Payer: NAPHCARE Commercial |
$106.80
|
| Rate for Payer: Preferred Network Access Commercial |
$163.76
|
| Rate for Payer: Quartz Beloit One Network |
$87.22
|
| Rate for Payer: Quartz Commercial |
$106.80
|
| Rate for Payer: WEA Trust Commercial |
$97.90
|
| Rate for Payer: WPS Commercial |
$131.84
|
|
|
Implanted port - blood drawn - Central IV Activity:
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT 36591
|
| Hospital Charge Code |
3025899
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$85.44 |
| Max. Negotiated Rate |
$505.04 |
| Rate for Payer: Aetna Commercial |
$160.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$153.08
|
| Rate for Payer: Aetna Managed Medicare |
$126.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$115.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$89.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$85.44
|
| Rate for Payer: Anthem Medicare Advantage |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$94.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$126.26
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$163.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$126.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$126.26
|
| Rate for Payer: Health EOS Commercial |
$158.42
|
| Rate for Payer: HFN Commercial |
$163.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$469.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$126.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$126.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$126.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$126.26
|
| Rate for Payer: Multiplan Commercial |
$142.40
|
| Rate for Payer: NAPHCARE Commercial |
$189.39
|
| Rate for Payer: Preferred Network Access Commercial |
$163.76
|
| Rate for Payer: Quartz Beloit One Network |
$87.22
|
| Rate for Payer: Quartz Commercial |
$115.70
|
| Rate for Payer: Quartz Medicare Advantage |
$126.26
|
| Rate for Payer: The Alliance Commercial |
$505.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.26
|
| Rate for Payer: WEA Trust Commercial |
$97.90
|
| Rate for Payer: Wellcare Medicare |
$126.26
|
| Rate for Payer: WPS Commercial |
$131.84
|
|
|
IMPLANT ENCOMPASS 19MM
|
Facility
|
IP
|
$12,509.00
|
|
| Hospital Charge Code |
2965450
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,129.41 |
| Max. Negotiated Rate |
$11,508.28 |
| Rate for Payer: Aetna Commercial |
$11,258.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,757.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,629.77
|
| Rate for Payer: Cash Price |
$3,752.70
|
| Rate for Payer: Cigna Commercial |
$11,508.28
|
| Rate for Payer: Health EOS Commercial |
$11,133.01
|
| Rate for Payer: HFN Commercial |
$11,508.28
|
| Rate for Payer: Multiplan Commercial |
$10,007.20
|
| Rate for Payer: NAPHCARE Commercial |
$7,505.40
|
| Rate for Payer: Preferred Network Access Commercial |
$11,508.28
|
| Rate for Payer: Quartz Beloit One Network |
$6,129.41
|
| Rate for Payer: Quartz Commercial |
$7,505.40
|
| Rate for Payer: WEA Trust Commercial |
$6,879.95
|
| Rate for Payer: WPS Commercial |
$9,265.42
|
|
|
IMPLANT ENCOMPASS 19MM
|
Facility
|
OP
|
$12,509.00
|
|
| Hospital Charge Code |
2965450
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,502.52 |
| Max. Negotiated Rate |
$50,036.00 |
| Rate for Payer: Aetna Commercial |
$11,258.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,757.74
|
| Rate for Payer: Aetna Managed Medicare |
$3,502.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,130.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,254.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,004.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,629.77
|
| Rate for Payer: Cash Price |
$3,752.70
|
| Rate for Payer: Cigna Commercial |
$11,508.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,000.04
|
| Rate for Payer: Health EOS Commercial |
$11,133.01
|
| Rate for Payer: HFN Commercial |
$11,508.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,381.75
|
| Rate for Payer: Multiplan Commercial |
$10,007.20
|
| Rate for Payer: NAPHCARE Commercial |
$7,505.40
|
| Rate for Payer: Preferred Network Access Commercial |
$11,508.28
|
| Rate for Payer: Quartz Beloit One Network |
$6,129.41
|
| Rate for Payer: Quartz Commercial |
$8,130.85
|
| Rate for Payer: Quartz Medicare Advantage |
$7,505.40
|
| Rate for Payer: The Alliance Commercial |
$50,036.00
|
| Rate for Payer: WEA Trust Commercial |
$6,879.95
|
| Rate for Payer: WPS Commercial |
$9,265.42
|
|
|
IMPLANT ENDOTINE 3.5 FOREHEAD CFD-22102
|
Facility
|
IP
|
$4,793.00
|
|
| Hospital Charge Code |
5106850
|
|
Hospital Revenue Code
|
272
|
| 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 ENDOTINE 3.5 FOREHEAD CFD-22102
|
Facility
|
OP
|
$4,793.00
|
|
| Hospital Charge Code |
5106850
|
|
Hospital Revenue Code
|
272
|
| 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 FUTURA LESSER METATARSAL PHALANGEAL JOINT SILASTIC SZ 20 LMP-20T
|
Facility
|
OP
|
$7,591.00
|
|
|
Service Code
|
HCPCS L8641
|
| Hospital Charge Code |
5787625
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,125.48 |
| Max. Negotiated Rate |
$30,364.00 |
| Rate for Payer: Aetna Commercial |
$6,831.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,528.26
|
| Rate for Payer: Aetna Managed Medicare |
$2,125.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,934.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,795.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,643.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,023.23
|
| Rate for Payer: Cash Price |
$2,277.30
|
| Rate for Payer: Cigna Commercial |
$6,983.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,247.92
|
| Rate for Payer: Health EOS Commercial |
$6,755.99
|
| Rate for Payer: HFN Commercial |
$6,983.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,693.25
|
| Rate for Payer: Multiplan Commercial |
$6,072.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,554.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,983.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,719.59
|
| Rate for Payer: Quartz Commercial |
$4,934.15
|
| Rate for Payer: Quartz Medicare Advantage |
$4,554.60
|
| Rate for Payer: The Alliance Commercial |
$30,364.00
|
| Rate for Payer: WEA Trust Commercial |
$4,175.05
|
| Rate for Payer: WPS Commercial |
$5,622.65
|
|
|
IMPLANT FUTURA LESSER METATARSAL PHALANGEAL JOINT SILASTIC SZ 20 LMP-20T
|
Facility
|
IP
|
$7,591.00
|
|
|
Service Code
|
HCPCS L8641
|
| Hospital Charge Code |
5787625
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,719.59 |
| Max. Negotiated Rate |
$6,983.72 |
| Rate for Payer: Aetna Commercial |
$6,831.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,528.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,023.23
|
| Rate for Payer: Cash Price |
$2,277.30
|
| Rate for Payer: Cigna Commercial |
$6,983.72
|
| Rate for Payer: Health EOS Commercial |
$6,755.99
|
| Rate for Payer: HFN Commercial |
$6,983.72
|
| Rate for Payer: Multiplan Commercial |
$6,072.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,554.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,983.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,719.59
|
| Rate for Payer: Quartz Commercial |
$4,554.60
|
| Rate for Payer: WEA Trust Commercial |
$4,175.05
|
| Rate for Payer: WPS Commercial |
$5,622.65
|
|
|
IMPLANT FUTURA LESSER METATARSAL PHALANGEAL JOINT SILASTIC SZ 30 LMP-30T
|
Facility
|
IP
|
$9,580.00
|
|
|
Service Code
|
HCPCS L8641
|
| Hospital Charge Code |
5107076
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,694.20 |
| Max. Negotiated Rate |
$8,813.60 |
| Rate for Payer: Aetna Commercial |
$8,622.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,238.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,077.40
|
| Rate for Payer: Cash Price |
$2,874.00
|
| Rate for Payer: Cigna Commercial |
$8,813.60
|
| Rate for Payer: Health EOS Commercial |
$8,526.20
|
| Rate for Payer: HFN Commercial |
$8,813.60
|
| Rate for Payer: Multiplan Commercial |
$7,664.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,748.00
|
| Rate for Payer: Preferred Network Access Commercial |
$8,813.60
|
| Rate for Payer: Quartz Beloit One Network |
$4,694.20
|
| Rate for Payer: Quartz Commercial |
$5,748.00
|
| Rate for Payer: WEA Trust Commercial |
$5,269.00
|
| Rate for Payer: WPS Commercial |
$7,095.91
|
|
|
IMPLANT FUTURA LESSER METATARSAL PHALANGEAL JOINT SILASTIC SZ 30 LMP-30T
|
Facility
|
OP
|
$9,580.00
|
|
|
Service Code
|
HCPCS L8641
|
| Hospital Charge Code |
5107076
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,682.40 |
| Max. Negotiated Rate |
$38,320.00 |
| Rate for Payer: Aetna Commercial |
$8,622.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,238.80
|
| Rate for Payer: Aetna Managed Medicare |
$2,682.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,227.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,790.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,598.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,077.40
|
| Rate for Payer: Cash Price |
$2,874.00
|
| Rate for Payer: Cigna Commercial |
$8,813.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,360.97
|
| Rate for Payer: Health EOS Commercial |
$8,526.20
|
| Rate for Payer: HFN Commercial |
$8,813.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,185.00
|
| Rate for Payer: Multiplan Commercial |
$7,664.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,748.00
|
| Rate for Payer: Preferred Network Access Commercial |
$8,813.60
|
| Rate for Payer: Quartz Beloit One Network |
$4,694.20
|
| Rate for Payer: Quartz Commercial |
$6,227.00
|
| Rate for Payer: Quartz Medicare Advantage |
$5,748.00
|
| Rate for Payer: The Alliance Commercial |
$38,320.00
|
| Rate for Payer: WEA Trust Commercial |
$5,269.00
|
| Rate for Payer: WPS Commercial |
$7,095.91
|
|
|
IMPLANT FUTURA LESSER METATARSAL PHALANGEAL JOINT SILASTIC SZ 40 LMP-40T
|
Facility
|
IP
|
$9,580.00
|
|
|
Service Code
|
HCPCS L8641
|
| Hospital Charge Code |
5458838
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,694.20 |
| Max. Negotiated Rate |
$8,813.60 |
| Rate for Payer: Aetna Commercial |
$8,622.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,238.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,077.40
|
| Rate for Payer: Cash Price |
$2,874.00
|
| Rate for Payer: Cigna Commercial |
$8,813.60
|
| Rate for Payer: Health EOS Commercial |
$8,526.20
|
| Rate for Payer: HFN Commercial |
$8,813.60
|
| Rate for Payer: Multiplan Commercial |
$7,664.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,748.00
|
| Rate for Payer: Preferred Network Access Commercial |
$8,813.60
|
| Rate for Payer: Quartz Beloit One Network |
$4,694.20
|
| Rate for Payer: Quartz Commercial |
$5,748.00
|
| Rate for Payer: WEA Trust Commercial |
$5,269.00
|
| Rate for Payer: WPS Commercial |
$7,095.91
|
|
|
IMPLANT FUTURA LESSER METATARSAL PHALANGEAL JOINT SILASTIC SZ 40 LMP-40T
|
Facility
|
OP
|
$9,580.00
|
|
|
Service Code
|
HCPCS L8641
|
| Hospital Charge Code |
5458838
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,682.40 |
| Max. Negotiated Rate |
$38,320.00 |
| Rate for Payer: Aetna Commercial |
$8,622.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,238.80
|
| Rate for Payer: Aetna Managed Medicare |
$2,682.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,227.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,790.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,598.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,077.40
|
| Rate for Payer: Cash Price |
$2,874.00
|
| Rate for Payer: Cigna Commercial |
$8,813.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,360.97
|
| Rate for Payer: Health EOS Commercial |
$8,526.20
|
| Rate for Payer: HFN Commercial |
$8,813.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,185.00
|
| Rate for Payer: Multiplan Commercial |
$7,664.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,748.00
|
| Rate for Payer: Preferred Network Access Commercial |
$8,813.60
|
| Rate for Payer: Quartz Beloit One Network |
$4,694.20
|
| Rate for Payer: Quartz Commercial |
$6,227.00
|
| Rate for Payer: Quartz Medicare Advantage |
$5,748.00
|
| Rate for Payer: The Alliance Commercial |
$38,320.00
|
| Rate for Payer: WEA Trust Commercial |
$5,269.00
|
| Rate for Payer: WPS Commercial |
$7,095.91
|
|
|
IMPLANT FUTURA LESSER METATARSAL PHALANGEAL JOINT SILASTIC SZ 50 LMP-50T
|
Facility
|
OP
|
$9,580.00
|
|
|
Service Code
|
HCPCS L8641
|
| Hospital Charge Code |
5458839
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,682.40 |
| Max. Negotiated Rate |
$38,320.00 |
| Rate for Payer: Aetna Commercial |
$8,622.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,238.80
|
| Rate for Payer: Aetna Managed Medicare |
$2,682.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,227.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,790.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,598.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,077.40
|
| Rate for Payer: Cash Price |
$2,874.00
|
| Rate for Payer: Cigna Commercial |
$8,813.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,360.97
|
| Rate for Payer: Health EOS Commercial |
$8,526.20
|
| Rate for Payer: HFN Commercial |
$8,813.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,185.00
|
| Rate for Payer: Multiplan Commercial |
$7,664.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,748.00
|
| Rate for Payer: Preferred Network Access Commercial |
$8,813.60
|
| Rate for Payer: Quartz Beloit One Network |
$4,694.20
|
| Rate for Payer: Quartz Commercial |
$6,227.00
|
| Rate for Payer: Quartz Medicare Advantage |
$5,748.00
|
| Rate for Payer: The Alliance Commercial |
$38,320.00
|
| Rate for Payer: WEA Trust Commercial |
$5,269.00
|
| Rate for Payer: WPS Commercial |
$7,095.91
|
|
