|
IMPLANT SMART TOE 19MM STO-19P
|
Facility
|
IP
|
$4,931.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966084
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,512.84 |
| Max. Negotiated Rate |
$4,717.98 |
| Rate for Payer: Aetna Commercial |
$4,615.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,410.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,717.97
|
| Rate for Payer: Cash Price |
$1,479.30
|
| Rate for Payer: Cigna Commercial |
$4,717.98
|
| Rate for Payer: Health EOS Commercial |
$4,564.13
|
| Rate for Payer: HFN Commercial |
$4,717.98
|
| Rate for Payer: Multiplan Commercial |
$4,102.59
|
| Rate for Payer: Preferred Network Access Commercial |
$4,717.98
|
| Rate for Payer: Quartz Beloit One Network |
$2,512.84
|
| Rate for Payer: Quartz Commercial |
$3,076.94
|
| Rate for Payer: WEA Trust Commercial |
$2,820.53
|
| Rate for Payer: WPS Commercial |
$3,798.35
|
|
|
IMPLANT SPACEOAR SYSTEM 10ML SO-2101
|
Facility
|
OP
|
$15,309.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
6165872
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,457.98 |
| Max. Negotiated Rate |
$14,647.65 |
| Rate for Payer: Aetna Commercial |
$14,329.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,692.37
|
| Rate for Payer: Aetna Managed Medicare |
$4,457.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,348.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,960.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,642.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,438.32
|
| Rate for Payer: Cash Price |
$4,592.70
|
| Rate for Payer: Cigna Commercial |
$14,647.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,909.84
|
| Rate for Payer: Health EOS Commercial |
$14,170.01
|
| Rate for Payer: HFN Commercial |
$14,647.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,941.02
|
| Rate for Payer: Multiplan Commercial |
$12,737.09
|
| Rate for Payer: NAPHCARE Commercial |
$9,552.82
|
| Rate for Payer: Preferred Network Access Commercial |
$14,647.65
|
| Rate for Payer: Quartz Beloit One Network |
$7,801.47
|
| Rate for Payer: Quartz Commercial |
$10,348.88
|
| Rate for Payer: Quartz Medicare Advantage |
$9,552.82
|
| Rate for Payer: The Alliance Commercial |
$7,960.68
|
| Rate for Payer: WEA Trust Commercial |
$8,756.75
|
| Rate for Payer: WPS Commercial |
$11,792.52
|
|
|
IMPLANT SPACEOAR SYSTEM 10ML SO-2101
|
Facility
|
IP
|
$15,309.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
6165872
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,801.47 |
| Max. Negotiated Rate |
$14,647.65 |
| Rate for Payer: Aetna Commercial |
$14,329.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,692.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,438.32
|
| Rate for Payer: Cash Price |
$4,592.70
|
| Rate for Payer: Cigna Commercial |
$14,647.65
|
| Rate for Payer: Health EOS Commercial |
$14,170.01
|
| Rate for Payer: HFN Commercial |
$14,647.65
|
| Rate for Payer: Multiplan Commercial |
$12,737.09
|
| Rate for Payer: Preferred Network Access Commercial |
$14,647.65
|
| Rate for Payer: Quartz Beloit One Network |
$7,801.47
|
| Rate for Payer: Quartz Commercial |
$9,552.82
|
| Rate for Payer: WEA Trust Commercial |
$8,756.75
|
| Rate for Payer: WPS Commercial |
$11,792.52
|
|
|
IMPLANT SPACEOAR VUE SYSTEM 10ML SV-2101
|
Facility
|
OP
|
$17,033.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
5456736
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,960.01 |
| Max. Negotiated Rate |
$16,297.17 |
| Rate for Payer: Aetna Commercial |
$15,942.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,234.32
|
| Rate for Payer: Aetna Managed Medicare |
$4,960.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,514.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,857.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,502.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,388.59
|
| Rate for Payer: Cash Price |
$5,109.90
|
| Rate for Payer: Cigna Commercial |
$16,297.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,913.21
|
| Rate for Payer: Health EOS Commercial |
$15,765.74
|
| Rate for Payer: HFN Commercial |
$16,297.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,285.74
|
| Rate for Payer: Multiplan Commercial |
$14,171.46
|
| Rate for Payer: NAPHCARE Commercial |
$10,628.59
|
| Rate for Payer: Preferred Network Access Commercial |
$16,297.17
|
| Rate for Payer: Quartz Beloit One Network |
$8,680.02
|
| Rate for Payer: Quartz Commercial |
$11,514.31
|
| Rate for Payer: Quartz Medicare Advantage |
$10,628.59
|
| Rate for Payer: The Alliance Commercial |
$8,857.16
|
| Rate for Payer: WEA Trust Commercial |
$9,742.88
|
| Rate for Payer: WPS Commercial |
$13,120.52
|
|
|
IMPLANT SPACEOAR VUE SYSTEM 10ML SV-2101
|
Facility
|
IP
|
$17,033.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
5456736
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,680.02 |
| Max. Negotiated Rate |
$16,297.17 |
| Rate for Payer: Aetna Commercial |
$15,942.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,234.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,388.59
|
| Rate for Payer: Cash Price |
$5,109.90
|
| Rate for Payer: Cigna Commercial |
$16,297.17
|
| Rate for Payer: Health EOS Commercial |
$15,765.74
|
| Rate for Payer: HFN Commercial |
$16,297.17
|
| Rate for Payer: Multiplan Commercial |
$14,171.46
|
| Rate for Payer: Preferred Network Access Commercial |
$16,297.17
|
| Rate for Payer: Quartz Beloit One Network |
$8,680.02
|
| Rate for Payer: Quartz Commercial |
$10,628.59
|
| Rate for Payer: WEA Trust Commercial |
$9,742.88
|
| Rate for Payer: WPS Commercial |
$13,120.52
|
|
|
IMPLANT SPECTRUM 475CC SALINE 354-2480M
|
Facility
|
IP
|
$6,103.00
|
|
| Hospital Charge Code |
2965397
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,110.09 |
| Max. Negotiated Rate |
$5,839.35 |
| Rate for Payer: Aetna Commercial |
$5,712.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,458.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,363.97
|
| Rate for Payer: Cash Price |
$1,830.90
|
| Rate for Payer: Cigna Commercial |
$5,839.35
|
| Rate for Payer: Health EOS Commercial |
$5,648.94
|
| Rate for Payer: HFN Commercial |
$5,839.35
|
| Rate for Payer: Multiplan Commercial |
$5,077.70
|
| Rate for Payer: Preferred Network Access Commercial |
$5,839.35
|
| Rate for Payer: Quartz Beloit One Network |
$3,110.09
|
| Rate for Payer: Quartz Commercial |
$3,808.27
|
| Rate for Payer: WEA Trust Commercial |
$3,490.92
|
| Rate for Payer: WPS Commercial |
$4,701.14
|
|
|
IMPLANT SPECTRUM 475CC SALINE 354-2480M
|
Facility
|
OP
|
$6,103.00
|
|
| Hospital Charge Code |
2965397
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,777.19 |
| Max. Negotiated Rate |
$5,839.35 |
| Rate for Payer: Aetna Commercial |
$5,712.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,458.52
|
| Rate for Payer: Aetna Managed Medicare |
$1,777.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,125.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,173.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,046.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,363.97
|
| Rate for Payer: Cash Price |
$1,830.90
|
| Rate for Payer: Cigna Commercial |
$5,839.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,551.95
|
| Rate for Payer: Health EOS Commercial |
$5,648.94
|
| Rate for Payer: HFN Commercial |
$5,839.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,760.34
|
| Rate for Payer: Multiplan Commercial |
$5,077.70
|
| Rate for Payer: NAPHCARE Commercial |
$3,808.27
|
| Rate for Payer: Preferred Network Access Commercial |
$5,839.35
|
| Rate for Payer: Quartz Beloit One Network |
$3,110.09
|
| Rate for Payer: Quartz Commercial |
$4,125.63
|
| Rate for Payer: Quartz Medicare Advantage |
$3,808.27
|
| Rate for Payer: The Alliance Commercial |
$3,173.56
|
| Rate for Payer: WEA Trust Commercial |
$3,490.92
|
| Rate for Payer: WPS Commercial |
$4,701.14
|
|
|
IMPLANT SUBTALAR 9MM
|
Facility
|
IP
|
$6,407.00
|
|
| Hospital Charge Code |
2965166
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,265.01 |
| Max. Negotiated Rate |
$6,130.22 |
| Rate for Payer: Aetna Commercial |
$5,996.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,730.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,531.54
|
| Rate for Payer: Cash Price |
$1,922.10
|
| Rate for Payer: Cigna Commercial |
$6,130.22
|
| Rate for Payer: Health EOS Commercial |
$5,930.32
|
| Rate for Payer: HFN Commercial |
$6,130.22
|
| Rate for Payer: Multiplan Commercial |
$5,330.62
|
| Rate for Payer: Preferred Network Access Commercial |
$6,130.22
|
| Rate for Payer: Quartz Beloit One Network |
$3,265.01
|
| Rate for Payer: Quartz Commercial |
$3,997.97
|
| Rate for Payer: WEA Trust Commercial |
$3,664.80
|
| Rate for Payer: WPS Commercial |
$4,935.31
|
|
|
IMPLANT SUBTALAR 9MM
|
Facility
|
OP
|
$6,407.00
|
|
| Hospital Charge Code |
2965166
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,865.72 |
| Max. Negotiated Rate |
$6,130.22 |
| Rate for Payer: Aetna Commercial |
$5,996.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,730.42
|
| Rate for Payer: Aetna Managed Medicare |
$1,865.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,331.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,331.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,198.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,531.54
|
| Rate for Payer: Cash Price |
$1,922.10
|
| Rate for Payer: Cigna Commercial |
$6,130.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,728.87
|
| Rate for Payer: Health EOS Commercial |
$5,930.32
|
| Rate for Payer: HFN Commercial |
$6,130.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,997.46
|
| Rate for Payer: Multiplan Commercial |
$5,330.62
|
| Rate for Payer: NAPHCARE Commercial |
$3,997.97
|
| Rate for Payer: Preferred Network Access Commercial |
$6,130.22
|
| Rate for Payer: Quartz Beloit One Network |
$3,265.01
|
| Rate for Payer: Quartz Commercial |
$4,331.13
|
| Rate for Payer: Quartz Medicare Advantage |
$3,997.97
|
| Rate for Payer: The Alliance Commercial |
$3,331.64
|
| Rate for Payer: WEA Trust Commercial |
$3,664.80
|
| Rate for Payer: WPS Commercial |
$4,935.31
|
|
|
IMPLANT SUBTALAR BIPRO 9MM 17222
|
Facility
|
OP
|
$7,627.00
|
|
|
Service Code
|
HCPCS L8642
|
| Hospital Charge Code |
2964803
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,594.03 |
| Max. Negotiated Rate |
$7,297.51 |
| Rate for Payer: Aetna Commercial |
$7,138.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,821.59
|
| Rate for Payer: Aetna Managed Medicare |
$2,220.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,155.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,966.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,807.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,204.00
|
| Rate for Payer: Cash Price |
$2,288.10
|
| Rate for Payer: Cash Price |
$2,288.10
|
| Rate for Payer: Cigna Commercial |
$7,297.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,438.91
|
| Rate for Payer: Health EOS Commercial |
$7,059.55
|
| Rate for Payer: HFN Commercial |
$7,297.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,949.06
|
| Rate for Payer: Multiplan Commercial |
$6,345.66
|
| Rate for Payer: NAPHCARE Commercial |
$4,759.25
|
| Rate for Payer: Preferred Network Access Commercial |
$7,297.51
|
| Rate for Payer: Quartz Beloit One Network |
$3,886.72
|
| Rate for Payer: Quartz Commercial |
$5,155.85
|
| Rate for Payer: Quartz Medicare Advantage |
$4,759.25
|
| Rate for Payer: The Alliance Commercial |
$1,594.03
|
| Rate for Payer: WEA Trust Commercial |
$4,362.64
|
| Rate for Payer: WPS Commercial |
$5,875.08
|
|
|
IMPLANT SUBTALAR BIPRO 9MM 17222
|
Facility
|
IP
|
$7,627.00
|
|
|
Service Code
|
HCPCS L8642
|
| Hospital Charge Code |
2964803
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,886.72 |
| Max. Negotiated Rate |
$7,297.51 |
| Rate for Payer: Aetna Commercial |
$7,138.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,821.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,204.00
|
| Rate for Payer: Cash Price |
$2,288.10
|
| Rate for Payer: Cigna Commercial |
$7,297.51
|
| Rate for Payer: Health EOS Commercial |
$7,059.55
|
| Rate for Payer: HFN Commercial |
$7,297.51
|
| Rate for Payer: Multiplan Commercial |
$6,345.66
|
| Rate for Payer: Preferred Network Access Commercial |
$7,297.51
|
| Rate for Payer: Quartz Beloit One Network |
$3,886.72
|
| Rate for Payer: Quartz Commercial |
$4,759.25
|
| Rate for Payer: WEA Trust Commercial |
$4,362.64
|
| Rate for Payer: WPS Commercial |
$5,875.08
|
|
|
IMPLANT SUBTALAR PROSTOP ATHROEREISIS 10 X 14 AR-4210-14
|
Facility
|
IP
|
$7,613.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729760
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,879.58 |
| Max. Negotiated Rate |
$7,284.12 |
| Rate for Payer: Aetna Commercial |
$7,125.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,809.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,196.29
|
| Rate for Payer: Cash Price |
$2,283.90
|
| Rate for Payer: Cigna Commercial |
$7,284.12
|
| Rate for Payer: Health EOS Commercial |
$7,046.59
|
| Rate for Payer: HFN Commercial |
$7,284.12
|
| Rate for Payer: Multiplan Commercial |
$6,334.02
|
| Rate for Payer: Preferred Network Access Commercial |
$7,284.12
|
| Rate for Payer: Quartz Beloit One Network |
$3,879.58
|
| Rate for Payer: Quartz Commercial |
$4,750.51
|
| Rate for Payer: WEA Trust Commercial |
$4,354.64
|
| Rate for Payer: WPS Commercial |
$5,864.29
|
|
|
IMPLANT SUBTALAR PROSTOP ATHROEREISIS 10 X 14 AR-4210-14
|
Facility
|
OP
|
$7,613.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729760
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,216.91 |
| Max. Negotiated Rate |
$7,284.12 |
| Rate for Payer: Aetna Commercial |
$7,125.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,809.07
|
| Rate for Payer: Aetna Managed Medicare |
$2,216.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,146.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,958.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,800.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,196.29
|
| Rate for Payer: Cash Price |
$2,283.90
|
| Rate for Payer: Cigna Commercial |
$7,284.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,430.77
|
| Rate for Payer: Health EOS Commercial |
$7,046.59
|
| Rate for Payer: HFN Commercial |
$7,284.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,938.14
|
| Rate for Payer: Multiplan Commercial |
$6,334.02
|
| Rate for Payer: NAPHCARE Commercial |
$4,750.51
|
| Rate for Payer: Preferred Network Access Commercial |
$7,284.12
|
| Rate for Payer: Quartz Beloit One Network |
$3,879.58
|
| Rate for Payer: Quartz Commercial |
$5,146.39
|
| Rate for Payer: Quartz Medicare Advantage |
$4,750.51
|
| Rate for Payer: The Alliance Commercial |
$3,958.76
|
| Rate for Payer: WEA Trust Commercial |
$4,354.64
|
| Rate for Payer: WPS Commercial |
$5,864.29
|
|
|
IMPLANT SUBTALAR PROSTOP ATHROEREISIS 9 X 14 AR-4209-14
|
Facility
|
IP
|
$7,646.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729759
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,896.40 |
| Max. Negotiated Rate |
$7,315.69 |
| Rate for Payer: Aetna Commercial |
$7,156.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,838.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,214.48
|
| Rate for Payer: Cash Price |
$2,293.80
|
| Rate for Payer: Cigna Commercial |
$7,315.69
|
| Rate for Payer: Health EOS Commercial |
$7,077.14
|
| Rate for Payer: HFN Commercial |
$7,315.69
|
| Rate for Payer: Multiplan Commercial |
$6,361.47
|
| Rate for Payer: Preferred Network Access Commercial |
$7,315.69
|
| Rate for Payer: Quartz Beloit One Network |
$3,896.40
|
| Rate for Payer: Quartz Commercial |
$4,771.10
|
| Rate for Payer: WEA Trust Commercial |
$4,373.51
|
| Rate for Payer: WPS Commercial |
$5,889.71
|
|
|
IMPLANT SUBTALAR PROSTOP ATHROEREISIS 9 X 14 AR-4209-14
|
Facility
|
OP
|
$7,646.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729759
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,226.52 |
| Max. Negotiated Rate |
$7,315.69 |
| Rate for Payer: Aetna Commercial |
$7,156.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,838.58
|
| Rate for Payer: Aetna Managed Medicare |
$2,226.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,168.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,975.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,816.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,214.48
|
| Rate for Payer: Cash Price |
$2,293.80
|
| Rate for Payer: Cigna Commercial |
$7,315.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,449.97
|
| Rate for Payer: Health EOS Commercial |
$7,077.14
|
| Rate for Payer: HFN Commercial |
$7,315.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,963.88
|
| Rate for Payer: Multiplan Commercial |
$6,361.47
|
| Rate for Payer: NAPHCARE Commercial |
$4,771.10
|
| Rate for Payer: Preferred Network Access Commercial |
$7,315.69
|
| Rate for Payer: Quartz Beloit One Network |
$3,896.40
|
| Rate for Payer: Quartz Commercial |
$5,168.70
|
| Rate for Payer: Quartz Medicare Advantage |
$4,771.10
|
| Rate for Payer: The Alliance Commercial |
$3,975.92
|
| Rate for Payer: WEA Trust Commercial |
$4,373.51
|
| Rate for Payer: WPS Commercial |
$5,889.71
|
|
|
IMPLANT SYSTEM 2.6MM FIBERTAK BUTTON AR-3680
|
Facility
|
OP
|
$5,599.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6192981
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,630.43 |
| Max. Negotiated Rate |
$5,357.12 |
| Rate for Payer: Aetna Commercial |
$5,240.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,007.75
|
| Rate for Payer: Aetna Managed Medicare |
$1,630.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,784.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,911.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,795.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,086.17
|
| Rate for Payer: Cash Price |
$1,679.70
|
| Rate for Payer: Cigna Commercial |
$5,357.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,258.62
|
| Rate for Payer: Health EOS Commercial |
$5,182.43
|
| Rate for Payer: HFN Commercial |
$5,357.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,367.22
|
| Rate for Payer: Multiplan Commercial |
$4,658.37
|
| Rate for Payer: NAPHCARE Commercial |
$3,493.78
|
| Rate for Payer: Preferred Network Access Commercial |
$5,357.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,853.25
|
| Rate for Payer: Quartz Commercial |
$3,784.92
|
| Rate for Payer: Quartz Medicare Advantage |
$3,493.78
|
| Rate for Payer: The Alliance Commercial |
$2,911.48
|
| Rate for Payer: WEA Trust Commercial |
$3,202.63
|
| Rate for Payer: WPS Commercial |
$4,312.91
|
|
|
IMPLANT SYSTEM 2.6MM FIBERTAK BUTTON AR-3680
|
Facility
|
IP
|
$5,599.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6192981
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,853.25 |
| Max. Negotiated Rate |
$5,357.12 |
| Rate for Payer: Aetna Commercial |
$5,240.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,007.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,086.17
|
| Rate for Payer: Cash Price |
$1,679.70
|
| Rate for Payer: Cigna Commercial |
$5,357.12
|
| Rate for Payer: Health EOS Commercial |
$5,182.43
|
| Rate for Payer: HFN Commercial |
$5,357.12
|
| Rate for Payer: Multiplan Commercial |
$4,658.37
|
| Rate for Payer: Preferred Network Access Commercial |
$5,357.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,853.25
|
| Rate for Payer: Quartz Commercial |
$3,493.78
|
| Rate for Payer: WEA Trust Commercial |
$3,202.63
|
| Rate for Payer: WPS Commercial |
$4,312.91
|
|
|
IMPLANT SYSTEM 5.5MM FDL AR-1555BC-CP
|
Facility
|
OP
|
$7,423.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6217116
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,161.58 |
| Max. Negotiated Rate |
$7,102.33 |
| Rate for Payer: Aetna Commercial |
$6,947.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,639.13
|
| Rate for Payer: Aetna Managed Medicare |
$2,161.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,017.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,859.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,705.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,091.56
|
| Rate for Payer: Cash Price |
$2,226.90
|
| Rate for Payer: Cigna Commercial |
$7,102.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,320.19
|
| Rate for Payer: Health EOS Commercial |
$6,870.73
|
| Rate for Payer: HFN Commercial |
$7,102.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,789.94
|
| Rate for Payer: Multiplan Commercial |
$6,175.94
|
| Rate for Payer: NAPHCARE Commercial |
$4,631.95
|
| Rate for Payer: Preferred Network Access Commercial |
$7,102.33
|
| Rate for Payer: Quartz Beloit One Network |
$3,782.76
|
| Rate for Payer: Quartz Commercial |
$5,017.95
|
| Rate for Payer: Quartz Medicare Advantage |
$4,631.95
|
| Rate for Payer: The Alliance Commercial |
$3,859.96
|
| Rate for Payer: WEA Trust Commercial |
$4,245.96
|
| Rate for Payer: WPS Commercial |
$5,717.94
|
|
|
IMPLANT SYSTEM 5.5MM FDL AR-1555BC-CP
|
Facility
|
IP
|
$7,423.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6217116
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,782.76 |
| Max. Negotiated Rate |
$7,102.33 |
| Rate for Payer: Aetna Commercial |
$6,947.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,639.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,091.56
|
| Rate for Payer: Cash Price |
$2,226.90
|
| Rate for Payer: Cigna Commercial |
$7,102.33
|
| Rate for Payer: Health EOS Commercial |
$6,870.73
|
| Rate for Payer: HFN Commercial |
$7,102.33
|
| Rate for Payer: Multiplan Commercial |
$6,175.94
|
| Rate for Payer: Preferred Network Access Commercial |
$7,102.33
|
| Rate for Payer: Quartz Beloit One Network |
$3,782.76
|
| Rate for Payer: Quartz Commercial |
$4,631.95
|
| Rate for Payer: WEA Trust Commercial |
$4,245.96
|
| Rate for Payer: WPS Commercial |
$5,717.94
|
|
|
IMPLANT SYSTEM BIRMINGHAM BICEPS AR-1662S-1
|
Facility
|
OP
|
$6,393.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4595504
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,861.64 |
| Max. Negotiated Rate |
$6,116.82 |
| Rate for Payer: Aetna Commercial |
$5,983.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,717.90
|
| Rate for Payer: Aetna Managed Medicare |
$1,861.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,321.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,324.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,191.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,523.82
|
| Rate for Payer: Cash Price |
$1,917.90
|
| Rate for Payer: Cigna Commercial |
$6,116.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,720.73
|
| Rate for Payer: Health EOS Commercial |
$5,917.36
|
| Rate for Payer: HFN Commercial |
$6,116.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,986.54
|
| Rate for Payer: Multiplan Commercial |
$5,318.98
|
| Rate for Payer: NAPHCARE Commercial |
$3,989.23
|
| Rate for Payer: Preferred Network Access Commercial |
$6,116.82
|
| Rate for Payer: Quartz Beloit One Network |
$3,257.87
|
| Rate for Payer: Quartz Commercial |
$4,321.67
|
| Rate for Payer: Quartz Medicare Advantage |
$3,989.23
|
| Rate for Payer: The Alliance Commercial |
$3,324.36
|
| Rate for Payer: WEA Trust Commercial |
$3,656.80
|
| Rate for Payer: WPS Commercial |
$4,924.53
|
|
|
IMPLANT SYSTEM BIRMINGHAM BICEPS AR-1662S-1
|
Facility
|
IP
|
$6,393.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4595504
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,257.87 |
| Max. Negotiated Rate |
$6,116.82 |
| Rate for Payer: Aetna Commercial |
$5,983.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,717.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,523.82
|
| Rate for Payer: Cash Price |
$1,917.90
|
| Rate for Payer: Cigna Commercial |
$6,116.82
|
| Rate for Payer: Health EOS Commercial |
$5,917.36
|
| Rate for Payer: HFN Commercial |
$6,116.82
|
| Rate for Payer: Multiplan Commercial |
$5,318.98
|
| Rate for Payer: Preferred Network Access Commercial |
$6,116.82
|
| Rate for Payer: Quartz Beloit One Network |
$3,257.87
|
| Rate for Payer: Quartz Commercial |
$3,989.23
|
| Rate for Payer: WEA Trust Commercial |
$3,656.80
|
| Rate for Payer: WPS Commercial |
$4,924.53
|
|
|
IMPLANT SYSTEM CPR MINI SCORPION DX AR-8690DS
|
Facility
|
OP
|
$6,191.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5627631
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,802.82 |
| Max. Negotiated Rate |
$5,923.55 |
| Rate for Payer: Aetna Commercial |
$5,794.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,537.23
|
| Rate for Payer: Aetna Managed Medicare |
$1,802.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,185.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,219.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,090.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,412.48
|
| Rate for Payer: Cash Price |
$1,857.30
|
| Rate for Payer: Cigna Commercial |
$5,923.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,603.16
|
| Rate for Payer: Health EOS Commercial |
$5,730.39
|
| Rate for Payer: HFN Commercial |
$5,923.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,828.98
|
| Rate for Payer: Multiplan Commercial |
$5,150.91
|
| Rate for Payer: NAPHCARE Commercial |
$3,863.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,923.55
|
| Rate for Payer: Quartz Beloit One Network |
$3,154.93
|
| Rate for Payer: Quartz Commercial |
$4,185.12
|
| Rate for Payer: Quartz Medicare Advantage |
$3,863.18
|
| Rate for Payer: The Alliance Commercial |
$3,219.32
|
| Rate for Payer: WEA Trust Commercial |
$3,541.25
|
| Rate for Payer: WPS Commercial |
$4,768.93
|
|
|
IMPLANT SYSTEM CPR MINI SCORPION DX AR-8690DS
|
Facility
|
IP
|
$6,191.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5627631
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,154.93 |
| Max. Negotiated Rate |
$5,923.55 |
| Rate for Payer: Aetna Commercial |
$5,794.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,537.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,412.48
|
| Rate for Payer: Cash Price |
$1,857.30
|
| Rate for Payer: Cigna Commercial |
$5,923.55
|
| Rate for Payer: Health EOS Commercial |
$5,730.39
|
| Rate for Payer: HFN Commercial |
$5,923.55
|
| Rate for Payer: Multiplan Commercial |
$5,150.91
|
| Rate for Payer: Preferred Network Access Commercial |
$5,923.55
|
| Rate for Payer: Quartz Beloit One Network |
$3,154.93
|
| Rate for Payer: Quartz Commercial |
$3,863.18
|
| Rate for Payer: WEA Trust Commercial |
$3,541.25
|
| Rate for Payer: WPS Commercial |
$4,768.93
|
|
|
IMPLANT SYSTEM ECLIPSE SPEEDSCAP AR-9400-SBK
|
Facility
|
IP
|
$12,786.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5729773
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,515.75 |
| Max. Negotiated Rate |
$12,233.64 |
| Rate for Payer: Aetna Commercial |
$11,967.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,435.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,047.64
|
| Rate for Payer: Cash Price |
$3,835.80
|
| Rate for Payer: Cigna Commercial |
$12,233.64
|
| Rate for Payer: Health EOS Commercial |
$11,834.72
|
| Rate for Payer: HFN Commercial |
$12,233.64
|
| Rate for Payer: Multiplan Commercial |
$10,637.95
|
| Rate for Payer: Preferred Network Access Commercial |
$12,233.64
|
| Rate for Payer: Quartz Beloit One Network |
$6,515.75
|
| Rate for Payer: Quartz Commercial |
$7,978.46
|
| Rate for Payer: WEA Trust Commercial |
$7,313.59
|
| Rate for Payer: WPS Commercial |
$9,849.06
|
|
|
IMPLANT SYSTEM ECLIPSE SPEEDSCAP AR-9400-SBK
|
Facility
|
OP
|
$12,786.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5729773
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,723.28 |
| Max. Negotiated Rate |
$12,233.64 |
| Rate for Payer: Aetna Commercial |
$11,967.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,435.80
|
| Rate for Payer: Aetna Managed Medicare |
$3,723.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,643.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,648.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,382.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,047.64
|
| Rate for Payer: Cash Price |
$3,835.80
|
| Rate for Payer: Cigna Commercial |
$12,233.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,441.45
|
| Rate for Payer: Health EOS Commercial |
$11,834.72
|
| Rate for Payer: HFN Commercial |
$12,233.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,973.08
|
| Rate for Payer: Multiplan Commercial |
$10,637.95
|
| Rate for Payer: NAPHCARE Commercial |
$7,978.46
|
| Rate for Payer: Preferred Network Access Commercial |
$12,233.64
|
| Rate for Payer: Quartz Beloit One Network |
$6,515.75
|
| Rate for Payer: Quartz Commercial |
$8,643.34
|
| Rate for Payer: Quartz Medicare Advantage |
$7,978.46
|
| Rate for Payer: The Alliance Commercial |
$6,648.72
|
| Rate for Payer: WEA Trust Commercial |
$7,313.59
|
| Rate for Payer: WPS Commercial |
$9,849.06
|
|
