|
IMPLANT SYSTEM FDL 4.75MM AR-1547BC-CP
|
Facility
|
IP
|
$7,069.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6185035
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,602.36 |
| Max. Negotiated Rate |
$6,763.62 |
| Rate for Payer: Aetna Commercial |
$6,616.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,322.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,896.43
|
| Rate for Payer: Cash Price |
$2,120.70
|
| Rate for Payer: Cigna Commercial |
$6,763.62
|
| Rate for Payer: Health EOS Commercial |
$6,543.07
|
| Rate for Payer: HFN Commercial |
$6,763.62
|
| Rate for Payer: Multiplan Commercial |
$5,881.41
|
| Rate for Payer: Preferred Network Access Commercial |
$6,763.62
|
| Rate for Payer: Quartz Beloit One Network |
$3,602.36
|
| Rate for Payer: Quartz Commercial |
$4,411.06
|
| Rate for Payer: WEA Trust Commercial |
$4,043.47
|
| Rate for Payer: WPS Commercial |
$5,445.25
|
|
|
IMPLANT SYSTEM FDL 4.75MM AR-1547BC-CP
|
Facility
|
OP
|
$7,069.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6185035
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,058.49 |
| Max. Negotiated Rate |
$6,763.62 |
| Rate for Payer: Aetna Commercial |
$6,616.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,322.51
|
| Rate for Payer: Aetna Managed Medicare |
$2,058.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,778.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,675.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,528.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,896.43
|
| Rate for Payer: Cash Price |
$2,120.70
|
| Rate for Payer: Cigna Commercial |
$6,763.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,114.16
|
| Rate for Payer: Health EOS Commercial |
$6,543.07
|
| Rate for Payer: HFN Commercial |
$6,763.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,513.82
|
| Rate for Payer: Multiplan Commercial |
$5,881.41
|
| Rate for Payer: NAPHCARE Commercial |
$4,411.06
|
| Rate for Payer: Preferred Network Access Commercial |
$6,763.62
|
| Rate for Payer: Quartz Beloit One Network |
$3,602.36
|
| Rate for Payer: Quartz Commercial |
$4,778.64
|
| Rate for Payer: Quartz Medicare Advantage |
$4,411.06
|
| Rate for Payer: The Alliance Commercial |
$3,675.88
|
| Rate for Payer: WEA Trust Commercial |
$4,043.47
|
| Rate for Payer: WPS Commercial |
$5,445.25
|
|
|
IMPLANT SYSTEM FIBER TAG TIGHTROPE WITH ATTACHED NEEDLE, FLIP CUTTER & FIBERSTICK AR-1288RTT-FC3
|
Facility
|
OP
|
$7,130.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6131637
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,076.26 |
| Max. Negotiated Rate |
$6,821.98 |
| Rate for Payer: Aetna Commercial |
$6,673.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,377.07
|
| Rate for Payer: Aetna Managed Medicare |
$2,076.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,819.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,707.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,559.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,930.06
|
| Rate for Payer: Cash Price |
$2,139.00
|
| Rate for Payer: Cigna Commercial |
$6,821.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,149.66
|
| Rate for Payer: Health EOS Commercial |
$6,599.53
|
| Rate for Payer: HFN Commercial |
$6,821.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,561.40
|
| Rate for Payer: Multiplan Commercial |
$5,932.16
|
| Rate for Payer: NAPHCARE Commercial |
$4,449.12
|
| Rate for Payer: Preferred Network Access Commercial |
$6,821.98
|
| Rate for Payer: Quartz Beloit One Network |
$3,633.45
|
| Rate for Payer: Quartz Commercial |
$4,819.88
|
| Rate for Payer: Quartz Medicare Advantage |
$4,449.12
|
| Rate for Payer: The Alliance Commercial |
$3,707.60
|
| Rate for Payer: WEA Trust Commercial |
$4,078.36
|
| Rate for Payer: WPS Commercial |
$5,492.24
|
|
|
IMPLANT SYSTEM FIBER TAG TIGHTROPE WITH ATTACHED NEEDLE, FLIP CUTTER & FIBERSTICK AR-1288RTT-FC3
|
Facility
|
IP
|
$7,130.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6131637
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,633.45 |
| Max. Negotiated Rate |
$6,821.98 |
| Rate for Payer: Aetna Commercial |
$6,673.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,377.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,930.06
|
| Rate for Payer: Cash Price |
$2,139.00
|
| Rate for Payer: Cigna Commercial |
$6,821.98
|
| Rate for Payer: Health EOS Commercial |
$6,599.53
|
| Rate for Payer: HFN Commercial |
$6,821.98
|
| Rate for Payer: Multiplan Commercial |
$5,932.16
|
| Rate for Payer: Preferred Network Access Commercial |
$6,821.98
|
| Rate for Payer: Quartz Beloit One Network |
$3,633.45
|
| Rate for Payer: Quartz Commercial |
$4,449.12
|
| Rate for Payer: WEA Trust Commercial |
$4,078.36
|
| Rate for Payer: WPS Commercial |
$5,492.24
|
|
|
IMPLANT SYSTEM GRAFT ANCHOR AR-8826DS
|
Facility
|
IP
|
$9,499.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4595802
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,840.69 |
| Max. Negotiated Rate |
$9,088.64 |
| Rate for Payer: Aetna Commercial |
$8,891.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,495.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,235.85
|
| Rate for Payer: Cash Price |
$2,849.70
|
| Rate for Payer: Cigna Commercial |
$9,088.64
|
| Rate for Payer: Health EOS Commercial |
$8,792.27
|
| Rate for Payer: HFN Commercial |
$9,088.64
|
| Rate for Payer: Multiplan Commercial |
$7,903.17
|
| Rate for Payer: Preferred Network Access Commercial |
$9,088.64
|
| Rate for Payer: Quartz Beloit One Network |
$4,840.69
|
| Rate for Payer: Quartz Commercial |
$5,927.38
|
| Rate for Payer: WEA Trust Commercial |
$5,433.43
|
| Rate for Payer: WPS Commercial |
$7,317.08
|
|
|
IMPLANT SYSTEM GRAFT ANCHOR AR-8826DS
|
Facility
|
OP
|
$9,499.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4595802
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,766.11 |
| Max. Negotiated Rate |
$9,088.64 |
| Rate for Payer: Aetna Commercial |
$8,891.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,495.91
|
| Rate for Payer: Aetna Managed Medicare |
$2,766.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,421.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,939.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,741.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,235.85
|
| Rate for Payer: Cash Price |
$2,849.70
|
| Rate for Payer: Cigna Commercial |
$9,088.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,528.42
|
| Rate for Payer: Health EOS Commercial |
$8,792.27
|
| Rate for Payer: HFN Commercial |
$9,088.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,409.22
|
| Rate for Payer: Multiplan Commercial |
$7,903.17
|
| Rate for Payer: NAPHCARE Commercial |
$5,927.38
|
| Rate for Payer: Preferred Network Access Commercial |
$9,088.64
|
| Rate for Payer: Quartz Beloit One Network |
$4,840.69
|
| Rate for Payer: Quartz Commercial |
$6,421.32
|
| Rate for Payer: Quartz Medicare Advantage |
$5,927.38
|
| Rate for Payer: The Alliance Commercial |
$4,939.48
|
| Rate for Payer: WEA Trust Commercial |
$5,433.43
|
| Rate for Payer: WPS Commercial |
$7,317.08
|
|
|
IMPLANT SYSTEM INTERNAL BRACE FOREFOOT AR-1530P-CP
|
Facility
|
OP
|
$6,926.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415156
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,016.85 |
| Max. Negotiated Rate |
$6,626.80 |
| Rate for Payer: Aetna Commercial |
$6,482.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,194.61
|
| Rate for Payer: Aetna Managed Medicare |
$2,016.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,681.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,601.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,457.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,817.61
|
| Rate for Payer: Cash Price |
$2,077.80
|
| Rate for Payer: Cigna Commercial |
$6,626.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,030.93
|
| Rate for Payer: Health EOS Commercial |
$6,410.71
|
| Rate for Payer: HFN Commercial |
$6,626.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,402.28
|
| Rate for Payer: Multiplan Commercial |
$5,762.43
|
| Rate for Payer: NAPHCARE Commercial |
$4,321.82
|
| Rate for Payer: Preferred Network Access Commercial |
$6,626.80
|
| Rate for Payer: Quartz Beloit One Network |
$3,529.49
|
| Rate for Payer: Quartz Commercial |
$4,681.98
|
| Rate for Payer: Quartz Medicare Advantage |
$4,321.82
|
| Rate for Payer: The Alliance Commercial |
$3,601.52
|
| Rate for Payer: WEA Trust Commercial |
$3,961.67
|
| Rate for Payer: WPS Commercial |
$5,335.10
|
|
|
IMPLANT SYSTEM INTERNAL BRACE FOREFOOT AR-1530P-CP
|
Facility
|
IP
|
$6,926.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415156
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,529.49 |
| Max. Negotiated Rate |
$6,626.80 |
| Rate for Payer: Aetna Commercial |
$6,482.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,194.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,817.61
|
| Rate for Payer: Cash Price |
$2,077.80
|
| Rate for Payer: Cigna Commercial |
$6,626.80
|
| Rate for Payer: Health EOS Commercial |
$6,410.71
|
| Rate for Payer: HFN Commercial |
$6,626.80
|
| Rate for Payer: Multiplan Commercial |
$5,762.43
|
| Rate for Payer: Preferred Network Access Commercial |
$6,626.80
|
| Rate for Payer: Quartz Beloit One Network |
$3,529.49
|
| Rate for Payer: Quartz Commercial |
$4,321.82
|
| Rate for Payer: WEA Trust Commercial |
$3,961.67
|
| Rate for Payer: WPS Commercial |
$5,335.10
|
|
|
IMPLANT SYSTEM INTERNAL BRACE KNEE LIGAMENT AUGMENTATION REPAIR AR-5511-CP
|
Facility
|
OP
|
$9,084.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5178928
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,645.26 |
| Max. Negotiated Rate |
$8,691.57 |
| Rate for Payer: Aetna Commercial |
$8,502.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,124.73
|
| Rate for Payer: Aetna Managed Medicare |
$2,645.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,140.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,723.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,534.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,007.10
|
| Rate for Payer: Cash Price |
$2,725.20
|
| Rate for Payer: Cigna Commercial |
$8,691.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,286.89
|
| Rate for Payer: Health EOS Commercial |
$8,408.15
|
| Rate for Payer: HFN Commercial |
$8,691.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,085.52
|
| Rate for Payer: Multiplan Commercial |
$7,557.89
|
| Rate for Payer: NAPHCARE Commercial |
$5,668.42
|
| Rate for Payer: Preferred Network Access Commercial |
$8,691.57
|
| Rate for Payer: Quartz Beloit One Network |
$4,629.21
|
| Rate for Payer: Quartz Commercial |
$6,140.78
|
| Rate for Payer: Quartz Medicare Advantage |
$5,668.42
|
| Rate for Payer: The Alliance Commercial |
$4,723.68
|
| Rate for Payer: WEA Trust Commercial |
$5,196.05
|
| Rate for Payer: WPS Commercial |
$6,997.41
|
|
|
IMPLANT SYSTEM INTERNAL BRACE KNEE LIGAMENT AUGMENTATION REPAIR AR-5511-CP
|
Facility
|
IP
|
$9,084.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5178928
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,629.21 |
| Max. Negotiated Rate |
$8,691.57 |
| Rate for Payer: Aetna Commercial |
$8,502.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,124.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,007.10
|
| Rate for Payer: Cash Price |
$2,725.20
|
| Rate for Payer: Cigna Commercial |
$8,691.57
|
| Rate for Payer: Health EOS Commercial |
$8,408.15
|
| Rate for Payer: HFN Commercial |
$8,691.57
|
| Rate for Payer: Multiplan Commercial |
$7,557.89
|
| Rate for Payer: Preferred Network Access Commercial |
$8,691.57
|
| Rate for Payer: Quartz Beloit One Network |
$4,629.21
|
| Rate for Payer: Quartz Commercial |
$5,668.42
|
| Rate for Payer: WEA Trust Commercial |
$5,196.05
|
| Rate for Payer: WPS Commercial |
$6,997.41
|
|
|
IMPLANT SYSTEM INTERNAL BRACE KNEE LIGAMENT AUGMENTATION REPAIR WITH JUMPSTART DRESSING AR-1788J-CP
|
Facility
|
IP
|
$11,361.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5583374
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,789.57 |
| Max. Negotiated Rate |
$10,870.20 |
| Rate for Payer: Aetna Commercial |
$10,633.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,161.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,262.18
|
| Rate for Payer: Cash Price |
$3,408.30
|
| Rate for Payer: Cigna Commercial |
$10,870.20
|
| Rate for Payer: Health EOS Commercial |
$10,515.74
|
| Rate for Payer: HFN Commercial |
$10,870.20
|
| Rate for Payer: Multiplan Commercial |
$9,452.35
|
| Rate for Payer: Preferred Network Access Commercial |
$10,870.20
|
| Rate for Payer: Quartz Beloit One Network |
$5,789.57
|
| Rate for Payer: Quartz Commercial |
$7,089.26
|
| Rate for Payer: WEA Trust Commercial |
$6,498.49
|
| Rate for Payer: WPS Commercial |
$8,751.38
|
|
|
IMPLANT SYSTEM INTERNAL BRACE KNEE LIGAMENT AUGMENTATION REPAIR WITH JUMPSTART DRESSING AR-1788J-CP
|
Facility
|
OP
|
$11,361.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5583374
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,308.32 |
| Max. Negotiated Rate |
$10,870.20 |
| Rate for Payer: Aetna Commercial |
$10,633.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,161.28
|
| Rate for Payer: Aetna Managed Medicare |
$3,308.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,680.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,907.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,671.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,262.18
|
| Rate for Payer: Cash Price |
$3,408.30
|
| Rate for Payer: Cigna Commercial |
$10,870.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,612.10
|
| Rate for Payer: Health EOS Commercial |
$10,515.74
|
| Rate for Payer: HFN Commercial |
$10,870.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,861.58
|
| Rate for Payer: Multiplan Commercial |
$9,452.35
|
| Rate for Payer: NAPHCARE Commercial |
$7,089.26
|
| Rate for Payer: Preferred Network Access Commercial |
$10,870.20
|
| Rate for Payer: Quartz Beloit One Network |
$5,789.57
|
| Rate for Payer: Quartz Commercial |
$7,680.04
|
| Rate for Payer: Quartz Medicare Advantage |
$7,089.26
|
| Rate for Payer: The Alliance Commercial |
$5,907.72
|
| Rate for Payer: WEA Trust Commercial |
$6,498.49
|
| Rate for Payer: WPS Commercial |
$8,751.38
|
|
|
IMPLANT SYSTEM INTERNAL LISFRANC AR-1698-CP
|
Facility
|
IP
|
$11,361.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5597551
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,789.57 |
| Max. Negotiated Rate |
$10,870.20 |
| Rate for Payer: Aetna Commercial |
$10,633.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,161.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,262.18
|
| Rate for Payer: Cash Price |
$3,408.30
|
| Rate for Payer: Cigna Commercial |
$10,870.20
|
| Rate for Payer: Health EOS Commercial |
$10,515.74
|
| Rate for Payer: HFN Commercial |
$10,870.20
|
| Rate for Payer: Multiplan Commercial |
$9,452.35
|
| Rate for Payer: Preferred Network Access Commercial |
$10,870.20
|
| Rate for Payer: Quartz Beloit One Network |
$5,789.57
|
| Rate for Payer: Quartz Commercial |
$7,089.26
|
| Rate for Payer: WEA Trust Commercial |
$6,498.49
|
| Rate for Payer: WPS Commercial |
$8,751.38
|
|
|
IMPLANT SYSTEM INTERNAL LISFRANC AR-1698-CP
|
Facility
|
OP
|
$11,361.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5597551
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,308.32 |
| Max. Negotiated Rate |
$10,870.20 |
| Rate for Payer: Aetna Commercial |
$10,633.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,161.28
|
| Rate for Payer: Aetna Managed Medicare |
$3,308.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,680.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,907.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,671.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,262.18
|
| Rate for Payer: Cash Price |
$3,408.30
|
| Rate for Payer: Cigna Commercial |
$10,870.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,612.10
|
| Rate for Payer: Health EOS Commercial |
$10,515.74
|
| Rate for Payer: HFN Commercial |
$10,870.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,861.58
|
| Rate for Payer: Multiplan Commercial |
$9,452.35
|
| Rate for Payer: NAPHCARE Commercial |
$7,089.26
|
| Rate for Payer: Preferred Network Access Commercial |
$10,870.20
|
| Rate for Payer: Quartz Beloit One Network |
$5,789.57
|
| Rate for Payer: Quartz Commercial |
$7,680.04
|
| Rate for Payer: Quartz Medicare Advantage |
$7,089.26
|
| Rate for Payer: The Alliance Commercial |
$5,907.72
|
| Rate for Payer: WEA Trust Commercial |
$6,498.49
|
| Rate for Payer: WPS Commercial |
$8,751.38
|
|
|
IMPLANT SYSTEM MENISCAL ROOT REPAIR AR-4550
|
Facility
|
OP
|
$9,088.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5074913
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,646.43 |
| Max. Negotiated Rate |
$8,695.40 |
| Rate for Payer: Aetna Commercial |
$8,506.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,128.31
|
| Rate for Payer: Aetna Managed Medicare |
$2,646.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,143.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,725.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,536.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,009.31
|
| Rate for Payer: Cash Price |
$2,726.40
|
| Rate for Payer: Cigna Commercial |
$8,695.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,289.22
|
| Rate for Payer: Health EOS Commercial |
$8,411.85
|
| Rate for Payer: HFN Commercial |
$8,695.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,088.64
|
| Rate for Payer: Multiplan Commercial |
$7,561.22
|
| Rate for Payer: NAPHCARE Commercial |
$5,670.91
|
| Rate for Payer: Preferred Network Access Commercial |
$8,695.40
|
| Rate for Payer: Quartz Beloit One Network |
$4,631.24
|
| Rate for Payer: Quartz Commercial |
$6,143.49
|
| Rate for Payer: Quartz Medicare Advantage |
$5,670.91
|
| Rate for Payer: The Alliance Commercial |
$4,725.76
|
| Rate for Payer: WEA Trust Commercial |
$5,198.34
|
| Rate for Payer: WPS Commercial |
$7,000.49
|
|
|
IMPLANT SYSTEM MENISCAL ROOT REPAIR AR-4550
|
Facility
|
IP
|
$9,088.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5074913
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,631.24 |
| Max. Negotiated Rate |
$8,695.40 |
| Rate for Payer: Aetna Commercial |
$8,506.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,128.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,009.31
|
| Rate for Payer: Cash Price |
$2,726.40
|
| Rate for Payer: Cigna Commercial |
$8,695.40
|
| Rate for Payer: Health EOS Commercial |
$8,411.85
|
| Rate for Payer: HFN Commercial |
$8,695.40
|
| Rate for Payer: Multiplan Commercial |
$7,561.22
|
| Rate for Payer: Preferred Network Access Commercial |
$8,695.40
|
| Rate for Payer: Quartz Beloit One Network |
$4,631.24
|
| Rate for Payer: Quartz Commercial |
$5,670.91
|
| Rate for Payer: WEA Trust Commercial |
$5,198.34
|
| Rate for Payer: WPS Commercial |
$7,000.49
|
|
|
IMPLANT SYSTEM MENISCAL ROOT REPAIR WITH PEEK SWIVELOCK AR-4550P
|
Facility
|
OP
|
$8,013.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459632
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,333.39 |
| Max. Negotiated Rate |
$7,666.84 |
| Rate for Payer: Aetna Commercial |
$7,500.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,166.83
|
| Rate for Payer: Aetna Managed Medicare |
$2,333.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,416.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,166.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,000.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,416.77
|
| Rate for Payer: Cash Price |
$2,403.90
|
| Rate for Payer: Cigna Commercial |
$7,666.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,663.57
|
| Rate for Payer: Health EOS Commercial |
$7,416.83
|
| Rate for Payer: HFN Commercial |
$7,666.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,250.14
|
| Rate for Payer: Multiplan Commercial |
$6,666.82
|
| Rate for Payer: NAPHCARE Commercial |
$5,000.11
|
| Rate for Payer: Preferred Network Access Commercial |
$7,666.84
|
| Rate for Payer: Quartz Beloit One Network |
$4,083.42
|
| Rate for Payer: Quartz Commercial |
$5,416.79
|
| Rate for Payer: Quartz Medicare Advantage |
$5,000.11
|
| Rate for Payer: The Alliance Commercial |
$4,166.76
|
| Rate for Payer: WEA Trust Commercial |
$4,583.44
|
| Rate for Payer: WPS Commercial |
$6,172.41
|
|
|
IMPLANT SYSTEM MENISCAL ROOT REPAIR WITH PEEK SWIVELOCK AR-4550P
|
Facility
|
IP
|
$8,013.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459632
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,083.42 |
| Max. Negotiated Rate |
$7,666.84 |
| Rate for Payer: Aetna Commercial |
$7,500.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,166.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,416.77
|
| Rate for Payer: Cash Price |
$2,403.90
|
| Rate for Payer: Cigna Commercial |
$7,666.84
|
| Rate for Payer: Health EOS Commercial |
$7,416.83
|
| Rate for Payer: HFN Commercial |
$7,666.84
|
| Rate for Payer: Multiplan Commercial |
$6,666.82
|
| Rate for Payer: Preferred Network Access Commercial |
$7,666.84
|
| Rate for Payer: Quartz Beloit One Network |
$4,083.42
|
| Rate for Payer: Quartz Commercial |
$5,000.11
|
| Rate for Payer: WEA Trust Commercial |
$4,583.44
|
| Rate for Payer: WPS Commercial |
$6,172.41
|
|
|
IMPLANT SYSTEM MENISCAL ROOT REPAIR WITH SUTURELOC AR-4551
|
Facility
|
IP
|
$9,930.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6226150
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,060.33 |
| Max. Negotiated Rate |
$9,501.02 |
| Rate for Payer: Aetna Commercial |
$9,294.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,881.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,473.42
|
| Rate for Payer: Cash Price |
$2,979.00
|
| Rate for Payer: Cigna Commercial |
$9,501.02
|
| Rate for Payer: Health EOS Commercial |
$9,191.21
|
| Rate for Payer: HFN Commercial |
$9,501.02
|
| Rate for Payer: Multiplan Commercial |
$8,261.76
|
| Rate for Payer: Preferred Network Access Commercial |
$9,501.02
|
| Rate for Payer: Quartz Beloit One Network |
$5,060.33
|
| Rate for Payer: Quartz Commercial |
$6,196.32
|
| Rate for Payer: WEA Trust Commercial |
$5,679.96
|
| Rate for Payer: WPS Commercial |
$7,649.08
|
|
|
IMPLANT SYSTEM MENISCAL ROOT REPAIR WITH SUTURELOC AR-4551
|
Facility
|
OP
|
$9,930.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6226150
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,891.62 |
| Max. Negotiated Rate |
$9,501.02 |
| Rate for Payer: Aetna Commercial |
$9,294.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,881.39
|
| Rate for Payer: Aetna Managed Medicare |
$2,891.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,712.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,163.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,957.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,473.42
|
| Rate for Payer: Cash Price |
$2,979.00
|
| Rate for Payer: Cigna Commercial |
$9,501.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,779.26
|
| Rate for Payer: Health EOS Commercial |
$9,191.21
|
| Rate for Payer: HFN Commercial |
$9,501.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,745.40
|
| Rate for Payer: Multiplan Commercial |
$8,261.76
|
| Rate for Payer: NAPHCARE Commercial |
$6,196.32
|
| Rate for Payer: Preferred Network Access Commercial |
$9,501.02
|
| Rate for Payer: Quartz Beloit One Network |
$5,060.33
|
| Rate for Payer: Quartz Commercial |
$6,712.68
|
| Rate for Payer: Quartz Medicare Advantage |
$6,196.32
|
| Rate for Payer: The Alliance Commercial |
$5,163.60
|
| Rate for Payer: WEA Trust Commercial |
$5,679.96
|
| Rate for Payer: WPS Commercial |
$7,649.08
|
|
|
IMPLANT SYSTEM MPFL BIOCOMPOSITE AR-1360C-CP
|
Facility
|
OP
|
$10,868.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415024
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,164.76 |
| Max. Negotiated Rate |
$10,398.50 |
| Rate for Payer: Aetna Commercial |
$10,172.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,720.34
|
| Rate for Payer: Aetna Managed Medicare |
$3,164.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,346.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,651.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,425.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,990.44
|
| Rate for Payer: Cash Price |
$3,260.40
|
| Rate for Payer: Cigna Commercial |
$10,398.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,325.18
|
| Rate for Payer: Health EOS Commercial |
$10,059.42
|
| Rate for Payer: HFN Commercial |
$10,398.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,477.04
|
| Rate for Payer: Multiplan Commercial |
$9,042.18
|
| Rate for Payer: NAPHCARE Commercial |
$6,781.63
|
| Rate for Payer: Preferred Network Access Commercial |
$10,398.50
|
| Rate for Payer: Quartz Beloit One Network |
$5,538.33
|
| Rate for Payer: Quartz Commercial |
$7,346.77
|
| Rate for Payer: Quartz Medicare Advantage |
$6,781.63
|
| Rate for Payer: The Alliance Commercial |
$5,651.36
|
| Rate for Payer: WEA Trust Commercial |
$6,216.50
|
| Rate for Payer: WPS Commercial |
$8,371.62
|
|
|
IMPLANT SYSTEM MPFL BIOCOMPOSITE AR-1360C-CP
|
Facility
|
IP
|
$10,868.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415024
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,538.33 |
| Max. Negotiated Rate |
$10,398.50 |
| Rate for Payer: Aetna Commercial |
$10,172.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,720.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,990.44
|
| Rate for Payer: Cash Price |
$3,260.40
|
| Rate for Payer: Cigna Commercial |
$10,398.50
|
| Rate for Payer: Health EOS Commercial |
$10,059.42
|
| Rate for Payer: HFN Commercial |
$10,398.50
|
| Rate for Payer: Multiplan Commercial |
$9,042.18
|
| Rate for Payer: Preferred Network Access Commercial |
$10,398.50
|
| Rate for Payer: Quartz Beloit One Network |
$5,538.33
|
| Rate for Payer: Quartz Commercial |
$6,781.63
|
| Rate for Payer: WEA Trust Commercial |
$6,216.50
|
| Rate for Payer: WPS Commercial |
$8,371.62
|
|
|
IMPLANT SYSTEM MPFL FAST THREAD SCREW & BIOCOMPOSITE SWIVELOCK ANCHORS 3.9X17.9MM/6X20MM AR-1360FT-
|
Facility
|
IP
|
$14,015.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6105628
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,142.04 |
| Max. Negotiated Rate |
$13,409.55 |
| Rate for Payer: Aetna Commercial |
$13,118.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,535.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,725.07
|
| Rate for Payer: Cash Price |
$4,204.50
|
| Rate for Payer: Cigna Commercial |
$13,409.55
|
| Rate for Payer: Health EOS Commercial |
$12,972.28
|
| Rate for Payer: HFN Commercial |
$13,409.55
|
| Rate for Payer: Multiplan Commercial |
$11,660.48
|
| Rate for Payer: Preferred Network Access Commercial |
$13,409.55
|
| Rate for Payer: Quartz Beloit One Network |
$7,142.04
|
| Rate for Payer: Quartz Commercial |
$8,745.36
|
| Rate for Payer: WEA Trust Commercial |
$8,016.58
|
| Rate for Payer: WPS Commercial |
$10,795.75
|
|
|
IMPLANT SYSTEM MPFL FAST THREAD SCREW & BIOCOMPOSITE SWIVELOCK ANCHORS 3.9X17.9MM/6X20MM AR-1360FT-
|
Facility
|
OP
|
$14,015.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6105628
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,081.17 |
| Max. Negotiated Rate |
$13,409.55 |
| Rate for Payer: Aetna Commercial |
$13,118.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,535.02
|
| Rate for Payer: Aetna Managed Medicare |
$4,081.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,474.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,287.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,996.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,725.07
|
| Rate for Payer: Cash Price |
$4,204.50
|
| Rate for Payer: Cigna Commercial |
$13,409.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,156.73
|
| Rate for Payer: Health EOS Commercial |
$12,972.28
|
| Rate for Payer: HFN Commercial |
$13,409.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,931.70
|
| Rate for Payer: Multiplan Commercial |
$11,660.48
|
| Rate for Payer: NAPHCARE Commercial |
$8,745.36
|
| Rate for Payer: Preferred Network Access Commercial |
$13,409.55
|
| Rate for Payer: Quartz Beloit One Network |
$7,142.04
|
| Rate for Payer: Quartz Commercial |
$9,474.14
|
| Rate for Payer: Quartz Medicare Advantage |
$8,745.36
|
| Rate for Payer: The Alliance Commercial |
$7,287.80
|
| Rate for Payer: WEA Trust Commercial |
$8,016.58
|
| Rate for Payer: WPS Commercial |
$10,795.75
|
|
|
IMPLANT SYSTEM MPFL TIGHTROPE AR-1360TR-BC
|
Facility
|
IP
|
$14,576.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685809
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,427.93 |
| Max. Negotiated Rate |
$13,946.32 |
| Rate for Payer: Aetna Commercial |
$13,643.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,036.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,034.29
|
| Rate for Payer: Cash Price |
$4,372.80
|
| Rate for Payer: Cigna Commercial |
$13,946.32
|
| Rate for Payer: Health EOS Commercial |
$13,491.55
|
| Rate for Payer: HFN Commercial |
$13,946.32
|
| Rate for Payer: Multiplan Commercial |
$12,127.23
|
| Rate for Payer: Preferred Network Access Commercial |
$13,946.32
|
| Rate for Payer: Quartz Beloit One Network |
$7,427.93
|
| Rate for Payer: Quartz Commercial |
$9,095.42
|
| Rate for Payer: WEA Trust Commercial |
$8,337.47
|
| Rate for Payer: WPS Commercial |
$11,227.89
|
|
