|
IMPLANT SUBTALAR 9MM
|
Facility
|
IP
|
$6,407.00
|
|
| Hospital Charge Code |
2965166
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,139.43 |
| Max. Negotiated Rate |
$5,894.44 |
| Rate for Payer: Aetna Commercial |
$5,766.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,510.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,395.71
|
| Rate for Payer: Cash Price |
$1,922.10
|
| Rate for Payer: Cigna Commercial |
$5,894.44
|
| Rate for Payer: Health EOS Commercial |
$5,702.23
|
| Rate for Payer: HFN Commercial |
$5,894.44
|
| Rate for Payer: Multiplan Commercial |
$5,125.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,844.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,894.44
|
| Rate for Payer: Quartz Beloit One Network |
$3,139.43
|
| Rate for Payer: Quartz Commercial |
$3,844.20
|
| Rate for Payer: WEA Trust Commercial |
$3,523.85
|
| Rate for Payer: WPS Commercial |
$4,745.66
|
|
|
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 |
$3,737.23 |
| Max. Negotiated Rate |
$7,016.84 |
| Rate for Payer: Aetna Commercial |
$6,864.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,559.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,042.31
|
| Rate for Payer: Cash Price |
$2,288.10
|
| Rate for Payer: Cigna Commercial |
$7,016.84
|
| Rate for Payer: Health EOS Commercial |
$6,788.03
|
| Rate for Payer: HFN Commercial |
$7,016.84
|
| Rate for Payer: Multiplan Commercial |
$6,101.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,576.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,016.84
|
| Rate for Payer: Quartz Beloit One Network |
$3,737.23
|
| Rate for Payer: Quartz Commercial |
$4,576.20
|
| Rate for Payer: WEA Trust Commercial |
$4,194.85
|
| Rate for Payer: WPS Commercial |
$5,649.32
|
|
|
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 |
$2,135.56 |
| Max. Negotiated Rate |
$30,508.00 |
| Rate for Payer: Aetna Commercial |
$6,864.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,559.22
|
| Rate for Payer: Aetna Managed Medicare |
$2,135.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,957.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,813.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,660.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,042.31
|
| Rate for Payer: Cash Price |
$2,288.10
|
| Rate for Payer: Cigna Commercial |
$7,016.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,268.07
|
| Rate for Payer: Health EOS Commercial |
$6,788.03
|
| Rate for Payer: HFN Commercial |
$7,016.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,720.25
|
| Rate for Payer: Multiplan Commercial |
$6,101.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,576.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,016.84
|
| Rate for Payer: Quartz Beloit One Network |
$3,737.23
|
| Rate for Payer: Quartz Commercial |
$4,957.55
|
| Rate for Payer: Quartz Medicare Advantage |
$4,576.20
|
| Rate for Payer: The Alliance Commercial |
$30,508.00
|
| Rate for Payer: WEA Trust Commercial |
$4,194.85
|
| Rate for Payer: WPS Commercial |
$5,649.32
|
|
|
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 |
$3,730.37 |
| Max. Negotiated Rate |
$7,003.96 |
| Rate for Payer: Aetna Commercial |
$6,851.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,547.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,034.89
|
| Rate for Payer: Cash Price |
$2,283.90
|
| Rate for Payer: Cigna Commercial |
$7,003.96
|
| Rate for Payer: Health EOS Commercial |
$6,775.57
|
| Rate for Payer: HFN Commercial |
$7,003.96
|
| Rate for Payer: Multiplan Commercial |
$6,090.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,567.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,003.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,730.37
|
| Rate for Payer: Quartz Commercial |
$4,567.80
|
| Rate for Payer: WEA Trust Commercial |
$4,187.15
|
| Rate for Payer: WPS Commercial |
$5,638.95
|
|
|
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 |
$2,131.64 |
| Max. Negotiated Rate |
$30,452.00 |
| Rate for Payer: Aetna Commercial |
$6,851.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,547.18
|
| Rate for Payer: Aetna Managed Medicare |
$2,131.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,948.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,806.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,654.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,034.89
|
| Rate for Payer: Cash Price |
$2,283.90
|
| Rate for Payer: Cigna Commercial |
$7,003.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,260.23
|
| Rate for Payer: Health EOS Commercial |
$6,775.57
|
| Rate for Payer: HFN Commercial |
$7,003.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,709.75
|
| Rate for Payer: Multiplan Commercial |
$6,090.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,567.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,003.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,730.37
|
| Rate for Payer: Quartz Commercial |
$4,948.45
|
| Rate for Payer: Quartz Medicare Advantage |
$4,567.80
|
| Rate for Payer: The Alliance Commercial |
$30,452.00
|
| Rate for Payer: WEA Trust Commercial |
$4,187.15
|
| Rate for Payer: WPS Commercial |
$5,638.95
|
|
|
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 |
$2,140.88 |
| Max. Negotiated Rate |
$30,584.00 |
| Rate for Payer: Aetna Commercial |
$6,881.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,575.56
|
| Rate for Payer: Aetna Managed Medicare |
$2,140.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,969.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,823.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,670.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,052.38
|
| Rate for Payer: Cash Price |
$2,293.80
|
| Rate for Payer: Cigna Commercial |
$7,034.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,278.70
|
| Rate for Payer: Health EOS Commercial |
$6,804.94
|
| Rate for Payer: HFN Commercial |
$7,034.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,734.50
|
| Rate for Payer: Multiplan Commercial |
$6,116.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,587.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,034.32
|
| Rate for Payer: Quartz Beloit One Network |
$3,746.54
|
| Rate for Payer: Quartz Commercial |
$4,969.90
|
| Rate for Payer: Quartz Medicare Advantage |
$4,587.60
|
| Rate for Payer: The Alliance Commercial |
$30,584.00
|
| Rate for Payer: WEA Trust Commercial |
$4,205.30
|
| Rate for Payer: WPS Commercial |
$5,663.39
|
|
|
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 |
$3,746.54 |
| Max. Negotiated Rate |
$7,034.32 |
| Rate for Payer: Aetna Commercial |
$6,881.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,575.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,052.38
|
| Rate for Payer: Cash Price |
$2,293.80
|
| Rate for Payer: Cigna Commercial |
$7,034.32
|
| Rate for Payer: Health EOS Commercial |
$6,804.94
|
| Rate for Payer: HFN Commercial |
$7,034.32
|
| Rate for Payer: Multiplan Commercial |
$6,116.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,587.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,034.32
|
| Rate for Payer: Quartz Beloit One Network |
$3,746.54
|
| Rate for Payer: Quartz Commercial |
$4,587.60
|
| Rate for Payer: WEA Trust Commercial |
$4,205.30
|
| Rate for Payer: WPS Commercial |
$5,663.39
|
|
|
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 |
$2,743.51 |
| Max. Negotiated Rate |
$5,151.08 |
| Rate for Payer: Aetna Commercial |
$5,039.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,815.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,967.47
|
| Rate for Payer: Cash Price |
$1,679.70
|
| Rate for Payer: Cigna Commercial |
$5,151.08
|
| Rate for Payer: Health EOS Commercial |
$4,983.11
|
| Rate for Payer: HFN Commercial |
$5,151.08
|
| Rate for Payer: Multiplan Commercial |
$4,479.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,359.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,151.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,743.51
|
| Rate for Payer: Quartz Commercial |
$3,359.40
|
| Rate for Payer: WEA Trust Commercial |
$3,079.45
|
| Rate for Payer: WPS Commercial |
$4,147.18
|
|
|
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 |
$1,567.72 |
| Max. Negotiated Rate |
$22,396.00 |
| Rate for Payer: Aetna Commercial |
$5,039.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,815.14
|
| Rate for Payer: Aetna Managed Medicare |
$1,567.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,639.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,799.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,687.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,967.47
|
| Rate for Payer: Cash Price |
$1,679.70
|
| Rate for Payer: Cigna Commercial |
$5,151.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,133.20
|
| Rate for Payer: Health EOS Commercial |
$4,983.11
|
| Rate for Payer: HFN Commercial |
$5,151.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,199.25
|
| Rate for Payer: Multiplan Commercial |
$4,479.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,359.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,151.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,743.51
|
| Rate for Payer: Quartz Commercial |
$3,639.35
|
| Rate for Payer: Quartz Medicare Advantage |
$3,359.40
|
| Rate for Payer: The Alliance Commercial |
$22,396.00
|
| Rate for Payer: WEA Trust Commercial |
$3,079.45
|
| Rate for Payer: WPS Commercial |
$4,147.18
|
|
|
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 |
$2,078.44 |
| Max. Negotiated Rate |
$29,692.00 |
| Rate for Payer: Aetna Commercial |
$6,680.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,383.78
|
| Rate for Payer: Aetna Managed Medicare |
$2,078.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,824.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,711.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,563.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,934.19
|
| Rate for Payer: Cash Price |
$2,226.90
|
| Rate for Payer: Cigna Commercial |
$6,829.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,153.91
|
| Rate for Payer: Health EOS Commercial |
$6,606.47
|
| Rate for Payer: HFN Commercial |
$6,829.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,567.25
|
| Rate for Payer: Multiplan Commercial |
$5,938.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,453.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,829.16
|
| Rate for Payer: Quartz Beloit One Network |
$3,637.27
|
| Rate for Payer: Quartz Commercial |
$4,824.95
|
| Rate for Payer: Quartz Medicare Advantage |
$4,453.80
|
| Rate for Payer: The Alliance Commercial |
$29,692.00
|
| Rate for Payer: WEA Trust Commercial |
$4,082.65
|
| Rate for Payer: WPS Commercial |
$5,498.22
|
|
|
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 |
$3,637.27 |
| Max. Negotiated Rate |
$6,829.16 |
| Rate for Payer: Aetna Commercial |
$6,680.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,383.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,934.19
|
| Rate for Payer: Cash Price |
$2,226.90
|
| Rate for Payer: Cigna Commercial |
$6,829.16
|
| Rate for Payer: Health EOS Commercial |
$6,606.47
|
| Rate for Payer: HFN Commercial |
$6,829.16
|
| Rate for Payer: Multiplan Commercial |
$5,938.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,453.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,829.16
|
| Rate for Payer: Quartz Beloit One Network |
$3,637.27
|
| Rate for Payer: Quartz Commercial |
$4,453.80
|
| Rate for Payer: WEA Trust Commercial |
$4,082.65
|
| Rate for Payer: WPS Commercial |
$5,498.22
|
|
|
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 |
$1,790.04 |
| Max. Negotiated Rate |
$25,572.00 |
| Rate for Payer: Aetna Commercial |
$5,753.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,497.98
|
| Rate for Payer: Aetna Managed Medicare |
$1,790.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,155.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,196.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,068.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,388.29
|
| Rate for Payer: Cash Price |
$1,917.90
|
| Rate for Payer: Cigna Commercial |
$5,881.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,577.52
|
| Rate for Payer: Health EOS Commercial |
$5,689.77
|
| Rate for Payer: HFN Commercial |
$5,881.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,794.75
|
| Rate for Payer: Multiplan Commercial |
$5,114.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,835.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,881.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,132.57
|
| Rate for Payer: Quartz Commercial |
$4,155.45
|
| Rate for Payer: Quartz Medicare Advantage |
$3,835.80
|
| Rate for Payer: The Alliance Commercial |
$25,572.00
|
| Rate for Payer: WEA Trust Commercial |
$3,516.15
|
| Rate for Payer: WPS Commercial |
$4,735.30
|
|
|
IMPLANT 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 |
$3,132.57 |
| Max. Negotiated Rate |
$5,881.56 |
| Rate for Payer: Aetna Commercial |
$5,753.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,497.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,388.29
|
| Rate for Payer: Cash Price |
$1,917.90
|
| Rate for Payer: Cigna Commercial |
$5,881.56
|
| Rate for Payer: Health EOS Commercial |
$5,689.77
|
| Rate for Payer: HFN Commercial |
$5,881.56
|
| Rate for Payer: Multiplan Commercial |
$5,114.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,835.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,881.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,132.57
|
| Rate for Payer: Quartz Commercial |
$3,835.80
|
| Rate for Payer: WEA Trust Commercial |
$3,516.15
|
| Rate for Payer: WPS Commercial |
$4,735.30
|
|
|
IMPLANT 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 |
$1,733.48 |
| Max. Negotiated Rate |
$24,764.00 |
| Rate for Payer: Aetna Commercial |
$5,571.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,324.26
|
| Rate for Payer: Aetna Managed Medicare |
$1,733.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,024.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,095.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,971.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,281.23
|
| Rate for Payer: Cash Price |
$1,857.30
|
| Rate for Payer: Cigna Commercial |
$5,695.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,464.48
|
| Rate for Payer: Health EOS Commercial |
$5,509.99
|
| Rate for Payer: HFN Commercial |
$5,695.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,643.25
|
| Rate for Payer: Multiplan Commercial |
$4,952.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,714.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,695.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,033.59
|
| Rate for Payer: Quartz Commercial |
$4,024.15
|
| Rate for Payer: Quartz Medicare Advantage |
$3,714.60
|
| Rate for Payer: The Alliance Commercial |
$24,764.00
|
| Rate for Payer: WEA Trust Commercial |
$3,405.05
|
| Rate for Payer: WPS Commercial |
$4,585.67
|
|
|
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 |
$3,033.59 |
| Max. Negotiated Rate |
$5,695.72 |
| Rate for Payer: Aetna Commercial |
$5,571.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,324.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,281.23
|
| Rate for Payer: Cash Price |
$1,857.30
|
| Rate for Payer: Cigna Commercial |
$5,695.72
|
| Rate for Payer: Health EOS Commercial |
$5,509.99
|
| Rate for Payer: HFN Commercial |
$5,695.72
|
| Rate for Payer: Multiplan Commercial |
$4,952.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,714.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,695.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,033.59
|
| Rate for Payer: Quartz Commercial |
$3,714.60
|
| Rate for Payer: WEA Trust Commercial |
$3,405.05
|
| Rate for Payer: WPS Commercial |
$4,585.67
|
|
|
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 |
$3,580.08 |
| Max. Negotiated Rate |
$51,144.00 |
| Rate for Payer: Aetna Commercial |
$11,507.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,995.96
|
| Rate for Payer: Aetna Managed Medicare |
$3,580.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,310.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,393.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,137.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,776.58
|
| Rate for Payer: Cash Price |
$3,835.80
|
| Rate for Payer: Cigna Commercial |
$11,763.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,155.05
|
| Rate for Payer: Health EOS Commercial |
$11,379.54
|
| Rate for Payer: HFN Commercial |
$11,763.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,589.50
|
| Rate for Payer: Multiplan Commercial |
$10,228.80
|
| Rate for Payer: NAPHCARE Commercial |
$7,671.60
|
| Rate for Payer: Preferred Network Access Commercial |
$11,763.12
|
| Rate for Payer: Quartz Beloit One Network |
$6,265.14
|
| Rate for Payer: Quartz Commercial |
$8,310.90
|
| Rate for Payer: Quartz Medicare Advantage |
$7,671.60
|
| Rate for Payer: The Alliance Commercial |
$51,144.00
|
| Rate for Payer: WEA Trust Commercial |
$7,032.30
|
| Rate for Payer: WPS Commercial |
$9,470.59
|
|
|
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 |
$6,265.14 |
| Max. Negotiated Rate |
$11,763.12 |
| Rate for Payer: Aetna Commercial |
$11,507.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,995.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,776.58
|
| Rate for Payer: Cash Price |
$3,835.80
|
| Rate for Payer: Cigna Commercial |
$11,763.12
|
| Rate for Payer: Health EOS Commercial |
$11,379.54
|
| Rate for Payer: HFN Commercial |
$11,763.12
|
| Rate for Payer: Multiplan Commercial |
$10,228.80
|
| Rate for Payer: NAPHCARE Commercial |
$7,671.60
|
| Rate for Payer: Preferred Network Access Commercial |
$11,763.12
|
| Rate for Payer: Quartz Beloit One Network |
$6,265.14
|
| Rate for Payer: Quartz Commercial |
$7,671.60
|
| Rate for Payer: WEA Trust Commercial |
$7,032.30
|
| Rate for Payer: WPS Commercial |
$9,470.59
|
|
|
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 |
$1,979.32 |
| Max. Negotiated Rate |
$28,276.00 |
| Rate for Payer: Aetna Commercial |
$6,362.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,079.34
|
| Rate for Payer: Aetna Managed Medicare |
$1,979.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,594.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,534.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,393.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,746.57
|
| Rate for Payer: Cash Price |
$2,120.70
|
| Rate for Payer: Cigna Commercial |
$6,503.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,955.81
|
| Rate for Payer: Health EOS Commercial |
$6,291.41
|
| Rate for Payer: HFN Commercial |
$6,503.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,301.75
|
| Rate for Payer: Multiplan Commercial |
$5,655.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,241.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,503.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,463.81
|
| Rate for Payer: Quartz Commercial |
$4,594.85
|
| Rate for Payer: Quartz Medicare Advantage |
$4,241.40
|
| Rate for Payer: The Alliance Commercial |
$28,276.00
|
| Rate for Payer: WEA Trust Commercial |
$3,887.95
|
| Rate for Payer: WPS Commercial |
$5,236.01
|
|
|
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 |
$3,463.81 |
| Max. Negotiated Rate |
$6,503.48 |
| Rate for Payer: Aetna Commercial |
$6,362.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,079.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,746.57
|
| Rate for Payer: Cash Price |
$2,120.70
|
| Rate for Payer: Cigna Commercial |
$6,503.48
|
| Rate for Payer: Health EOS Commercial |
$6,291.41
|
| Rate for Payer: HFN Commercial |
$6,503.48
|
| Rate for Payer: Multiplan Commercial |
$5,655.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,241.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,503.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,463.81
|
| Rate for Payer: Quartz Commercial |
$4,241.40
|
| Rate for Payer: WEA Trust Commercial |
$3,887.95
|
| Rate for Payer: WPS Commercial |
$5,236.01
|
|
|
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 |
$1,996.40 |
| Max. Negotiated Rate |
$28,520.00 |
| Rate for Payer: Aetna Commercial |
$6,417.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,131.80
|
| Rate for Payer: Aetna Managed Medicare |
$1,996.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,634.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,565.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,422.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,778.90
|
| Rate for Payer: Cash Price |
$2,139.00
|
| Rate for Payer: Cigna Commercial |
$6,559.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,989.95
|
| Rate for Payer: Health EOS Commercial |
$6,345.70
|
| Rate for Payer: HFN Commercial |
$6,559.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,347.50
|
| Rate for Payer: Multiplan Commercial |
$5,704.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,278.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,559.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,493.70
|
| Rate for Payer: Quartz Commercial |
$4,634.50
|
| Rate for Payer: Quartz Medicare Advantage |
$4,278.00
|
| Rate for Payer: The Alliance Commercial |
$28,520.00
|
| Rate for Payer: WEA Trust Commercial |
$3,921.50
|
| Rate for Payer: WPS Commercial |
$5,281.19
|
|
|
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 |
$3,493.70 |
| Max. Negotiated Rate |
$6,559.60 |
| Rate for Payer: Aetna Commercial |
$6,417.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,131.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,778.90
|
| Rate for Payer: Cash Price |
$2,139.00
|
| Rate for Payer: Cigna Commercial |
$6,559.60
|
| Rate for Payer: Health EOS Commercial |
$6,345.70
|
| Rate for Payer: HFN Commercial |
$6,559.60
|
| Rate for Payer: Multiplan Commercial |
$5,704.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,278.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,559.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,493.70
|
| Rate for Payer: Quartz Commercial |
$4,278.00
|
| Rate for Payer: WEA Trust Commercial |
$3,921.50
|
| Rate for Payer: WPS Commercial |
$5,281.19
|
|
|
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 |
$4,654.51 |
| Max. Negotiated Rate |
$8,739.08 |
| Rate for Payer: Aetna Commercial |
$8,549.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,169.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,034.47
|
| Rate for Payer: Cash Price |
$2,849.70
|
| Rate for Payer: Cigna Commercial |
$8,739.08
|
| Rate for Payer: Health EOS Commercial |
$8,454.11
|
| Rate for Payer: HFN Commercial |
$8,739.08
|
| Rate for Payer: Multiplan Commercial |
$7,599.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,699.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,739.08
|
| Rate for Payer: Quartz Beloit One Network |
$4,654.51
|
| Rate for Payer: Quartz Commercial |
$5,699.40
|
| Rate for Payer: WEA Trust Commercial |
$5,224.45
|
| Rate for Payer: WPS Commercial |
$7,035.91
|
|
|
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 |
$2,659.72 |
| Max. Negotiated Rate |
$37,996.00 |
| Rate for Payer: Aetna Commercial |
$8,549.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,169.14
|
| Rate for Payer: Aetna Managed Medicare |
$2,659.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,174.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,749.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,559.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,034.47
|
| Rate for Payer: Cash Price |
$2,849.70
|
| Rate for Payer: Cigna Commercial |
$8,739.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,315.64
|
| Rate for Payer: Health EOS Commercial |
$8,454.11
|
| Rate for Payer: HFN Commercial |
$8,739.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,124.25
|
| Rate for Payer: Multiplan Commercial |
$7,599.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,699.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,739.08
|
| Rate for Payer: Quartz Beloit One Network |
$4,654.51
|
| Rate for Payer: Quartz Commercial |
$6,174.35
|
| Rate for Payer: Quartz Medicare Advantage |
$5,699.40
|
| Rate for Payer: The Alliance Commercial |
$37,996.00
|
| Rate for Payer: WEA Trust Commercial |
$5,224.45
|
| Rate for Payer: WPS Commercial |
$7,035.91
|
|
|
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 |
$1,939.28 |
| Max. Negotiated Rate |
$27,704.00 |
| Rate for Payer: Aetna Commercial |
$6,233.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,956.36
|
| Rate for Payer: Aetna Managed Medicare |
$1,939.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,501.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,463.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,324.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,670.78
|
| Rate for Payer: Cash Price |
$2,077.80
|
| Rate for Payer: Cigna Commercial |
$6,371.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,875.79
|
| Rate for Payer: Health EOS Commercial |
$6,164.14
|
| Rate for Payer: HFN Commercial |
$6,371.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,194.50
|
| Rate for Payer: Multiplan Commercial |
$5,540.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,155.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,371.92
|
| Rate for Payer: Quartz Beloit One Network |
$3,393.74
|
| Rate for Payer: Quartz Commercial |
$4,501.90
|
| Rate for Payer: Quartz Medicare Advantage |
$4,155.60
|
| Rate for Payer: The Alliance Commercial |
$27,704.00
|
| Rate for Payer: WEA Trust Commercial |
$3,809.30
|
| Rate for Payer: WPS Commercial |
$5,130.09
|
|
|
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 |
$3,393.74 |
| Max. Negotiated Rate |
$6,371.92 |
| Rate for Payer: Aetna Commercial |
$6,233.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,956.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,670.78
|
| Rate for Payer: Cash Price |
$2,077.80
|
| Rate for Payer: Cigna Commercial |
$6,371.92
|
| Rate for Payer: Health EOS Commercial |
$6,164.14
|
| Rate for Payer: HFN Commercial |
$6,371.92
|
| Rate for Payer: Multiplan Commercial |
$5,540.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,155.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,371.92
|
| Rate for Payer: Quartz Beloit One Network |
$3,393.74
|
| Rate for Payer: Quartz Commercial |
$4,155.60
|
| Rate for Payer: WEA Trust Commercial |
$3,809.30
|
| Rate for Payer: WPS Commercial |
$5,130.09
|
|
