|
IMPLANT SYSTEM MPFL TIGHTROPE AR-1360TR-BC
|
Facility
|
OP
|
$14,576.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685809
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,244.53 |
| 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: Aetna Managed Medicare |
$4,244.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,853.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,579.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,276.34
|
| 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: Dean Health DHI/DHP/ASO |
$8,483.23
|
| Rate for Payer: Health EOS Commercial |
$13,491.55
|
| Rate for Payer: HFN Commercial |
$13,946.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,369.28
|
| Rate for Payer: Multiplan Commercial |
$12,127.23
|
| Rate for Payer: NAPHCARE Commercial |
$9,095.42
|
| 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 |
$9,853.38
|
| Rate for Payer: Quartz Medicare Advantage |
$9,095.42
|
| Rate for Payer: The Alliance Commercial |
$7,579.52
|
| Rate for Payer: WEA Trust Commercial |
$8,337.47
|
| Rate for Payer: WPS Commercial |
$11,227.89
|
|
|
IMPLANT SYSTEM PARS SUTURE TAPE AR-8862DS
|
Facility
|
OP
|
$10,924.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5831810
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,181.07 |
| Max. Negotiated Rate |
$10,452.08 |
| Rate for Payer: Aetna Commercial |
$10,224.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,770.43
|
| Rate for Payer: Aetna Managed Medicare |
$3,181.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,384.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,680.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,453.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,021.31
|
| Rate for Payer: Cash Price |
$3,277.20
|
| Rate for Payer: Cigna Commercial |
$10,452.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,357.77
|
| Rate for Payer: Health EOS Commercial |
$10,111.25
|
| Rate for Payer: HFN Commercial |
$10,452.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,520.72
|
| Rate for Payer: Multiplan Commercial |
$9,088.77
|
| Rate for Payer: NAPHCARE Commercial |
$6,816.58
|
| Rate for Payer: Preferred Network Access Commercial |
$10,452.08
|
| Rate for Payer: Quartz Beloit One Network |
$5,566.87
|
| Rate for Payer: Quartz Commercial |
$7,384.62
|
| Rate for Payer: Quartz Medicare Advantage |
$6,816.58
|
| Rate for Payer: The Alliance Commercial |
$5,680.48
|
| Rate for Payer: WEA Trust Commercial |
$6,248.53
|
| Rate for Payer: WPS Commercial |
$8,414.76
|
|
|
IMPLANT SYSTEM PARS SUTURE TAPE AR-8862DS
|
Facility
|
IP
|
$10,924.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5831810
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,566.87 |
| Max. Negotiated Rate |
$10,452.08 |
| Rate for Payer: Aetna Commercial |
$10,224.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,770.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,021.31
|
| Rate for Payer: Cash Price |
$3,277.20
|
| Rate for Payer: Cigna Commercial |
$10,452.08
|
| Rate for Payer: Health EOS Commercial |
$10,111.25
|
| Rate for Payer: HFN Commercial |
$10,452.08
|
| Rate for Payer: Multiplan Commercial |
$9,088.77
|
| Rate for Payer: Preferred Network Access Commercial |
$10,452.08
|
| Rate for Payer: Quartz Beloit One Network |
$5,566.87
|
| Rate for Payer: Quartz Commercial |
$6,816.58
|
| Rate for Payer: WEA Trust Commercial |
$6,248.53
|
| Rate for Payer: WPS Commercial |
$8,414.76
|
|
|
IMPLANT SYSTEM SECONDARY FIXATION SWIVELOCK ACL/PCL REPAIR AR-1593/AR-1593-BC
|
Facility
|
OP
|
$4,787.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5349533
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,393.97 |
| Max. Negotiated Rate |
$4,580.20 |
| Rate for Payer: Aetna Commercial |
$4,480.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,281.49
|
| Rate for Payer: Aetna Managed Medicare |
$1,393.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,236.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,489.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,389.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,638.59
|
| Rate for Payer: Cash Price |
$1,436.10
|
| Rate for Payer: Cigna Commercial |
$4,580.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,786.03
|
| Rate for Payer: Health EOS Commercial |
$4,430.85
|
| Rate for Payer: HFN Commercial |
$4,580.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,733.86
|
| Rate for Payer: Multiplan Commercial |
$3,982.78
|
| Rate for Payer: NAPHCARE Commercial |
$2,987.09
|
| Rate for Payer: Preferred Network Access Commercial |
$4,580.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,439.46
|
| Rate for Payer: Quartz Commercial |
$3,236.01
|
| Rate for Payer: Quartz Medicare Advantage |
$2,987.09
|
| Rate for Payer: The Alliance Commercial |
$2,489.24
|
| Rate for Payer: WEA Trust Commercial |
$2,738.16
|
| Rate for Payer: WPS Commercial |
$3,687.43
|
|
|
IMPLANT SYSTEM SECONDARY FIXATION SWIVELOCK ACL/PCL REPAIR AR-1593/AR-1593-BC
|
Facility
|
IP
|
$4,787.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5349533
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,439.46 |
| Max. Negotiated Rate |
$4,580.20 |
| Rate for Payer: Aetna Commercial |
$4,480.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,281.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,638.59
|
| Rate for Payer: Cash Price |
$1,436.10
|
| Rate for Payer: Cigna Commercial |
$4,580.20
|
| Rate for Payer: Health EOS Commercial |
$4,430.85
|
| Rate for Payer: HFN Commercial |
$4,580.20
|
| Rate for Payer: Multiplan Commercial |
$3,982.78
|
| Rate for Payer: Preferred Network Access Commercial |
$4,580.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,439.46
|
| Rate for Payer: Quartz Commercial |
$2,987.09
|
| Rate for Payer: WEA Trust Commercial |
$2,738.16
|
| Rate for Payer: WPS Commercial |
$3,687.43
|
|
|
IMPLANT SYSTEM SWIVELOCK DX KNOTLESS BC 4.75MM AR-8981BCTJ-CP
|
Facility
|
OP
|
$7,339.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6175724
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,137.12 |
| Max. Negotiated Rate |
$7,021.96 |
| Rate for Payer: Aetna Commercial |
$6,869.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,564.00
|
| Rate for Payer: Aetna Managed Medicare |
$2,137.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,961.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,816.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,663.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,045.26
|
| Rate for Payer: Cash Price |
$2,201.70
|
| Rate for Payer: Cigna Commercial |
$7,021.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,271.30
|
| Rate for Payer: Health EOS Commercial |
$6,792.98
|
| Rate for Payer: HFN Commercial |
$7,021.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,724.42
|
| Rate for Payer: Multiplan Commercial |
$6,106.05
|
| Rate for Payer: NAPHCARE Commercial |
$4,579.54
|
| Rate for Payer: Preferred Network Access Commercial |
$7,021.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,739.95
|
| Rate for Payer: Quartz Commercial |
$4,961.16
|
| Rate for Payer: Quartz Medicare Advantage |
$4,579.54
|
| Rate for Payer: The Alliance Commercial |
$3,816.28
|
| Rate for Payer: WEA Trust Commercial |
$4,197.91
|
| Rate for Payer: WPS Commercial |
$5,653.23
|
|
|
IMPLANT SYSTEM SWIVELOCK DX KNOTLESS BC 4.75MM AR-8981BCTJ-CP
|
Facility
|
IP
|
$7,339.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6175724
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,739.95 |
| Max. Negotiated Rate |
$7,021.96 |
| Rate for Payer: Aetna Commercial |
$6,869.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,564.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,045.26
|
| Rate for Payer: Cash Price |
$2,201.70
|
| Rate for Payer: Cigna Commercial |
$7,021.96
|
| Rate for Payer: Health EOS Commercial |
$6,792.98
|
| Rate for Payer: HFN Commercial |
$7,021.96
|
| Rate for Payer: Multiplan Commercial |
$6,106.05
|
| Rate for Payer: Preferred Network Access Commercial |
$7,021.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,739.95
|
| Rate for Payer: Quartz Commercial |
$4,579.54
|
| Rate for Payer: WEA Trust Commercial |
$4,197.91
|
| Rate for Payer: WPS Commercial |
$5,653.23
|
|
|
IMPLANT TESTICULAR TOROSA SALINE-FILLED 2.9 X 4.5CM LARGE 450-1329
|
Facility
|
IP
|
$11,201.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4006567
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,708.03 |
| Max. Negotiated Rate |
$10,717.12 |
| Rate for Payer: Aetna Commercial |
$10,484.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,018.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,173.99
|
| Rate for Payer: Cash Price |
$3,360.30
|
| Rate for Payer: Cigna Commercial |
$10,717.12
|
| Rate for Payer: Health EOS Commercial |
$10,367.65
|
| Rate for Payer: HFN Commercial |
$10,717.12
|
| Rate for Payer: Multiplan Commercial |
$9,319.23
|
| Rate for Payer: Preferred Network Access Commercial |
$10,717.12
|
| Rate for Payer: Quartz Beloit One Network |
$5,708.03
|
| Rate for Payer: Quartz Commercial |
$6,989.42
|
| Rate for Payer: WEA Trust Commercial |
$6,406.97
|
| Rate for Payer: WPS Commercial |
$8,628.13
|
|
|
IMPLANT TESTICULAR TOROSA SALINE-FILLED 2.9 X 4.5CM LARGE 450-1329
|
Facility
|
OP
|
$11,201.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4006567
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,261.73 |
| Max. Negotiated Rate |
$10,717.12 |
| Rate for Payer: Aetna Commercial |
$10,484.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,018.17
|
| Rate for Payer: Aetna Managed Medicare |
$3,261.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,571.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,824.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,591.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,173.99
|
| Rate for Payer: Cash Price |
$3,360.30
|
| Rate for Payer: Cigna Commercial |
$10,717.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,518.98
|
| Rate for Payer: Health EOS Commercial |
$10,367.65
|
| Rate for Payer: HFN Commercial |
$10,717.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,736.78
|
| Rate for Payer: Multiplan Commercial |
$9,319.23
|
| Rate for Payer: NAPHCARE Commercial |
$6,989.42
|
| Rate for Payer: Preferred Network Access Commercial |
$10,717.12
|
| Rate for Payer: Quartz Beloit One Network |
$5,708.03
|
| Rate for Payer: Quartz Commercial |
$7,571.88
|
| Rate for Payer: Quartz Medicare Advantage |
$6,989.42
|
| Rate for Payer: The Alliance Commercial |
$5,824.52
|
| Rate for Payer: WEA Trust Commercial |
$6,406.97
|
| Rate for Payer: WPS Commercial |
$8,628.13
|
|
|
IMPLANT TESTICULAR TOROSA SALINE-FILLED MED 2.7CM X 4.0CM 450-1327
|
Facility
|
OP
|
$11,632.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4124758
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,387.24 |
| Max. Negotiated Rate |
$11,129.50 |
| Rate for Payer: Aetna Commercial |
$10,887.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,403.66
|
| Rate for Payer: Aetna Managed Medicare |
$3,387.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,863.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,048.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,806.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,411.56
|
| Rate for Payer: Cash Price |
$3,489.60
|
| Rate for Payer: Cigna Commercial |
$11,129.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,769.82
|
| Rate for Payer: Health EOS Commercial |
$10,766.58
|
| Rate for Payer: HFN Commercial |
$11,129.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,072.96
|
| Rate for Payer: Multiplan Commercial |
$9,677.82
|
| Rate for Payer: NAPHCARE Commercial |
$7,258.37
|
| Rate for Payer: Preferred Network Access Commercial |
$11,129.50
|
| Rate for Payer: Quartz Beloit One Network |
$5,927.67
|
| Rate for Payer: Quartz Commercial |
$7,863.23
|
| Rate for Payer: Quartz Medicare Advantage |
$7,258.37
|
| Rate for Payer: The Alliance Commercial |
$6,048.64
|
| Rate for Payer: WEA Trust Commercial |
$6,653.50
|
| Rate for Payer: WPS Commercial |
$8,960.13
|
|
|
IMPLANT TESTICULAR TOROSA SALINE-FILLED MED 2.7CM X 4.0CM 450-1327
|
Facility
|
IP
|
$11,632.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4124758
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,927.67 |
| Max. Negotiated Rate |
$11,129.50 |
| Rate for Payer: Aetna Commercial |
$10,887.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,403.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,411.56
|
| Rate for Payer: Cash Price |
$3,489.60
|
| Rate for Payer: Cigna Commercial |
$11,129.50
|
| Rate for Payer: Health EOS Commercial |
$10,766.58
|
| Rate for Payer: HFN Commercial |
$11,129.50
|
| Rate for Payer: Multiplan Commercial |
$9,677.82
|
| Rate for Payer: Preferred Network Access Commercial |
$11,129.50
|
| Rate for Payer: Quartz Beloit One Network |
$5,927.67
|
| Rate for Payer: Quartz Commercial |
$7,258.37
|
| Rate for Payer: WEA Trust Commercial |
$6,653.50
|
| Rate for Payer: WPS Commercial |
$8,960.13
|
|
|
IMPLANT THYROPLASTY DEVICE
|
Facility
|
IP
|
$3,064.00
|
|
| Hospital Charge Code |
2965333
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,561.41 |
| Max. Negotiated Rate |
$2,931.64 |
| Rate for Payer: Aetna Commercial |
$2,867.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,740.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,688.88
|
| Rate for Payer: Cash Price |
$919.20
|
| Rate for Payer: Cigna Commercial |
$2,931.64
|
| Rate for Payer: Health EOS Commercial |
$2,836.04
|
| Rate for Payer: HFN Commercial |
$2,931.64
|
| Rate for Payer: Multiplan Commercial |
$2,549.25
|
| Rate for Payer: Preferred Network Access Commercial |
$2,931.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,561.41
|
| Rate for Payer: Quartz Commercial |
$1,911.94
|
| Rate for Payer: WEA Trust Commercial |
$1,752.61
|
| Rate for Payer: WPS Commercial |
$2,360.20
|
|
|
IMPLANT THYROPLASTY DEVICE
|
Facility
|
OP
|
$3,064.00
|
|
| Hospital Charge Code |
2965333
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$892.24 |
| Max. Negotiated Rate |
$2,931.64 |
| Rate for Payer: Aetna Commercial |
$2,867.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,740.44
|
| Rate for Payer: Aetna Managed Medicare |
$892.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,071.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,593.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,529.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,688.88
|
| Rate for Payer: Cash Price |
$919.20
|
| Rate for Payer: Cigna Commercial |
$2,931.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,783.25
|
| Rate for Payer: Health EOS Commercial |
$2,836.04
|
| Rate for Payer: HFN Commercial |
$2,931.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,389.92
|
| Rate for Payer: Multiplan Commercial |
$2,549.25
|
| Rate for Payer: NAPHCARE Commercial |
$1,911.94
|
| Rate for Payer: Preferred Network Access Commercial |
$2,931.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,561.41
|
| Rate for Payer: Quartz Commercial |
$2,071.26
|
| Rate for Payer: Quartz Medicare Advantage |
$1,911.94
|
| Rate for Payer: The Alliance Commercial |
$1,593.28
|
| Rate for Payer: WEA Trust Commercial |
$1,752.61
|
| Rate for Payer: WPS Commercial |
$2,360.20
|
|
|
IMPLANT TIGHTROPE SYNDESMOSIS XP AR-8925SS
|
Facility
|
IP
|
$8,588.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414739
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,376.44 |
| Max. Negotiated Rate |
$8,217.00 |
| Rate for Payer: Aetna Commercial |
$8,038.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,681.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,733.71
|
| Rate for Payer: Cash Price |
$2,576.40
|
| Rate for Payer: Cigna Commercial |
$8,217.00
|
| Rate for Payer: Health EOS Commercial |
$7,949.05
|
| Rate for Payer: HFN Commercial |
$8,217.00
|
| Rate for Payer: Multiplan Commercial |
$7,145.22
|
| Rate for Payer: Preferred Network Access Commercial |
$8,217.00
|
| Rate for Payer: Quartz Beloit One Network |
$4,376.44
|
| Rate for Payer: Quartz Commercial |
$5,358.91
|
| Rate for Payer: WEA Trust Commercial |
$4,912.34
|
| Rate for Payer: WPS Commercial |
$6,615.34
|
|
|
IMPLANT TIGHTROPE SYNDESMOSIS XP AR-8925SS
|
Facility
|
OP
|
$8,588.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414739
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,500.83 |
| Max. Negotiated Rate |
$8,217.00 |
| Rate for Payer: Aetna Commercial |
$8,038.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,681.11
|
| Rate for Payer: Aetna Managed Medicare |
$2,500.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,805.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,465.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,287.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,733.71
|
| Rate for Payer: Cash Price |
$2,576.40
|
| Rate for Payer: Cigna Commercial |
$8,217.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,998.22
|
| Rate for Payer: Health EOS Commercial |
$7,949.05
|
| Rate for Payer: HFN Commercial |
$8,217.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,698.64
|
| Rate for Payer: Multiplan Commercial |
$7,145.22
|
| Rate for Payer: NAPHCARE Commercial |
$5,358.91
|
| Rate for Payer: Preferred Network Access Commercial |
$8,217.00
|
| Rate for Payer: Quartz Beloit One Network |
$4,376.44
|
| Rate for Payer: Quartz Commercial |
$5,805.49
|
| Rate for Payer: Quartz Medicare Advantage |
$5,358.91
|
| Rate for Payer: The Alliance Commercial |
$4,465.76
|
| Rate for Payer: WEA Trust Commercial |
$4,912.34
|
| Rate for Payer: WPS Commercial |
$6,615.34
|
|
|
IMPLANT TOE JOINT BIOPRO NPS MD 20MM COBALT CHROME 10061
|
Facility
|
OP
|
$7,544.00
|
|
|
Service Code
|
HCPCS L8642
|
| Hospital Charge Code |
5415479
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,594.03 |
| Max. Negotiated Rate |
$7,218.10 |
| Rate for Payer: Aetna Commercial |
$7,061.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,747.35
|
| Rate for Payer: Aetna Managed Medicare |
$2,196.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,099.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,922.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,765.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,158.25
|
| Rate for Payer: Cash Price |
$2,263.20
|
| Rate for Payer: Cash Price |
$2,263.20
|
| Rate for Payer: Cigna Commercial |
$7,218.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,390.61
|
| Rate for Payer: Health EOS Commercial |
$6,982.73
|
| Rate for Payer: HFN Commercial |
$7,218.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,884.32
|
| Rate for Payer: Multiplan Commercial |
$6,276.61
|
| Rate for Payer: NAPHCARE Commercial |
$4,707.46
|
| Rate for Payer: Preferred Network Access Commercial |
$7,218.10
|
| Rate for Payer: Quartz Beloit One Network |
$3,844.42
|
| Rate for Payer: Quartz Commercial |
$5,099.74
|
| Rate for Payer: Quartz Medicare Advantage |
$4,707.46
|
| Rate for Payer: The Alliance Commercial |
$1,594.03
|
| Rate for Payer: WEA Trust Commercial |
$4,315.17
|
| Rate for Payer: WPS Commercial |
$5,811.14
|
|
|
IMPLANT TOE JOINT BIOPRO NPS MD 20MM COBALT CHROME 10061
|
Facility
|
IP
|
$7,544.00
|
|
|
Service Code
|
HCPCS L8642
|
| Hospital Charge Code |
5415479
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,844.42 |
| Max. Negotiated Rate |
$7,218.10 |
| Rate for Payer: Aetna Commercial |
$7,061.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,747.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,158.25
|
| Rate for Payer: Cash Price |
$2,263.20
|
| Rate for Payer: Cigna Commercial |
$7,218.10
|
| Rate for Payer: Health EOS Commercial |
$6,982.73
|
| Rate for Payer: HFN Commercial |
$7,218.10
|
| Rate for Payer: Multiplan Commercial |
$6,276.61
|
| Rate for Payer: Preferred Network Access Commercial |
$7,218.10
|
| Rate for Payer: Quartz Beloit One Network |
$3,844.42
|
| Rate for Payer: Quartz Commercial |
$4,707.46
|
| Rate for Payer: WEA Trust Commercial |
$4,315.17
|
| Rate for Payer: WPS Commercial |
$5,811.14
|
|
|
IMPLANT TOETAC XPRESS LARGE HAMMERTOE HT-00003
|
Facility
|
IP
|
$8,142.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5547499
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,149.16 |
| Max. Negotiated Rate |
$7,790.27 |
| Rate for Payer: Aetna Commercial |
$7,620.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,282.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,487.87
|
| Rate for Payer: Cash Price |
$2,442.60
|
| Rate for Payer: Cigna Commercial |
$7,790.27
|
| Rate for Payer: Health EOS Commercial |
$7,536.24
|
| Rate for Payer: HFN Commercial |
$7,790.27
|
| Rate for Payer: Multiplan Commercial |
$6,774.14
|
| Rate for Payer: Preferred Network Access Commercial |
$7,790.27
|
| Rate for Payer: Quartz Beloit One Network |
$4,149.16
|
| Rate for Payer: Quartz Commercial |
$5,080.61
|
| Rate for Payer: WEA Trust Commercial |
$4,657.22
|
| Rate for Payer: WPS Commercial |
$6,271.78
|
|
|
IMPLANT TOETAC XPRESS LARGE HAMMERTOE HT-00003
|
Facility
|
OP
|
$8,142.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5547499
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,370.95 |
| Max. Negotiated Rate |
$7,790.27 |
| Rate for Payer: Aetna Commercial |
$7,620.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,282.20
|
| Rate for Payer: Aetna Managed Medicare |
$2,370.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,503.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,233.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,064.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,487.87
|
| Rate for Payer: Cash Price |
$2,442.60
|
| Rate for Payer: Cigna Commercial |
$7,790.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,738.64
|
| Rate for Payer: Health EOS Commercial |
$7,536.24
|
| Rate for Payer: HFN Commercial |
$7,790.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,350.76
|
| Rate for Payer: Multiplan Commercial |
$6,774.14
|
| Rate for Payer: NAPHCARE Commercial |
$5,080.61
|
| Rate for Payer: Preferred Network Access Commercial |
$7,790.27
|
| Rate for Payer: Quartz Beloit One Network |
$4,149.16
|
| Rate for Payer: Quartz Commercial |
$5,503.99
|
| Rate for Payer: Quartz Medicare Advantage |
$5,080.61
|
| Rate for Payer: The Alliance Commercial |
$4,233.84
|
| Rate for Payer: WEA Trust Commercial |
$4,657.22
|
| Rate for Payer: WPS Commercial |
$6,271.78
|
|
|
IMPLANT TOETAC XPRESS MEDIUM 10DEG HAMMERTOE HT-00005
|
Facility
|
OP
|
$2,239.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$652.00 |
| Max. Negotiated Rate |
$2,142.28 |
| Rate for Payer: Aetna Commercial |
$2,095.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,002.56
|
| Rate for Payer: Aetna Managed Medicare |
$652.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,513.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,164.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,117.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,234.14
|
| Rate for Payer: Cash Price |
$671.70
|
| Rate for Payer: Cigna Commercial |
$2,142.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,303.10
|
| Rate for Payer: Health EOS Commercial |
$2,072.42
|
| Rate for Payer: HFN Commercial |
$2,142.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,746.42
|
| Rate for Payer: Multiplan Commercial |
$1,862.85
|
| Rate for Payer: NAPHCARE Commercial |
$1,397.14
|
| Rate for Payer: Preferred Network Access Commercial |
$2,142.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,140.99
|
| Rate for Payer: Quartz Commercial |
$1,513.56
|
| Rate for Payer: Quartz Medicare Advantage |
$1,397.14
|
| Rate for Payer: The Alliance Commercial |
$1,164.28
|
| Rate for Payer: WEA Trust Commercial |
$1,280.71
|
| Rate for Payer: WPS Commercial |
$1,724.70
|
|
|
IMPLANT TOETAC XPRESS MEDIUM 10DEG HAMMERTOE HT-00005
|
Facility
|
IP
|
$2,239.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,140.99 |
| Max. Negotiated Rate |
$2,142.28 |
| Rate for Payer: Aetna Commercial |
$2,095.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,002.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,234.14
|
| Rate for Payer: Cash Price |
$671.70
|
| Rate for Payer: Cigna Commercial |
$2,142.28
|
| Rate for Payer: Health EOS Commercial |
$2,072.42
|
| Rate for Payer: HFN Commercial |
$2,142.28
|
| Rate for Payer: Multiplan Commercial |
$1,862.85
|
| Rate for Payer: Preferred Network Access Commercial |
$2,142.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,140.99
|
| Rate for Payer: Quartz Commercial |
$1,397.14
|
| Rate for Payer: WEA Trust Commercial |
$1,280.71
|
| Rate for Payer: WPS Commercial |
$1,724.70
|
|
|
IMPLANT TOETAC XPRESS MEDIUM HAMMERTOE HT-00002
|
Facility
|
OP
|
$8,142.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5306927
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,370.95 |
| Max. Negotiated Rate |
$7,790.27 |
| Rate for Payer: Aetna Commercial |
$7,620.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,282.20
|
| Rate for Payer: Aetna Managed Medicare |
$2,370.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,503.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,233.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,064.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,487.87
|
| Rate for Payer: Cash Price |
$2,442.60
|
| Rate for Payer: Cigna Commercial |
$7,790.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,738.64
|
| Rate for Payer: Health EOS Commercial |
$7,536.24
|
| Rate for Payer: HFN Commercial |
$7,790.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,350.76
|
| Rate for Payer: Multiplan Commercial |
$6,774.14
|
| Rate for Payer: NAPHCARE Commercial |
$5,080.61
|
| Rate for Payer: Preferred Network Access Commercial |
$7,790.27
|
| Rate for Payer: Quartz Beloit One Network |
$4,149.16
|
| Rate for Payer: Quartz Commercial |
$5,503.99
|
| Rate for Payer: Quartz Medicare Advantage |
$5,080.61
|
| Rate for Payer: The Alliance Commercial |
$4,233.84
|
| Rate for Payer: WEA Trust Commercial |
$4,657.22
|
| Rate for Payer: WPS Commercial |
$6,271.78
|
|
|
IMPLANT TOETAC XPRESS MEDIUM HAMMERTOE HT-00002
|
Facility
|
IP
|
$8,142.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5306927
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,149.16 |
| Max. Negotiated Rate |
$7,790.27 |
| Rate for Payer: Aetna Commercial |
$7,620.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,282.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,487.87
|
| Rate for Payer: Cash Price |
$2,442.60
|
| Rate for Payer: Cigna Commercial |
$7,790.27
|
| Rate for Payer: Health EOS Commercial |
$7,536.24
|
| Rate for Payer: HFN Commercial |
$7,790.27
|
| Rate for Payer: Multiplan Commercial |
$6,774.14
|
| Rate for Payer: Preferred Network Access Commercial |
$7,790.27
|
| Rate for Payer: Quartz Beloit One Network |
$4,149.16
|
| Rate for Payer: Quartz Commercial |
$5,080.61
|
| Rate for Payer: WEA Trust Commercial |
$4,657.22
|
| Rate for Payer: WPS Commercial |
$6,271.78
|
|
|
IMPLANT TOETAC XPRESS SMALL HAMMERTOE HT-00001
|
Facility
|
OP
|
$1,278.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5265022
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$372.15 |
| Max. Negotiated Rate |
$1,222.79 |
| Rate for Payer: Aetna Commercial |
$1,196.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,143.04
|
| Rate for Payer: Aetna Managed Medicare |
$372.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$863.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$664.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$637.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$704.43
|
| Rate for Payer: Cash Price |
$383.40
|
| Rate for Payer: Cigna Commercial |
$1,222.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$743.80
|
| Rate for Payer: Health EOS Commercial |
$1,182.92
|
| Rate for Payer: HFN Commercial |
$1,222.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$996.84
|
| Rate for Payer: Multiplan Commercial |
$1,063.30
|
| Rate for Payer: NAPHCARE Commercial |
$797.47
|
| Rate for Payer: Preferred Network Access Commercial |
$1,222.79
|
| Rate for Payer: Quartz Beloit One Network |
$651.27
|
| Rate for Payer: Quartz Commercial |
$863.93
|
| Rate for Payer: Quartz Medicare Advantage |
$797.47
|
| Rate for Payer: The Alliance Commercial |
$664.56
|
| Rate for Payer: WEA Trust Commercial |
$731.02
|
| Rate for Payer: WPS Commercial |
$984.44
|
|
|
IMPLANT TOETAC XPRESS SMALL HAMMERTOE HT-00001
|
Facility
|
IP
|
$1,278.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5265022
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$651.27 |
| Max. Negotiated Rate |
$1,222.79 |
| Rate for Payer: Aetna Commercial |
$1,196.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,143.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$704.43
|
| Rate for Payer: Cash Price |
$383.40
|
| Rate for Payer: Cigna Commercial |
$1,222.79
|
| Rate for Payer: Health EOS Commercial |
$1,182.92
|
| Rate for Payer: HFN Commercial |
$1,222.79
|
| Rate for Payer: Multiplan Commercial |
$1,063.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,222.79
|
| Rate for Payer: Quartz Beloit One Network |
$651.27
|
| Rate for Payer: Quartz Commercial |
$797.47
|
| Rate for Payer: WEA Trust Commercial |
$731.02
|
| Rate for Payer: WPS Commercial |
$984.44
|
|
