|
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 |
$2,543.52 |
| Max. Negotiated Rate |
$36,336.00 |
| Rate for Payer: Aetna Commercial |
$8,175.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,812.24
|
| Rate for Payer: Aetna Managed Medicare |
$2,543.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,904.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,542.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,360.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,814.52
|
| Rate for Payer: Cash Price |
$2,725.20
|
| Rate for Payer: Cigna Commercial |
$8,357.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,083.41
|
| Rate for Payer: Health EOS Commercial |
$8,084.76
|
| Rate for Payer: HFN Commercial |
$8,357.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,813.00
|
| Rate for Payer: Multiplan Commercial |
$7,267.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,450.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,357.28
|
| Rate for Payer: Quartz Beloit One Network |
$4,451.16
|
| Rate for Payer: Quartz Commercial |
$5,904.60
|
| Rate for Payer: Quartz Medicare Advantage |
$5,450.40
|
| Rate for Payer: The Alliance Commercial |
$36,336.00
|
| Rate for Payer: WEA Trust Commercial |
$4,996.20
|
| Rate for Payer: WPS Commercial |
$6,728.52
|
|
|
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 |
$4,451.16 |
| Max. Negotiated Rate |
$8,357.28 |
| Rate for Payer: Aetna Commercial |
$8,175.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,812.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,814.52
|
| Rate for Payer: Cash Price |
$2,725.20
|
| Rate for Payer: Cigna Commercial |
$8,357.28
|
| Rate for Payer: Health EOS Commercial |
$8,084.76
|
| Rate for Payer: HFN Commercial |
$8,357.28
|
| Rate for Payer: Multiplan Commercial |
$7,267.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,450.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,357.28
|
| Rate for Payer: Quartz Beloit One Network |
$4,451.16
|
| Rate for Payer: Quartz Commercial |
$5,450.40
|
| Rate for Payer: WEA Trust Commercial |
$4,996.20
|
| Rate for Payer: WPS Commercial |
$6,728.52
|
|
|
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 |
$3,181.08 |
| Max. Negotiated Rate |
$45,444.00 |
| Rate for Payer: Aetna Commercial |
$10,224.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,770.46
|
| Rate for Payer: Aetna Managed Medicare |
$3,181.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,384.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,680.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,453.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,021.33
|
| Rate for Payer: Cash Price |
$3,408.30
|
| Rate for Payer: Cigna Commercial |
$10,452.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,357.62
|
| Rate for Payer: Health EOS Commercial |
$10,111.29
|
| Rate for Payer: HFN Commercial |
$10,452.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,520.75
|
| Rate for Payer: Multiplan Commercial |
$9,088.80
|
| Rate for Payer: NAPHCARE Commercial |
$6,816.60
|
| Rate for Payer: Preferred Network Access Commercial |
$10,452.12
|
| Rate for Payer: Quartz Beloit One Network |
$5,566.89
|
| Rate for Payer: Quartz Commercial |
$7,384.65
|
| Rate for Payer: Quartz Medicare Advantage |
$6,816.60
|
| Rate for Payer: The Alliance Commercial |
$45,444.00
|
| Rate for Payer: WEA Trust Commercial |
$6,248.55
|
| Rate for Payer: WPS Commercial |
$8,415.09
|
|
|
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 |
$5,566.89 |
| Max. Negotiated Rate |
$10,452.12 |
| Rate for Payer: Aetna Commercial |
$10,224.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,770.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,021.33
|
| Rate for Payer: Cash Price |
$3,408.30
|
| Rate for Payer: Cigna Commercial |
$10,452.12
|
| Rate for Payer: Health EOS Commercial |
$10,111.29
|
| Rate for Payer: HFN Commercial |
$10,452.12
|
| Rate for Payer: Multiplan Commercial |
$9,088.80
|
| Rate for Payer: NAPHCARE Commercial |
$6,816.60
|
| Rate for Payer: Preferred Network Access Commercial |
$10,452.12
|
| Rate for Payer: Quartz Beloit One Network |
$5,566.89
|
| Rate for Payer: Quartz Commercial |
$6,816.60
|
| Rate for Payer: WEA Trust Commercial |
$6,248.55
|
| Rate for Payer: WPS Commercial |
$8,415.09
|
|
|
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 |
$3,181.08 |
| Max. Negotiated Rate |
$45,444.00 |
| Rate for Payer: Aetna Commercial |
$10,224.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,770.46
|
| Rate for Payer: Aetna Managed Medicare |
$3,181.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,384.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,680.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,453.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,021.33
|
| Rate for Payer: Cash Price |
$3,408.30
|
| Rate for Payer: Cigna Commercial |
$10,452.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,357.62
|
| Rate for Payer: Health EOS Commercial |
$10,111.29
|
| Rate for Payer: HFN Commercial |
$10,452.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,520.75
|
| Rate for Payer: Multiplan Commercial |
$9,088.80
|
| Rate for Payer: NAPHCARE Commercial |
$6,816.60
|
| Rate for Payer: Preferred Network Access Commercial |
$10,452.12
|
| Rate for Payer: Quartz Beloit One Network |
$5,566.89
|
| Rate for Payer: Quartz Commercial |
$7,384.65
|
| Rate for Payer: Quartz Medicare Advantage |
$6,816.60
|
| Rate for Payer: The Alliance Commercial |
$45,444.00
|
| Rate for Payer: WEA Trust Commercial |
$6,248.55
|
| Rate for Payer: WPS Commercial |
$8,415.09
|
|
|
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 |
$5,566.89 |
| Max. Negotiated Rate |
$10,452.12 |
| Rate for Payer: Aetna Commercial |
$10,224.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,770.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,021.33
|
| Rate for Payer: Cash Price |
$3,408.30
|
| Rate for Payer: Cigna Commercial |
$10,452.12
|
| Rate for Payer: Health EOS Commercial |
$10,111.29
|
| Rate for Payer: HFN Commercial |
$10,452.12
|
| Rate for Payer: Multiplan Commercial |
$9,088.80
|
| Rate for Payer: NAPHCARE Commercial |
$6,816.60
|
| Rate for Payer: Preferred Network Access Commercial |
$10,452.12
|
| Rate for Payer: Quartz Beloit One Network |
$5,566.89
|
| Rate for Payer: Quartz Commercial |
$6,816.60
|
| Rate for Payer: WEA Trust Commercial |
$6,248.55
|
| Rate for Payer: WPS Commercial |
$8,415.09
|
|
|
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 |
$2,544.64 |
| Max. Negotiated Rate |
$36,352.00 |
| Rate for Payer: Aetna Commercial |
$8,179.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,815.68
|
| Rate for Payer: Aetna Managed Medicare |
$2,544.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,907.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,544.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,362.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,816.64
|
| Rate for Payer: Cash Price |
$2,726.40
|
| Rate for Payer: Cigna Commercial |
$8,360.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,085.64
|
| Rate for Payer: Health EOS Commercial |
$8,088.32
|
| Rate for Payer: HFN Commercial |
$8,360.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,816.00
|
| Rate for Payer: Multiplan Commercial |
$7,270.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,452.80
|
| Rate for Payer: Preferred Network Access Commercial |
$8,360.96
|
| Rate for Payer: Quartz Beloit One Network |
$4,453.12
|
| Rate for Payer: Quartz Commercial |
$5,907.20
|
| Rate for Payer: Quartz Medicare Advantage |
$5,452.80
|
| Rate for Payer: The Alliance Commercial |
$36,352.00
|
| Rate for Payer: WEA Trust Commercial |
$4,998.40
|
| Rate for Payer: WPS Commercial |
$6,731.48
|
|
|
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 |
$4,453.12 |
| Max. Negotiated Rate |
$8,360.96 |
| Rate for Payer: Aetna Commercial |
$8,179.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,815.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,816.64
|
| Rate for Payer: Cash Price |
$2,726.40
|
| Rate for Payer: Cigna Commercial |
$8,360.96
|
| Rate for Payer: Health EOS Commercial |
$8,088.32
|
| Rate for Payer: HFN Commercial |
$8,360.96
|
| Rate for Payer: Multiplan Commercial |
$7,270.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,452.80
|
| Rate for Payer: Preferred Network Access Commercial |
$8,360.96
|
| Rate for Payer: Quartz Beloit One Network |
$4,453.12
|
| Rate for Payer: Quartz Commercial |
$5,452.80
|
| Rate for Payer: WEA Trust Commercial |
$4,998.40
|
| Rate for Payer: WPS Commercial |
$6,731.48
|
|
|
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 |
$2,243.64 |
| Max. Negotiated Rate |
$32,052.00 |
| Rate for Payer: Aetna Commercial |
$7,211.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,891.18
|
| Rate for Payer: Aetna Managed Medicare |
$2,243.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,208.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,006.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,846.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,246.89
|
| Rate for Payer: Cash Price |
$2,403.90
|
| Rate for Payer: Cigna Commercial |
$7,371.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,484.07
|
| Rate for Payer: Health EOS Commercial |
$7,131.57
|
| Rate for Payer: HFN Commercial |
$7,371.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,009.75
|
| Rate for Payer: Multiplan Commercial |
$6,410.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,807.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,371.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,926.37
|
| Rate for Payer: Quartz Commercial |
$5,208.45
|
| Rate for Payer: Quartz Medicare Advantage |
$4,807.80
|
| Rate for Payer: The Alliance Commercial |
$32,052.00
|
| Rate for Payer: WEA Trust Commercial |
$4,407.15
|
| Rate for Payer: WPS Commercial |
$5,935.23
|
|
|
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 |
$3,926.37 |
| Max. Negotiated Rate |
$7,371.96 |
| Rate for Payer: Aetna Commercial |
$7,211.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,891.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,246.89
|
| Rate for Payer: Cash Price |
$2,403.90
|
| Rate for Payer: Cigna Commercial |
$7,371.96
|
| Rate for Payer: Health EOS Commercial |
$7,131.57
|
| Rate for Payer: HFN Commercial |
$7,371.96
|
| Rate for Payer: Multiplan Commercial |
$6,410.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,807.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,371.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,926.37
|
| Rate for Payer: Quartz Commercial |
$4,807.80
|
| Rate for Payer: WEA Trust Commercial |
$4,407.15
|
| Rate for Payer: WPS Commercial |
$5,935.23
|
|
|
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 |
$4,865.70 |
| Max. Negotiated Rate |
$9,135.60 |
| Rate for Payer: Aetna Commercial |
$8,937.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,539.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,262.90
|
| Rate for Payer: Cash Price |
$2,979.00
|
| Rate for Payer: Cigna Commercial |
$9,135.60
|
| Rate for Payer: Health EOS Commercial |
$8,837.70
|
| Rate for Payer: HFN Commercial |
$9,135.60
|
| Rate for Payer: Multiplan Commercial |
$7,944.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,958.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9,135.60
|
| Rate for Payer: Quartz Beloit One Network |
$4,865.70
|
| Rate for Payer: Quartz Commercial |
$5,958.00
|
| Rate for Payer: WEA Trust Commercial |
$5,461.50
|
| Rate for Payer: WPS Commercial |
$7,355.15
|
|
|
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 |
$2,780.40 |
| Max. Negotiated Rate |
$39,720.00 |
| Rate for Payer: Aetna Commercial |
$8,937.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,539.80
|
| Rate for Payer: Aetna Managed Medicare |
$2,780.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,454.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,965.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,766.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,262.90
|
| Rate for Payer: Cash Price |
$2,979.00
|
| Rate for Payer: Cigna Commercial |
$9,135.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,556.83
|
| Rate for Payer: Health EOS Commercial |
$8,837.70
|
| Rate for Payer: HFN Commercial |
$9,135.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,447.50
|
| Rate for Payer: Multiplan Commercial |
$7,944.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,958.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9,135.60
|
| Rate for Payer: Quartz Beloit One Network |
$4,865.70
|
| Rate for Payer: Quartz Commercial |
$6,454.50
|
| Rate for Payer: Quartz Medicare Advantage |
$5,958.00
|
| Rate for Payer: The Alliance Commercial |
$39,720.00
|
| Rate for Payer: WEA Trust Commercial |
$5,461.50
|
| Rate for Payer: WPS Commercial |
$7,355.15
|
|
|
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 |
$5,325.32 |
| Max. Negotiated Rate |
$9,998.56 |
| Rate for Payer: Aetna Commercial |
$9,781.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,346.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,760.04
|
| Rate for Payer: Cash Price |
$3,260.40
|
| Rate for Payer: Cigna Commercial |
$9,998.56
|
| Rate for Payer: Health EOS Commercial |
$9,672.52
|
| Rate for Payer: HFN Commercial |
$9,998.56
|
| Rate for Payer: Multiplan Commercial |
$8,694.40
|
| Rate for Payer: NAPHCARE Commercial |
$6,520.80
|
| Rate for Payer: Preferred Network Access Commercial |
$9,998.56
|
| Rate for Payer: Quartz Beloit One Network |
$5,325.32
|
| Rate for Payer: Quartz Commercial |
$6,520.80
|
| Rate for Payer: WEA Trust Commercial |
$5,977.40
|
| Rate for Payer: WPS Commercial |
$8,049.93
|
|
|
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 |
$3,043.04 |
| Max. Negotiated Rate |
$43,472.00 |
| Rate for Payer: Aetna Commercial |
$9,781.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,346.48
|
| Rate for Payer: Aetna Managed Medicare |
$3,043.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,064.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,434.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,216.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,760.04
|
| Rate for Payer: Cash Price |
$3,260.40
|
| Rate for Payer: Cigna Commercial |
$9,998.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,081.73
|
| Rate for Payer: Health EOS Commercial |
$9,672.52
|
| Rate for Payer: HFN Commercial |
$9,998.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,151.00
|
| Rate for Payer: Multiplan Commercial |
$8,694.40
|
| Rate for Payer: NAPHCARE Commercial |
$6,520.80
|
| Rate for Payer: Preferred Network Access Commercial |
$9,998.56
|
| Rate for Payer: Quartz Beloit One Network |
$5,325.32
|
| Rate for Payer: Quartz Commercial |
$7,064.20
|
| Rate for Payer: Quartz Medicare Advantage |
$6,520.80
|
| Rate for Payer: The Alliance Commercial |
$43,472.00
|
| Rate for Payer: WEA Trust Commercial |
$5,977.40
|
| Rate for Payer: WPS Commercial |
$8,049.93
|
|
|
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 |
$3,924.20 |
| Max. Negotiated Rate |
$56,060.00 |
| Rate for Payer: Aetna Commercial |
$12,613.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,052.90
|
| Rate for Payer: Aetna Managed Medicare |
$3,924.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,109.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,007.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,727.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,427.95
|
| Rate for Payer: Cash Price |
$4,204.50
|
| Rate for Payer: Cigna Commercial |
$12,893.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,842.79
|
| Rate for Payer: Health EOS Commercial |
$12,473.35
|
| Rate for Payer: HFN Commercial |
$12,893.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,511.25
|
| Rate for Payer: Multiplan Commercial |
$11,212.00
|
| Rate for Payer: NAPHCARE Commercial |
$8,409.00
|
| Rate for Payer: Preferred Network Access Commercial |
$12,893.80
|
| Rate for Payer: Quartz Beloit One Network |
$6,867.35
|
| Rate for Payer: Quartz Commercial |
$9,109.75
|
| Rate for Payer: Quartz Medicare Advantage |
$8,409.00
|
| Rate for Payer: The Alliance Commercial |
$56,060.00
|
| Rate for Payer: WEA Trust Commercial |
$7,708.25
|
| Rate for Payer: WPS Commercial |
$10,380.91
|
|
|
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 |
$6,867.35 |
| Max. Negotiated Rate |
$12,893.80 |
| Rate for Payer: Aetna Commercial |
$12,613.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,052.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,427.95
|
| Rate for Payer: Cash Price |
$4,204.50
|
| Rate for Payer: Cigna Commercial |
$12,893.80
|
| Rate for Payer: Health EOS Commercial |
$12,473.35
|
| Rate for Payer: HFN Commercial |
$12,893.80
|
| Rate for Payer: Multiplan Commercial |
$11,212.00
|
| Rate for Payer: NAPHCARE Commercial |
$8,409.00
|
| Rate for Payer: Preferred Network Access Commercial |
$12,893.80
|
| Rate for Payer: Quartz Beloit One Network |
$6,867.35
|
| Rate for Payer: Quartz Commercial |
$8,409.00
|
| Rate for Payer: WEA Trust Commercial |
$7,708.25
|
| Rate for Payer: WPS Commercial |
$10,380.91
|
|
|
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 |
$4,081.28 |
| Max. Negotiated Rate |
$58,304.00 |
| Rate for Payer: Aetna Commercial |
$13,118.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,535.36
|
| Rate for Payer: Aetna Managed Medicare |
$4,081.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,474.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,288.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,996.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,725.28
|
| Rate for Payer: Cash Price |
$4,372.80
|
| Rate for Payer: Cigna Commercial |
$13,409.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,156.73
|
| Rate for Payer: Health EOS Commercial |
$12,972.64
|
| Rate for Payer: HFN Commercial |
$13,409.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,932.00
|
| Rate for Payer: Multiplan Commercial |
$11,660.80
|
| Rate for Payer: NAPHCARE Commercial |
$8,745.60
|
| Rate for Payer: Preferred Network Access Commercial |
$13,409.92
|
| Rate for Payer: Quartz Beloit One Network |
$7,142.24
|
| Rate for Payer: Quartz Commercial |
$9,474.40
|
| Rate for Payer: Quartz Medicare Advantage |
$8,745.60
|
| Rate for Payer: The Alliance Commercial |
$58,304.00
|
| Rate for Payer: WEA Trust Commercial |
$8,016.80
|
| Rate for Payer: WPS Commercial |
$10,796.44
|
|
|
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 |
$7,142.24 |
| Max. Negotiated Rate |
$13,409.92 |
| Rate for Payer: Aetna Commercial |
$13,118.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,535.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,725.28
|
| Rate for Payer: Cash Price |
$4,372.80
|
| Rate for Payer: Cigna Commercial |
$13,409.92
|
| Rate for Payer: Health EOS Commercial |
$12,972.64
|
| Rate for Payer: HFN Commercial |
$13,409.92
|
| Rate for Payer: Multiplan Commercial |
$11,660.80
|
| Rate for Payer: NAPHCARE Commercial |
$8,745.60
|
| Rate for Payer: Preferred Network Access Commercial |
$13,409.92
|
| Rate for Payer: Quartz Beloit One Network |
$7,142.24
|
| Rate for Payer: Quartz Commercial |
$8,745.60
|
| Rate for Payer: WEA Trust Commercial |
$8,016.80
|
| Rate for Payer: WPS Commercial |
$10,796.44
|
|
|
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 |
$5,352.76 |
| Max. Negotiated Rate |
$10,050.08 |
| Rate for Payer: Aetna Commercial |
$9,831.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,394.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,789.72
|
| Rate for Payer: Cash Price |
$3,277.20
|
| Rate for Payer: Cigna Commercial |
$10,050.08
|
| Rate for Payer: Health EOS Commercial |
$9,722.36
|
| Rate for Payer: HFN Commercial |
$10,050.08
|
| Rate for Payer: Multiplan Commercial |
$8,739.20
|
| Rate for Payer: NAPHCARE Commercial |
$6,554.40
|
| Rate for Payer: Preferred Network Access Commercial |
$10,050.08
|
| Rate for Payer: Quartz Beloit One Network |
$5,352.76
|
| Rate for Payer: Quartz Commercial |
$6,554.40
|
| Rate for Payer: WEA Trust Commercial |
$6,008.20
|
| Rate for Payer: WPS Commercial |
$8,091.41
|
|
|
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 |
$3,058.72 |
| Max. Negotiated Rate |
$43,696.00 |
| Rate for Payer: Aetna Commercial |
$9,831.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,394.64
|
| Rate for Payer: Aetna Managed Medicare |
$3,058.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,100.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,462.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,243.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,789.72
|
| Rate for Payer: Cash Price |
$3,277.20
|
| Rate for Payer: Cigna Commercial |
$10,050.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,113.07
|
| Rate for Payer: Health EOS Commercial |
$9,722.36
|
| Rate for Payer: HFN Commercial |
$10,050.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,193.00
|
| Rate for Payer: Multiplan Commercial |
$8,739.20
|
| Rate for Payer: NAPHCARE Commercial |
$6,554.40
|
| Rate for Payer: Preferred Network Access Commercial |
$10,050.08
|
| Rate for Payer: Quartz Beloit One Network |
$5,352.76
|
| Rate for Payer: Quartz Commercial |
$7,100.60
|
| Rate for Payer: Quartz Medicare Advantage |
$6,554.40
|
| Rate for Payer: The Alliance Commercial |
$43,696.00
|
| Rate for Payer: WEA Trust Commercial |
$6,008.20
|
| Rate for Payer: WPS Commercial |
$8,091.41
|
|
|
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 |
$1,340.36 |
| Max. Negotiated Rate |
$19,148.00 |
| Rate for Payer: Aetna Commercial |
$4,308.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,116.82
|
| Rate for Payer: Aetna Managed Medicare |
$1,340.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,111.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,393.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,297.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,537.11
|
| Rate for Payer: Cash Price |
$1,436.10
|
| Rate for Payer: Cigna Commercial |
$4,404.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,678.81
|
| Rate for Payer: Health EOS Commercial |
$4,260.43
|
| Rate for Payer: HFN Commercial |
$4,404.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,590.25
|
| Rate for Payer: Multiplan Commercial |
$3,829.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,872.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,404.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,345.63
|
| Rate for Payer: Quartz Commercial |
$3,111.55
|
| Rate for Payer: Quartz Medicare Advantage |
$2,872.20
|
| Rate for Payer: The Alliance Commercial |
$19,148.00
|
| Rate for Payer: WEA Trust Commercial |
$2,632.85
|
| Rate for Payer: WPS Commercial |
$3,545.73
|
|
|
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 |
$2,345.63 |
| Max. Negotiated Rate |
$4,404.04 |
| Rate for Payer: Aetna Commercial |
$4,308.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,116.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,537.11
|
| Rate for Payer: Cash Price |
$1,436.10
|
| Rate for Payer: Cigna Commercial |
$4,404.04
|
| Rate for Payer: Health EOS Commercial |
$4,260.43
|
| Rate for Payer: HFN Commercial |
$4,404.04
|
| Rate for Payer: Multiplan Commercial |
$3,829.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,872.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,404.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,345.63
|
| Rate for Payer: Quartz Commercial |
$2,872.20
|
| Rate for Payer: WEA Trust Commercial |
$2,632.85
|
| Rate for Payer: WPS Commercial |
$3,545.73
|
|
|
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 |
$2,054.92 |
| Max. Negotiated Rate |
$29,356.00 |
| Rate for Payer: Aetna Commercial |
$6,605.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,311.54
|
| Rate for Payer: Aetna Managed Medicare |
$2,054.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,770.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,669.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,522.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,889.67
|
| Rate for Payer: Cash Price |
$2,201.70
|
| Rate for Payer: Cigna Commercial |
$6,751.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,106.90
|
| Rate for Payer: Health EOS Commercial |
$6,531.71
|
| Rate for Payer: HFN Commercial |
$6,751.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,504.25
|
| Rate for Payer: Multiplan Commercial |
$5,871.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,403.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,751.88
|
| Rate for Payer: Quartz Beloit One Network |
$3,596.11
|
| Rate for Payer: Quartz Commercial |
$4,770.35
|
| Rate for Payer: Quartz Medicare Advantage |
$4,403.40
|
| Rate for Payer: The Alliance Commercial |
$29,356.00
|
| Rate for Payer: WEA Trust Commercial |
$4,036.45
|
| Rate for Payer: WPS Commercial |
$5,436.00
|
|
|
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 |
$3,596.11 |
| Max. Negotiated Rate |
$6,751.88 |
| Rate for Payer: Aetna Commercial |
$6,605.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,311.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,889.67
|
| Rate for Payer: Cash Price |
$2,201.70
|
| Rate for Payer: Cigna Commercial |
$6,751.88
|
| Rate for Payer: Health EOS Commercial |
$6,531.71
|
| Rate for Payer: HFN Commercial |
$6,751.88
|
| Rate for Payer: Multiplan Commercial |
$5,871.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,403.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,751.88
|
| Rate for Payer: Quartz Beloit One Network |
$3,596.11
|
| Rate for Payer: Quartz Commercial |
$4,403.40
|
| Rate for Payer: WEA Trust Commercial |
$4,036.45
|
| Rate for Payer: WPS Commercial |
$5,436.00
|
|
|
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 |
$3,136.28 |
| Max. Negotiated Rate |
$44,804.00 |
| Rate for Payer: Aetna Commercial |
$10,080.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,632.86
|
| Rate for Payer: Aetna Managed Medicare |
$3,136.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,280.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,600.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,376.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,936.53
|
| Rate for Payer: Cash Price |
$3,360.30
|
| Rate for Payer: Cigna Commercial |
$10,304.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,268.08
|
| Rate for Payer: Health EOS Commercial |
$9,968.89
|
| Rate for Payer: HFN Commercial |
$10,304.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,400.75
|
| Rate for Payer: Multiplan Commercial |
$8,960.80
|
| Rate for Payer: NAPHCARE Commercial |
$6,720.60
|
| Rate for Payer: Preferred Network Access Commercial |
$10,304.92
|
| Rate for Payer: Quartz Beloit One Network |
$5,488.49
|
| Rate for Payer: Quartz Commercial |
$7,280.65
|
| Rate for Payer: Quartz Medicare Advantage |
$6,720.60
|
| Rate for Payer: The Alliance Commercial |
$44,804.00
|
| Rate for Payer: WEA Trust Commercial |
$6,160.55
|
| Rate for Payer: WPS Commercial |
$8,296.58
|
|
