|
IMPLANT CHANDRAL DART 1.3 X 18MM AR-4005B-18
|
Facility
|
IP
|
$2,214.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5885643
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,128.25 |
| Max. Negotiated Rate |
$2,118.36 |
| Rate for Payer: Aetna Commercial |
$2,072.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,980.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,220.36
|
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Cigna Commercial |
$2,118.36
|
| Rate for Payer: Health EOS Commercial |
$2,049.28
|
| Rate for Payer: HFN Commercial |
$2,118.36
|
| Rate for Payer: Multiplan Commercial |
$1,842.05
|
| Rate for Payer: Preferred Network Access Commercial |
$2,118.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,128.25
|
| Rate for Payer: Quartz Commercial |
$1,381.54
|
| Rate for Payer: WEA Trust Commercial |
$1,266.41
|
| Rate for Payer: WPS Commercial |
$1,705.44
|
|
|
IMPLANT DELIVERY SYSTEM DISTAL BICEPS REPAIR AR-2260
|
Facility
|
IP
|
$7,699.00
|
|
| Hospital Charge Code |
2964682
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,923.41 |
| Max. Negotiated Rate |
$7,366.40 |
| Rate for Payer: Aetna Commercial |
$7,206.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,885.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,243.69
|
| Rate for Payer: Cash Price |
$2,309.70
|
| Rate for Payer: Cigna Commercial |
$7,366.40
|
| Rate for Payer: Health EOS Commercial |
$7,126.19
|
| Rate for Payer: HFN Commercial |
$7,366.40
|
| Rate for Payer: Multiplan Commercial |
$6,405.57
|
| Rate for Payer: Preferred Network Access Commercial |
$7,366.40
|
| Rate for Payer: Quartz Beloit One Network |
$3,923.41
|
| Rate for Payer: Quartz Commercial |
$4,804.18
|
| Rate for Payer: WEA Trust Commercial |
$4,403.83
|
| Rate for Payer: WPS Commercial |
$5,930.54
|
|
|
IMPLANT DELIVERY SYSTEM DISTAL BICEPS REPAIR AR-2260
|
Facility
|
OP
|
$7,699.00
|
|
| Hospital Charge Code |
2964682
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,241.95 |
| Max. Negotiated Rate |
$7,366.40 |
| Rate for Payer: Aetna Commercial |
$7,206.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,885.99
|
| Rate for Payer: Aetna Managed Medicare |
$2,241.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,204.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,003.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,843.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,243.69
|
| Rate for Payer: Cash Price |
$2,309.70
|
| Rate for Payer: Cigna Commercial |
$7,366.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,480.82
|
| Rate for Payer: Health EOS Commercial |
$7,126.19
|
| Rate for Payer: HFN Commercial |
$7,366.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,005.22
|
| Rate for Payer: Multiplan Commercial |
$6,405.57
|
| Rate for Payer: NAPHCARE Commercial |
$4,804.18
|
| Rate for Payer: Preferred Network Access Commercial |
$7,366.40
|
| Rate for Payer: Quartz Beloit One Network |
$3,923.41
|
| Rate for Payer: Quartz Commercial |
$5,204.52
|
| Rate for Payer: Quartz Medicare Advantage |
$4,804.18
|
| Rate for Payer: The Alliance Commercial |
$4,003.48
|
| Rate for Payer: WEA Trust Commercial |
$4,403.83
|
| Rate for Payer: WPS Commercial |
$5,930.54
|
|
|
IMPLANT DELIVERY SYSTEM DISTAL BICEPS REPAIR BC AR-2260BC
|
Facility
|
OP
|
$8,695.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5520889
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,531.98 |
| Max. Negotiated Rate |
$8,319.38 |
| Rate for Payer: Aetna Commercial |
$8,138.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,776.81
|
| Rate for Payer: Aetna Managed Medicare |
$2,531.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,877.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,521.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,340.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,792.68
|
| Rate for Payer: Cash Price |
$2,608.50
|
| Rate for Payer: Cigna Commercial |
$8,319.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,060.49
|
| Rate for Payer: Health EOS Commercial |
$8,048.09
|
| Rate for Payer: HFN Commercial |
$8,319.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,782.10
|
| Rate for Payer: Multiplan Commercial |
$7,234.24
|
| Rate for Payer: NAPHCARE Commercial |
$5,425.68
|
| Rate for Payer: Preferred Network Access Commercial |
$8,319.38
|
| Rate for Payer: Quartz Beloit One Network |
$4,430.97
|
| Rate for Payer: Quartz Commercial |
$5,877.82
|
| Rate for Payer: Quartz Medicare Advantage |
$5,425.68
|
| Rate for Payer: The Alliance Commercial |
$4,521.40
|
| Rate for Payer: WEA Trust Commercial |
$4,973.54
|
| Rate for Payer: WPS Commercial |
$6,697.76
|
|
|
IMPLANT DELIVERY SYSTEM DISTAL BICEPS REPAIR BC AR-2260BC
|
Facility
|
IP
|
$8,695.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5520889
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,430.97 |
| Max. Negotiated Rate |
$8,319.38 |
| Rate for Payer: Aetna Commercial |
$8,138.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,776.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,792.68
|
| Rate for Payer: Cash Price |
$2,608.50
|
| Rate for Payer: Cigna Commercial |
$8,319.38
|
| Rate for Payer: Health EOS Commercial |
$8,048.09
|
| Rate for Payer: HFN Commercial |
$8,319.38
|
| Rate for Payer: Multiplan Commercial |
$7,234.24
|
| Rate for Payer: Preferred Network Access Commercial |
$8,319.38
|
| Rate for Payer: Quartz Beloit One Network |
$4,430.97
|
| Rate for Payer: Quartz Commercial |
$5,425.68
|
| Rate for Payer: WEA Trust Commercial |
$4,973.54
|
| Rate for Payer: WPS Commercial |
$6,697.76
|
|
|
IMPLANT DIGIFUSE 2.0MM X 10 DEG ANGLE DF2010
|
Facility
|
OP
|
$11,306.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729623
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,292.31 |
| Max. Negotiated Rate |
$10,817.58 |
| Rate for Payer: Aetna Commercial |
$10,582.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,112.09
|
| Rate for Payer: Aetna Managed Medicare |
$3,292.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,642.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,879.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,643.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,231.87
|
| Rate for Payer: Cash Price |
$3,391.80
|
| Rate for Payer: Cigna Commercial |
$10,817.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,580.09
|
| Rate for Payer: Health EOS Commercial |
$10,464.83
|
| Rate for Payer: HFN Commercial |
$10,817.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,818.68
|
| Rate for Payer: Multiplan Commercial |
$9,406.59
|
| Rate for Payer: NAPHCARE Commercial |
$7,054.94
|
| Rate for Payer: Preferred Network Access Commercial |
$10,817.58
|
| Rate for Payer: Quartz Beloit One Network |
$5,761.54
|
| Rate for Payer: Quartz Commercial |
$7,642.86
|
| Rate for Payer: Quartz Medicare Advantage |
$7,054.94
|
| Rate for Payer: The Alliance Commercial |
$5,879.12
|
| Rate for Payer: WEA Trust Commercial |
$6,467.03
|
| Rate for Payer: WPS Commercial |
$8,709.01
|
|
|
IMPLANT DIGIFUSE 2.0MM X 10 DEG ANGLE DF2010
|
Facility
|
IP
|
$11,306.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5729623
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,761.54 |
| Max. Negotiated Rate |
$10,817.58 |
| Rate for Payer: Aetna Commercial |
$10,582.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,112.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,231.87
|
| Rate for Payer: Cash Price |
$3,391.80
|
| Rate for Payer: Cigna Commercial |
$10,817.58
|
| Rate for Payer: Health EOS Commercial |
$10,464.83
|
| Rate for Payer: HFN Commercial |
$10,817.58
|
| Rate for Payer: Multiplan Commercial |
$9,406.59
|
| Rate for Payer: Preferred Network Access Commercial |
$10,817.58
|
| Rate for Payer: Quartz Beloit One Network |
$5,761.54
|
| Rate for Payer: Quartz Commercial |
$7,054.94
|
| Rate for Payer: WEA Trust Commercial |
$6,467.03
|
| Rate for Payer: WPS Commercial |
$8,709.01
|
|
|
IMPLANT DIGIFUSE 2.5MM 10 DEGREE DF2510
|
Facility
|
OP
|
$6,393.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5627642
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,861.64 |
| Max. Negotiated Rate |
$6,116.82 |
| Rate for Payer: Aetna Commercial |
$5,983.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,717.90
|
| Rate for Payer: Aetna Managed Medicare |
$1,861.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,321.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,324.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,191.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,523.82
|
| Rate for Payer: Cash Price |
$1,917.90
|
| Rate for Payer: Cigna Commercial |
$6,116.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,720.73
|
| Rate for Payer: Health EOS Commercial |
$5,917.36
|
| Rate for Payer: HFN Commercial |
$6,116.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,986.54
|
| Rate for Payer: Multiplan Commercial |
$5,318.98
|
| Rate for Payer: NAPHCARE Commercial |
$3,989.23
|
| Rate for Payer: Preferred Network Access Commercial |
$6,116.82
|
| Rate for Payer: Quartz Beloit One Network |
$3,257.87
|
| Rate for Payer: Quartz Commercial |
$4,321.67
|
| Rate for Payer: Quartz Medicare Advantage |
$3,989.23
|
| Rate for Payer: The Alliance Commercial |
$3,324.36
|
| Rate for Payer: WEA Trust Commercial |
$3,656.80
|
| Rate for Payer: WPS Commercial |
$4,924.53
|
|
|
IMPLANT DIGIFUSE 2.5MM 10 DEGREE DF2510
|
Facility
|
IP
|
$6,393.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5627642
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,257.87 |
| Max. Negotiated Rate |
$6,116.82 |
| Rate for Payer: Aetna Commercial |
$5,983.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,717.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,523.82
|
| Rate for Payer: Cash Price |
$1,917.90
|
| Rate for Payer: Cigna Commercial |
$6,116.82
|
| Rate for Payer: Health EOS Commercial |
$5,917.36
|
| Rate for Payer: HFN Commercial |
$6,116.82
|
| Rate for Payer: Multiplan Commercial |
$5,318.98
|
| Rate for Payer: Preferred Network Access Commercial |
$6,116.82
|
| Rate for Payer: Quartz Beloit One Network |
$3,257.87
|
| Rate for Payer: Quartz Commercial |
$3,989.23
|
| Rate for Payer: WEA Trust Commercial |
$3,656.80
|
| Rate for Payer: WPS Commercial |
$4,924.53
|
|
|
IMPLANT EAR KURZ ANGULAR PLESTER 2.25MM 1002 610
|
Facility
|
OP
|
$4,793.00
|
|
| Hospital Charge Code |
3713506
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,395.72 |
| Max. Negotiated Rate |
$4,585.94 |
| Rate for Payer: Aetna Commercial |
$4,486.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,286.86
|
| Rate for Payer: Aetna Managed Medicare |
$1,395.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,240.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,492.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,392.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,641.90
|
| Rate for Payer: Cash Price |
$1,437.90
|
| Rate for Payer: Cigna Commercial |
$4,585.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,789.53
|
| Rate for Payer: Health EOS Commercial |
$4,436.40
|
| Rate for Payer: HFN Commercial |
$4,585.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,738.54
|
| Rate for Payer: Multiplan Commercial |
$3,987.78
|
| Rate for Payer: NAPHCARE Commercial |
$2,990.83
|
| Rate for Payer: Preferred Network Access Commercial |
$4,585.94
|
| Rate for Payer: Quartz Beloit One Network |
$2,442.51
|
| Rate for Payer: Quartz Commercial |
$3,240.07
|
| Rate for Payer: Quartz Medicare Advantage |
$2,990.83
|
| Rate for Payer: The Alliance Commercial |
$2,492.36
|
| Rate for Payer: WEA Trust Commercial |
$2,741.60
|
| Rate for Payer: WPS Commercial |
$3,692.05
|
|
|
IMPLANT EAR KURZ ANGULAR PLESTER 2.25MM 1002 610
|
Facility
|
IP
|
$4,793.00
|
|
| Hospital Charge Code |
3713506
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,442.51 |
| Max. Negotiated Rate |
$4,585.94 |
| Rate for Payer: Aetna Commercial |
$4,486.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,286.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,641.90
|
| Rate for Payer: Cash Price |
$1,437.90
|
| Rate for Payer: Cigna Commercial |
$4,585.94
|
| Rate for Payer: Health EOS Commercial |
$4,436.40
|
| Rate for Payer: HFN Commercial |
$4,585.94
|
| Rate for Payer: Multiplan Commercial |
$3,987.78
|
| Rate for Payer: Preferred Network Access Commercial |
$4,585.94
|
| Rate for Payer: Quartz Beloit One Network |
$2,442.51
|
| Rate for Payer: Quartz Commercial |
$2,990.83
|
| Rate for Payer: WEA Trust Commercial |
$2,741.60
|
| Rate for Payer: WPS Commercial |
$3,692.05
|
|
|
IMPLANT EAR KURZ ANGULAR PLESTER 3.25MM 1002 612
|
Facility
|
IP
|
$4,793.00
|
|
| Hospital Charge Code |
3713507
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,442.51 |
| Max. Negotiated Rate |
$4,585.94 |
| Rate for Payer: Aetna Commercial |
$4,486.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,286.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,641.90
|
| Rate for Payer: Cash Price |
$1,437.90
|
| Rate for Payer: Cigna Commercial |
$4,585.94
|
| Rate for Payer: Health EOS Commercial |
$4,436.40
|
| Rate for Payer: HFN Commercial |
$4,585.94
|
| Rate for Payer: Multiplan Commercial |
$3,987.78
|
| Rate for Payer: Preferred Network Access Commercial |
$4,585.94
|
| Rate for Payer: Quartz Beloit One Network |
$2,442.51
|
| Rate for Payer: Quartz Commercial |
$2,990.83
|
| Rate for Payer: WEA Trust Commercial |
$2,741.60
|
| Rate for Payer: WPS Commercial |
$3,692.05
|
|
|
IMPLANT EAR KURZ ANGULAR PLESTER 3.25MM 1002 612
|
Facility
|
OP
|
$4,793.00
|
|
| Hospital Charge Code |
3713507
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,395.72 |
| Max. Negotiated Rate |
$4,585.94 |
| Rate for Payer: Aetna Commercial |
$4,486.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,286.86
|
| Rate for Payer: Aetna Managed Medicare |
$1,395.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,240.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,492.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,392.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,641.90
|
| Rate for Payer: Cash Price |
$1,437.90
|
| Rate for Payer: Cigna Commercial |
$4,585.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,789.53
|
| Rate for Payer: Health EOS Commercial |
$4,436.40
|
| Rate for Payer: HFN Commercial |
$4,585.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,738.54
|
| Rate for Payer: Multiplan Commercial |
$3,987.78
|
| Rate for Payer: NAPHCARE Commercial |
$2,990.83
|
| Rate for Payer: Preferred Network Access Commercial |
$4,585.94
|
| Rate for Payer: Quartz Beloit One Network |
$2,442.51
|
| Rate for Payer: Quartz Commercial |
$3,240.07
|
| Rate for Payer: Quartz Medicare Advantage |
$2,990.83
|
| Rate for Payer: The Alliance Commercial |
$2,492.36
|
| Rate for Payer: WEA Trust Commercial |
$2,741.60
|
| Rate for Payer: WPS Commercial |
$3,692.05
|
|
|
IMPLANT EAR KURZ TTP VARIAC PARTIAL (1.75 - 4.5MM) 1002 020
|
Facility
|
IP
|
$4,856.00
|
|
| Hospital Charge Code |
3583499
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,474.62 |
| Max. Negotiated Rate |
$4,646.22 |
| Rate for Payer: Aetna Commercial |
$4,545.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,343.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,676.63
|
| Rate for Payer: Cash Price |
$1,456.80
|
| Rate for Payer: Cigna Commercial |
$4,646.22
|
| Rate for Payer: Health EOS Commercial |
$4,494.71
|
| Rate for Payer: HFN Commercial |
$4,646.22
|
| Rate for Payer: Multiplan Commercial |
$4,040.19
|
| Rate for Payer: Preferred Network Access Commercial |
$4,646.22
|
| Rate for Payer: Quartz Beloit One Network |
$2,474.62
|
| Rate for Payer: Quartz Commercial |
$3,030.14
|
| Rate for Payer: WEA Trust Commercial |
$2,777.63
|
| Rate for Payer: WPS Commercial |
$3,740.58
|
|
|
IMPLANT EAR KURZ TTP VARIAC PARTIAL (1.75 - 4.5MM) 1002 020
|
Facility
|
OP
|
$4,856.00
|
|
| Hospital Charge Code |
3583499
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,414.07 |
| Max. Negotiated Rate |
$4,646.22 |
| Rate for Payer: Aetna Commercial |
$4,545.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,343.21
|
| Rate for Payer: Aetna Managed Medicare |
$1,414.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,282.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,525.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,424.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,676.63
|
| Rate for Payer: Cash Price |
$1,456.80
|
| Rate for Payer: Cigna Commercial |
$4,646.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,826.19
|
| Rate for Payer: Health EOS Commercial |
$4,494.71
|
| Rate for Payer: HFN Commercial |
$4,646.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,787.68
|
| Rate for Payer: Multiplan Commercial |
$4,040.19
|
| Rate for Payer: NAPHCARE Commercial |
$3,030.14
|
| Rate for Payer: Preferred Network Access Commercial |
$4,646.22
|
| Rate for Payer: Quartz Beloit One Network |
$2,474.62
|
| Rate for Payer: Quartz Commercial |
$3,282.66
|
| Rate for Payer: Quartz Medicare Advantage |
$3,030.14
|
| Rate for Payer: The Alliance Commercial |
$2,525.12
|
| Rate for Payer: WEA Trust Commercial |
$2,777.63
|
| Rate for Payer: WPS Commercial |
$3,740.58
|
|
|
IMPLANT EAR KURZ TTP VARIAC TOTAL (3.0 - 7.0MM) 1004 020
|
Facility
|
IP
|
$4,856.00
|
|
| Hospital Charge Code |
3591496
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,474.62 |
| Max. Negotiated Rate |
$4,646.22 |
| Rate for Payer: Aetna Commercial |
$4,545.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,343.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,676.63
|
| Rate for Payer: Cash Price |
$1,456.80
|
| Rate for Payer: Cigna Commercial |
$4,646.22
|
| Rate for Payer: Health EOS Commercial |
$4,494.71
|
| Rate for Payer: HFN Commercial |
$4,646.22
|
| Rate for Payer: Multiplan Commercial |
$4,040.19
|
| Rate for Payer: Preferred Network Access Commercial |
$4,646.22
|
| Rate for Payer: Quartz Beloit One Network |
$2,474.62
|
| Rate for Payer: Quartz Commercial |
$3,030.14
|
| Rate for Payer: WEA Trust Commercial |
$2,777.63
|
| Rate for Payer: WPS Commercial |
$3,740.58
|
|
|
IMPLANT EAR KURZ TTP VARIAC TOTAL (3.0 - 7.0MM) 1004 020
|
Facility
|
OP
|
$4,856.00
|
|
| Hospital Charge Code |
3591496
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,414.07 |
| Max. Negotiated Rate |
$4,646.22 |
| Rate for Payer: Aetna Commercial |
$4,545.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,343.21
|
| Rate for Payer: Aetna Managed Medicare |
$1,414.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,282.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,525.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,424.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,676.63
|
| Rate for Payer: Cash Price |
$1,456.80
|
| Rate for Payer: Cigna Commercial |
$4,646.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,826.19
|
| Rate for Payer: Health EOS Commercial |
$4,494.71
|
| Rate for Payer: HFN Commercial |
$4,646.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,787.68
|
| Rate for Payer: Multiplan Commercial |
$4,040.19
|
| Rate for Payer: NAPHCARE Commercial |
$3,030.14
|
| Rate for Payer: Preferred Network Access Commercial |
$4,646.22
|
| Rate for Payer: Quartz Beloit One Network |
$2,474.62
|
| Rate for Payer: Quartz Commercial |
$3,282.66
|
| Rate for Payer: Quartz Medicare Advantage |
$3,030.14
|
| Rate for Payer: The Alliance Commercial |
$2,525.12
|
| Rate for Payer: WEA Trust Commercial |
$2,777.63
|
| Rate for Payer: WPS Commercial |
$3,740.58
|
|
|
IMPLANT EAR MEDPOR EAR BASE EXTENDED LT 30MM X 59MM 8331
|
Facility
|
OP
|
$7,197.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6200990
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,095.77 |
| Max. Negotiated Rate |
$6,886.09 |
| Rate for Payer: Aetna Commercial |
$6,736.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,437.00
|
| Rate for Payer: Aetna Managed Medicare |
$2,095.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,865.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,742.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,592.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,966.99
|
| Rate for Payer: Cash Price |
$2,159.10
|
| Rate for Payer: Cigna Commercial |
$6,886.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,188.65
|
| Rate for Payer: Health EOS Commercial |
$6,661.54
|
| Rate for Payer: HFN Commercial |
$6,886.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,613.66
|
| Rate for Payer: Multiplan Commercial |
$5,987.90
|
| Rate for Payer: NAPHCARE Commercial |
$4,490.93
|
| Rate for Payer: Preferred Network Access Commercial |
$6,886.09
|
| Rate for Payer: Quartz Beloit One Network |
$3,667.59
|
| Rate for Payer: Quartz Commercial |
$4,865.17
|
| Rate for Payer: Quartz Medicare Advantage |
$4,490.93
|
| Rate for Payer: The Alliance Commercial |
$3,742.44
|
| Rate for Payer: WEA Trust Commercial |
$4,116.68
|
| Rate for Payer: WPS Commercial |
$5,543.85
|
|
|
IMPLANT EAR MEDPOR EAR BASE EXTENDED LT 30MM X 59MM 8331
|
Facility
|
IP
|
$7,197.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6200990
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,667.59 |
| Max. Negotiated Rate |
$6,886.09 |
| Rate for Payer: Aetna Commercial |
$6,736.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,437.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,966.99
|
| Rate for Payer: Cash Price |
$2,159.10
|
| Rate for Payer: Cigna Commercial |
$6,886.09
|
| Rate for Payer: Health EOS Commercial |
$6,661.54
|
| Rate for Payer: HFN Commercial |
$6,886.09
|
| Rate for Payer: Multiplan Commercial |
$5,987.90
|
| Rate for Payer: Preferred Network Access Commercial |
$6,886.09
|
| Rate for Payer: Quartz Beloit One Network |
$3,667.59
|
| Rate for Payer: Quartz Commercial |
$4,490.93
|
| Rate for Payer: WEA Trust Commercial |
$4,116.68
|
| Rate for Payer: WPS Commercial |
$5,543.85
|
|
|
IMPLANT EAR MEDPOR EAR BASE EXTENDED RT 30MM X 59MM 8330
|
Facility
|
IP
|
$7,197.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6200986
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,667.59 |
| Max. Negotiated Rate |
$6,886.09 |
| Rate for Payer: Aetna Commercial |
$6,736.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,437.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,966.99
|
| Rate for Payer: Cash Price |
$2,159.10
|
| Rate for Payer: Cigna Commercial |
$6,886.09
|
| Rate for Payer: Health EOS Commercial |
$6,661.54
|
| Rate for Payer: HFN Commercial |
$6,886.09
|
| Rate for Payer: Multiplan Commercial |
$5,987.90
|
| Rate for Payer: Preferred Network Access Commercial |
$6,886.09
|
| Rate for Payer: Quartz Beloit One Network |
$3,667.59
|
| Rate for Payer: Quartz Commercial |
$4,490.93
|
| Rate for Payer: WEA Trust Commercial |
$4,116.68
|
| Rate for Payer: WPS Commercial |
$5,543.85
|
|
|
IMPLANT EAR MEDPOR EAR BASE EXTENDED RT 30MM X 59MM 8330
|
Facility
|
OP
|
$7,197.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6200986
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,095.77 |
| Max. Negotiated Rate |
$6,886.09 |
| Rate for Payer: Aetna Commercial |
$6,736.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,437.00
|
| Rate for Payer: Aetna Managed Medicare |
$2,095.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,865.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,742.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,592.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,966.99
|
| Rate for Payer: Cash Price |
$2,159.10
|
| Rate for Payer: Cigna Commercial |
$6,886.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,188.65
|
| Rate for Payer: Health EOS Commercial |
$6,661.54
|
| Rate for Payer: HFN Commercial |
$6,886.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,613.66
|
| Rate for Payer: Multiplan Commercial |
$5,987.90
|
| Rate for Payer: NAPHCARE Commercial |
$4,490.93
|
| Rate for Payer: Preferred Network Access Commercial |
$6,886.09
|
| Rate for Payer: Quartz Beloit One Network |
$3,667.59
|
| Rate for Payer: Quartz Commercial |
$4,865.17
|
| Rate for Payer: Quartz Medicare Advantage |
$4,490.93
|
| Rate for Payer: The Alliance Commercial |
$3,742.44
|
| Rate for Payer: WEA Trust Commercial |
$4,116.68
|
| Rate for Payer: WPS Commercial |
$5,543.85
|
|
|
IMPLANT EAR MEDPOR HELICAL RIM LT 37MM X 62MM 8329
|
Facility
|
OP
|
$5,894.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6200984
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,716.33 |
| Max. Negotiated Rate |
$5,639.38 |
| Rate for Payer: Aetna Commercial |
$5,516.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,271.59
|
| Rate for Payer: Aetna Managed Medicare |
$1,716.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,984.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,064.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,942.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,248.77
|
| Rate for Payer: Cash Price |
$1,768.20
|
| Rate for Payer: Cigna Commercial |
$5,639.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,430.31
|
| Rate for Payer: Health EOS Commercial |
$5,455.49
|
| Rate for Payer: HFN Commercial |
$5,639.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,597.32
|
| Rate for Payer: Multiplan Commercial |
$4,903.81
|
| Rate for Payer: NAPHCARE Commercial |
$3,677.86
|
| Rate for Payer: Preferred Network Access Commercial |
$5,639.38
|
| Rate for Payer: Quartz Beloit One Network |
$3,003.58
|
| Rate for Payer: Quartz Commercial |
$3,984.34
|
| Rate for Payer: Quartz Medicare Advantage |
$3,677.86
|
| Rate for Payer: The Alliance Commercial |
$3,064.88
|
| Rate for Payer: WEA Trust Commercial |
$3,371.37
|
| Rate for Payer: WPS Commercial |
$4,540.15
|
|
|
IMPLANT EAR MEDPOR HELICAL RIM LT 37MM X 62MM 8329
|
Facility
|
IP
|
$5,894.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6200984
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,003.58 |
| Max. Negotiated Rate |
$5,639.38 |
| Rate for Payer: Aetna Commercial |
$5,516.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,271.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,248.77
|
| Rate for Payer: Cash Price |
$1,768.20
|
| Rate for Payer: Cigna Commercial |
$5,639.38
|
| Rate for Payer: Health EOS Commercial |
$5,455.49
|
| Rate for Payer: HFN Commercial |
$5,639.38
|
| Rate for Payer: Multiplan Commercial |
$4,903.81
|
| Rate for Payer: Preferred Network Access Commercial |
$5,639.38
|
| Rate for Payer: Quartz Beloit One Network |
$3,003.58
|
| Rate for Payer: Quartz Commercial |
$3,677.86
|
| Rate for Payer: WEA Trust Commercial |
$3,371.37
|
| Rate for Payer: WPS Commercial |
$4,540.15
|
|
|
IMPLANT EAR MEDPOR HELICAL RIM RT 37MM X 62MM 8328
|
Facility
|
IP
|
$5,894.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6200982
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,003.58 |
| Max. Negotiated Rate |
$5,639.38 |
| Rate for Payer: Aetna Commercial |
$5,516.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,271.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,248.77
|
| Rate for Payer: Cash Price |
$1,768.20
|
| Rate for Payer: Cigna Commercial |
$5,639.38
|
| Rate for Payer: Health EOS Commercial |
$5,455.49
|
| Rate for Payer: HFN Commercial |
$5,639.38
|
| Rate for Payer: Multiplan Commercial |
$4,903.81
|
| Rate for Payer: Preferred Network Access Commercial |
$5,639.38
|
| Rate for Payer: Quartz Beloit One Network |
$3,003.58
|
| Rate for Payer: Quartz Commercial |
$3,677.86
|
| Rate for Payer: WEA Trust Commercial |
$3,371.37
|
| Rate for Payer: WPS Commercial |
$4,540.15
|
|
|
IMPLANT EAR MEDPOR HELICAL RIM RT 37MM X 62MM 8328
|
Facility
|
OP
|
$5,894.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6200982
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,716.33 |
| Max. Negotiated Rate |
$5,639.38 |
| Rate for Payer: Aetna Commercial |
$5,516.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,271.59
|
| Rate for Payer: Aetna Managed Medicare |
$1,716.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,984.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,064.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,942.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,248.77
|
| Rate for Payer: Cash Price |
$1,768.20
|
| Rate for Payer: Cigna Commercial |
$5,639.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,430.31
|
| Rate for Payer: Health EOS Commercial |
$5,455.49
|
| Rate for Payer: HFN Commercial |
$5,639.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,597.32
|
| Rate for Payer: Multiplan Commercial |
$4,903.81
|
| Rate for Payer: NAPHCARE Commercial |
$3,677.86
|
| Rate for Payer: Preferred Network Access Commercial |
$5,639.38
|
| Rate for Payer: Quartz Beloit One Network |
$3,003.58
|
| Rate for Payer: Quartz Commercial |
$3,984.34
|
| Rate for Payer: Quartz Medicare Advantage |
$3,677.86
|
| Rate for Payer: The Alliance Commercial |
$3,064.88
|
| Rate for Payer: WEA Trust Commercial |
$3,371.37
|
| Rate for Payer: WPS Commercial |
$4,540.15
|
|
