|
IMPLANT SYSTEM 5.5MM FDL AR-1555BC-CP
|
Facility
|
IP
|
$7,423.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6217116
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,782.76 |
| Max. Negotiated Rate |
$7,102.33 |
| Rate for Payer: Aetna Commercial |
$6,947.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,639.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,091.56
|
| Rate for Payer: Cash Price |
$2,226.90
|
| Rate for Payer: Cigna Commercial |
$7,102.33
|
| Rate for Payer: Health EOS Commercial |
$6,870.73
|
| Rate for Payer: HFN Commercial |
$7,102.33
|
| Rate for Payer: Multiplan Commercial |
$6,175.94
|
| Rate for Payer: Preferred Network Access Commercial |
$7,102.33
|
| Rate for Payer: Quartz Beloit One Network |
$3,782.76
|
| Rate for Payer: Quartz Commercial |
$4,631.95
|
| Rate for Payer: WEA Trust Commercial |
$4,245.96
|
| Rate for Payer: WPS Commercial |
$5,717.94
|
|
|
IMPLANT SYSTEM BIRMINGHAM BICEPS AR-1662S-1
|
Facility
|
OP
|
$6,393.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4595504
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,861.64 |
| 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 SYSTEM BIRMINGHAM BICEPS AR-1662S-1
|
Facility
|
IP
|
$6,393.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4595504
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,257.87 |
| 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 SYSTEM CPR MINI SCORPION DX AR-8690DS
|
Facility
|
OP
|
$6,191.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5627631
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,802.82 |
| Max. Negotiated Rate |
$5,923.55 |
| Rate for Payer: Aetna Commercial |
$5,794.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,537.23
|
| Rate for Payer: Aetna Managed Medicare |
$1,802.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,185.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,219.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,090.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,412.48
|
| Rate for Payer: Cash Price |
$1,857.30
|
| Rate for Payer: Cigna Commercial |
$5,923.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,603.16
|
| Rate for Payer: Health EOS Commercial |
$5,730.39
|
| Rate for Payer: HFN Commercial |
$5,923.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,828.98
|
| Rate for Payer: Multiplan Commercial |
$5,150.91
|
| Rate for Payer: NAPHCARE Commercial |
$3,863.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,923.55
|
| Rate for Payer: Quartz Beloit One Network |
$3,154.93
|
| Rate for Payer: Quartz Commercial |
$4,185.12
|
| Rate for Payer: Quartz Medicare Advantage |
$3,863.18
|
| Rate for Payer: The Alliance Commercial |
$3,219.32
|
| Rate for Payer: WEA Trust Commercial |
$3,541.25
|
| Rate for Payer: WPS Commercial |
$4,768.93
|
|
|
IMPLANT SYSTEM CPR MINI SCORPION DX AR-8690DS
|
Facility
|
IP
|
$6,191.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5627631
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,154.93 |
| Max. Negotiated Rate |
$5,923.55 |
| Rate for Payer: Aetna Commercial |
$5,794.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,537.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,412.48
|
| Rate for Payer: Cash Price |
$1,857.30
|
| Rate for Payer: Cigna Commercial |
$5,923.55
|
| Rate for Payer: Health EOS Commercial |
$5,730.39
|
| Rate for Payer: HFN Commercial |
$5,923.55
|
| Rate for Payer: Multiplan Commercial |
$5,150.91
|
| Rate for Payer: Preferred Network Access Commercial |
$5,923.55
|
| Rate for Payer: Quartz Beloit One Network |
$3,154.93
|
| Rate for Payer: Quartz Commercial |
$3,863.18
|
| Rate for Payer: WEA Trust Commercial |
$3,541.25
|
| Rate for Payer: WPS Commercial |
$4,768.93
|
|
|
IMPLANT SYSTEM ECLIPSE SPEEDSCAP AR-9400-SBK
|
Facility
|
OP
|
$12,786.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5729773
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,723.28 |
| Max. Negotiated Rate |
$12,233.64 |
| Rate for Payer: Aetna Commercial |
$11,967.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,435.80
|
| Rate for Payer: Aetna Managed Medicare |
$3,723.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,643.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,648.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,382.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,047.64
|
| Rate for Payer: Cash Price |
$3,835.80
|
| Rate for Payer: Cigna Commercial |
$12,233.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,441.45
|
| Rate for Payer: Health EOS Commercial |
$11,834.72
|
| Rate for Payer: HFN Commercial |
$12,233.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,973.08
|
| Rate for Payer: Multiplan Commercial |
$10,637.95
|
| Rate for Payer: NAPHCARE Commercial |
$7,978.46
|
| Rate for Payer: Preferred Network Access Commercial |
$12,233.64
|
| Rate for Payer: Quartz Beloit One Network |
$6,515.75
|
| Rate for Payer: Quartz Commercial |
$8,643.34
|
| Rate for Payer: Quartz Medicare Advantage |
$7,978.46
|
| Rate for Payer: The Alliance Commercial |
$6,648.72
|
| Rate for Payer: WEA Trust Commercial |
$7,313.59
|
| Rate for Payer: WPS Commercial |
$9,849.06
|
|
|
IMPLANT SYSTEM ECLIPSE SPEEDSCAP AR-9400-SBK
|
Facility
|
IP
|
$12,786.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5729773
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,515.75 |
| Max. Negotiated Rate |
$12,233.64 |
| Rate for Payer: Aetna Commercial |
$11,967.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,435.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,047.64
|
| Rate for Payer: Cash Price |
$3,835.80
|
| Rate for Payer: Cigna Commercial |
$12,233.64
|
| Rate for Payer: Health EOS Commercial |
$11,834.72
|
| Rate for Payer: HFN Commercial |
$12,233.64
|
| Rate for Payer: Multiplan Commercial |
$10,637.95
|
| Rate for Payer: Preferred Network Access Commercial |
$12,233.64
|
| Rate for Payer: Quartz Beloit One Network |
$6,515.75
|
| Rate for Payer: Quartz Commercial |
$7,978.46
|
| Rate for Payer: WEA Trust Commercial |
$7,313.59
|
| Rate for Payer: WPS Commercial |
$9,849.06
|
|
|
IMPLANT SYSTEM FDL 4.75MM AR-1547BC-CP
|
Facility
|
IP
|
$7,069.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6185035
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,602.36 |
| Max. Negotiated Rate |
$6,763.62 |
| Rate for Payer: Aetna Commercial |
$6,616.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,322.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,896.43
|
| Rate for Payer: Cash Price |
$2,120.70
|
| Rate for Payer: Cigna Commercial |
$6,763.62
|
| Rate for Payer: Health EOS Commercial |
$6,543.07
|
| Rate for Payer: HFN Commercial |
$6,763.62
|
| Rate for Payer: Multiplan Commercial |
$5,881.41
|
| Rate for Payer: Preferred Network Access Commercial |
$6,763.62
|
| Rate for Payer: Quartz Beloit One Network |
$3,602.36
|
| Rate for Payer: Quartz Commercial |
$4,411.06
|
| Rate for Payer: WEA Trust Commercial |
$4,043.47
|
| Rate for Payer: WPS Commercial |
$5,445.25
|
|
|
IMPLANT SYSTEM FDL 4.75MM AR-1547BC-CP
|
Facility
|
OP
|
$7,069.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6185035
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,058.49 |
| Max. Negotiated Rate |
$6,763.62 |
| Rate for Payer: Aetna Commercial |
$6,616.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,322.51
|
| Rate for Payer: Aetna Managed Medicare |
$2,058.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,778.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,675.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,528.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,896.43
|
| Rate for Payer: Cash Price |
$2,120.70
|
| Rate for Payer: Cigna Commercial |
$6,763.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,114.16
|
| Rate for Payer: Health EOS Commercial |
$6,543.07
|
| Rate for Payer: HFN Commercial |
$6,763.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,513.82
|
| Rate for Payer: Multiplan Commercial |
$5,881.41
|
| Rate for Payer: NAPHCARE Commercial |
$4,411.06
|
| Rate for Payer: Preferred Network Access Commercial |
$6,763.62
|
| Rate for Payer: Quartz Beloit One Network |
$3,602.36
|
| Rate for Payer: Quartz Commercial |
$4,778.64
|
| Rate for Payer: Quartz Medicare Advantage |
$4,411.06
|
| Rate for Payer: The Alliance Commercial |
$3,675.88
|
| Rate for Payer: WEA Trust Commercial |
$4,043.47
|
| Rate for Payer: WPS Commercial |
$5,445.25
|
|
|
IMPLANT SYSTEM FIBER TAG TIGHTROPE WITH ATTACHED NEEDLE, FLIP CUTTER & FIBERSTICK AR-1288RTT-FC3
|
Facility
|
IP
|
$7,130.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6131637
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,633.45 |
| Max. Negotiated Rate |
$6,821.98 |
| Rate for Payer: Aetna Commercial |
$6,673.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,377.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,930.06
|
| Rate for Payer: Cash Price |
$2,139.00
|
| Rate for Payer: Cigna Commercial |
$6,821.98
|
| Rate for Payer: Health EOS Commercial |
$6,599.53
|
| Rate for Payer: HFN Commercial |
$6,821.98
|
| Rate for Payer: Multiplan Commercial |
$5,932.16
|
| Rate for Payer: Preferred Network Access Commercial |
$6,821.98
|
| Rate for Payer: Quartz Beloit One Network |
$3,633.45
|
| Rate for Payer: Quartz Commercial |
$4,449.12
|
| Rate for Payer: WEA Trust Commercial |
$4,078.36
|
| Rate for Payer: WPS Commercial |
$5,492.24
|
|
|
IMPLANT SYSTEM FIBER TAG TIGHTROPE WITH ATTACHED NEEDLE, FLIP CUTTER & FIBERSTICK AR-1288RTT-FC3
|
Facility
|
OP
|
$7,130.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6131637
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,076.26 |
| Max. Negotiated Rate |
$6,821.98 |
| Rate for Payer: Aetna Commercial |
$6,673.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,377.07
|
| Rate for Payer: Aetna Managed Medicare |
$2,076.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,819.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,707.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,559.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,930.06
|
| Rate for Payer: Cash Price |
$2,139.00
|
| Rate for Payer: Cigna Commercial |
$6,821.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,149.66
|
| Rate for Payer: Health EOS Commercial |
$6,599.53
|
| Rate for Payer: HFN Commercial |
$6,821.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,561.40
|
| Rate for Payer: Multiplan Commercial |
$5,932.16
|
| Rate for Payer: NAPHCARE Commercial |
$4,449.12
|
| Rate for Payer: Preferred Network Access Commercial |
$6,821.98
|
| Rate for Payer: Quartz Beloit One Network |
$3,633.45
|
| Rate for Payer: Quartz Commercial |
$4,819.88
|
| Rate for Payer: Quartz Medicare Advantage |
$4,449.12
|
| Rate for Payer: The Alliance Commercial |
$3,707.60
|
| Rate for Payer: WEA Trust Commercial |
$4,078.36
|
| Rate for Payer: WPS Commercial |
$5,492.24
|
|
|
IMPLANT SYSTEM GRAFT ANCHOR AR-8826DS
|
Facility
|
OP
|
$9,499.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4595802
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,766.11 |
| Max. Negotiated Rate |
$9,088.64 |
| Rate for Payer: Aetna Commercial |
$8,891.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,495.91
|
| Rate for Payer: Aetna Managed Medicare |
$2,766.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,421.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,939.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,741.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,235.85
|
| Rate for Payer: Cash Price |
$2,849.70
|
| Rate for Payer: Cigna Commercial |
$9,088.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,528.42
|
| Rate for Payer: Health EOS Commercial |
$8,792.27
|
| Rate for Payer: HFN Commercial |
$9,088.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,409.22
|
| Rate for Payer: Multiplan Commercial |
$7,903.17
|
| Rate for Payer: NAPHCARE Commercial |
$5,927.38
|
| Rate for Payer: Preferred Network Access Commercial |
$9,088.64
|
| Rate for Payer: Quartz Beloit One Network |
$4,840.69
|
| Rate for Payer: Quartz Commercial |
$6,421.32
|
| Rate for Payer: Quartz Medicare Advantage |
$5,927.38
|
| Rate for Payer: The Alliance Commercial |
$4,939.48
|
| Rate for Payer: WEA Trust Commercial |
$5,433.43
|
| Rate for Payer: WPS Commercial |
$7,317.08
|
|
|
IMPLANT SYSTEM GRAFT ANCHOR AR-8826DS
|
Facility
|
IP
|
$9,499.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4595802
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,840.69 |
| Max. Negotiated Rate |
$9,088.64 |
| Rate for Payer: Aetna Commercial |
$8,891.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,495.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,235.85
|
| Rate for Payer: Cash Price |
$2,849.70
|
| Rate for Payer: Cigna Commercial |
$9,088.64
|
| Rate for Payer: Health EOS Commercial |
$8,792.27
|
| Rate for Payer: HFN Commercial |
$9,088.64
|
| Rate for Payer: Multiplan Commercial |
$7,903.17
|
| Rate for Payer: Preferred Network Access Commercial |
$9,088.64
|
| Rate for Payer: Quartz Beloit One Network |
$4,840.69
|
| Rate for Payer: Quartz Commercial |
$5,927.38
|
| Rate for Payer: WEA Trust Commercial |
$5,433.43
|
| Rate for Payer: WPS Commercial |
$7,317.08
|
|
|
IMPLANT SYSTEM INTERNAL BRACE FOREFOOT AR-1530P-CP
|
Facility
|
IP
|
$6,926.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415156
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,529.49 |
| Max. Negotiated Rate |
$6,626.80 |
| Rate for Payer: Aetna Commercial |
$6,482.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,194.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,817.61
|
| Rate for Payer: Cash Price |
$2,077.80
|
| Rate for Payer: Cigna Commercial |
$6,626.80
|
| Rate for Payer: Health EOS Commercial |
$6,410.71
|
| Rate for Payer: HFN Commercial |
$6,626.80
|
| Rate for Payer: Multiplan Commercial |
$5,762.43
|
| Rate for Payer: Preferred Network Access Commercial |
$6,626.80
|
| Rate for Payer: Quartz Beloit One Network |
$3,529.49
|
| Rate for Payer: Quartz Commercial |
$4,321.82
|
| Rate for Payer: WEA Trust Commercial |
$3,961.67
|
| Rate for Payer: WPS Commercial |
$5,335.10
|
|
|
IMPLANT SYSTEM INTERNAL BRACE FOREFOOT AR-1530P-CP
|
Facility
|
OP
|
$6,926.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415156
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,016.85 |
| Max. Negotiated Rate |
$6,626.80 |
| Rate for Payer: Aetna Commercial |
$6,482.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,194.61
|
| Rate for Payer: Aetna Managed Medicare |
$2,016.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,681.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,601.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,457.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,817.61
|
| Rate for Payer: Cash Price |
$2,077.80
|
| Rate for Payer: Cigna Commercial |
$6,626.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,030.93
|
| Rate for Payer: Health EOS Commercial |
$6,410.71
|
| Rate for Payer: HFN Commercial |
$6,626.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,402.28
|
| Rate for Payer: Multiplan Commercial |
$5,762.43
|
| Rate for Payer: NAPHCARE Commercial |
$4,321.82
|
| Rate for Payer: Preferred Network Access Commercial |
$6,626.80
|
| Rate for Payer: Quartz Beloit One Network |
$3,529.49
|
| Rate for Payer: Quartz Commercial |
$4,681.98
|
| Rate for Payer: Quartz Medicare Advantage |
$4,321.82
|
| Rate for Payer: The Alliance Commercial |
$3,601.52
|
| Rate for Payer: WEA Trust Commercial |
$3,961.67
|
| Rate for Payer: WPS Commercial |
$5,335.10
|
|
|
IMPLANT SYSTEM INTERNAL BRACE KNEE LIGAMENT AUGMENTATION REPAIR AR-5511-CP
|
Facility
|
IP
|
$9,084.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5178928
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,629.21 |
| Max. Negotiated Rate |
$8,691.57 |
| Rate for Payer: Aetna Commercial |
$8,502.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,124.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,007.10
|
| Rate for Payer: Cash Price |
$2,725.20
|
| Rate for Payer: Cigna Commercial |
$8,691.57
|
| Rate for Payer: Health EOS Commercial |
$8,408.15
|
| Rate for Payer: HFN Commercial |
$8,691.57
|
| Rate for Payer: Multiplan Commercial |
$7,557.89
|
| Rate for Payer: Preferred Network Access Commercial |
$8,691.57
|
| Rate for Payer: Quartz Beloit One Network |
$4,629.21
|
| Rate for Payer: Quartz Commercial |
$5,668.42
|
| Rate for Payer: WEA Trust Commercial |
$5,196.05
|
| Rate for Payer: WPS Commercial |
$6,997.41
|
|
|
IMPLANT SYSTEM INTERNAL BRACE KNEE LIGAMENT AUGMENTATION REPAIR AR-5511-CP
|
Facility
|
OP
|
$9,084.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5178928
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,645.26 |
| Max. Negotiated Rate |
$8,691.57 |
| Rate for Payer: Aetna Commercial |
$8,502.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,124.73
|
| Rate for Payer: Aetna Managed Medicare |
$2,645.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,140.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,723.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,534.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,007.10
|
| Rate for Payer: Cash Price |
$2,725.20
|
| Rate for Payer: Cigna Commercial |
$8,691.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,286.89
|
| Rate for Payer: Health EOS Commercial |
$8,408.15
|
| Rate for Payer: HFN Commercial |
$8,691.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,085.52
|
| Rate for Payer: Multiplan Commercial |
$7,557.89
|
| Rate for Payer: NAPHCARE Commercial |
$5,668.42
|
| Rate for Payer: Preferred Network Access Commercial |
$8,691.57
|
| Rate for Payer: Quartz Beloit One Network |
$4,629.21
|
| Rate for Payer: Quartz Commercial |
$6,140.78
|
| Rate for Payer: Quartz Medicare Advantage |
$5,668.42
|
| Rate for Payer: The Alliance Commercial |
$4,723.68
|
| Rate for Payer: WEA Trust Commercial |
$5,196.05
|
| Rate for Payer: WPS Commercial |
$6,997.41
|
|
|
IMPLANT SYSTEM INTERNAL BRACE KNEE LIGAMENT AUGMENTATION REPAIR WITH JUMPSTART DRESSING AR-1788J-CP
|
Facility
|
IP
|
$11,361.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5583374
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,789.57 |
| Max. Negotiated Rate |
$10,870.20 |
| Rate for Payer: Aetna Commercial |
$10,633.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,161.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,262.18
|
| Rate for Payer: Cash Price |
$3,408.30
|
| Rate for Payer: Cigna Commercial |
$10,870.20
|
| Rate for Payer: Health EOS Commercial |
$10,515.74
|
| Rate for Payer: HFN Commercial |
$10,870.20
|
| Rate for Payer: Multiplan Commercial |
$9,452.35
|
| Rate for Payer: Preferred Network Access Commercial |
$10,870.20
|
| Rate for Payer: Quartz Beloit One Network |
$5,789.57
|
| Rate for Payer: Quartz Commercial |
$7,089.26
|
| Rate for Payer: WEA Trust Commercial |
$6,498.49
|
| Rate for Payer: WPS Commercial |
$8,751.38
|
|
|
IMPLANT SYSTEM INTERNAL BRACE KNEE LIGAMENT AUGMENTATION REPAIR WITH JUMPSTART DRESSING AR-1788J-CP
|
Facility
|
OP
|
$11,361.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5583374
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,308.32 |
| Max. Negotiated Rate |
$10,870.20 |
| Rate for Payer: Aetna Commercial |
$10,633.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,161.28
|
| Rate for Payer: Aetna Managed Medicare |
$3,308.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,680.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,907.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,671.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,262.18
|
| Rate for Payer: Cash Price |
$3,408.30
|
| Rate for Payer: Cigna Commercial |
$10,870.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,612.10
|
| Rate for Payer: Health EOS Commercial |
$10,515.74
|
| Rate for Payer: HFN Commercial |
$10,870.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,861.58
|
| Rate for Payer: Multiplan Commercial |
$9,452.35
|
| Rate for Payer: NAPHCARE Commercial |
$7,089.26
|
| Rate for Payer: Preferred Network Access Commercial |
$10,870.20
|
| Rate for Payer: Quartz Beloit One Network |
$5,789.57
|
| Rate for Payer: Quartz Commercial |
$7,680.04
|
| Rate for Payer: Quartz Medicare Advantage |
$7,089.26
|
| Rate for Payer: The Alliance Commercial |
$5,907.72
|
| Rate for Payer: WEA Trust Commercial |
$6,498.49
|
| Rate for Payer: WPS Commercial |
$8,751.38
|
|
|
IMPLANT SYSTEM INTERNAL LISFRANC AR-1698-CP
|
Facility
|
IP
|
$11,361.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5597551
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,789.57 |
| Max. Negotiated Rate |
$10,870.20 |
| Rate for Payer: Aetna Commercial |
$10,633.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,161.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,262.18
|
| Rate for Payer: Cash Price |
$3,408.30
|
| Rate for Payer: Cigna Commercial |
$10,870.20
|
| Rate for Payer: Health EOS Commercial |
$10,515.74
|
| Rate for Payer: HFN Commercial |
$10,870.20
|
| Rate for Payer: Multiplan Commercial |
$9,452.35
|
| Rate for Payer: Preferred Network Access Commercial |
$10,870.20
|
| Rate for Payer: Quartz Beloit One Network |
$5,789.57
|
| Rate for Payer: Quartz Commercial |
$7,089.26
|
| Rate for Payer: WEA Trust Commercial |
$6,498.49
|
| Rate for Payer: WPS Commercial |
$8,751.38
|
|
|
IMPLANT SYSTEM INTERNAL LISFRANC AR-1698-CP
|
Facility
|
OP
|
$11,361.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5597551
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,308.32 |
| Max. Negotiated Rate |
$10,870.20 |
| Rate for Payer: Aetna Commercial |
$10,633.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,161.28
|
| Rate for Payer: Aetna Managed Medicare |
$3,308.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,680.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,907.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,671.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,262.18
|
| Rate for Payer: Cash Price |
$3,408.30
|
| Rate for Payer: Cigna Commercial |
$10,870.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,612.10
|
| Rate for Payer: Health EOS Commercial |
$10,515.74
|
| Rate for Payer: HFN Commercial |
$10,870.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,861.58
|
| Rate for Payer: Multiplan Commercial |
$9,452.35
|
| Rate for Payer: NAPHCARE Commercial |
$7,089.26
|
| Rate for Payer: Preferred Network Access Commercial |
$10,870.20
|
| Rate for Payer: Quartz Beloit One Network |
$5,789.57
|
| Rate for Payer: Quartz Commercial |
$7,680.04
|
| Rate for Payer: Quartz Medicare Advantage |
$7,089.26
|
| Rate for Payer: The Alliance Commercial |
$5,907.72
|
| Rate for Payer: WEA Trust Commercial |
$6,498.49
|
| Rate for Payer: WPS Commercial |
$8,751.38
|
|
|
IMPLANT SYSTEM MENISCAL ROOT REPAIR AR-4550
|
Facility
|
IP
|
$9,088.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5074913
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,631.24 |
| Max. Negotiated Rate |
$8,695.40 |
| Rate for Payer: Aetna Commercial |
$8,506.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,128.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,009.31
|
| Rate for Payer: Cash Price |
$2,726.40
|
| Rate for Payer: Cigna Commercial |
$8,695.40
|
| Rate for Payer: Health EOS Commercial |
$8,411.85
|
| Rate for Payer: HFN Commercial |
$8,695.40
|
| Rate for Payer: Multiplan Commercial |
$7,561.22
|
| Rate for Payer: Preferred Network Access Commercial |
$8,695.40
|
| Rate for Payer: Quartz Beloit One Network |
$4,631.24
|
| Rate for Payer: Quartz Commercial |
$5,670.91
|
| Rate for Payer: WEA Trust Commercial |
$5,198.34
|
| Rate for Payer: WPS Commercial |
$7,000.49
|
|
|
IMPLANT SYSTEM MENISCAL ROOT REPAIR AR-4550
|
Facility
|
OP
|
$9,088.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5074913
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,646.43 |
| Max. Negotiated Rate |
$8,695.40 |
| Rate for Payer: Aetna Commercial |
$8,506.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,128.31
|
| Rate for Payer: Aetna Managed Medicare |
$2,646.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,143.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,725.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,536.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,009.31
|
| Rate for Payer: Cash Price |
$2,726.40
|
| Rate for Payer: Cigna Commercial |
$8,695.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,289.22
|
| Rate for Payer: Health EOS Commercial |
$8,411.85
|
| Rate for Payer: HFN Commercial |
$8,695.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,088.64
|
| Rate for Payer: Multiplan Commercial |
$7,561.22
|
| Rate for Payer: NAPHCARE Commercial |
$5,670.91
|
| Rate for Payer: Preferred Network Access Commercial |
$8,695.40
|
| Rate for Payer: Quartz Beloit One Network |
$4,631.24
|
| Rate for Payer: Quartz Commercial |
$6,143.49
|
| Rate for Payer: Quartz Medicare Advantage |
$5,670.91
|
| Rate for Payer: The Alliance Commercial |
$4,725.76
|
| Rate for Payer: WEA Trust Commercial |
$5,198.34
|
| Rate for Payer: WPS Commercial |
$7,000.49
|
|
|
IMPLANT SYSTEM MENISCAL ROOT REPAIR WITH PEEK SWIVELOCK AR-4550P
|
Facility
|
OP
|
$8,013.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459632
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,333.39 |
| Max. Negotiated Rate |
$7,666.84 |
| Rate for Payer: Aetna Commercial |
$7,500.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,166.83
|
| Rate for Payer: Aetna Managed Medicare |
$2,333.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,416.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,166.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,000.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,416.77
|
| Rate for Payer: Cash Price |
$2,403.90
|
| Rate for Payer: Cigna Commercial |
$7,666.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,663.57
|
| Rate for Payer: Health EOS Commercial |
$7,416.83
|
| Rate for Payer: HFN Commercial |
$7,666.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,250.14
|
| Rate for Payer: Multiplan Commercial |
$6,666.82
|
| Rate for Payer: NAPHCARE Commercial |
$5,000.11
|
| Rate for Payer: Preferred Network Access Commercial |
$7,666.84
|
| Rate for Payer: Quartz Beloit One Network |
$4,083.42
|
| Rate for Payer: Quartz Commercial |
$5,416.79
|
| Rate for Payer: Quartz Medicare Advantage |
$5,000.11
|
| Rate for Payer: The Alliance Commercial |
$4,166.76
|
| Rate for Payer: WEA Trust Commercial |
$4,583.44
|
| Rate for Payer: WPS Commercial |
$6,172.41
|
|
|
IMPLANT SYSTEM MENISCAL ROOT REPAIR WITH PEEK SWIVELOCK AR-4550P
|
Facility
|
IP
|
$8,013.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459632
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,083.42 |
| Max. Negotiated Rate |
$7,666.84 |
| Rate for Payer: Aetna Commercial |
$7,500.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,166.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,416.77
|
| Rate for Payer: Cash Price |
$2,403.90
|
| Rate for Payer: Cigna Commercial |
$7,666.84
|
| Rate for Payer: Health EOS Commercial |
$7,416.83
|
| Rate for Payer: HFN Commercial |
$7,666.84
|
| Rate for Payer: Multiplan Commercial |
$6,666.82
|
| Rate for Payer: Preferred Network Access Commercial |
$7,666.84
|
| Rate for Payer: Quartz Beloit One Network |
$4,083.42
|
| Rate for Payer: Quartz Commercial |
$5,000.11
|
| Rate for Payer: WEA Trust Commercial |
$4,583.44
|
| Rate for Payer: WPS Commercial |
$6,172.41
|
|
