|
KIT RESUS ADJ MSK50 10 #RD1350-10
|
Facility
|
OP
|
$261.00
|
|
| Hospital Charge Code |
2972426
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$76.00 |
| Max. Negotiated Rate |
$249.72 |
| Rate for Payer: Aetna Commercial |
$244.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.44
|
| Rate for Payer: Aetna Managed Medicare |
$76.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$176.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$135.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$130.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.86
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna Commercial |
$249.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$151.90
|
| Rate for Payer: Health EOS Commercial |
$241.58
|
| Rate for Payer: HFN Commercial |
$249.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$203.58
|
| Rate for Payer: Multiplan Commercial |
$217.15
|
| Rate for Payer: NAPHCARE Commercial |
$162.86
|
| Rate for Payer: Preferred Network Access Commercial |
$249.72
|
| Rate for Payer: Quartz Beloit One Network |
$133.01
|
| Rate for Payer: Quartz Commercial |
$176.44
|
| Rate for Payer: Quartz Medicare Advantage |
$162.86
|
| Rate for Payer: The Alliance Commercial |
$135.72
|
| Rate for Payer: WEA Trust Commercial |
$149.29
|
| Rate for Payer: WPS Commercial |
$201.05
|
|
|
KIT RESUS ADJ MSK60 10 #RD1360-10
|
Facility
|
IP
|
$261.00
|
|
| Hospital Charge Code |
2972427
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$133.01 |
| Max. Negotiated Rate |
$249.72 |
| Rate for Payer: Aetna Commercial |
$244.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.86
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna Commercial |
$249.72
|
| Rate for Payer: Health EOS Commercial |
$241.58
|
| Rate for Payer: HFN Commercial |
$249.72
|
| Rate for Payer: Multiplan Commercial |
$217.15
|
| Rate for Payer: Preferred Network Access Commercial |
$249.72
|
| Rate for Payer: Quartz Beloit One Network |
$133.01
|
| Rate for Payer: Quartz Commercial |
$162.86
|
| Rate for Payer: WEA Trust Commercial |
$149.29
|
| Rate for Payer: WPS Commercial |
$201.05
|
|
|
KIT RESUS ADJ MSK60 10 #RD1360-10
|
Facility
|
OP
|
$261.00
|
|
| Hospital Charge Code |
2972427
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$76.00 |
| Max. Negotiated Rate |
$249.72 |
| Rate for Payer: Aetna Commercial |
$244.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.44
|
| Rate for Payer: Aetna Managed Medicare |
$76.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$176.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$135.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$130.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.86
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna Commercial |
$249.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$151.90
|
| Rate for Payer: Health EOS Commercial |
$241.58
|
| Rate for Payer: HFN Commercial |
$249.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$203.58
|
| Rate for Payer: Multiplan Commercial |
$217.15
|
| Rate for Payer: NAPHCARE Commercial |
$162.86
|
| Rate for Payer: Preferred Network Access Commercial |
$249.72
|
| Rate for Payer: Quartz Beloit One Network |
$133.01
|
| Rate for Payer: Quartz Commercial |
$176.44
|
| Rate for Payer: Quartz Medicare Advantage |
$162.86
|
| Rate for Payer: The Alliance Commercial |
$135.72
|
| Rate for Payer: WEA Trust Commercial |
$149.29
|
| Rate for Payer: WPS Commercial |
$201.05
|
|
|
KIT SCP FOOT & ANKLE 11GA 3CC 514.303
|
Facility
|
OP
|
$15,898.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5591319
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,629.50 |
| Max. Negotiated Rate |
$15,211.21 |
| Rate for Payer: Aetna Commercial |
$14,880.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,219.17
|
| Rate for Payer: Aetna Managed Medicare |
$4,629.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,747.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,266.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,936.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,762.98
|
| Rate for Payer: Cash Price |
$4,769.40
|
| Rate for Payer: Cigna Commercial |
$15,211.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,252.64
|
| Rate for Payer: Health EOS Commercial |
$14,715.19
|
| Rate for Payer: HFN Commercial |
$15,211.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,400.44
|
| Rate for Payer: Multiplan Commercial |
$13,227.14
|
| Rate for Payer: NAPHCARE Commercial |
$9,920.35
|
| Rate for Payer: Preferred Network Access Commercial |
$15,211.21
|
| Rate for Payer: Quartz Beloit One Network |
$8,101.62
|
| Rate for Payer: Quartz Commercial |
$10,747.05
|
| Rate for Payer: Quartz Medicare Advantage |
$9,920.35
|
| Rate for Payer: The Alliance Commercial |
$8,266.96
|
| Rate for Payer: WEA Trust Commercial |
$9,093.66
|
| Rate for Payer: WPS Commercial |
$12,246.23
|
|
|
KIT SCP FOOT & ANKLE 11GA 3CC 514.303
|
Facility
|
IP
|
$15,898.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5591319
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,101.62 |
| Max. Negotiated Rate |
$15,211.21 |
| Rate for Payer: Aetna Commercial |
$14,880.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,219.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,762.98
|
| Rate for Payer: Cash Price |
$4,769.40
|
| Rate for Payer: Cigna Commercial |
$15,211.21
|
| Rate for Payer: Health EOS Commercial |
$14,715.19
|
| Rate for Payer: HFN Commercial |
$15,211.21
|
| Rate for Payer: Multiplan Commercial |
$13,227.14
|
| Rate for Payer: Preferred Network Access Commercial |
$15,211.21
|
| Rate for Payer: Quartz Beloit One Network |
$8,101.62
|
| Rate for Payer: Quartz Commercial |
$9,920.35
|
| Rate for Payer: WEA Trust Commercial |
$9,093.66
|
| Rate for Payer: WPS Commercial |
$12,246.23
|
|
|
KIT SCP KNEE WITH ACCUPORT SIDE DELIVERY CANNULA 414.502
|
Facility
|
IP
|
$20,842.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5206672
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,621.08 |
| Max. Negotiated Rate |
$19,941.63 |
| Rate for Payer: Aetna Commercial |
$19,508.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,641.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,488.11
|
| Rate for Payer: Cash Price |
$6,252.60
|
| Rate for Payer: Cigna Commercial |
$19,941.63
|
| Rate for Payer: Health EOS Commercial |
$19,291.36
|
| Rate for Payer: HFN Commercial |
$19,941.63
|
| Rate for Payer: Multiplan Commercial |
$17,340.54
|
| Rate for Payer: Preferred Network Access Commercial |
$19,941.63
|
| Rate for Payer: Quartz Beloit One Network |
$10,621.08
|
| Rate for Payer: Quartz Commercial |
$13,005.41
|
| Rate for Payer: WEA Trust Commercial |
$11,921.62
|
| Rate for Payer: WPS Commercial |
$16,054.59
|
|
|
KIT SCP KNEE WITH ACCUPORT SIDE DELIVERY CANNULA 414.502
|
Facility
|
OP
|
$20,842.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5206672
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,069.19 |
| Max. Negotiated Rate |
$19,941.63 |
| Rate for Payer: Aetna Commercial |
$19,508.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,641.08
|
| Rate for Payer: Aetna Managed Medicare |
$6,069.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14,089.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,837.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,404.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,488.11
|
| Rate for Payer: Cash Price |
$6,252.60
|
| Rate for Payer: Cigna Commercial |
$19,941.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,130.04
|
| Rate for Payer: Health EOS Commercial |
$19,291.36
|
| Rate for Payer: HFN Commercial |
$19,941.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16,256.76
|
| Rate for Payer: Multiplan Commercial |
$17,340.54
|
| Rate for Payer: NAPHCARE Commercial |
$13,005.41
|
| Rate for Payer: Preferred Network Access Commercial |
$19,941.63
|
| Rate for Payer: Quartz Beloit One Network |
$10,621.08
|
| Rate for Payer: Quartz Commercial |
$14,089.19
|
| Rate for Payer: Quartz Medicare Advantage |
$13,005.41
|
| Rate for Payer: The Alliance Commercial |
$10,837.84
|
| Rate for Payer: WEA Trust Commercial |
$11,921.62
|
| Rate for Payer: WPS Commercial |
$16,054.59
|
|
|
KIT SCP PF KNEE WITH ACCUPORT END DELIVERY CANNULA 11GAX120MM 464303
|
Facility
|
IP
|
$14,085.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685670
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,177.72 |
| Max. Negotiated Rate |
$13,476.53 |
| Rate for Payer: Aetna Commercial |
$13,183.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,597.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,763.65
|
| Rate for Payer: Cash Price |
$4,225.50
|
| Rate for Payer: Cigna Commercial |
$13,476.53
|
| Rate for Payer: Health EOS Commercial |
$13,037.08
|
| Rate for Payer: HFN Commercial |
$13,476.53
|
| Rate for Payer: Multiplan Commercial |
$11,718.72
|
| Rate for Payer: Preferred Network Access Commercial |
$13,476.53
|
| Rate for Payer: Quartz Beloit One Network |
$7,177.72
|
| Rate for Payer: Quartz Commercial |
$8,789.04
|
| Rate for Payer: WEA Trust Commercial |
$8,056.62
|
| Rate for Payer: WPS Commercial |
$10,849.68
|
|
|
KIT SCP PF KNEE WITH ACCUPORT END DELIVERY CANNULA 11GAX120MM 464303
|
Facility
|
OP
|
$14,085.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685670
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,101.55 |
| Max. Negotiated Rate |
$13,476.53 |
| Rate for Payer: Aetna Commercial |
$13,183.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,597.62
|
| Rate for Payer: Aetna Managed Medicare |
$4,101.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,521.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,324.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,031.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,763.65
|
| Rate for Payer: Cash Price |
$4,225.50
|
| Rate for Payer: Cigna Commercial |
$13,476.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,197.47
|
| Rate for Payer: Health EOS Commercial |
$13,037.08
|
| Rate for Payer: HFN Commercial |
$13,476.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,986.30
|
| Rate for Payer: Multiplan Commercial |
$11,718.72
|
| Rate for Payer: NAPHCARE Commercial |
$8,789.04
|
| Rate for Payer: Preferred Network Access Commercial |
$13,476.53
|
| Rate for Payer: Quartz Beloit One Network |
$7,177.72
|
| Rate for Payer: Quartz Commercial |
$9,521.46
|
| Rate for Payer: Quartz Medicare Advantage |
$8,789.04
|
| Rate for Payer: The Alliance Commercial |
$7,324.20
|
| Rate for Payer: WEA Trust Commercial |
$8,056.62
|
| Rate for Payer: WPS Commercial |
$10,849.68
|
|
|
KIT SHEATH INTRODUCER 9FR AK-29903-CDC
|
Facility
|
OP
|
$707.00
|
|
| Hospital Charge Code |
2962970
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$205.88 |
| Max. Negotiated Rate |
$676.46 |
| Rate for Payer: The Alliance Commercial |
$367.64
|
| Rate for Payer: Aetna Commercial |
$661.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$632.34
|
| Rate for Payer: Aetna Managed Medicare |
$205.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$477.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$367.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$352.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$389.70
|
| Rate for Payer: Cash Price |
$212.10
|
| Rate for Payer: Cigna Commercial |
$676.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$411.47
|
| Rate for Payer: Health EOS Commercial |
$654.40
|
| Rate for Payer: HFN Commercial |
$676.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$551.46
|
| Rate for Payer: Multiplan Commercial |
$588.22
|
| Rate for Payer: NAPHCARE Commercial |
$441.17
|
| Rate for Payer: Preferred Network Access Commercial |
$676.46
|
| Rate for Payer: Quartz Beloit One Network |
$360.29
|
| Rate for Payer: Quartz Commercial |
$477.93
|
| Rate for Payer: Quartz Medicare Advantage |
$441.17
|
| Rate for Payer: WEA Trust Commercial |
$404.40
|
| Rate for Payer: WPS Commercial |
$544.60
|
|
|
KIT SHEATH INTRODUCER 9FR AK-29903-CDC
|
Facility
|
IP
|
$707.00
|
|
| Hospital Charge Code |
2962970
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$360.29 |
| Max. Negotiated Rate |
$676.46 |
| Rate for Payer: Aetna Commercial |
$661.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$632.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$389.70
|
| Rate for Payer: Cash Price |
$212.10
|
| Rate for Payer: Cigna Commercial |
$676.46
|
| Rate for Payer: Health EOS Commercial |
$654.40
|
| Rate for Payer: HFN Commercial |
$676.46
|
| Rate for Payer: Multiplan Commercial |
$588.22
|
| Rate for Payer: Preferred Network Access Commercial |
$676.46
|
| Rate for Payer: Quartz Beloit One Network |
$360.29
|
| Rate for Payer: Quartz Commercial |
$441.17
|
| Rate for Payer: WEA Trust Commercial |
$404.40
|
| Rate for Payer: WPS Commercial |
$544.60
|
|
|
KIT SHOULDER SPACER SM 41MM SBS0121K
|
Facility
|
IP
|
$20,049.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5787626
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,216.97 |
| Max. Negotiated Rate |
$19,182.88 |
| Rate for Payer: Aetna Commercial |
$18,765.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,931.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,051.01
|
| Rate for Payer: Cash Price |
$6,014.70
|
| Rate for Payer: Cigna Commercial |
$19,182.88
|
| Rate for Payer: Health EOS Commercial |
$18,557.35
|
| Rate for Payer: HFN Commercial |
$19,182.88
|
| Rate for Payer: Multiplan Commercial |
$16,680.77
|
| Rate for Payer: Preferred Network Access Commercial |
$19,182.88
|
| Rate for Payer: Quartz Beloit One Network |
$10,216.97
|
| Rate for Payer: Quartz Commercial |
$12,510.58
|
| Rate for Payer: WEA Trust Commercial |
$11,468.03
|
| Rate for Payer: WPS Commercial |
$15,443.74
|
|
|
KIT SHOULDER SPACER SM 41MM SBS0121K
|
Facility
|
OP
|
$20,049.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5787626
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,838.27 |
| Max. Negotiated Rate |
$19,182.88 |
| Rate for Payer: Aetna Commercial |
$18,765.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,931.83
|
| Rate for Payer: Aetna Managed Medicare |
$5,838.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,553.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,425.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,008.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,051.01
|
| Rate for Payer: Cash Price |
$6,014.70
|
| Rate for Payer: Cigna Commercial |
$19,182.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,668.52
|
| Rate for Payer: Health EOS Commercial |
$18,557.35
|
| Rate for Payer: HFN Commercial |
$19,182.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,638.22
|
| Rate for Payer: Multiplan Commercial |
$16,680.77
|
| Rate for Payer: NAPHCARE Commercial |
$12,510.58
|
| Rate for Payer: Preferred Network Access Commercial |
$19,182.88
|
| Rate for Payer: Quartz Beloit One Network |
$10,216.97
|
| Rate for Payer: Quartz Commercial |
$13,553.12
|
| Rate for Payer: Quartz Medicare Advantage |
$12,510.58
|
| Rate for Payer: The Alliance Commercial |
$10,425.48
|
| Rate for Payer: WEA Trust Commercial |
$11,468.03
|
| Rate for Payer: WPS Commercial |
$15,443.74
|
|
|
KIT SHOULDER STABILIZER (SPIDER S&N) 7210573
|
Facility
|
IP
|
$1,380.00
|
|
| Hospital Charge Code |
6214966
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$703.25 |
| Max. Negotiated Rate |
$1,320.38 |
| Rate for Payer: Aetna Commercial |
$1,291.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,234.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$760.66
|
| Rate for Payer: Cash Price |
$414.00
|
| Rate for Payer: Cigna Commercial |
$1,320.38
|
| Rate for Payer: Health EOS Commercial |
$1,277.33
|
| Rate for Payer: HFN Commercial |
$1,320.38
|
| Rate for Payer: Multiplan Commercial |
$1,148.16
|
| Rate for Payer: Preferred Network Access Commercial |
$1,320.38
|
| Rate for Payer: Quartz Beloit One Network |
$703.25
|
| Rate for Payer: Quartz Commercial |
$861.12
|
| Rate for Payer: WEA Trust Commercial |
$789.36
|
| Rate for Payer: WPS Commercial |
$1,063.01
|
|
|
KIT SHOULDER STABILIZER (SPIDER S&N) 7210573
|
Facility
|
OP
|
$1,380.00
|
|
| Hospital Charge Code |
6214966
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$401.86 |
| Max. Negotiated Rate |
$1,320.38 |
| Rate for Payer: Aetna Commercial |
$1,291.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,234.27
|
| Rate for Payer: Aetna Managed Medicare |
$401.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$932.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$717.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$688.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$760.66
|
| Rate for Payer: Cash Price |
$414.00
|
| Rate for Payer: Cigna Commercial |
$1,320.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$803.16
|
| Rate for Payer: Health EOS Commercial |
$1,277.33
|
| Rate for Payer: HFN Commercial |
$1,320.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,076.40
|
| Rate for Payer: Multiplan Commercial |
$1,148.16
|
| Rate for Payer: NAPHCARE Commercial |
$861.12
|
| Rate for Payer: Preferred Network Access Commercial |
$1,320.38
|
| Rate for Payer: Quartz Beloit One Network |
$703.25
|
| Rate for Payer: Quartz Commercial |
$932.88
|
| Rate for Payer: Quartz Medicare Advantage |
$861.12
|
| Rate for Payer: The Alliance Commercial |
$717.60
|
| Rate for Payer: WEA Trust Commercial |
$789.36
|
| Rate for Payer: WPS Commercial |
$1,063.01
|
|
|
KIT SHOULDER SUSPENSION (DYONICS) 72200195
|
Facility
|
OP
|
$1,822.00
|
|
| Hospital Charge Code |
6214967
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$530.57 |
| Max. Negotiated Rate |
$1,743.29 |
| Rate for Payer: Aetna Commercial |
$1,705.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,629.60
|
| Rate for Payer: Aetna Managed Medicare |
$530.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,231.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$947.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$909.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,004.29
|
| Rate for Payer: Cash Price |
$546.60
|
| Rate for Payer: Cigna Commercial |
$1,743.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,060.40
|
| Rate for Payer: Health EOS Commercial |
$1,686.44
|
| Rate for Payer: HFN Commercial |
$1,743.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,421.16
|
| Rate for Payer: Multiplan Commercial |
$1,515.90
|
| Rate for Payer: NAPHCARE Commercial |
$1,136.93
|
| Rate for Payer: Preferred Network Access Commercial |
$1,743.29
|
| Rate for Payer: Quartz Beloit One Network |
$928.49
|
| Rate for Payer: Quartz Commercial |
$1,231.67
|
| Rate for Payer: Quartz Medicare Advantage |
$1,136.93
|
| Rate for Payer: The Alliance Commercial |
$947.44
|
| Rate for Payer: WEA Trust Commercial |
$1,042.18
|
| Rate for Payer: WPS Commercial |
$1,403.49
|
|
|
KIT SHOULDER SUSPENSION (DYONICS) 72200195
|
Facility
|
IP
|
$1,822.00
|
|
| Hospital Charge Code |
6214967
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$928.49 |
| Max. Negotiated Rate |
$1,743.29 |
| Rate for Payer: Aetna Commercial |
$1,705.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,629.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,004.29
|
| Rate for Payer: Cash Price |
$546.60
|
| Rate for Payer: Cigna Commercial |
$1,743.29
|
| Rate for Payer: Health EOS Commercial |
$1,686.44
|
| Rate for Payer: HFN Commercial |
$1,743.29
|
| Rate for Payer: Multiplan Commercial |
$1,515.90
|
| Rate for Payer: Preferred Network Access Commercial |
$1,743.29
|
| Rate for Payer: Quartz Beloit One Network |
$928.49
|
| Rate for Payer: Quartz Commercial |
$1,136.93
|
| Rate for Payer: WEA Trust Commercial |
$1,042.18
|
| Rate for Payer: WPS Commercial |
$1,403.49
|
|
|
KIT SUTURE LACERATION
|
Facility
|
IP
|
$83.00
|
|
| Hospital Charge Code |
2963040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.30 |
| Max. Negotiated Rate |
$79.41 |
| Rate for Payer: Aetna Commercial |
$77.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.75
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$79.41
|
| Rate for Payer: Health EOS Commercial |
$76.82
|
| Rate for Payer: HFN Commercial |
$79.41
|
| Rate for Payer: Multiplan Commercial |
$69.06
|
| Rate for Payer: Preferred Network Access Commercial |
$79.41
|
| Rate for Payer: Quartz Beloit One Network |
$42.30
|
| Rate for Payer: Quartz Commercial |
$51.79
|
| Rate for Payer: WEA Trust Commercial |
$47.48
|
| Rate for Payer: WPS Commercial |
$63.93
|
|
|
KIT SUTURE LACERATION
|
Facility
|
OP
|
$83.00
|
|
| Hospital Charge Code |
2963040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.17 |
| Max. Negotiated Rate |
$79.41 |
| Rate for Payer: Aetna Commercial |
$77.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.24
|
| Rate for Payer: Aetna Managed Medicare |
$24.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$43.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$41.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.75
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$79.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.31
|
| Rate for Payer: Health EOS Commercial |
$76.82
|
| Rate for Payer: HFN Commercial |
$79.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.74
|
| Rate for Payer: Multiplan Commercial |
$69.06
|
| Rate for Payer: NAPHCARE Commercial |
$51.79
|
| Rate for Payer: Preferred Network Access Commercial |
$79.41
|
| Rate for Payer: Quartz Beloit One Network |
$42.30
|
| Rate for Payer: Quartz Commercial |
$56.11
|
| Rate for Payer: Quartz Medicare Advantage |
$51.79
|
| Rate for Payer: The Alliance Commercial |
$43.16
|
| Rate for Payer: WEA Trust Commercial |
$47.48
|
| Rate for Payer: WPS Commercial |
$63.93
|
|
|
KIT SUTURETAK PERC INSERTION AR-1934PI
|
Facility
|
OP
|
$3,404.00
|
|
| Hospital Charge Code |
2964686
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$991.24 |
| Max. Negotiated Rate |
$3,256.95 |
| Rate for Payer: Aetna Commercial |
$3,186.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,044.54
|
| Rate for Payer: Aetna Managed Medicare |
$991.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,301.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,770.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,699.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,876.28
|
| Rate for Payer: Cash Price |
$1,021.20
|
| Rate for Payer: Cigna Commercial |
$3,256.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,981.13
|
| Rate for Payer: Health EOS Commercial |
$3,150.74
|
| Rate for Payer: HFN Commercial |
$3,256.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,655.12
|
| Rate for Payer: Multiplan Commercial |
$2,832.13
|
| Rate for Payer: NAPHCARE Commercial |
$2,124.10
|
| Rate for Payer: Preferred Network Access Commercial |
$3,256.95
|
| Rate for Payer: Quartz Beloit One Network |
$1,734.68
|
| Rate for Payer: Quartz Commercial |
$2,301.10
|
| Rate for Payer: Quartz Medicare Advantage |
$2,124.10
|
| Rate for Payer: The Alliance Commercial |
$1,770.08
|
| Rate for Payer: WEA Trust Commercial |
$1,947.09
|
| Rate for Payer: WPS Commercial |
$2,622.10
|
|
|
KIT SUTURETAK PERC INSERTION AR-1934PI
|
Facility
|
IP
|
$3,404.00
|
|
| Hospital Charge Code |
2964686
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,734.68 |
| Max. Negotiated Rate |
$3,256.95 |
| Rate for Payer: Aetna Commercial |
$3,186.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,044.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,876.28
|
| Rate for Payer: Cash Price |
$1,021.20
|
| Rate for Payer: Cigna Commercial |
$3,256.95
|
| Rate for Payer: Health EOS Commercial |
$3,150.74
|
| Rate for Payer: HFN Commercial |
$3,256.95
|
| Rate for Payer: Multiplan Commercial |
$2,832.13
|
| Rate for Payer: Preferred Network Access Commercial |
$3,256.95
|
| Rate for Payer: Quartz Beloit One Network |
$1,734.68
|
| Rate for Payer: Quartz Commercial |
$2,124.10
|
| Rate for Payer: WEA Trust Commercial |
$1,947.09
|
| Rate for Payer: WPS Commercial |
$2,622.10
|
|
|
KIT SYSTEM INTERNAL BRACE HAND/WRIST LIGAMENT AUGMENT REPAIR AR-8978-CP
|
Facility
|
OP
|
$11,361.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414870
|
|
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
|
|
|
KIT SYSTEM INTERNAL BRACE HAND/WRIST LIGAMENT AUGMENT REPAIR AR-8978-CP
|
Facility
|
IP
|
$11,361.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5414870
|
|
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
|
|
|
KIT TENODESIS GRAFT SIZING W FIBERLOOK SUTURETAPE & NEEDLE AR-1676ST
|
Facility
|
IP
|
$2,790.00
|
|
| Hospital Charge Code |
6185036
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,421.78 |
| Max. Negotiated Rate |
$2,669.47 |
| Rate for Payer: Aetna Commercial |
$2,611.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,495.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,537.85
|
| Rate for Payer: Cash Price |
$837.00
|
| Rate for Payer: Cigna Commercial |
$2,669.47
|
| Rate for Payer: Health EOS Commercial |
$2,582.42
|
| Rate for Payer: HFN Commercial |
$2,669.47
|
| Rate for Payer: Multiplan Commercial |
$2,321.28
|
| Rate for Payer: Preferred Network Access Commercial |
$2,669.47
|
| Rate for Payer: Quartz Beloit One Network |
$1,421.78
|
| Rate for Payer: Quartz Commercial |
$1,740.96
|
| Rate for Payer: WEA Trust Commercial |
$1,595.88
|
| Rate for Payer: WPS Commercial |
$2,149.14
|
|
|
KIT TENODESIS GRAFT SIZING W FIBERLOOK SUTURETAPE & NEEDLE AR-1676ST
|
Facility
|
OP
|
$2,790.00
|
|
| Hospital Charge Code |
6185036
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$812.45 |
| Max. Negotiated Rate |
$2,669.47 |
| Rate for Payer: Aetna Commercial |
$2,611.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,495.38
|
| Rate for Payer: Aetna Managed Medicare |
$812.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,886.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,450.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,392.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,537.85
|
| Rate for Payer: Cash Price |
$837.00
|
| Rate for Payer: Cigna Commercial |
$2,669.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,623.78
|
| Rate for Payer: Health EOS Commercial |
$2,582.42
|
| Rate for Payer: HFN Commercial |
$2,669.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,176.20
|
| Rate for Payer: Multiplan Commercial |
$2,321.28
|
| Rate for Payer: NAPHCARE Commercial |
$1,740.96
|
| Rate for Payer: Preferred Network Access Commercial |
$2,669.47
|
| Rate for Payer: Quartz Beloit One Network |
$1,421.78
|
| Rate for Payer: Quartz Commercial |
$1,886.04
|
| Rate for Payer: Quartz Medicare Advantage |
$1,740.96
|
| Rate for Payer: The Alliance Commercial |
$1,450.80
|
| Rate for Payer: WEA Trust Commercial |
$1,595.88
|
| Rate for Payer: WPS Commercial |
$2,149.14
|
|
