|
PLATE SEMI TUBULAR 7HL 222.07
|
Facility
|
OP
|
$478.00
|
|
| Hospital Charge Code |
2966782
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$133.84 |
| Max. Negotiated Rate |
$1,912.00 |
| Rate for Payer: Aetna Commercial |
$430.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$411.08
|
| Rate for Payer: Aetna Managed Medicare |
$133.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$310.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$239.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$229.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$253.34
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cigna Commercial |
$439.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$267.49
|
| Rate for Payer: Health EOS Commercial |
$425.42
|
| Rate for Payer: HFN Commercial |
$439.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$358.50
|
| Rate for Payer: Multiplan Commercial |
$382.40
|
| Rate for Payer: NAPHCARE Commercial |
$286.80
|
| Rate for Payer: Preferred Network Access Commercial |
$439.76
|
| Rate for Payer: Quartz Beloit One Network |
$234.22
|
| Rate for Payer: Quartz Commercial |
$310.70
|
| Rate for Payer: Quartz Medicare Advantage |
$286.80
|
| Rate for Payer: The Alliance Commercial |
$1,912.00
|
| Rate for Payer: WEA Trust Commercial |
$262.90
|
| Rate for Payer: WPS Commercial |
$354.05
|
|
|
PLATE SEMI TUBULAR 7HL 222.07
|
Facility
|
IP
|
$478.00
|
|
| Hospital Charge Code |
2966782
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$234.22 |
| Max. Negotiated Rate |
$439.76 |
| Rate for Payer: Aetna Commercial |
$430.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$411.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$253.34
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cigna Commercial |
$439.76
|
| Rate for Payer: Health EOS Commercial |
$425.42
|
| Rate for Payer: HFN Commercial |
$439.76
|
| Rate for Payer: Multiplan Commercial |
$382.40
|
| Rate for Payer: NAPHCARE Commercial |
$286.80
|
| Rate for Payer: Preferred Network Access Commercial |
$439.76
|
| Rate for Payer: Quartz Beloit One Network |
$234.22
|
| Rate for Payer: Quartz Commercial |
$286.80
|
| Rate for Payer: WEA Trust Commercial |
$262.90
|
| Rate for Payer: WPS Commercial |
$354.05
|
|
|
PLATE SEMI TUBULAR 8HL 222.08
|
Facility
|
OP
|
$445.00
|
|
| Hospital Charge Code |
2966783
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$124.60 |
| Max. Negotiated Rate |
$1,780.00 |
| Rate for Payer: Aetna Commercial |
$400.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$382.70
|
| Rate for Payer: Aetna Managed Medicare |
$124.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$289.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$222.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$213.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$235.85
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cigna Commercial |
$409.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$249.02
|
| Rate for Payer: Health EOS Commercial |
$396.05
|
| Rate for Payer: HFN Commercial |
$409.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$333.75
|
| Rate for Payer: Multiplan Commercial |
$356.00
|
| Rate for Payer: NAPHCARE Commercial |
$267.00
|
| Rate for Payer: Preferred Network Access Commercial |
$409.40
|
| Rate for Payer: Quartz Beloit One Network |
$218.05
|
| Rate for Payer: Quartz Commercial |
$289.25
|
| Rate for Payer: Quartz Medicare Advantage |
$267.00
|
| Rate for Payer: The Alliance Commercial |
$1,780.00
|
| Rate for Payer: WEA Trust Commercial |
$244.75
|
| Rate for Payer: WPS Commercial |
$329.61
|
|
|
PLATE SEMI TUBULAR 8HL 222.08
|
Facility
|
IP
|
$445.00
|
|
| Hospital Charge Code |
2966783
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$218.05 |
| Max. Negotiated Rate |
$409.40 |
| Rate for Payer: Aetna Commercial |
$400.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$382.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$235.85
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cigna Commercial |
$409.40
|
| Rate for Payer: Health EOS Commercial |
$396.05
|
| Rate for Payer: HFN Commercial |
$409.40
|
| Rate for Payer: Multiplan Commercial |
$356.00
|
| Rate for Payer: NAPHCARE Commercial |
$267.00
|
| Rate for Payer: Preferred Network Access Commercial |
$409.40
|
| Rate for Payer: Quartz Beloit One Network |
$218.05
|
| Rate for Payer: Quartz Commercial |
$267.00
|
| Rate for Payer: WEA Trust Commercial |
$244.75
|
| Rate for Payer: WPS Commercial |
$329.61
|
|
|
PLATE SLIM STRAIGHT 3 HOLE 626963
|
Facility
|
IP
|
$5,026.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6173720
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,462.74 |
| Max. Negotiated Rate |
$4,623.92 |
| Rate for Payer: Aetna Commercial |
$4,523.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,322.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,663.78
|
| Rate for Payer: Cash Price |
$1,507.80
|
| Rate for Payer: Cigna Commercial |
$4,623.92
|
| Rate for Payer: Health EOS Commercial |
$4,473.14
|
| Rate for Payer: HFN Commercial |
$4,623.92
|
| Rate for Payer: Multiplan Commercial |
$4,020.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,015.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,623.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,462.74
|
| Rate for Payer: Quartz Commercial |
$3,015.60
|
| Rate for Payer: WEA Trust Commercial |
$2,764.30
|
| Rate for Payer: WPS Commercial |
$3,722.76
|
|
|
PLATE SLIM STRAIGHT 3 HOLE 626963
|
Facility
|
OP
|
$5,026.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6173720
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,407.28 |
| Max. Negotiated Rate |
$20,104.00 |
| Rate for Payer: Aetna Commercial |
$4,523.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,322.36
|
| Rate for Payer: Aetna Managed Medicare |
$1,407.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,266.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,513.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,412.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,663.78
|
| Rate for Payer: Cash Price |
$1,507.80
|
| Rate for Payer: Cigna Commercial |
$4,623.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,812.55
|
| Rate for Payer: Health EOS Commercial |
$4,473.14
|
| Rate for Payer: HFN Commercial |
$4,623.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,769.50
|
| Rate for Payer: Multiplan Commercial |
$4,020.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,015.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,623.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,462.74
|
| Rate for Payer: Quartz Commercial |
$3,266.90
|
| Rate for Payer: Quartz Medicare Advantage |
$3,015.60
|
| Rate for Payer: The Alliance Commercial |
$20,104.00
|
| Rate for Payer: WEA Trust Commercial |
$2,764.30
|
| Rate for Payer: WPS Commercial |
$3,722.76
|
|
|
PLATE SLIM STRAIGHT 5 HOLE 626965
|
Facility
|
OP
|
$7,469.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5563673
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,091.32 |
| Max. Negotiated Rate |
$29,876.00 |
| Rate for Payer: Aetna Commercial |
$6,722.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,423.34
|
| Rate for Payer: Aetna Managed Medicare |
$2,091.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,854.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,734.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,585.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,958.57
|
| Rate for Payer: Cash Price |
$2,240.70
|
| Rate for Payer: Cigna Commercial |
$6,871.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,179.65
|
| Rate for Payer: Health EOS Commercial |
$6,647.41
|
| Rate for Payer: HFN Commercial |
$6,871.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,601.75
|
| Rate for Payer: Multiplan Commercial |
$5,975.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,481.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,871.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,659.81
|
| Rate for Payer: Quartz Commercial |
$4,854.85
|
| Rate for Payer: Quartz Medicare Advantage |
$4,481.40
|
| Rate for Payer: The Alliance Commercial |
$29,876.00
|
| Rate for Payer: WEA Trust Commercial |
$4,107.95
|
| Rate for Payer: WPS Commercial |
$5,532.29
|
|
|
PLATE SLIM STRAIGHT 5 HOLE 626965
|
Facility
|
IP
|
$7,469.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5563673
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,659.81 |
| Max. Negotiated Rate |
$6,871.48 |
| Rate for Payer: Aetna Commercial |
$6,722.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,423.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,958.57
|
| Rate for Payer: Cash Price |
$2,240.70
|
| Rate for Payer: Cigna Commercial |
$6,871.48
|
| Rate for Payer: Health EOS Commercial |
$6,647.41
|
| Rate for Payer: HFN Commercial |
$6,871.48
|
| Rate for Payer: Multiplan Commercial |
$5,975.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,481.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,871.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,659.81
|
| Rate for Payer: Quartz Commercial |
$4,481.40
|
| Rate for Payer: WEA Trust Commercial |
$4,107.95
|
| Rate for Payer: WPS Commercial |
$5,532.29
|
|
|
PLATE SLIM STRAIGHT 6 HOLE 626966
|
Facility
|
OP
|
$5,026.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6171787
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,407.28 |
| Max. Negotiated Rate |
$20,104.00 |
| Rate for Payer: Aetna Commercial |
$4,523.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,322.36
|
| Rate for Payer: Aetna Managed Medicare |
$1,407.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,266.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,513.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,412.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,663.78
|
| Rate for Payer: Cash Price |
$1,507.80
|
| Rate for Payer: Cigna Commercial |
$4,623.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,812.55
|
| Rate for Payer: Health EOS Commercial |
$4,473.14
|
| Rate for Payer: HFN Commercial |
$4,623.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,769.50
|
| Rate for Payer: Multiplan Commercial |
$4,020.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,015.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,623.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,462.74
|
| Rate for Payer: Quartz Commercial |
$3,266.90
|
| Rate for Payer: Quartz Medicare Advantage |
$3,015.60
|
| Rate for Payer: The Alliance Commercial |
$20,104.00
|
| Rate for Payer: WEA Trust Commercial |
$2,764.30
|
| Rate for Payer: WPS Commercial |
$3,722.76
|
|
|
PLATE SLIM STRAIGHT 6 HOLE 626966
|
Facility
|
IP
|
$5,026.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6171787
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,462.74 |
| Max. Negotiated Rate |
$4,623.92 |
| Rate for Payer: Aetna Commercial |
$4,523.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,322.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,663.78
|
| Rate for Payer: Cash Price |
$1,507.80
|
| Rate for Payer: Cigna Commercial |
$4,623.92
|
| Rate for Payer: Health EOS Commercial |
$4,473.14
|
| Rate for Payer: HFN Commercial |
$4,623.92
|
| Rate for Payer: Multiplan Commercial |
$4,020.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,015.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,623.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,462.74
|
| Rate for Payer: Quartz Commercial |
$3,015.60
|
| Rate for Payer: WEA Trust Commercial |
$2,764.30
|
| Rate for Payer: WPS Commercial |
$3,722.76
|
|
|
PLATE SLIM STRAIGHT 7 HOLE 626967
|
Facility
|
IP
|
$7,469.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767632
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,659.81 |
| Max. Negotiated Rate |
$6,871.48 |
| Rate for Payer: Aetna Commercial |
$6,722.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,423.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,958.57
|
| Rate for Payer: Cash Price |
$2,240.70
|
| Rate for Payer: Cigna Commercial |
$6,871.48
|
| Rate for Payer: Health EOS Commercial |
$6,647.41
|
| Rate for Payer: HFN Commercial |
$6,871.48
|
| Rate for Payer: Multiplan Commercial |
$5,975.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,481.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,871.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,659.81
|
| Rate for Payer: Quartz Commercial |
$4,481.40
|
| Rate for Payer: WEA Trust Commercial |
$4,107.95
|
| Rate for Payer: WPS Commercial |
$5,532.29
|
|
|
PLATE SLIM STRAIGHT 7 HOLE 626967
|
Facility
|
OP
|
$7,469.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767632
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,091.32 |
| Max. Negotiated Rate |
$29,876.00 |
| Rate for Payer: Aetna Commercial |
$6,722.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,423.34
|
| Rate for Payer: Aetna Managed Medicare |
$2,091.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,854.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,734.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,585.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,958.57
|
| Rate for Payer: Cash Price |
$2,240.70
|
| Rate for Payer: Cigna Commercial |
$6,871.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,179.65
|
| Rate for Payer: Health EOS Commercial |
$6,647.41
|
| Rate for Payer: HFN Commercial |
$6,871.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,601.75
|
| Rate for Payer: Multiplan Commercial |
$5,975.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,481.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,871.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,659.81
|
| Rate for Payer: Quartz Commercial |
$4,854.85
|
| Rate for Payer: Quartz Medicare Advantage |
$4,481.40
|
| Rate for Payer: The Alliance Commercial |
$29,876.00
|
| Rate for Payer: WEA Trust Commercial |
$4,107.95
|
| Rate for Payer: WPS Commercial |
$5,532.29
|
|
|
PLATE SLIM Y 2 SHAFT HOLE 626982
|
Facility
|
OP
|
$5,456.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5563677
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,527.68 |
| Max. Negotiated Rate |
$21,824.00 |
| Rate for Payer: Aetna Commercial |
$4,910.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,692.16
|
| Rate for Payer: Aetna Managed Medicare |
$1,527.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,546.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,728.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,618.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,891.68
|
| Rate for Payer: Cash Price |
$1,636.80
|
| Rate for Payer: Cigna Commercial |
$5,019.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,053.18
|
| Rate for Payer: Health EOS Commercial |
$4,855.84
|
| Rate for Payer: HFN Commercial |
$5,019.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,092.00
|
| Rate for Payer: Multiplan Commercial |
$4,364.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,273.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,019.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,673.44
|
| Rate for Payer: Quartz Commercial |
$3,546.40
|
| Rate for Payer: Quartz Medicare Advantage |
$3,273.60
|
| Rate for Payer: The Alliance Commercial |
$21,824.00
|
| Rate for Payer: WEA Trust Commercial |
$3,000.80
|
| Rate for Payer: WPS Commercial |
$4,041.26
|
|
|
PLATE SLIM Y 2 SHAFT HOLE 626982
|
Facility
|
IP
|
$5,456.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5563677
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,673.44 |
| Max. Negotiated Rate |
$5,019.52 |
| Rate for Payer: Aetna Commercial |
$4,910.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,692.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,891.68
|
| Rate for Payer: Cash Price |
$1,636.80
|
| Rate for Payer: Cigna Commercial |
$5,019.52
|
| Rate for Payer: Health EOS Commercial |
$4,855.84
|
| Rate for Payer: HFN Commercial |
$5,019.52
|
| Rate for Payer: Multiplan Commercial |
$4,364.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,273.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,019.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,673.44
|
| Rate for Payer: Quartz Commercial |
$3,273.60
|
| Rate for Payer: WEA Trust Commercial |
$3,000.80
|
| Rate for Payer: WPS Commercial |
$4,041.26
|
|
|
PLATE SLIM Y 4 SHAFT HOLE 626984
|
Facility
|
IP
|
$5,456.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685845
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,673.44 |
| Max. Negotiated Rate |
$5,019.52 |
| Rate for Payer: Aetna Commercial |
$4,910.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,692.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,891.68
|
| Rate for Payer: Cash Price |
$1,636.80
|
| Rate for Payer: Cigna Commercial |
$5,019.52
|
| Rate for Payer: Health EOS Commercial |
$4,855.84
|
| Rate for Payer: HFN Commercial |
$5,019.52
|
| Rate for Payer: Multiplan Commercial |
$4,364.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,273.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,019.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,673.44
|
| Rate for Payer: Quartz Commercial |
$3,273.60
|
| Rate for Payer: WEA Trust Commercial |
$3,000.80
|
| Rate for Payer: WPS Commercial |
$4,041.26
|
|
|
PLATE SLIM Y 4 SHAFT HOLE 626984
|
Facility
|
OP
|
$5,456.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685845
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,527.68 |
| Max. Negotiated Rate |
$21,824.00 |
| Rate for Payer: Aetna Commercial |
$4,910.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,692.16
|
| Rate for Payer: Aetna Managed Medicare |
$1,527.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,546.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,728.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,618.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,891.68
|
| Rate for Payer: Cash Price |
$1,636.80
|
| Rate for Payer: Cigna Commercial |
$5,019.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,053.18
|
| Rate for Payer: Health EOS Commercial |
$4,855.84
|
| Rate for Payer: HFN Commercial |
$5,019.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,092.00
|
| Rate for Payer: Multiplan Commercial |
$4,364.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,273.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,019.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,673.44
|
| Rate for Payer: Quartz Commercial |
$3,546.40
|
| Rate for Payer: Quartz Medicare Advantage |
$3,273.60
|
| Rate for Payer: The Alliance Commercial |
$21,824.00
|
| Rate for Payer: WEA Trust Commercial |
$3,000.80
|
| Rate for Payer: WPS Commercial |
$4,041.26
|
|
|
PLATE SPIDER 20MM SMALL 814100003
|
Facility
|
IP
|
$726.00
|
|
| Hospital Charge Code |
2965014
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$355.74 |
| Max. Negotiated Rate |
$667.92 |
| Rate for Payer: Aetna Commercial |
$653.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$624.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$384.78
|
| Rate for Payer: Cash Price |
$217.80
|
| Rate for Payer: Cigna Commercial |
$667.92
|
| Rate for Payer: Health EOS Commercial |
$646.14
|
| Rate for Payer: HFN Commercial |
$667.92
|
| Rate for Payer: Multiplan Commercial |
$580.80
|
| Rate for Payer: NAPHCARE Commercial |
$435.60
|
| Rate for Payer: Preferred Network Access Commercial |
$667.92
|
| Rate for Payer: Quartz Beloit One Network |
$355.74
|
| Rate for Payer: Quartz Commercial |
$435.60
|
| Rate for Payer: WEA Trust Commercial |
$399.30
|
| Rate for Payer: WPS Commercial |
$537.75
|
|
|
PLATE SPIDER 20MM SMALL 814100003
|
Facility
|
OP
|
$726.00
|
|
| Hospital Charge Code |
2965014
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$203.28 |
| Max. Negotiated Rate |
$2,904.00 |
| Rate for Payer: Aetna Commercial |
$653.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$624.36
|
| Rate for Payer: Aetna Managed Medicare |
$203.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$471.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$363.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$348.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$384.78
|
| Rate for Payer: Cash Price |
$217.80
|
| Rate for Payer: Cigna Commercial |
$667.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$406.27
|
| Rate for Payer: Health EOS Commercial |
$646.14
|
| Rate for Payer: HFN Commercial |
$667.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$544.50
|
| Rate for Payer: Multiplan Commercial |
$580.80
|
| Rate for Payer: NAPHCARE Commercial |
$435.60
|
| Rate for Payer: Preferred Network Access Commercial |
$667.92
|
| Rate for Payer: Quartz Beloit One Network |
$355.74
|
| Rate for Payer: Quartz Commercial |
$471.90
|
| Rate for Payer: Quartz Medicare Advantage |
$435.60
|
| Rate for Payer: The Alliance Commercial |
$2,904.00
|
| Rate for Payer: WEA Trust Commercial |
$399.30
|
| Rate for Payer: WPS Commercial |
$537.75
|
|
|
PLATE SQUARE 4 HOLE BIOMET 73-2622
|
Facility
|
OP
|
$4,320.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4205985
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,209.60 |
| Max. Negotiated Rate |
$17,280.00 |
| Rate for Payer: Aetna Commercial |
$3,888.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,715.20
|
| Rate for Payer: Aetna Managed Medicare |
$1,209.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,808.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,160.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,073.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,289.60
|
| Rate for Payer: Cash Price |
$1,296.00
|
| Rate for Payer: Cigna Commercial |
$3,974.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,417.47
|
| Rate for Payer: Health EOS Commercial |
$3,844.80
|
| Rate for Payer: HFN Commercial |
$3,974.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,240.00
|
| Rate for Payer: Multiplan Commercial |
$3,456.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,592.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,974.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,116.80
|
| Rate for Payer: Quartz Commercial |
$2,808.00
|
| Rate for Payer: Quartz Medicare Advantage |
$2,592.00
|
| Rate for Payer: The Alliance Commercial |
$17,280.00
|
| Rate for Payer: WEA Trust Commercial |
$2,376.00
|
| Rate for Payer: WPS Commercial |
$3,199.82
|
|
|
PLATE SQUARE 4 HOLE BIOMET 73-2622
|
Facility
|
IP
|
$4,320.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4205985
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,116.80 |
| Max. Negotiated Rate |
$3,974.40 |
| Rate for Payer: Aetna Commercial |
$3,888.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,715.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,289.60
|
| Rate for Payer: Cash Price |
$1,296.00
|
| Rate for Payer: Cigna Commercial |
$3,974.40
|
| Rate for Payer: Health EOS Commercial |
$3,844.80
|
| Rate for Payer: HFN Commercial |
$3,974.40
|
| Rate for Payer: Multiplan Commercial |
$3,456.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,592.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,974.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,116.80
|
| Rate for Payer: Quartz Commercial |
$2,592.00
|
| Rate for Payer: WEA Trust Commercial |
$2,376.00
|
| Rate for Payer: WPS Commercial |
$3,199.82
|
|
|
PLATE STERNALOCK 8HL STRAIGHT 73-1952
|
Facility
|
IP
|
$4,440.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5447129
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,175.60 |
| Max. Negotiated Rate |
$4,084.80 |
| Rate for Payer: Aetna Commercial |
$3,996.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,818.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,353.20
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cigna Commercial |
$4,084.80
|
| Rate for Payer: Health EOS Commercial |
$3,951.60
|
| Rate for Payer: HFN Commercial |
$4,084.80
|
| Rate for Payer: Multiplan Commercial |
$3,552.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,664.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,084.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,175.60
|
| Rate for Payer: Quartz Commercial |
$2,664.00
|
| Rate for Payer: WEA Trust Commercial |
$2,442.00
|
| Rate for Payer: WPS Commercial |
$3,288.71
|
|
|
PLATE STERNALOCK 8HL STRAIGHT 73-1952
|
Facility
|
OP
|
$4,440.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5447129
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,243.20 |
| Max. Negotiated Rate |
$17,760.00 |
| Rate for Payer: Aetna Commercial |
$3,996.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,818.40
|
| Rate for Payer: Aetna Managed Medicare |
$1,243.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,886.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,220.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,131.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,353.20
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cigna Commercial |
$4,084.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,484.62
|
| Rate for Payer: Health EOS Commercial |
$3,951.60
|
| Rate for Payer: HFN Commercial |
$4,084.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,330.00
|
| Rate for Payer: Multiplan Commercial |
$3,552.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,664.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,084.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,175.60
|
| Rate for Payer: Quartz Commercial |
$2,886.00
|
| Rate for Payer: Quartz Medicare Advantage |
$2,664.00
|
| Rate for Payer: The Alliance Commercial |
$17,760.00
|
| Rate for Payer: WEA Trust Commercial |
$2,442.00
|
| Rate for Payer: WPS Commercial |
$3,288.71
|
|
|
PLATE STRAIGHT 1.3MM 12HL 221.312
|
Facility
|
IP
|
$3,488.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508590
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,709.12 |
| Max. Negotiated Rate |
$3,208.96 |
| Rate for Payer: Aetna Commercial |
$3,139.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,999.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,848.64
|
| Rate for Payer: Cash Price |
$1,046.40
|
| Rate for Payer: Cigna Commercial |
$3,208.96
|
| Rate for Payer: Health EOS Commercial |
$3,104.32
|
| Rate for Payer: HFN Commercial |
$3,208.96
|
| Rate for Payer: Multiplan Commercial |
$2,790.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,092.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,208.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,709.12
|
| Rate for Payer: Quartz Commercial |
$2,092.80
|
| Rate for Payer: WEA Trust Commercial |
$1,918.40
|
| Rate for Payer: WPS Commercial |
$2,583.56
|
|
|
PLATE STRAIGHT 1.3MM 12HL 221.312
|
Facility
|
OP
|
$3,488.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508590
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$976.64 |
| Max. Negotiated Rate |
$13,952.00 |
| Rate for Payer: Aetna Commercial |
$3,139.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,999.68
|
| Rate for Payer: Aetna Managed Medicare |
$976.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,267.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,744.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,674.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,848.64
|
| Rate for Payer: Cash Price |
$1,046.40
|
| Rate for Payer: Cigna Commercial |
$3,208.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,951.88
|
| Rate for Payer: Health EOS Commercial |
$3,104.32
|
| Rate for Payer: HFN Commercial |
$3,208.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,616.00
|
| Rate for Payer: Multiplan Commercial |
$2,790.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,092.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,208.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,709.12
|
| Rate for Payer: Quartz Commercial |
$2,267.20
|
| Rate for Payer: Quartz Medicare Advantage |
$2,092.80
|
| Rate for Payer: The Alliance Commercial |
$13,952.00
|
| Rate for Payer: WEA Trust Commercial |
$1,918.40
|
| Rate for Payer: WPS Commercial |
$2,583.56
|
|
|
PLATE STRAIGHT 1.3MM 6HL 221.306
|
Facility
|
OP
|
$2,793.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508588
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$782.04 |
| Max. Negotiated Rate |
$11,172.00 |
| Rate for Payer: Aetna Commercial |
$2,513.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,401.98
|
| Rate for Payer: Aetna Managed Medicare |
$782.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,815.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,396.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,340.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,480.29
|
| Rate for Payer: Cash Price |
$837.90
|
| Rate for Payer: Cigna Commercial |
$2,569.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,562.96
|
| Rate for Payer: Health EOS Commercial |
$2,485.77
|
| Rate for Payer: HFN Commercial |
$2,569.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,094.75
|
| Rate for Payer: Multiplan Commercial |
$2,234.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,675.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,569.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,368.57
|
| Rate for Payer: Quartz Commercial |
$1,815.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,675.80
|
| Rate for Payer: The Alliance Commercial |
$11,172.00
|
| Rate for Payer: WEA Trust Commercial |
$1,536.15
|
| Rate for Payer: WPS Commercial |
$2,068.78
|
|
