|
PLATE 1/3 TUB 7HL 241.371
|
Facility
|
OP
|
$757.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966653
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$220.44 |
| Max. Negotiated Rate |
$724.30 |
| Rate for Payer: Aetna Commercial |
$708.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$677.06
|
| Rate for Payer: Aetna Managed Medicare |
$220.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$511.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$393.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$377.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$417.26
|
| Rate for Payer: Cash Price |
$227.10
|
| Rate for Payer: Cigna Commercial |
$724.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$440.57
|
| Rate for Payer: Health EOS Commercial |
$700.68
|
| Rate for Payer: HFN Commercial |
$724.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$590.46
|
| Rate for Payer: Multiplan Commercial |
$629.82
|
| Rate for Payer: NAPHCARE Commercial |
$472.37
|
| Rate for Payer: Preferred Network Access Commercial |
$724.30
|
| Rate for Payer: Quartz Beloit One Network |
$385.77
|
| Rate for Payer: Quartz Commercial |
$511.73
|
| Rate for Payer: Quartz Medicare Advantage |
$472.37
|
| Rate for Payer: The Alliance Commercial |
$393.64
|
| Rate for Payer: WEA Trust Commercial |
$433.00
|
| Rate for Payer: WPS Commercial |
$583.12
|
|
|
PLATE 1/3 TUB 7HL 241.371
|
Facility
|
IP
|
$757.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966653
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$385.77 |
| Max. Negotiated Rate |
$724.30 |
| Rate for Payer: Aetna Commercial |
$708.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$677.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$417.26
|
| Rate for Payer: Cash Price |
$227.10
|
| Rate for Payer: Cigna Commercial |
$724.30
|
| Rate for Payer: Health EOS Commercial |
$700.68
|
| Rate for Payer: HFN Commercial |
$724.30
|
| Rate for Payer: Multiplan Commercial |
$629.82
|
| Rate for Payer: Preferred Network Access Commercial |
$724.30
|
| Rate for Payer: Quartz Beloit One Network |
$385.77
|
| Rate for Payer: Quartz Commercial |
$472.37
|
| Rate for Payer: WEA Trust Commercial |
$433.00
|
| Rate for Payer: WPS Commercial |
$583.12
|
|
|
PLATE 1/3 TUB 8HL 241.381
|
Facility
|
IP
|
$792.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966655
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$403.60 |
| Max. Negotiated Rate |
$757.79 |
| Rate for Payer: Aetna Commercial |
$741.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$708.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$436.55
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cigna Commercial |
$757.79
|
| Rate for Payer: Health EOS Commercial |
$733.08
|
| Rate for Payer: HFN Commercial |
$757.79
|
| Rate for Payer: Multiplan Commercial |
$658.94
|
| Rate for Payer: Preferred Network Access Commercial |
$757.79
|
| Rate for Payer: Quartz Beloit One Network |
$403.60
|
| Rate for Payer: Quartz Commercial |
$494.21
|
| Rate for Payer: WEA Trust Commercial |
$453.02
|
| Rate for Payer: WPS Commercial |
$610.08
|
|
|
PLATE 1/3 TUB 8HL 241.381
|
Facility
|
OP
|
$792.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966655
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$230.63 |
| Max. Negotiated Rate |
$757.79 |
| Rate for Payer: Aetna Commercial |
$741.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$708.36
|
| Rate for Payer: Aetna Managed Medicare |
$230.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$535.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$411.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$395.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$436.55
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cigna Commercial |
$757.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$460.94
|
| Rate for Payer: Health EOS Commercial |
$733.08
|
| Rate for Payer: HFN Commercial |
$757.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$617.76
|
| Rate for Payer: Multiplan Commercial |
$658.94
|
| Rate for Payer: NAPHCARE Commercial |
$494.21
|
| Rate for Payer: Preferred Network Access Commercial |
$757.79
|
| Rate for Payer: Quartz Beloit One Network |
$403.60
|
| Rate for Payer: Quartz Commercial |
$535.39
|
| Rate for Payer: Quartz Medicare Advantage |
$494.21
|
| Rate for Payer: The Alliance Commercial |
$411.84
|
| Rate for Payer: WEA Trust Commercial |
$453.02
|
| Rate for Payer: WPS Commercial |
$610.08
|
|
|
PLATE 1/3 TUBUALR LOCK 10HL ARTHREX AR-8943T-10
|
Facility
|
OP
|
$2,979.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5563349
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$867.48 |
| Max. Negotiated Rate |
$2,850.31 |
| Rate for Payer: Aetna Commercial |
$2,788.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,664.42
|
| Rate for Payer: Aetna Managed Medicare |
$867.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,013.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,549.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,487.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,642.02
|
| Rate for Payer: Cash Price |
$893.70
|
| Rate for Payer: Cigna Commercial |
$2,850.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,733.78
|
| Rate for Payer: Health EOS Commercial |
$2,757.36
|
| Rate for Payer: HFN Commercial |
$2,850.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,323.62
|
| Rate for Payer: Multiplan Commercial |
$2,478.53
|
| Rate for Payer: NAPHCARE Commercial |
$1,858.90
|
| Rate for Payer: Preferred Network Access Commercial |
$2,850.31
|
| Rate for Payer: Quartz Beloit One Network |
$1,518.10
|
| Rate for Payer: Quartz Commercial |
$2,013.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,858.90
|
| Rate for Payer: The Alliance Commercial |
$1,549.08
|
| Rate for Payer: WEA Trust Commercial |
$1,703.99
|
| Rate for Payer: WPS Commercial |
$2,294.72
|
|
|
PLATE 1/3 TUBUALR LOCK 10HL ARTHREX AR-8943T-10
|
Facility
|
IP
|
$2,979.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5563349
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,518.10 |
| Max. Negotiated Rate |
$2,850.31 |
| Rate for Payer: Aetna Commercial |
$2,788.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,664.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,642.02
|
| Rate for Payer: Cash Price |
$893.70
|
| Rate for Payer: Cigna Commercial |
$2,850.31
|
| Rate for Payer: Health EOS Commercial |
$2,757.36
|
| Rate for Payer: HFN Commercial |
$2,850.31
|
| Rate for Payer: Multiplan Commercial |
$2,478.53
|
| Rate for Payer: Preferred Network Access Commercial |
$2,850.31
|
| Rate for Payer: Quartz Beloit One Network |
$1,518.10
|
| Rate for Payer: Quartz Commercial |
$1,858.90
|
| Rate for Payer: WEA Trust Commercial |
$1,703.99
|
| Rate for Payer: WPS Commercial |
$2,294.72
|
|
|
PLATE 1/3 TUBUALR LOCK 12HL ARTHREX AR-8943T-12
|
Facility
|
OP
|
$3,848.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6178526
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,120.54 |
| Max. Negotiated Rate |
$3,681.77 |
| Rate for Payer: Aetna Commercial |
$3,601.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,441.65
|
| Rate for Payer: Aetna Managed Medicare |
$1,120.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,601.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,000.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,920.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,121.02
|
| Rate for Payer: Cash Price |
$1,154.40
|
| Rate for Payer: Cigna Commercial |
$3,681.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,239.54
|
| Rate for Payer: Health EOS Commercial |
$3,561.71
|
| Rate for Payer: HFN Commercial |
$3,681.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,001.44
|
| Rate for Payer: Multiplan Commercial |
$3,201.54
|
| Rate for Payer: NAPHCARE Commercial |
$2,401.15
|
| Rate for Payer: Preferred Network Access Commercial |
$3,681.77
|
| Rate for Payer: Quartz Beloit One Network |
$1,960.94
|
| Rate for Payer: Quartz Commercial |
$2,601.25
|
| Rate for Payer: Quartz Medicare Advantage |
$2,401.15
|
| Rate for Payer: The Alliance Commercial |
$2,000.96
|
| Rate for Payer: WEA Trust Commercial |
$2,201.06
|
| Rate for Payer: WPS Commercial |
$2,964.11
|
|
|
PLATE 1/3 TUBUALR LOCK 12HL ARTHREX AR-8943T-12
|
Facility
|
IP
|
$3,848.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6178526
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,960.94 |
| Max. Negotiated Rate |
$3,681.77 |
| Rate for Payer: Aetna Commercial |
$3,601.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,441.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,121.02
|
| Rate for Payer: Cash Price |
$1,154.40
|
| Rate for Payer: Cigna Commercial |
$3,681.77
|
| Rate for Payer: Health EOS Commercial |
$3,561.71
|
| Rate for Payer: HFN Commercial |
$3,681.77
|
| Rate for Payer: Multiplan Commercial |
$3,201.54
|
| Rate for Payer: Preferred Network Access Commercial |
$3,681.77
|
| Rate for Payer: Quartz Beloit One Network |
$1,960.94
|
| Rate for Payer: Quartz Commercial |
$2,401.15
|
| Rate for Payer: WEA Trust Commercial |
$2,201.06
|
| Rate for Payer: WPS Commercial |
$2,964.11
|
|
|
PLATE 1/3 TUBUALR LOCK 4HL ARTHREX AR-8943T-04
|
Facility
|
IP
|
$2,394.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4594701
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,219.98 |
| Max. Negotiated Rate |
$2,290.58 |
| Rate for Payer: Aetna Commercial |
$2,240.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,141.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,319.57
|
| Rate for Payer: Cash Price |
$718.20
|
| Rate for Payer: Cigna Commercial |
$2,290.58
|
| Rate for Payer: Health EOS Commercial |
$2,215.89
|
| Rate for Payer: HFN Commercial |
$2,290.58
|
| Rate for Payer: Multiplan Commercial |
$1,991.81
|
| Rate for Payer: Preferred Network Access Commercial |
$2,290.58
|
| Rate for Payer: Quartz Beloit One Network |
$1,219.98
|
| Rate for Payer: Quartz Commercial |
$1,493.86
|
| Rate for Payer: WEA Trust Commercial |
$1,369.37
|
| Rate for Payer: WPS Commercial |
$1,844.10
|
|
|
PLATE 1/3 TUBUALR LOCK 4HL ARTHREX AR-8943T-04
|
Facility
|
OP
|
$2,394.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4594701
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$697.13 |
| Max. Negotiated Rate |
$2,290.58 |
| Rate for Payer: Aetna Commercial |
$2,240.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,141.19
|
| Rate for Payer: Aetna Managed Medicare |
$697.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,618.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,244.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,195.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,319.57
|
| Rate for Payer: Cash Price |
$718.20
|
| Rate for Payer: Cigna Commercial |
$2,290.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,393.31
|
| Rate for Payer: Health EOS Commercial |
$2,215.89
|
| Rate for Payer: HFN Commercial |
$2,290.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,867.32
|
| Rate for Payer: Multiplan Commercial |
$1,991.81
|
| Rate for Payer: NAPHCARE Commercial |
$1,493.86
|
| Rate for Payer: Preferred Network Access Commercial |
$2,290.58
|
| Rate for Payer: Quartz Beloit One Network |
$1,219.98
|
| Rate for Payer: Quartz Commercial |
$1,618.34
|
| Rate for Payer: Quartz Medicare Advantage |
$1,493.86
|
| Rate for Payer: The Alliance Commercial |
$1,244.88
|
| Rate for Payer: WEA Trust Commercial |
$1,369.37
|
| Rate for Payer: WPS Commercial |
$1,844.10
|
|
|
PLATE 1/3 TUBUALR LOCK 5HL ARTHREX AR-8943T-05
|
Facility
|
OP
|
$2,499.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5563348
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$727.71 |
| Max. Negotiated Rate |
$2,391.04 |
| Rate for Payer: Aetna Commercial |
$2,339.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,235.11
|
| Rate for Payer: Aetna Managed Medicare |
$727.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,689.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,299.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,247.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,377.45
|
| Rate for Payer: Cash Price |
$749.70
|
| Rate for Payer: Cigna Commercial |
$2,391.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,454.42
|
| Rate for Payer: Health EOS Commercial |
$2,313.07
|
| Rate for Payer: HFN Commercial |
$2,391.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,949.22
|
| Rate for Payer: Multiplan Commercial |
$2,079.17
|
| Rate for Payer: NAPHCARE Commercial |
$1,559.38
|
| Rate for Payer: Preferred Network Access Commercial |
$2,391.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,273.49
|
| Rate for Payer: Quartz Commercial |
$1,689.32
|
| Rate for Payer: Quartz Medicare Advantage |
$1,559.38
|
| Rate for Payer: The Alliance Commercial |
$1,299.48
|
| Rate for Payer: WEA Trust Commercial |
$1,429.43
|
| Rate for Payer: WPS Commercial |
$1,924.98
|
|
|
PLATE 1/3 TUBUALR LOCK 5HL ARTHREX AR-8943T-05
|
Facility
|
IP
|
$2,499.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5563348
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,273.49 |
| Max. Negotiated Rate |
$2,391.04 |
| Rate for Payer: Aetna Commercial |
$2,339.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,235.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,377.45
|
| Rate for Payer: Cash Price |
$749.70
|
| Rate for Payer: Cigna Commercial |
$2,391.04
|
| Rate for Payer: Health EOS Commercial |
$2,313.07
|
| Rate for Payer: HFN Commercial |
$2,391.04
|
| Rate for Payer: Multiplan Commercial |
$2,079.17
|
| Rate for Payer: Preferred Network Access Commercial |
$2,391.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,273.49
|
| Rate for Payer: Quartz Commercial |
$1,559.38
|
| Rate for Payer: WEA Trust Commercial |
$1,429.43
|
| Rate for Payer: WPS Commercial |
$1,924.98
|
|
|
PLATE 1/3 TUBUALR LOCK 6HL ARTHREX AR-8943T-06
|
Facility
|
IP
|
$2,317.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6182541
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,180.74 |
| Max. Negotiated Rate |
$2,216.91 |
| Rate for Payer: Aetna Commercial |
$2,168.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,072.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,277.13
|
| Rate for Payer: Cash Price |
$695.10
|
| Rate for Payer: Cigna Commercial |
$2,216.91
|
| Rate for Payer: Health EOS Commercial |
$2,144.62
|
| Rate for Payer: HFN Commercial |
$2,216.91
|
| Rate for Payer: Multiplan Commercial |
$1,927.74
|
| Rate for Payer: Preferred Network Access Commercial |
$2,216.91
|
| Rate for Payer: Quartz Beloit One Network |
$1,180.74
|
| Rate for Payer: Quartz Commercial |
$1,445.81
|
| Rate for Payer: WEA Trust Commercial |
$1,325.32
|
| Rate for Payer: WPS Commercial |
$1,784.79
|
|
|
PLATE 1/3 TUBUALR LOCK 6HL ARTHREX AR-8943T-06
|
Facility
|
OP
|
$2,317.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6182541
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$674.71 |
| Max. Negotiated Rate |
$2,216.91 |
| Rate for Payer: Aetna Commercial |
$2,168.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,072.32
|
| Rate for Payer: Aetna Managed Medicare |
$674.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,566.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,204.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,156.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,277.13
|
| Rate for Payer: Cash Price |
$695.10
|
| Rate for Payer: Cigna Commercial |
$2,216.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,348.49
|
| Rate for Payer: Health EOS Commercial |
$2,144.62
|
| Rate for Payer: HFN Commercial |
$2,216.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,807.26
|
| Rate for Payer: Multiplan Commercial |
$1,927.74
|
| Rate for Payer: NAPHCARE Commercial |
$1,445.81
|
| Rate for Payer: Preferred Network Access Commercial |
$2,216.91
|
| Rate for Payer: Quartz Beloit One Network |
$1,180.74
|
| Rate for Payer: Quartz Commercial |
$1,566.29
|
| Rate for Payer: Quartz Medicare Advantage |
$1,445.81
|
| Rate for Payer: The Alliance Commercial |
$1,204.84
|
| Rate for Payer: WEA Trust Commercial |
$1,325.32
|
| Rate for Payer: WPS Commercial |
$1,784.79
|
|
|
PLATE 1/3 TUBUALR LOCK 7HL ARTHREX AR-8943T-07
|
Facility
|
OP
|
$4,031.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415094
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,173.83 |
| Max. Negotiated Rate |
$3,856.86 |
| Rate for Payer: Aetna Commercial |
$3,773.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,605.33
|
| Rate for Payer: Aetna Managed Medicare |
$1,173.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,724.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,096.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,012.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,221.89
|
| Rate for Payer: Cash Price |
$1,209.30
|
| Rate for Payer: Cigna Commercial |
$3,856.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,346.04
|
| Rate for Payer: Health EOS Commercial |
$3,731.09
|
| Rate for Payer: HFN Commercial |
$3,856.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,144.18
|
| Rate for Payer: Multiplan Commercial |
$3,353.79
|
| Rate for Payer: NAPHCARE Commercial |
$2,515.34
|
| Rate for Payer: Preferred Network Access Commercial |
$3,856.86
|
| Rate for Payer: Quartz Beloit One Network |
$2,054.20
|
| Rate for Payer: Quartz Commercial |
$2,724.96
|
| Rate for Payer: Quartz Medicare Advantage |
$2,515.34
|
| Rate for Payer: The Alliance Commercial |
$2,096.12
|
| Rate for Payer: WEA Trust Commercial |
$2,305.73
|
| Rate for Payer: WPS Commercial |
$3,105.08
|
|
|
PLATE 1/3 TUBUALR LOCK 7HL ARTHREX AR-8943T-07
|
Facility
|
IP
|
$4,031.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415094
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,054.20 |
| Max. Negotiated Rate |
$3,856.86 |
| Rate for Payer: Aetna Commercial |
$3,773.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,605.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,221.89
|
| Rate for Payer: Cash Price |
$1,209.30
|
| Rate for Payer: Cigna Commercial |
$3,856.86
|
| Rate for Payer: Health EOS Commercial |
$3,731.09
|
| Rate for Payer: HFN Commercial |
$3,856.86
|
| Rate for Payer: Multiplan Commercial |
$3,353.79
|
| Rate for Payer: Preferred Network Access Commercial |
$3,856.86
|
| Rate for Payer: Quartz Beloit One Network |
$2,054.20
|
| Rate for Payer: Quartz Commercial |
$2,515.34
|
| Rate for Payer: WEA Trust Commercial |
$2,305.73
|
| Rate for Payer: WPS Commercial |
$3,105.08
|
|
|
PLATE 1/3 TUBUALR LOCK 8HL ARTHREX AR-8943T-08
|
Facility
|
IP
|
$4,031.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5563258
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,054.20 |
| Max. Negotiated Rate |
$3,856.86 |
| Rate for Payer: Aetna Commercial |
$3,773.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,605.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,221.89
|
| Rate for Payer: Cash Price |
$1,209.30
|
| Rate for Payer: Cigna Commercial |
$3,856.86
|
| Rate for Payer: Health EOS Commercial |
$3,731.09
|
| Rate for Payer: HFN Commercial |
$3,856.86
|
| Rate for Payer: Multiplan Commercial |
$3,353.79
|
| Rate for Payer: Preferred Network Access Commercial |
$3,856.86
|
| Rate for Payer: Quartz Beloit One Network |
$2,054.20
|
| Rate for Payer: Quartz Commercial |
$2,515.34
|
| Rate for Payer: WEA Trust Commercial |
$2,305.73
|
| Rate for Payer: WPS Commercial |
$3,105.08
|
|
|
PLATE 1/3 TUBUALR LOCK 8HL ARTHREX AR-8943T-08
|
Facility
|
OP
|
$4,031.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5563258
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,173.83 |
| Max. Negotiated Rate |
$3,856.86 |
| Rate for Payer: Aetna Commercial |
$3,773.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,605.33
|
| Rate for Payer: Aetna Managed Medicare |
$1,173.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,724.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,096.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,012.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,221.89
|
| Rate for Payer: Cash Price |
$1,209.30
|
| Rate for Payer: Cigna Commercial |
$3,856.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,346.04
|
| Rate for Payer: Health EOS Commercial |
$3,731.09
|
| Rate for Payer: HFN Commercial |
$3,856.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,144.18
|
| Rate for Payer: Multiplan Commercial |
$3,353.79
|
| Rate for Payer: NAPHCARE Commercial |
$2,515.34
|
| Rate for Payer: Preferred Network Access Commercial |
$3,856.86
|
| Rate for Payer: Quartz Beloit One Network |
$2,054.20
|
| Rate for Payer: Quartz Commercial |
$2,724.96
|
| Rate for Payer: Quartz Medicare Advantage |
$2,515.34
|
| Rate for Payer: The Alliance Commercial |
$2,096.12
|
| Rate for Payer: WEA Trust Commercial |
$2,305.73
|
| Rate for Payer: WPS Commercial |
$3,105.08
|
|
|
PLATE 1/3 TUBULAR 10HL 241.40
|
Facility
|
IP
|
$1,021.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966642
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$520.30 |
| Max. Negotiated Rate |
$976.89 |
| Rate for Payer: Aetna Commercial |
$955.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$913.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$562.78
|
| Rate for Payer: Cash Price |
$306.30
|
| Rate for Payer: Cigna Commercial |
$976.89
|
| Rate for Payer: Health EOS Commercial |
$945.04
|
| Rate for Payer: HFN Commercial |
$976.89
|
| Rate for Payer: Multiplan Commercial |
$849.47
|
| Rate for Payer: Preferred Network Access Commercial |
$976.89
|
| Rate for Payer: Quartz Beloit One Network |
$520.30
|
| Rate for Payer: Quartz Commercial |
$637.10
|
| Rate for Payer: WEA Trust Commercial |
$584.01
|
| Rate for Payer: WPS Commercial |
$786.48
|
|
|
PLATE 1/3 TUBULAR 10HL 241.40
|
Facility
|
OP
|
$1,021.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966642
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$297.32 |
| Max. Negotiated Rate |
$976.89 |
| Rate for Payer: Aetna Commercial |
$955.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$913.18
|
| Rate for Payer: Aetna Managed Medicare |
$297.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$690.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$530.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$509.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$562.78
|
| Rate for Payer: Cash Price |
$306.30
|
| Rate for Payer: Cigna Commercial |
$976.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$594.22
|
| Rate for Payer: Health EOS Commercial |
$945.04
|
| Rate for Payer: HFN Commercial |
$976.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$796.38
|
| Rate for Payer: Multiplan Commercial |
$849.47
|
| Rate for Payer: NAPHCARE Commercial |
$637.10
|
| Rate for Payer: Preferred Network Access Commercial |
$976.89
|
| Rate for Payer: Quartz Beloit One Network |
$520.30
|
| Rate for Payer: Quartz Commercial |
$690.20
|
| Rate for Payer: Quartz Medicare Advantage |
$637.10
|
| Rate for Payer: The Alliance Commercial |
$530.92
|
| Rate for Payer: WEA Trust Commercial |
$584.01
|
| Rate for Payer: WPS Commercial |
$786.48
|
|
|
PLATE 1/3 TUBULAR 2HL 241.32
|
Facility
|
IP
|
$373.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$190.08 |
| Max. Negotiated Rate |
$356.89 |
| Rate for Payer: Aetna Commercial |
$349.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$333.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$205.60
|
| Rate for Payer: Cash Price |
$111.90
|
| Rate for Payer: Cigna Commercial |
$356.89
|
| Rate for Payer: Health EOS Commercial |
$345.25
|
| Rate for Payer: HFN Commercial |
$356.89
|
| Rate for Payer: Multiplan Commercial |
$310.34
|
| Rate for Payer: Preferred Network Access Commercial |
$356.89
|
| Rate for Payer: Quartz Beloit One Network |
$190.08
|
| Rate for Payer: Quartz Commercial |
$232.75
|
| Rate for Payer: WEA Trust Commercial |
$213.36
|
| Rate for Payer: WPS Commercial |
$287.32
|
|
|
PLATE 1/3 TUBULAR 2HL 241.32
|
Facility
|
OP
|
$373.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$108.62 |
| Max. Negotiated Rate |
$356.89 |
| Rate for Payer: Aetna Commercial |
$349.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$333.61
|
| Rate for Payer: Aetna Managed Medicare |
$108.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$252.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$193.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$186.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$205.60
|
| Rate for Payer: Cash Price |
$111.90
|
| Rate for Payer: Cigna Commercial |
$356.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$217.09
|
| Rate for Payer: Health EOS Commercial |
$345.25
|
| Rate for Payer: HFN Commercial |
$356.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$290.94
|
| Rate for Payer: Multiplan Commercial |
$310.34
|
| Rate for Payer: NAPHCARE Commercial |
$232.75
|
| Rate for Payer: Preferred Network Access Commercial |
$356.89
|
| Rate for Payer: Quartz Beloit One Network |
$190.08
|
| Rate for Payer: Quartz Commercial |
$252.15
|
| Rate for Payer: Quartz Medicare Advantage |
$232.75
|
| Rate for Payer: The Alliance Commercial |
$193.96
|
| Rate for Payer: WEA Trust Commercial |
$213.36
|
| Rate for Payer: WPS Commercial |
$287.32
|
|
|
PLATE 1/3 TUBULAR 3HL 241.33
|
Facility
|
OP
|
$851.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966646
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$247.81 |
| Max. Negotiated Rate |
$814.24 |
| Rate for Payer: Aetna Commercial |
$796.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$761.13
|
| Rate for Payer: Aetna Managed Medicare |
$247.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$575.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$442.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$424.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$469.07
|
| Rate for Payer: Cash Price |
$255.30
|
| Rate for Payer: Cigna Commercial |
$814.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$495.28
|
| Rate for Payer: Health EOS Commercial |
$787.69
|
| Rate for Payer: HFN Commercial |
$814.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$663.78
|
| Rate for Payer: Multiplan Commercial |
$708.03
|
| Rate for Payer: NAPHCARE Commercial |
$531.02
|
| Rate for Payer: Preferred Network Access Commercial |
$814.24
|
| Rate for Payer: Quartz Beloit One Network |
$433.67
|
| Rate for Payer: Quartz Commercial |
$575.28
|
| Rate for Payer: Quartz Medicare Advantage |
$531.02
|
| Rate for Payer: The Alliance Commercial |
$442.52
|
| Rate for Payer: WEA Trust Commercial |
$486.77
|
| Rate for Payer: WPS Commercial |
$655.53
|
|
|
PLATE 1/3 TUBULAR 3HL 241.33
|
Facility
|
IP
|
$851.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966646
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$433.67 |
| Max. Negotiated Rate |
$814.24 |
| Rate for Payer: Aetna Commercial |
$796.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$761.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$469.07
|
| Rate for Payer: Cash Price |
$255.30
|
| Rate for Payer: Cigna Commercial |
$814.24
|
| Rate for Payer: Health EOS Commercial |
$787.69
|
| Rate for Payer: HFN Commercial |
$814.24
|
| Rate for Payer: Multiplan Commercial |
$708.03
|
| Rate for Payer: Preferred Network Access Commercial |
$814.24
|
| Rate for Payer: Quartz Beloit One Network |
$433.67
|
| Rate for Payer: Quartz Commercial |
$531.02
|
| Rate for Payer: WEA Trust Commercial |
$486.77
|
| Rate for Payer: WPS Commercial |
$655.53
|
|
|
PLATE 1/3 TUBULAR 4HL 241.34
|
Facility
|
OP
|
$991.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966647
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$288.58 |
| Max. Negotiated Rate |
$948.19 |
| Rate for Payer: Aetna Commercial |
$927.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$886.35
|
| Rate for Payer: Aetna Managed Medicare |
$288.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$669.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$515.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$494.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$546.24
|
| Rate for Payer: Cash Price |
$297.30
|
| Rate for Payer: Cigna Commercial |
$948.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$576.76
|
| Rate for Payer: Health EOS Commercial |
$917.27
|
| Rate for Payer: HFN Commercial |
$948.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$772.98
|
| Rate for Payer: Multiplan Commercial |
$824.51
|
| Rate for Payer: NAPHCARE Commercial |
$618.38
|
| Rate for Payer: Preferred Network Access Commercial |
$948.19
|
| Rate for Payer: Quartz Beloit One Network |
$505.01
|
| Rate for Payer: Quartz Commercial |
$669.92
|
| Rate for Payer: Quartz Medicare Advantage |
$618.38
|
| Rate for Payer: The Alliance Commercial |
$515.32
|
| Rate for Payer: WEA Trust Commercial |
$566.85
|
| Rate for Payer: WPS Commercial |
$763.37
|
|
