|
PLATE 3.5MM METAPHYSEAL 11HOLE
|
Facility
|
IP
|
$6,283.00
|
|
| Hospital Charge Code |
2966342
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,201.82 |
| Max. Negotiated Rate |
$6,011.57 |
| Rate for Payer: Aetna Commercial |
$5,880.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,619.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,463.19
|
| Rate for Payer: Cash Price |
$1,884.90
|
| Rate for Payer: Cigna Commercial |
$6,011.57
|
| Rate for Payer: Health EOS Commercial |
$5,815.54
|
| Rate for Payer: HFN Commercial |
$6,011.57
|
| Rate for Payer: Multiplan Commercial |
$5,227.46
|
| Rate for Payer: Preferred Network Access Commercial |
$6,011.57
|
| Rate for Payer: Quartz Beloit One Network |
$3,201.82
|
| Rate for Payer: Quartz Commercial |
$3,920.59
|
| Rate for Payer: WEA Trust Commercial |
$3,593.88
|
| Rate for Payer: WPS Commercial |
$4,839.79
|
|
|
PLATE 3.5MM METAPHYSEAL 11HOLE
|
Facility
|
OP
|
$6,283.00
|
|
| Hospital Charge Code |
2966342
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,829.61 |
| Max. Negotiated Rate |
$6,011.57 |
| Rate for Payer: Aetna Commercial |
$5,880.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,619.52
|
| Rate for Payer: Aetna Managed Medicare |
$1,829.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,247.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,267.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,136.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,463.19
|
| Rate for Payer: Cash Price |
$1,884.90
|
| Rate for Payer: Cigna Commercial |
$6,011.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,656.71
|
| Rate for Payer: Health EOS Commercial |
$5,815.54
|
| Rate for Payer: HFN Commercial |
$6,011.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,900.74
|
| Rate for Payer: Multiplan Commercial |
$5,227.46
|
| Rate for Payer: NAPHCARE Commercial |
$3,920.59
|
| Rate for Payer: Preferred Network Access Commercial |
$6,011.57
|
| Rate for Payer: Quartz Beloit One Network |
$3,201.82
|
| Rate for Payer: Quartz Commercial |
$4,247.31
|
| Rate for Payer: Quartz Medicare Advantage |
$3,920.59
|
| Rate for Payer: The Alliance Commercial |
$3,267.16
|
| Rate for Payer: WEA Trust Commercial |
$3,593.88
|
| Rate for Payer: WPS Commercial |
$4,839.79
|
|
|
PLATE 3.5MM PROXIMAL TIBIA SM BEND 4HL LT 02.127.211
|
Facility
|
OP
|
$7,222.00
|
|
| Hospital Charge Code |
4462801
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,103.05 |
| Max. Negotiated Rate |
$6,910.01 |
| Rate for Payer: Aetna Commercial |
$6,759.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,459.36
|
| Rate for Payer: Aetna Managed Medicare |
$2,103.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,882.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,755.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,605.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,980.77
|
| Rate for Payer: Cash Price |
$2,166.60
|
| Rate for Payer: Cigna Commercial |
$6,910.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,203.20
|
| Rate for Payer: Health EOS Commercial |
$6,684.68
|
| Rate for Payer: HFN Commercial |
$6,910.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,633.16
|
| Rate for Payer: Multiplan Commercial |
$6,008.70
|
| Rate for Payer: NAPHCARE Commercial |
$4,506.53
|
| Rate for Payer: Preferred Network Access Commercial |
$6,910.01
|
| Rate for Payer: Quartz Beloit One Network |
$3,680.33
|
| Rate for Payer: Quartz Commercial |
$4,882.07
|
| Rate for Payer: Quartz Medicare Advantage |
$4,506.53
|
| Rate for Payer: The Alliance Commercial |
$3,755.44
|
| Rate for Payer: WEA Trust Commercial |
$4,130.98
|
| Rate for Payer: WPS Commercial |
$5,563.11
|
|
|
PLATE 3.5MM PROXIMAL TIBIA SM BEND 4HL LT 02.127.211
|
Facility
|
IP
|
$7,222.00
|
|
| Hospital Charge Code |
4462801
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,680.33 |
| Max. Negotiated Rate |
$6,910.01 |
| Rate for Payer: Aetna Commercial |
$6,759.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,459.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,980.77
|
| Rate for Payer: Cash Price |
$2,166.60
|
| Rate for Payer: Cigna Commercial |
$6,910.01
|
| Rate for Payer: Health EOS Commercial |
$6,684.68
|
| Rate for Payer: HFN Commercial |
$6,910.01
|
| Rate for Payer: Multiplan Commercial |
$6,008.70
|
| Rate for Payer: Preferred Network Access Commercial |
$6,910.01
|
| Rate for Payer: Quartz Beloit One Network |
$3,680.33
|
| Rate for Payer: Quartz Commercial |
$4,506.53
|
| Rate for Payer: WEA Trust Commercial |
$4,130.98
|
| Rate for Payer: WPS Commercial |
$5,563.11
|
|
|
PLATE 3.5MM PROXIMAL TIBIA SM BEND 4HL RT 02.127.210S
|
Facility
|
OP
|
$7,222.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5106922
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,103.05 |
| Max. Negotiated Rate |
$6,910.01 |
| Rate for Payer: Aetna Commercial |
$6,759.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,459.36
|
| Rate for Payer: Aetna Managed Medicare |
$2,103.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,882.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,755.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,605.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,980.77
|
| Rate for Payer: Cash Price |
$2,166.60
|
| Rate for Payer: Cigna Commercial |
$6,910.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,203.20
|
| Rate for Payer: Health EOS Commercial |
$6,684.68
|
| Rate for Payer: HFN Commercial |
$6,910.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,633.16
|
| Rate for Payer: Multiplan Commercial |
$6,008.70
|
| Rate for Payer: NAPHCARE Commercial |
$4,506.53
|
| Rate for Payer: Preferred Network Access Commercial |
$6,910.01
|
| Rate for Payer: Quartz Beloit One Network |
$3,680.33
|
| Rate for Payer: Quartz Commercial |
$4,882.07
|
| Rate for Payer: Quartz Medicare Advantage |
$4,506.53
|
| Rate for Payer: The Alliance Commercial |
$3,755.44
|
| Rate for Payer: WEA Trust Commercial |
$4,130.98
|
| Rate for Payer: WPS Commercial |
$5,563.11
|
|
|
PLATE 3.5MM PROXIMAL TIBIA SM BEND 4HL RT 02.127.210S
|
Facility
|
IP
|
$7,222.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5106922
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,680.33 |
| Max. Negotiated Rate |
$6,910.01 |
| Rate for Payer: Aetna Commercial |
$6,759.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,459.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,980.77
|
| Rate for Payer: Cash Price |
$2,166.60
|
| Rate for Payer: Cigna Commercial |
$6,910.01
|
| Rate for Payer: Health EOS Commercial |
$6,684.68
|
| Rate for Payer: HFN Commercial |
$6,910.01
|
| Rate for Payer: Multiplan Commercial |
$6,008.70
|
| Rate for Payer: Preferred Network Access Commercial |
$6,910.01
|
| Rate for Payer: Quartz Beloit One Network |
$3,680.33
|
| Rate for Payer: Quartz Commercial |
$4,506.53
|
| Rate for Payer: WEA Trust Commercial |
$4,130.98
|
| Rate for Payer: WPS Commercial |
$5,563.11
|
|
|
PLATE 3.5MM PROXIMAL TIBIA SM BEND 6HL LT 02.127.221S
|
Facility
|
IP
|
$7,533.00
|
|
| Hospital Charge Code |
5074826
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,838.82 |
| Max. Negotiated Rate |
$7,207.57 |
| Rate for Payer: Aetna Commercial |
$7,050.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,737.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,152.19
|
| Rate for Payer: Cash Price |
$2,259.90
|
| Rate for Payer: Cigna Commercial |
$7,207.57
|
| Rate for Payer: Health EOS Commercial |
$6,972.54
|
| Rate for Payer: HFN Commercial |
$7,207.57
|
| Rate for Payer: Multiplan Commercial |
$6,267.46
|
| Rate for Payer: Preferred Network Access Commercial |
$7,207.57
|
| Rate for Payer: Quartz Beloit One Network |
$3,838.82
|
| Rate for Payer: Quartz Commercial |
$4,700.59
|
| Rate for Payer: WEA Trust Commercial |
$4,308.88
|
| Rate for Payer: WPS Commercial |
$5,802.67
|
|
|
PLATE 3.5MM PROXIMAL TIBIA SM BEND 6HL LT 02.127.221S
|
Facility
|
OP
|
$7,533.00
|
|
| Hospital Charge Code |
5074826
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,193.61 |
| Max. Negotiated Rate |
$7,207.57 |
| Rate for Payer: Aetna Commercial |
$7,050.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,737.52
|
| Rate for Payer: Aetna Managed Medicare |
$2,193.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,092.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,917.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,760.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,152.19
|
| Rate for Payer: Cash Price |
$2,259.90
|
| Rate for Payer: Cigna Commercial |
$7,207.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,384.21
|
| Rate for Payer: Health EOS Commercial |
$6,972.54
|
| Rate for Payer: HFN Commercial |
$7,207.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,875.74
|
| Rate for Payer: Multiplan Commercial |
$6,267.46
|
| Rate for Payer: NAPHCARE Commercial |
$4,700.59
|
| Rate for Payer: Preferred Network Access Commercial |
$7,207.57
|
| Rate for Payer: Quartz Beloit One Network |
$3,838.82
|
| Rate for Payer: Quartz Commercial |
$5,092.31
|
| Rate for Payer: Quartz Medicare Advantage |
$4,700.59
|
| Rate for Payer: The Alliance Commercial |
$3,917.16
|
| Rate for Payer: WEA Trust Commercial |
$4,308.88
|
| Rate for Payer: WPS Commercial |
$5,802.67
|
|
|
PLATE 3H 3H OBLIQ RT T 241.031
|
Facility
|
IP
|
$1,514.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966702
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$771.53 |
| Max. Negotiated Rate |
$1,448.60 |
| Rate for Payer: Aetna Commercial |
$1,417.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,354.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$834.52
|
| Rate for Payer: Cash Price |
$454.20
|
| Rate for Payer: Cigna Commercial |
$1,448.60
|
| Rate for Payer: Health EOS Commercial |
$1,401.36
|
| Rate for Payer: HFN Commercial |
$1,448.60
|
| Rate for Payer: Multiplan Commercial |
$1,259.65
|
| Rate for Payer: Preferred Network Access Commercial |
$1,448.60
|
| Rate for Payer: Quartz Beloit One Network |
$771.53
|
| Rate for Payer: Quartz Commercial |
$944.74
|
| Rate for Payer: WEA Trust Commercial |
$866.01
|
| Rate for Payer: WPS Commercial |
$1,166.23
|
|
|
PLATE 3H 3H OBLIQ RT T 241.031
|
Facility
|
OP
|
$1,514.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966702
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$440.88 |
| Max. Negotiated Rate |
$1,448.60 |
| Rate for Payer: Aetna Commercial |
$1,417.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,354.12
|
| Rate for Payer: Aetna Managed Medicare |
$440.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,023.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$787.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$755.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$834.52
|
| Rate for Payer: Cash Price |
$454.20
|
| Rate for Payer: Cigna Commercial |
$1,448.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$881.15
|
| Rate for Payer: Health EOS Commercial |
$1,401.36
|
| Rate for Payer: HFN Commercial |
$1,448.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,180.92
|
| Rate for Payer: Multiplan Commercial |
$1,259.65
|
| Rate for Payer: NAPHCARE Commercial |
$944.74
|
| Rate for Payer: Preferred Network Access Commercial |
$1,448.60
|
| Rate for Payer: Quartz Beloit One Network |
$771.53
|
| Rate for Payer: Quartz Commercial |
$1,023.46
|
| Rate for Payer: Quartz Medicare Advantage |
$944.74
|
| Rate for Payer: The Alliance Commercial |
$787.28
|
| Rate for Payer: WEA Trust Commercial |
$866.01
|
| Rate for Payer: WPS Commercial |
$1,166.23
|
|
|
PLATE 3H 3H RT ANGLE T 241.131
|
Facility
|
OP
|
$1,324.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966704
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$385.55 |
| Max. Negotiated Rate |
$1,266.80 |
| Rate for Payer: Aetna Commercial |
$1,239.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,184.19
|
| Rate for Payer: Aetna Managed Medicare |
$385.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$895.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$688.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$660.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$729.79
|
| Rate for Payer: Cash Price |
$397.20
|
| Rate for Payer: Cigna Commercial |
$1,266.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$770.57
|
| Rate for Payer: Health EOS Commercial |
$1,225.49
|
| Rate for Payer: HFN Commercial |
$1,266.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,032.72
|
| Rate for Payer: Multiplan Commercial |
$1,101.57
|
| Rate for Payer: NAPHCARE Commercial |
$826.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,266.80
|
| Rate for Payer: Quartz Beloit One Network |
$674.71
|
| Rate for Payer: Quartz Commercial |
$895.02
|
| Rate for Payer: Quartz Medicare Advantage |
$826.18
|
| Rate for Payer: The Alliance Commercial |
$688.48
|
| Rate for Payer: WEA Trust Commercial |
$757.33
|
| Rate for Payer: WPS Commercial |
$1,019.88
|
|
|
PLATE 3H 3H RT ANGLE T 241.131
|
Facility
|
IP
|
$1,324.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966704
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$674.71 |
| Max. Negotiated Rate |
$1,266.80 |
| Rate for Payer: Aetna Commercial |
$1,239.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,184.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$729.79
|
| Rate for Payer: Cash Price |
$397.20
|
| Rate for Payer: Cigna Commercial |
$1,266.80
|
| Rate for Payer: Health EOS Commercial |
$1,225.49
|
| Rate for Payer: HFN Commercial |
$1,266.80
|
| Rate for Payer: Multiplan Commercial |
$1,101.57
|
| Rate for Payer: Preferred Network Access Commercial |
$1,266.80
|
| Rate for Payer: Quartz Beloit One Network |
$674.71
|
| Rate for Payer: Quartz Commercial |
$826.18
|
| Rate for Payer: WEA Trust Commercial |
$757.33
|
| Rate for Payer: WPS Commercial |
$1,019.88
|
|
|
PLATE 3H 4H OBLIQ RT T 241.041
|
Facility
|
OP
|
$1,591.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966706
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$463.30 |
| Max. Negotiated Rate |
$1,522.27 |
| Rate for Payer: Aetna Commercial |
$1,489.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,422.99
|
| Rate for Payer: Aetna Managed Medicare |
$463.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,075.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$827.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$794.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$876.96
|
| Rate for Payer: Cash Price |
$477.30
|
| Rate for Payer: Cigna Commercial |
$1,522.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$925.96
|
| Rate for Payer: Health EOS Commercial |
$1,472.63
|
| Rate for Payer: HFN Commercial |
$1,522.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,240.98
|
| Rate for Payer: Multiplan Commercial |
$1,323.71
|
| Rate for Payer: NAPHCARE Commercial |
$992.78
|
| Rate for Payer: Preferred Network Access Commercial |
$1,522.27
|
| Rate for Payer: Quartz Beloit One Network |
$810.77
|
| Rate for Payer: Quartz Commercial |
$1,075.52
|
| Rate for Payer: Quartz Medicare Advantage |
$992.78
|
| Rate for Payer: The Alliance Commercial |
$827.32
|
| Rate for Payer: WEA Trust Commercial |
$910.05
|
| Rate for Payer: WPS Commercial |
$1,225.55
|
|
|
PLATE 3H 4H OBLIQ RT T 241.041
|
Facility
|
IP
|
$1,591.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966706
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$810.77 |
| Max. Negotiated Rate |
$1,522.27 |
| Rate for Payer: Aetna Commercial |
$1,489.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,422.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$876.96
|
| Rate for Payer: Cash Price |
$477.30
|
| Rate for Payer: Cigna Commercial |
$1,522.27
|
| Rate for Payer: Health EOS Commercial |
$1,472.63
|
| Rate for Payer: HFN Commercial |
$1,522.27
|
| Rate for Payer: Multiplan Commercial |
$1,323.71
|
| Rate for Payer: Preferred Network Access Commercial |
$1,522.27
|
| Rate for Payer: Quartz Beloit One Network |
$810.77
|
| Rate for Payer: Quartz Commercial |
$992.78
|
| Rate for Payer: WEA Trust Commercial |
$910.05
|
| Rate for Payer: WPS Commercial |
$1,225.55
|
|
|
PLATE 3H 5H OBLIQ RT T 241.051
|
Facility
|
OP
|
$1,650.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966708
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$480.48 |
| Max. Negotiated Rate |
$1,578.72 |
| Rate for Payer: Aetna Commercial |
$1,544.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,475.76
|
| Rate for Payer: Aetna Managed Medicare |
$480.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,115.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$858.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$823.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$909.48
|
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: Cigna Commercial |
$1,578.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$960.30
|
| Rate for Payer: Health EOS Commercial |
$1,527.24
|
| Rate for Payer: HFN Commercial |
$1,578.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,287.00
|
| Rate for Payer: Multiplan Commercial |
$1,372.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,029.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,578.72
|
| Rate for Payer: Quartz Beloit One Network |
$840.84
|
| Rate for Payer: Quartz Commercial |
$1,115.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,029.60
|
| Rate for Payer: The Alliance Commercial |
$858.00
|
| Rate for Payer: WEA Trust Commercial |
$943.80
|
| Rate for Payer: WPS Commercial |
$1,270.99
|
|
|
PLATE 3H 5H OBLIQ RT T 241.051
|
Facility
|
IP
|
$1,650.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966708
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$840.84 |
| Max. Negotiated Rate |
$1,578.72 |
| Rate for Payer: Aetna Commercial |
$1,544.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,475.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$909.48
|
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: Cigna Commercial |
$1,578.72
|
| Rate for Payer: Health EOS Commercial |
$1,527.24
|
| Rate for Payer: HFN Commercial |
$1,578.72
|
| Rate for Payer: Multiplan Commercial |
$1,372.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,578.72
|
| Rate for Payer: Quartz Beloit One Network |
$840.84
|
| Rate for Payer: Quartz Commercial |
$1,029.60
|
| Rate for Payer: WEA Trust Commercial |
$943.80
|
| Rate for Payer: WPS Commercial |
$1,270.99
|
|
|
PLATE 3H 5H RT ANGLE T 241.151
|
Facility
|
IP
|
$1,520.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966709
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$774.59 |
| Max. Negotiated Rate |
$1,454.34 |
| Rate for Payer: Aetna Commercial |
$1,422.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,359.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$837.82
|
| Rate for Payer: Cash Price |
$456.00
|
| Rate for Payer: Cigna Commercial |
$1,454.34
|
| Rate for Payer: Health EOS Commercial |
$1,406.91
|
| Rate for Payer: HFN Commercial |
$1,454.34
|
| Rate for Payer: Multiplan Commercial |
$1,264.64
|
| Rate for Payer: Preferred Network Access Commercial |
$1,454.34
|
| Rate for Payer: Quartz Beloit One Network |
$774.59
|
| Rate for Payer: Quartz Commercial |
$948.48
|
| Rate for Payer: WEA Trust Commercial |
$869.44
|
| Rate for Payer: WPS Commercial |
$1,170.86
|
|
|
PLATE 3H 5H RT ANGLE T 241.151
|
Facility
|
OP
|
$1,520.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966709
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$442.62 |
| Max. Negotiated Rate |
$1,454.34 |
| Rate for Payer: Aetna Commercial |
$1,422.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,359.49
|
| Rate for Payer: Aetna Managed Medicare |
$442.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,027.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$790.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$758.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$837.82
|
| Rate for Payer: Cash Price |
$456.00
|
| Rate for Payer: Cigna Commercial |
$1,454.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$884.64
|
| Rate for Payer: Health EOS Commercial |
$1,406.91
|
| Rate for Payer: HFN Commercial |
$1,454.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,185.60
|
| Rate for Payer: Multiplan Commercial |
$1,264.64
|
| Rate for Payer: NAPHCARE Commercial |
$948.48
|
| Rate for Payer: Preferred Network Access Commercial |
$1,454.34
|
| Rate for Payer: Quartz Beloit One Network |
$774.59
|
| Rate for Payer: Quartz Commercial |
$1,027.52
|
| Rate for Payer: Quartz Medicare Advantage |
$948.48
|
| Rate for Payer: The Alliance Commercial |
$790.40
|
| Rate for Payer: WEA Trust Commercial |
$869.44
|
| Rate for Payer: WPS Commercial |
$1,170.86
|
|
|
PLATE 3H 7H OBLIQ RT T 241.071
|
Facility
|
OP
|
$1,867.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966711
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$543.67 |
| Max. Negotiated Rate |
$1,786.35 |
| Rate for Payer: Aetna Commercial |
$1,747.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,669.84
|
| Rate for Payer: Aetna Managed Medicare |
$543.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,262.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$970.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$932.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,029.09
|
| Rate for Payer: Cash Price |
$560.10
|
| Rate for Payer: Cigna Commercial |
$1,786.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,086.59
|
| Rate for Payer: Health EOS Commercial |
$1,728.10
|
| Rate for Payer: HFN Commercial |
$1,786.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,456.26
|
| Rate for Payer: Multiplan Commercial |
$1,553.34
|
| Rate for Payer: NAPHCARE Commercial |
$1,165.01
|
| Rate for Payer: Preferred Network Access Commercial |
$1,786.35
|
| Rate for Payer: Quartz Beloit One Network |
$951.42
|
| Rate for Payer: Quartz Commercial |
$1,262.09
|
| Rate for Payer: Quartz Medicare Advantage |
$1,165.01
|
| Rate for Payer: The Alliance Commercial |
$970.84
|
| Rate for Payer: WEA Trust Commercial |
$1,067.92
|
| Rate for Payer: WPS Commercial |
$1,438.15
|
|
|
PLATE 3H 7H OBLIQ RT T 241.071
|
Facility
|
IP
|
$1,867.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966711
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$951.42 |
| Max. Negotiated Rate |
$1,786.35 |
| Rate for Payer: Aetna Commercial |
$1,747.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,669.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,029.09
|
| Rate for Payer: Cash Price |
$560.10
|
| Rate for Payer: Cigna Commercial |
$1,786.35
|
| Rate for Payer: Health EOS Commercial |
$1,728.10
|
| Rate for Payer: HFN Commercial |
$1,786.35
|
| Rate for Payer: Multiplan Commercial |
$1,553.34
|
| Rate for Payer: Preferred Network Access Commercial |
$1,786.35
|
| Rate for Payer: Quartz Beloit One Network |
$951.42
|
| Rate for Payer: Quartz Commercial |
$1,165.01
|
| Rate for Payer: WEA Trust Commercial |
$1,067.92
|
| Rate for Payer: WPS Commercial |
$1,438.15
|
|
|
PLATE 3H 7H RT ANGLE T 241.171
|
Facility
|
IP
|
$2,225.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966712
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,133.86 |
| Max. Negotiated Rate |
$2,128.88 |
| Rate for Payer: Aetna Commercial |
$2,082.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,990.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,226.42
|
| Rate for Payer: Cash Price |
$667.50
|
| Rate for Payer: Cigna Commercial |
$2,128.88
|
| Rate for Payer: Health EOS Commercial |
$2,059.46
|
| Rate for Payer: HFN Commercial |
$2,128.88
|
| Rate for Payer: Multiplan Commercial |
$1,851.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,128.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,133.86
|
| Rate for Payer: Quartz Commercial |
$1,388.40
|
| Rate for Payer: WEA Trust Commercial |
$1,272.70
|
| Rate for Payer: WPS Commercial |
$1,713.92
|
|
|
PLATE 3H 7H RT ANGLE T 241.171
|
Facility
|
OP
|
$2,225.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966712
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.92 |
| Max. Negotiated Rate |
$2,128.88 |
| Rate for Payer: Aetna Commercial |
$2,082.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,990.04
|
| Rate for Payer: Aetna Managed Medicare |
$647.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,504.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,157.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,110.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,226.42
|
| Rate for Payer: Cash Price |
$667.50
|
| Rate for Payer: Cigna Commercial |
$2,128.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,294.95
|
| Rate for Payer: Health EOS Commercial |
$2,059.46
|
| Rate for Payer: HFN Commercial |
$2,128.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,735.50
|
| Rate for Payer: Multiplan Commercial |
$1,851.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,388.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,128.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,133.86
|
| Rate for Payer: Quartz Commercial |
$1,504.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,388.40
|
| Rate for Payer: The Alliance Commercial |
$1,157.00
|
| Rate for Payer: WEA Trust Commercial |
$1,272.70
|
| Rate for Payer: WPS Commercial |
$1,713.92
|
|
|
PLATE 3HH/3HS L +20 442.508
|
Facility
|
IP
|
$4,275.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,178.54 |
| Max. Negotiated Rate |
$4,090.32 |
| Rate for Payer: Aetna Commercial |
$4,001.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,823.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,356.38
|
| Rate for Payer: Cash Price |
$1,282.50
|
| Rate for Payer: Cigna Commercial |
$4,090.32
|
| Rate for Payer: Health EOS Commercial |
$3,956.94
|
| Rate for Payer: HFN Commercial |
$4,090.32
|
| Rate for Payer: Multiplan Commercial |
$3,556.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,090.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,178.54
|
| Rate for Payer: Quartz Commercial |
$2,667.60
|
| Rate for Payer: WEA Trust Commercial |
$2,445.30
|
| Rate for Payer: WPS Commercial |
$3,293.03
|
|
|
PLATE 3HH/3HS L +20 442.508
|
Facility
|
OP
|
$4,275.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,244.88 |
| Max. Negotiated Rate |
$4,090.32 |
| Rate for Payer: Aetna Commercial |
$4,001.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,823.56
|
| Rate for Payer: Aetna Managed Medicare |
$1,244.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,889.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,223.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,134.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,356.38
|
| Rate for Payer: Cash Price |
$1,282.50
|
| Rate for Payer: Cigna Commercial |
$4,090.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,488.05
|
| Rate for Payer: Health EOS Commercial |
$3,956.94
|
| Rate for Payer: HFN Commercial |
$4,090.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,334.50
|
| Rate for Payer: Multiplan Commercial |
$3,556.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,667.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,090.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,178.54
|
| Rate for Payer: Quartz Commercial |
$2,889.90
|
| Rate for Payer: Quartz Medicare Advantage |
$2,667.60
|
| Rate for Payer: The Alliance Commercial |
$2,223.00
|
| Rate for Payer: WEA Trust Commercial |
$2,445.30
|
| Rate for Payer: WPS Commercial |
$3,293.03
|
|
|
PLATE 3HH/3HS L -20 442.511
|
Facility
|
OP
|
$4,275.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2990951
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,244.88 |
| Max. Negotiated Rate |
$4,090.32 |
| Rate for Payer: Aetna Commercial |
$4,001.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,823.56
|
| Rate for Payer: Aetna Managed Medicare |
$1,244.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,889.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,223.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,134.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,356.38
|
| Rate for Payer: Cash Price |
$1,282.50
|
| Rate for Payer: Cigna Commercial |
$4,090.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,488.05
|
| Rate for Payer: Health EOS Commercial |
$3,956.94
|
| Rate for Payer: HFN Commercial |
$4,090.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,334.50
|
| Rate for Payer: Multiplan Commercial |
$3,556.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,667.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,090.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,178.54
|
| Rate for Payer: Quartz Commercial |
$2,889.90
|
| Rate for Payer: Quartz Medicare Advantage |
$2,667.60
|
| Rate for Payer: The Alliance Commercial |
$2,223.00
|
| Rate for Payer: WEA Trust Commercial |
$2,445.30
|
| Rate for Payer: WPS Commercial |
$3,293.03
|
|
