|
PLATE ACU-LOC 2 VDR PROX STD LONG RT 70-0373
|
Facility
|
IP
|
$11,051.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6181295
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,631.59 |
| Max. Negotiated Rate |
$10,573.60 |
| Rate for Payer: Aetna Commercial |
$10,343.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,884.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,091.31
|
| Rate for Payer: Cash Price |
$3,315.30
|
| Rate for Payer: Cigna Commercial |
$10,573.60
|
| Rate for Payer: Health EOS Commercial |
$10,228.81
|
| Rate for Payer: HFN Commercial |
$10,573.60
|
| Rate for Payer: Multiplan Commercial |
$9,194.43
|
| Rate for Payer: Preferred Network Access Commercial |
$10,573.60
|
| Rate for Payer: Quartz Beloit One Network |
$5,631.59
|
| Rate for Payer: Quartz Commercial |
$6,895.82
|
| Rate for Payer: WEA Trust Commercial |
$6,321.17
|
| Rate for Payer: WPS Commercial |
$8,512.59
|
|
|
PLATE ACU-LOC 2 VDR STD RT 70-0357
|
Facility
|
IP
|
$8,852.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5248649
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,510.98 |
| Max. Negotiated Rate |
$8,469.59 |
| Rate for Payer: Aetna Commercial |
$8,285.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,917.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,879.22
|
| Rate for Payer: Cash Price |
$2,655.60
|
| Rate for Payer: Cigna Commercial |
$8,469.59
|
| Rate for Payer: Health EOS Commercial |
$8,193.41
|
| Rate for Payer: HFN Commercial |
$8,469.59
|
| Rate for Payer: Multiplan Commercial |
$7,364.86
|
| Rate for Payer: Preferred Network Access Commercial |
$8,469.59
|
| Rate for Payer: Quartz Beloit One Network |
$4,510.98
|
| Rate for Payer: Quartz Commercial |
$5,523.65
|
| Rate for Payer: WEA Trust Commercial |
$5,063.34
|
| Rate for Payer: WPS Commercial |
$6,818.70
|
|
|
PLATE ACU-LOC 2 VDR STD RT 70-0357
|
Facility
|
OP
|
$8,852.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5248649
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,577.70 |
| Max. Negotiated Rate |
$8,469.59 |
| Rate for Payer: Aetna Commercial |
$8,285.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,917.23
|
| Rate for Payer: Aetna Managed Medicare |
$2,577.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,983.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,603.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,418.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,879.22
|
| Rate for Payer: Cash Price |
$2,655.60
|
| Rate for Payer: Cigna Commercial |
$8,469.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,151.86
|
| Rate for Payer: Health EOS Commercial |
$8,193.41
|
| Rate for Payer: HFN Commercial |
$8,469.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,904.56
|
| Rate for Payer: Multiplan Commercial |
$7,364.86
|
| Rate for Payer: NAPHCARE Commercial |
$5,523.65
|
| Rate for Payer: Preferred Network Access Commercial |
$8,469.59
|
| Rate for Payer: Quartz Beloit One Network |
$4,510.98
|
| Rate for Payer: Quartz Commercial |
$5,983.95
|
| Rate for Payer: Quartz Medicare Advantage |
$5,523.65
|
| Rate for Payer: The Alliance Commercial |
$4,603.04
|
| Rate for Payer: WEA Trust Commercial |
$5,063.34
|
| Rate for Payer: WPS Commercial |
$6,818.70
|
|
|
PLATE ACU-LOC 2 VDR WIDE RT 70-0361
|
Facility
|
OP
|
$8,524.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4998623
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,482.19 |
| Max. Negotiated Rate |
$8,155.76 |
| Rate for Payer: Aetna Commercial |
$7,978.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,623.87
|
| Rate for Payer: Aetna Managed Medicare |
$2,482.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,762.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,432.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,255.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,698.43
|
| Rate for Payer: Cash Price |
$2,557.20
|
| Rate for Payer: Cigna Commercial |
$8,155.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,960.97
|
| Rate for Payer: Health EOS Commercial |
$7,889.81
|
| Rate for Payer: HFN Commercial |
$8,155.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,648.72
|
| Rate for Payer: Multiplan Commercial |
$7,091.97
|
| Rate for Payer: NAPHCARE Commercial |
$5,318.98
|
| Rate for Payer: Preferred Network Access Commercial |
$8,155.76
|
| Rate for Payer: Quartz Beloit One Network |
$4,343.83
|
| Rate for Payer: Quartz Commercial |
$5,762.22
|
| Rate for Payer: Quartz Medicare Advantage |
$5,318.98
|
| Rate for Payer: The Alliance Commercial |
$4,432.48
|
| Rate for Payer: WEA Trust Commercial |
$4,875.73
|
| Rate for Payer: WPS Commercial |
$6,566.04
|
|
|
PLATE ACU-LOC 2 VDR WIDE RT 70-0361
|
Facility
|
IP
|
$8,524.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4998623
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,343.83 |
| Max. Negotiated Rate |
$8,155.76 |
| Rate for Payer: Aetna Commercial |
$7,978.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,623.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,698.43
|
| Rate for Payer: Cash Price |
$2,557.20
|
| Rate for Payer: Cigna Commercial |
$8,155.76
|
| Rate for Payer: Health EOS Commercial |
$7,889.81
|
| Rate for Payer: HFN Commercial |
$8,155.76
|
| Rate for Payer: Multiplan Commercial |
$7,091.97
|
| Rate for Payer: Preferred Network Access Commercial |
$8,155.76
|
| Rate for Payer: Quartz Beloit One Network |
$4,343.83
|
| Rate for Payer: Quartz Commercial |
$5,318.98
|
| Rate for Payer: WEA Trust Commercial |
$4,875.73
|
| Rate for Payer: WPS Commercial |
$6,566.04
|
|
|
PLATE ACU-LOC VDR STD. RIGHT
|
Facility
|
OP
|
$7,093.00
|
|
| Hospital Charge Code |
2964146
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,065.48 |
| Max. Negotiated Rate |
$6,786.58 |
| Rate for Payer: Aetna Commercial |
$6,639.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,343.98
|
| Rate for Payer: Aetna Managed Medicare |
$2,065.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,794.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,688.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,540.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,909.66
|
| Rate for Payer: Cash Price |
$2,127.90
|
| Rate for Payer: Cigna Commercial |
$6,786.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,128.13
|
| Rate for Payer: Health EOS Commercial |
$6,565.28
|
| Rate for Payer: HFN Commercial |
$6,786.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,532.54
|
| Rate for Payer: Multiplan Commercial |
$5,901.38
|
| Rate for Payer: NAPHCARE Commercial |
$4,426.03
|
| Rate for Payer: Preferred Network Access Commercial |
$6,786.58
|
| Rate for Payer: Quartz Beloit One Network |
$3,614.59
|
| Rate for Payer: Quartz Commercial |
$4,794.87
|
| Rate for Payer: Quartz Medicare Advantage |
$4,426.03
|
| Rate for Payer: The Alliance Commercial |
$3,688.36
|
| Rate for Payer: WEA Trust Commercial |
$4,057.20
|
| Rate for Payer: WPS Commercial |
$5,463.74
|
|
|
PLATE ACU-LOC VDR STD. RIGHT
|
Facility
|
IP
|
$7,093.00
|
|
| Hospital Charge Code |
2964146
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,614.59 |
| Max. Negotiated Rate |
$6,786.58 |
| Rate for Payer: Aetna Commercial |
$6,639.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,343.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,909.66
|
| Rate for Payer: Cash Price |
$2,127.90
|
| Rate for Payer: Cigna Commercial |
$6,786.58
|
| Rate for Payer: Health EOS Commercial |
$6,565.28
|
| Rate for Payer: HFN Commercial |
$6,786.58
|
| Rate for Payer: Multiplan Commercial |
$5,901.38
|
| Rate for Payer: Preferred Network Access Commercial |
$6,786.58
|
| Rate for Payer: Quartz Beloit One Network |
$3,614.59
|
| Rate for Payer: Quartz Commercial |
$4,426.03
|
| Rate for Payer: WEA Trust Commercial |
$4,057.20
|
| Rate for Payer: WPS Commercial |
$5,463.74
|
|
|
PLATE ACUTIE STERNUM WIRE STW-1104
|
Facility
|
IP
|
$4,593.00
|
|
| Hospital Charge Code |
2964166
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,340.59 |
| Max. Negotiated Rate |
$4,394.58 |
| Rate for Payer: Aetna Commercial |
$4,299.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,107.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,531.66
|
| Rate for Payer: Cash Price |
$1,377.90
|
| Rate for Payer: Cigna Commercial |
$4,394.58
|
| Rate for Payer: Health EOS Commercial |
$4,251.28
|
| Rate for Payer: HFN Commercial |
$4,394.58
|
| Rate for Payer: Multiplan Commercial |
$3,821.38
|
| Rate for Payer: Preferred Network Access Commercial |
$4,394.58
|
| Rate for Payer: Quartz Beloit One Network |
$2,340.59
|
| Rate for Payer: Quartz Commercial |
$2,866.03
|
| Rate for Payer: WEA Trust Commercial |
$2,627.20
|
| Rate for Payer: WPS Commercial |
$3,537.99
|
|
|
PLATE ACUTIE STERNUM WIRE STW-1104
|
Facility
|
OP
|
$4,593.00
|
|
| Hospital Charge Code |
2964166
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,337.48 |
| Max. Negotiated Rate |
$4,394.58 |
| Rate for Payer: Aetna Commercial |
$4,299.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,107.98
|
| Rate for Payer: Aetna Managed Medicare |
$1,337.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,104.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,388.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,292.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,531.66
|
| Rate for Payer: Cash Price |
$1,377.90
|
| Rate for Payer: Cigna Commercial |
$4,394.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,673.13
|
| Rate for Payer: Health EOS Commercial |
$4,251.28
|
| Rate for Payer: HFN Commercial |
$4,394.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,582.54
|
| Rate for Payer: Multiplan Commercial |
$3,821.38
|
| Rate for Payer: NAPHCARE Commercial |
$2,866.03
|
| Rate for Payer: Preferred Network Access Commercial |
$4,394.58
|
| Rate for Payer: Quartz Beloit One Network |
$2,340.59
|
| Rate for Payer: Quartz Commercial |
$3,104.87
|
| Rate for Payer: Quartz Medicare Advantage |
$2,866.03
|
| Rate for Payer: The Alliance Commercial |
$2,388.36
|
| Rate for Payer: WEA Trust Commercial |
$2,627.20
|
| Rate for Payer: WPS Commercial |
$3,537.99
|
|
|
PLATE AMBI 120DEG 4HL 91-5968
|
Facility
|
IP
|
$5,753.00
|
|
| Hospital Charge Code |
2966015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,931.73 |
| Max. Negotiated Rate |
$5,504.47 |
| Rate for Payer: Aetna Commercial |
$5,384.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,145.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,171.05
|
| Rate for Payer: Cash Price |
$1,725.90
|
| Rate for Payer: Cigna Commercial |
$5,504.47
|
| Rate for Payer: Health EOS Commercial |
$5,324.98
|
| Rate for Payer: HFN Commercial |
$5,504.47
|
| Rate for Payer: Multiplan Commercial |
$4,786.50
|
| Rate for Payer: Preferred Network Access Commercial |
$5,504.47
|
| Rate for Payer: Quartz Beloit One Network |
$2,931.73
|
| Rate for Payer: Quartz Commercial |
$3,589.87
|
| Rate for Payer: WEA Trust Commercial |
$3,290.72
|
| Rate for Payer: WPS Commercial |
$4,431.54
|
|
|
PLATE AMBI 120DEG 4HL 91-5968
|
Facility
|
OP
|
$5,753.00
|
|
| Hospital Charge Code |
2966015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,675.27 |
| Max. Negotiated Rate |
$5,504.47 |
| Rate for Payer: Aetna Commercial |
$5,384.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,145.48
|
| Rate for Payer: Aetna Managed Medicare |
$1,675.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,889.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,991.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,871.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,171.05
|
| Rate for Payer: Cash Price |
$1,725.90
|
| Rate for Payer: Cigna Commercial |
$5,504.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,348.25
|
| Rate for Payer: Health EOS Commercial |
$5,324.98
|
| Rate for Payer: HFN Commercial |
$5,504.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,487.34
|
| Rate for Payer: Multiplan Commercial |
$4,786.50
|
| Rate for Payer: NAPHCARE Commercial |
$3,589.87
|
| Rate for Payer: Preferred Network Access Commercial |
$5,504.47
|
| Rate for Payer: Quartz Beloit One Network |
$2,931.73
|
| Rate for Payer: Quartz Commercial |
$3,889.03
|
| Rate for Payer: Quartz Medicare Advantage |
$3,589.87
|
| Rate for Payer: The Alliance Commercial |
$2,991.56
|
| Rate for Payer: WEA Trust Commercial |
$3,290.72
|
| Rate for Payer: WPS Commercial |
$4,431.54
|
|
|
PLATE AMBI 125DEG 4HL 91-4543
|
Facility
|
OP
|
$5,753.00
|
|
| Hospital Charge Code |
2966016
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,675.27 |
| Max. Negotiated Rate |
$5,504.47 |
| Rate for Payer: Aetna Commercial |
$5,384.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,145.48
|
| Rate for Payer: Aetna Managed Medicare |
$1,675.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,889.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,991.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,871.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,171.05
|
| Rate for Payer: Cash Price |
$1,725.90
|
| Rate for Payer: Cigna Commercial |
$5,504.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,348.25
|
| Rate for Payer: Health EOS Commercial |
$5,324.98
|
| Rate for Payer: HFN Commercial |
$5,504.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,487.34
|
| Rate for Payer: Multiplan Commercial |
$4,786.50
|
| Rate for Payer: NAPHCARE Commercial |
$3,589.87
|
| Rate for Payer: Preferred Network Access Commercial |
$5,504.47
|
| Rate for Payer: Quartz Beloit One Network |
$2,931.73
|
| Rate for Payer: Quartz Commercial |
$3,889.03
|
| Rate for Payer: Quartz Medicare Advantage |
$3,589.87
|
| Rate for Payer: The Alliance Commercial |
$2,991.56
|
| Rate for Payer: WEA Trust Commercial |
$3,290.72
|
| Rate for Payer: WPS Commercial |
$4,431.54
|
|
|
PLATE AMBI 125DEG 4HL 91-4543
|
Facility
|
IP
|
$5,753.00
|
|
| Hospital Charge Code |
2966016
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,931.73 |
| Max. Negotiated Rate |
$5,504.47 |
| Rate for Payer: Aetna Commercial |
$5,384.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,145.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,171.05
|
| Rate for Payer: Cash Price |
$1,725.90
|
| Rate for Payer: Cigna Commercial |
$5,504.47
|
| Rate for Payer: Health EOS Commercial |
$5,324.98
|
| Rate for Payer: HFN Commercial |
$5,504.47
|
| Rate for Payer: Multiplan Commercial |
$4,786.50
|
| Rate for Payer: Preferred Network Access Commercial |
$5,504.47
|
| Rate for Payer: Quartz Beloit One Network |
$2,931.73
|
| Rate for Payer: Quartz Commercial |
$3,589.87
|
| Rate for Payer: WEA Trust Commercial |
$3,290.72
|
| Rate for Payer: WPS Commercial |
$4,431.54
|
|
|
PLATE AMBI 130DEG 3HL 124125
|
Facility
|
OP
|
$3,707.00
|
|
| Hospital Charge Code |
2966017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,079.48 |
| Max. Negotiated Rate |
$3,546.86 |
| Rate for Payer: Aetna Commercial |
$3,469.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,315.54
|
| Rate for Payer: Aetna Managed Medicare |
$1,079.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,505.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,927.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,850.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,043.30
|
| Rate for Payer: Cash Price |
$1,112.10
|
| Rate for Payer: Cigna Commercial |
$3,546.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,157.47
|
| Rate for Payer: Health EOS Commercial |
$3,431.20
|
| Rate for Payer: HFN Commercial |
$3,546.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,891.46
|
| Rate for Payer: Multiplan Commercial |
$3,084.22
|
| Rate for Payer: NAPHCARE Commercial |
$2,313.17
|
| Rate for Payer: Preferred Network Access Commercial |
$3,546.86
|
| Rate for Payer: Quartz Beloit One Network |
$1,889.09
|
| Rate for Payer: Quartz Commercial |
$2,505.93
|
| Rate for Payer: Quartz Medicare Advantage |
$2,313.17
|
| Rate for Payer: The Alliance Commercial |
$1,927.64
|
| Rate for Payer: WEA Trust Commercial |
$2,120.40
|
| Rate for Payer: WPS Commercial |
$2,855.50
|
|
|
PLATE AMBI 130DEG 3HL 124125
|
Facility
|
IP
|
$3,707.00
|
|
| Hospital Charge Code |
2966017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,889.09 |
| Max. Negotiated Rate |
$3,546.86 |
| Rate for Payer: Aetna Commercial |
$3,469.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,315.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,043.30
|
| Rate for Payer: Cash Price |
$1,112.10
|
| Rate for Payer: Cigna Commercial |
$3,546.86
|
| Rate for Payer: Health EOS Commercial |
$3,431.20
|
| Rate for Payer: HFN Commercial |
$3,546.86
|
| Rate for Payer: Multiplan Commercial |
$3,084.22
|
| Rate for Payer: Preferred Network Access Commercial |
$3,546.86
|
| Rate for Payer: Quartz Beloit One Network |
$1,889.09
|
| Rate for Payer: Quartz Commercial |
$2,313.17
|
| Rate for Payer: WEA Trust Commercial |
$2,120.40
|
| Rate for Payer: WPS Commercial |
$2,855.50
|
|
|
PLATE AMBI 130DEG 4HL 124130
|
Facility
|
OP
|
$3,707.00
|
|
| Hospital Charge Code |
2966018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,079.48 |
| Max. Negotiated Rate |
$3,546.86 |
| Rate for Payer: Aetna Commercial |
$3,469.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,315.54
|
| Rate for Payer: Aetna Managed Medicare |
$1,079.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,505.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,927.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,850.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,043.30
|
| Rate for Payer: Cash Price |
$1,112.10
|
| Rate for Payer: Cigna Commercial |
$3,546.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,157.47
|
| Rate for Payer: Health EOS Commercial |
$3,431.20
|
| Rate for Payer: HFN Commercial |
$3,546.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,891.46
|
| Rate for Payer: Multiplan Commercial |
$3,084.22
|
| Rate for Payer: NAPHCARE Commercial |
$2,313.17
|
| Rate for Payer: Preferred Network Access Commercial |
$3,546.86
|
| Rate for Payer: Quartz Beloit One Network |
$1,889.09
|
| Rate for Payer: Quartz Commercial |
$2,505.93
|
| Rate for Payer: Quartz Medicare Advantage |
$2,313.17
|
| Rate for Payer: The Alliance Commercial |
$1,927.64
|
| Rate for Payer: WEA Trust Commercial |
$2,120.40
|
| Rate for Payer: WPS Commercial |
$2,855.50
|
|
|
PLATE AMBI 130DEG 4HL 124130
|
Facility
|
IP
|
$3,707.00
|
|
| Hospital Charge Code |
2966018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,889.09 |
| Max. Negotiated Rate |
$3,546.86 |
| Rate for Payer: Aetna Commercial |
$3,469.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,315.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,043.30
|
| Rate for Payer: Cash Price |
$1,112.10
|
| Rate for Payer: Cigna Commercial |
$3,546.86
|
| Rate for Payer: Health EOS Commercial |
$3,431.20
|
| Rate for Payer: HFN Commercial |
$3,546.86
|
| Rate for Payer: Multiplan Commercial |
$3,084.22
|
| Rate for Payer: Preferred Network Access Commercial |
$3,546.86
|
| Rate for Payer: Quartz Beloit One Network |
$1,889.09
|
| Rate for Payer: Quartz Commercial |
$2,313.17
|
| Rate for Payer: WEA Trust Commercial |
$2,120.40
|
| Rate for Payer: WPS Commercial |
$2,855.50
|
|
|
PLATE AMBI 130DEG 5HL 124135
|
Facility
|
IP
|
$4,064.00
|
|
| Hospital Charge Code |
2966019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,071.01 |
| Max. Negotiated Rate |
$3,888.44 |
| Rate for Payer: Aetna Commercial |
$3,803.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,634.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,240.08
|
| Rate for Payer: Cash Price |
$1,219.20
|
| Rate for Payer: Cigna Commercial |
$3,888.44
|
| Rate for Payer: Health EOS Commercial |
$3,761.64
|
| Rate for Payer: HFN Commercial |
$3,888.44
|
| Rate for Payer: Multiplan Commercial |
$3,381.25
|
| Rate for Payer: Preferred Network Access Commercial |
$3,888.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,071.01
|
| Rate for Payer: Quartz Commercial |
$2,535.94
|
| Rate for Payer: WEA Trust Commercial |
$2,324.61
|
| Rate for Payer: WPS Commercial |
$3,130.50
|
|
|
PLATE AMBI 130DEG 5HL 124135
|
Facility
|
OP
|
$4,064.00
|
|
| Hospital Charge Code |
2966019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,183.44 |
| Max. Negotiated Rate |
$3,888.44 |
| Rate for Payer: Aetna Commercial |
$3,803.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,634.84
|
| Rate for Payer: Aetna Managed Medicare |
$1,183.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,747.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,113.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,028.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,240.08
|
| Rate for Payer: Cash Price |
$1,219.20
|
| Rate for Payer: Cigna Commercial |
$3,888.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,365.25
|
| Rate for Payer: Health EOS Commercial |
$3,761.64
|
| Rate for Payer: HFN Commercial |
$3,888.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,169.92
|
| Rate for Payer: Multiplan Commercial |
$3,381.25
|
| Rate for Payer: NAPHCARE Commercial |
$2,535.94
|
| Rate for Payer: Preferred Network Access Commercial |
$3,888.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,071.01
|
| Rate for Payer: Quartz Commercial |
$2,747.26
|
| Rate for Payer: Quartz Medicare Advantage |
$2,535.94
|
| Rate for Payer: The Alliance Commercial |
$2,113.28
|
| Rate for Payer: WEA Trust Commercial |
$2,324.61
|
| Rate for Payer: WPS Commercial |
$3,130.50
|
|
|
PLATE AMBI 130DEG 6HL 124140
|
Facility
|
OP
|
$4,064.00
|
|
| Hospital Charge Code |
2966020
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,183.44 |
| Max. Negotiated Rate |
$3,888.44 |
| Rate for Payer: Aetna Commercial |
$3,803.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,634.84
|
| Rate for Payer: Aetna Managed Medicare |
$1,183.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,747.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,113.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,028.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,240.08
|
| Rate for Payer: Cash Price |
$1,219.20
|
| Rate for Payer: Cigna Commercial |
$3,888.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,365.25
|
| Rate for Payer: Health EOS Commercial |
$3,761.64
|
| Rate for Payer: HFN Commercial |
$3,888.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,169.92
|
| Rate for Payer: Multiplan Commercial |
$3,381.25
|
| Rate for Payer: NAPHCARE Commercial |
$2,535.94
|
| Rate for Payer: Preferred Network Access Commercial |
$3,888.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,071.01
|
| Rate for Payer: Quartz Commercial |
$2,747.26
|
| Rate for Payer: Quartz Medicare Advantage |
$2,535.94
|
| Rate for Payer: The Alliance Commercial |
$2,113.28
|
| Rate for Payer: WEA Trust Commercial |
$2,324.61
|
| Rate for Payer: WPS Commercial |
$3,130.50
|
|
|
PLATE AMBI 130DEG 6HL 124140
|
Facility
|
IP
|
$4,064.00
|
|
| Hospital Charge Code |
2966020
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,071.01 |
| Max. Negotiated Rate |
$3,888.44 |
| Rate for Payer: Aetna Commercial |
$3,803.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,634.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,240.08
|
| Rate for Payer: Cash Price |
$1,219.20
|
| Rate for Payer: Cigna Commercial |
$3,888.44
|
| Rate for Payer: Health EOS Commercial |
$3,761.64
|
| Rate for Payer: HFN Commercial |
$3,888.44
|
| Rate for Payer: Multiplan Commercial |
$3,381.25
|
| Rate for Payer: Preferred Network Access Commercial |
$3,888.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,071.01
|
| Rate for Payer: Quartz Commercial |
$2,535.94
|
| Rate for Payer: WEA Trust Commercial |
$2,324.61
|
| Rate for Payer: WPS Commercial |
$3,130.50
|
|
|
PLATE AMBI 130DEG 8HL 124145
|
Facility
|
IP
|
$3,747.00
|
|
| Hospital Charge Code |
2966030
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,909.47 |
| Max. Negotiated Rate |
$3,585.13 |
| Rate for Payer: Aetna Commercial |
$3,507.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,351.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,065.35
|
| Rate for Payer: Cash Price |
$1,124.10
|
| Rate for Payer: Cigna Commercial |
$3,585.13
|
| Rate for Payer: Health EOS Commercial |
$3,468.22
|
| Rate for Payer: HFN Commercial |
$3,585.13
|
| Rate for Payer: Multiplan Commercial |
$3,117.50
|
| Rate for Payer: Preferred Network Access Commercial |
$3,585.13
|
| Rate for Payer: Quartz Beloit One Network |
$1,909.47
|
| Rate for Payer: Quartz Commercial |
$2,338.13
|
| Rate for Payer: WEA Trust Commercial |
$2,143.28
|
| Rate for Payer: WPS Commercial |
$2,886.31
|
|
|
PLATE AMBI 130DEG 8HL 124145
|
Facility
|
OP
|
$3,747.00
|
|
| Hospital Charge Code |
2966030
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,091.13 |
| Max. Negotiated Rate |
$3,585.13 |
| Rate for Payer: Aetna Commercial |
$3,507.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,351.32
|
| Rate for Payer: Aetna Managed Medicare |
$1,091.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,532.97
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,948.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,870.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,065.35
|
| Rate for Payer: Cash Price |
$1,124.10
|
| Rate for Payer: Cigna Commercial |
$3,585.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,180.75
|
| Rate for Payer: Health EOS Commercial |
$3,468.22
|
| Rate for Payer: HFN Commercial |
$3,585.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,922.66
|
| Rate for Payer: Multiplan Commercial |
$3,117.50
|
| Rate for Payer: NAPHCARE Commercial |
$2,338.13
|
| Rate for Payer: Preferred Network Access Commercial |
$3,585.13
|
| Rate for Payer: Quartz Beloit One Network |
$1,909.47
|
| Rate for Payer: Quartz Commercial |
$2,532.97
|
| Rate for Payer: Quartz Medicare Advantage |
$2,338.13
|
| Rate for Payer: The Alliance Commercial |
$1,948.44
|
| Rate for Payer: WEA Trust Commercial |
$2,143.28
|
| Rate for Payer: WPS Commercial |
$2,886.31
|
|
|
PLATE AMBI 135DEG 10HL 124151
|
Facility
|
IP
|
$5,753.00
|
|
| Hospital Charge Code |
2966031
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,931.73 |
| Max. Negotiated Rate |
$5,504.47 |
| Rate for Payer: Aetna Commercial |
$5,384.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,145.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,171.05
|
| Rate for Payer: Cash Price |
$1,725.90
|
| Rate for Payer: Cigna Commercial |
$5,504.47
|
| Rate for Payer: Health EOS Commercial |
$5,324.98
|
| Rate for Payer: HFN Commercial |
$5,504.47
|
| Rate for Payer: Multiplan Commercial |
$4,786.50
|
| Rate for Payer: Preferred Network Access Commercial |
$5,504.47
|
| Rate for Payer: Quartz Beloit One Network |
$2,931.73
|
| Rate for Payer: Quartz Commercial |
$3,589.87
|
| Rate for Payer: WEA Trust Commercial |
$3,290.72
|
| Rate for Payer: WPS Commercial |
$4,431.54
|
|
|
PLATE AMBI 135DEG 10HL 124151
|
Facility
|
OP
|
$5,753.00
|
|
| Hospital Charge Code |
2966031
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,675.27 |
| Max. Negotiated Rate |
$5,504.47 |
| Rate for Payer: Aetna Commercial |
$5,384.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,145.48
|
| Rate for Payer: Aetna Managed Medicare |
$1,675.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,889.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,991.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,871.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,171.05
|
| Rate for Payer: Cash Price |
$1,725.90
|
| Rate for Payer: Cigna Commercial |
$5,504.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,348.25
|
| Rate for Payer: Health EOS Commercial |
$5,324.98
|
| Rate for Payer: HFN Commercial |
$5,504.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,487.34
|
| Rate for Payer: Multiplan Commercial |
$4,786.50
|
| Rate for Payer: NAPHCARE Commercial |
$3,589.87
|
| Rate for Payer: Preferred Network Access Commercial |
$5,504.47
|
| Rate for Payer: Quartz Beloit One Network |
$2,931.73
|
| Rate for Payer: Quartz Commercial |
$3,889.03
|
| Rate for Payer: Quartz Medicare Advantage |
$3,589.87
|
| Rate for Payer: The Alliance Commercial |
$2,991.56
|
| Rate for Payer: WEA Trust Commercial |
$3,290.72
|
| Rate for Payer: WPS Commercial |
$4,431.54
|
|
