|
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 |
$211.96 |
| Max. Negotiated Rate |
$3,028.00 |
| Rate for Payer: Aetna Commercial |
$681.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$651.02
|
| Rate for Payer: Aetna Managed Medicare |
$211.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$492.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$378.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$363.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$401.21
|
| Rate for Payer: Cash Price |
$227.10
|
| Rate for Payer: Cigna Commercial |
$696.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$423.62
|
| Rate for Payer: Health EOS Commercial |
$673.73
|
| Rate for Payer: HFN Commercial |
$696.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$567.75
|
| Rate for Payer: Multiplan Commercial |
$605.60
|
| Rate for Payer: NAPHCARE Commercial |
$454.20
|
| Rate for Payer: Preferred Network Access Commercial |
$696.44
|
| Rate for Payer: Quartz Beloit One Network |
$370.93
|
| Rate for Payer: Quartz Commercial |
$492.05
|
| Rate for Payer: Quartz Medicare Advantage |
$454.20
|
| Rate for Payer: The Alliance Commercial |
$3,028.00
|
| Rate for Payer: WEA Trust Commercial |
$416.35
|
| Rate for Payer: WPS Commercial |
$560.71
|
|
|
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 |
$370.93 |
| Max. Negotiated Rate |
$696.44 |
| Rate for Payer: Aetna Commercial |
$681.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$651.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$401.21
|
| Rate for Payer: Cash Price |
$227.10
|
| Rate for Payer: Cigna Commercial |
$696.44
|
| Rate for Payer: Health EOS Commercial |
$673.73
|
| Rate for Payer: HFN Commercial |
$696.44
|
| Rate for Payer: Multiplan Commercial |
$605.60
|
| Rate for Payer: NAPHCARE Commercial |
$454.20
|
| Rate for Payer: Preferred Network Access Commercial |
$696.44
|
| Rate for Payer: Quartz Beloit One Network |
$370.93
|
| Rate for Payer: Quartz Commercial |
$454.20
|
| Rate for Payer: WEA Trust Commercial |
$416.35
|
| Rate for Payer: WPS Commercial |
$560.71
|
|
|
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 |
$221.76 |
| Max. Negotiated Rate |
$3,168.00 |
| Rate for Payer: Aetna Commercial |
$712.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$681.12
|
| Rate for Payer: Aetna Managed Medicare |
$221.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$514.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$396.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$380.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$419.76
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cigna Commercial |
$728.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$443.20
|
| Rate for Payer: Health EOS Commercial |
$704.88
|
| Rate for Payer: HFN Commercial |
$728.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$594.00
|
| Rate for Payer: Multiplan Commercial |
$633.60
|
| Rate for Payer: NAPHCARE Commercial |
$475.20
|
| Rate for Payer: Preferred Network Access Commercial |
$728.64
|
| Rate for Payer: Quartz Beloit One Network |
$388.08
|
| Rate for Payer: Quartz Commercial |
$514.80
|
| Rate for Payer: Quartz Medicare Advantage |
$475.20
|
| Rate for Payer: The Alliance Commercial |
$3,168.00
|
| Rate for Payer: WEA Trust Commercial |
$435.60
|
| Rate for Payer: WPS Commercial |
$586.63
|
|
|
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 |
$388.08 |
| Max. Negotiated Rate |
$728.64 |
| Rate for Payer: Aetna Commercial |
$712.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$681.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$419.76
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cigna Commercial |
$728.64
|
| Rate for Payer: Health EOS Commercial |
$704.88
|
| Rate for Payer: HFN Commercial |
$728.64
|
| Rate for Payer: Multiplan Commercial |
$633.60
|
| Rate for Payer: NAPHCARE Commercial |
$475.20
|
| Rate for Payer: Preferred Network Access Commercial |
$728.64
|
| Rate for Payer: Quartz Beloit One Network |
$388.08
|
| Rate for Payer: Quartz Commercial |
$475.20
|
| Rate for Payer: WEA Trust Commercial |
$435.60
|
| Rate for Payer: WPS Commercial |
$586.63
|
|
|
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 |
$1,459.71 |
| Max. Negotiated Rate |
$2,740.68 |
| Rate for Payer: Aetna Commercial |
$2,681.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,561.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,578.87
|
| Rate for Payer: Cash Price |
$893.70
|
| Rate for Payer: Cigna Commercial |
$2,740.68
|
| Rate for Payer: Health EOS Commercial |
$2,651.31
|
| Rate for Payer: HFN Commercial |
$2,740.68
|
| Rate for Payer: Multiplan Commercial |
$2,383.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,787.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,740.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,459.71
|
| Rate for Payer: Quartz Commercial |
$1,787.40
|
| Rate for Payer: WEA Trust Commercial |
$1,638.45
|
| Rate for Payer: WPS Commercial |
$2,206.55
|
|
|
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 |
$834.12 |
| Max. Negotiated Rate |
$11,916.00 |
| Rate for Payer: Aetna Commercial |
$2,681.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,561.94
|
| Rate for Payer: Aetna Managed Medicare |
$834.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,936.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,489.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,429.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,578.87
|
| Rate for Payer: Cash Price |
$893.70
|
| Rate for Payer: Cigna Commercial |
$2,740.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,667.05
|
| Rate for Payer: Health EOS Commercial |
$2,651.31
|
| Rate for Payer: HFN Commercial |
$2,740.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,234.25
|
| Rate for Payer: Multiplan Commercial |
$2,383.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,787.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,740.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,459.71
|
| Rate for Payer: Quartz Commercial |
$1,936.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,787.40
|
| Rate for Payer: The Alliance Commercial |
$11,916.00
|
| Rate for Payer: WEA Trust Commercial |
$1,638.45
|
| Rate for Payer: WPS Commercial |
$2,206.55
|
|
|
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 |
$1,885.52 |
| Max. Negotiated Rate |
$3,540.16 |
| Rate for Payer: Aetna Commercial |
$3,463.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,309.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,039.44
|
| Rate for Payer: Cash Price |
$1,154.40
|
| Rate for Payer: Cigna Commercial |
$3,540.16
|
| Rate for Payer: Health EOS Commercial |
$3,424.72
|
| Rate for Payer: HFN Commercial |
$3,540.16
|
| Rate for Payer: Multiplan Commercial |
$3,078.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,308.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,540.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,885.52
|
| Rate for Payer: Quartz Commercial |
$2,308.80
|
| Rate for Payer: WEA Trust Commercial |
$2,116.40
|
| Rate for Payer: WPS Commercial |
$2,850.21
|
|
|
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 |
$1,077.44 |
| Max. Negotiated Rate |
$15,392.00 |
| Rate for Payer: Aetna Commercial |
$3,463.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,309.28
|
| Rate for Payer: Aetna Managed Medicare |
$1,077.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,501.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,924.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,847.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,039.44
|
| Rate for Payer: Cash Price |
$1,154.40
|
| Rate for Payer: Cigna Commercial |
$3,540.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,153.34
|
| Rate for Payer: Health EOS Commercial |
$3,424.72
|
| Rate for Payer: HFN Commercial |
$3,540.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,886.00
|
| Rate for Payer: Multiplan Commercial |
$3,078.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,308.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,540.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,885.52
|
| Rate for Payer: Quartz Commercial |
$2,501.20
|
| Rate for Payer: Quartz Medicare Advantage |
$2,308.80
|
| Rate for Payer: The Alliance Commercial |
$15,392.00
|
| Rate for Payer: WEA Trust Commercial |
$2,116.40
|
| Rate for Payer: WPS Commercial |
$2,850.21
|
|
|
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 |
$1,173.06 |
| Max. Negotiated Rate |
$2,202.48 |
| Rate for Payer: Aetna Commercial |
$2,154.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,058.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,268.82
|
| Rate for Payer: Cash Price |
$718.20
|
| Rate for Payer: Cigna Commercial |
$2,202.48
|
| Rate for Payer: Health EOS Commercial |
$2,130.66
|
| Rate for Payer: HFN Commercial |
$2,202.48
|
| Rate for Payer: Multiplan Commercial |
$1,915.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,436.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,202.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,173.06
|
| Rate for Payer: Quartz Commercial |
$1,436.40
|
| Rate for Payer: WEA Trust Commercial |
$1,316.70
|
| Rate for Payer: WPS Commercial |
$1,773.24
|
|
|
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 |
$670.32 |
| Max. Negotiated Rate |
$9,576.00 |
| Rate for Payer: Aetna Commercial |
$2,154.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,058.84
|
| Rate for Payer: Aetna Managed Medicare |
$670.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,556.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,197.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,149.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,268.82
|
| Rate for Payer: Cash Price |
$718.20
|
| Rate for Payer: Cigna Commercial |
$2,202.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,339.68
|
| Rate for Payer: Health EOS Commercial |
$2,130.66
|
| Rate for Payer: HFN Commercial |
$2,202.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,795.50
|
| Rate for Payer: Multiplan Commercial |
$1,915.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,436.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,202.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,173.06
|
| Rate for Payer: Quartz Commercial |
$1,556.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,436.40
|
| Rate for Payer: The Alliance Commercial |
$9,576.00
|
| Rate for Payer: WEA Trust Commercial |
$1,316.70
|
| Rate for Payer: WPS Commercial |
$1,773.24
|
|
|
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 |
$1,224.51 |
| Max. Negotiated Rate |
$2,299.08 |
| Rate for Payer: Aetna Commercial |
$2,249.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,149.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,324.47
|
| Rate for Payer: Cash Price |
$749.70
|
| Rate for Payer: Cigna Commercial |
$2,299.08
|
| Rate for Payer: Health EOS Commercial |
$2,224.11
|
| Rate for Payer: HFN Commercial |
$2,299.08
|
| Rate for Payer: Multiplan Commercial |
$1,999.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,499.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,299.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,224.51
|
| Rate for Payer: Quartz Commercial |
$1,499.40
|
| Rate for Payer: WEA Trust Commercial |
$1,374.45
|
| Rate for Payer: WPS Commercial |
$1,851.01
|
|
|
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 |
$699.72 |
| Max. Negotiated Rate |
$9,996.00 |
| Rate for Payer: Aetna Commercial |
$2,249.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,149.14
|
| Rate for Payer: Aetna Managed Medicare |
$699.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,624.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,249.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,199.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,324.47
|
| Rate for Payer: Cash Price |
$749.70
|
| Rate for Payer: Cigna Commercial |
$2,299.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,398.44
|
| Rate for Payer: Health EOS Commercial |
$2,224.11
|
| Rate for Payer: HFN Commercial |
$2,299.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,874.25
|
| Rate for Payer: Multiplan Commercial |
$1,999.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,499.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,299.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,224.51
|
| Rate for Payer: Quartz Commercial |
$1,624.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,499.40
|
| Rate for Payer: The Alliance Commercial |
$9,996.00
|
| Rate for Payer: WEA Trust Commercial |
$1,374.45
|
| Rate for Payer: WPS Commercial |
$1,851.01
|
|
|
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 |
$1,135.33 |
| Max. Negotiated Rate |
$2,131.64 |
| Rate for Payer: Aetna Commercial |
$2,085.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,992.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,228.01
|
| Rate for Payer: Cash Price |
$695.10
|
| Rate for Payer: Cigna Commercial |
$2,131.64
|
| Rate for Payer: Health EOS Commercial |
$2,062.13
|
| Rate for Payer: HFN Commercial |
$2,131.64
|
| Rate for Payer: Multiplan Commercial |
$1,853.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,390.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,131.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,135.33
|
| Rate for Payer: Quartz Commercial |
$1,390.20
|
| Rate for Payer: WEA Trust Commercial |
$1,274.35
|
| Rate for Payer: WPS Commercial |
$1,716.20
|
|
|
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 |
$648.76 |
| Max. Negotiated Rate |
$9,268.00 |
| Rate for Payer: Aetna Commercial |
$2,085.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,992.62
|
| Rate for Payer: Aetna Managed Medicare |
$648.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,506.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,158.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,112.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,228.01
|
| Rate for Payer: Cash Price |
$695.10
|
| Rate for Payer: Cigna Commercial |
$2,131.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,296.59
|
| Rate for Payer: Health EOS Commercial |
$2,062.13
|
| Rate for Payer: HFN Commercial |
$2,131.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,737.75
|
| Rate for Payer: Multiplan Commercial |
$1,853.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,390.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,131.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,135.33
|
| Rate for Payer: Quartz Commercial |
$1,506.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,390.20
|
| Rate for Payer: The Alliance Commercial |
$9,268.00
|
| Rate for Payer: WEA Trust Commercial |
$1,274.35
|
| Rate for Payer: WPS Commercial |
$1,716.20
|
|
|
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 |
$1,128.68 |
| Max. Negotiated Rate |
$16,124.00 |
| Rate for Payer: Aetna Commercial |
$3,627.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,466.66
|
| Rate for Payer: Aetna Managed Medicare |
$1,128.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,620.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,015.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,934.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,136.43
|
| Rate for Payer: Cash Price |
$1,209.30
|
| Rate for Payer: Cigna Commercial |
$3,708.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,255.75
|
| Rate for Payer: Health EOS Commercial |
$3,587.59
|
| Rate for Payer: HFN Commercial |
$3,708.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,023.25
|
| Rate for Payer: Multiplan Commercial |
$3,224.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,418.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,708.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,975.19
|
| Rate for Payer: Quartz Commercial |
$2,620.15
|
| Rate for Payer: Quartz Medicare Advantage |
$2,418.60
|
| Rate for Payer: The Alliance Commercial |
$16,124.00
|
| Rate for Payer: WEA Trust Commercial |
$2,217.05
|
| Rate for Payer: WPS Commercial |
$2,985.76
|
|
|
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 |
$1,975.19 |
| Max. Negotiated Rate |
$3,708.52 |
| Rate for Payer: Aetna Commercial |
$3,627.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,466.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,136.43
|
| Rate for Payer: Cash Price |
$1,209.30
|
| Rate for Payer: Cigna Commercial |
$3,708.52
|
| Rate for Payer: Health EOS Commercial |
$3,587.59
|
| Rate for Payer: HFN Commercial |
$3,708.52
|
| Rate for Payer: Multiplan Commercial |
$3,224.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,418.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,708.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,975.19
|
| Rate for Payer: Quartz Commercial |
$2,418.60
|
| Rate for Payer: WEA Trust Commercial |
$2,217.05
|
| Rate for Payer: WPS Commercial |
$2,985.76
|
|
|
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 |
$1,128.68 |
| Max. Negotiated Rate |
$16,124.00 |
| Rate for Payer: Aetna Commercial |
$3,627.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,466.66
|
| Rate for Payer: Aetna Managed Medicare |
$1,128.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,620.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,015.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,934.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,136.43
|
| Rate for Payer: Cash Price |
$1,209.30
|
| Rate for Payer: Cigna Commercial |
$3,708.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,255.75
|
| Rate for Payer: Health EOS Commercial |
$3,587.59
|
| Rate for Payer: HFN Commercial |
$3,708.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,023.25
|
| Rate for Payer: Multiplan Commercial |
$3,224.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,418.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,708.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,975.19
|
| Rate for Payer: Quartz Commercial |
$2,620.15
|
| Rate for Payer: Quartz Medicare Advantage |
$2,418.60
|
| Rate for Payer: The Alliance Commercial |
$16,124.00
|
| Rate for Payer: WEA Trust Commercial |
$2,217.05
|
| Rate for Payer: WPS Commercial |
$2,985.76
|
|
|
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 |
$1,975.19 |
| Max. Negotiated Rate |
$3,708.52 |
| Rate for Payer: Aetna Commercial |
$3,627.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,466.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,136.43
|
| Rate for Payer: Cash Price |
$1,209.30
|
| Rate for Payer: Cigna Commercial |
$3,708.52
|
| Rate for Payer: Health EOS Commercial |
$3,587.59
|
| Rate for Payer: HFN Commercial |
$3,708.52
|
| Rate for Payer: Multiplan Commercial |
$3,224.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,418.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,708.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,975.19
|
| Rate for Payer: Quartz Commercial |
$2,418.60
|
| Rate for Payer: WEA Trust Commercial |
$2,217.05
|
| Rate for Payer: WPS Commercial |
$2,985.76
|
|
|
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 |
$285.88 |
| Max. Negotiated Rate |
$4,084.00 |
| Rate for Payer: Aetna Commercial |
$918.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$878.06
|
| Rate for Payer: Aetna Managed Medicare |
$285.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$663.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$510.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$490.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$541.13
|
| Rate for Payer: Cash Price |
$306.30
|
| Rate for Payer: Cigna Commercial |
$939.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$571.35
|
| Rate for Payer: Health EOS Commercial |
$908.69
|
| Rate for Payer: HFN Commercial |
$939.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$765.75
|
| Rate for Payer: Multiplan Commercial |
$816.80
|
| Rate for Payer: NAPHCARE Commercial |
$612.60
|
| Rate for Payer: Preferred Network Access Commercial |
$939.32
|
| Rate for Payer: Quartz Beloit One Network |
$500.29
|
| Rate for Payer: Quartz Commercial |
$663.65
|
| Rate for Payer: Quartz Medicare Advantage |
$612.60
|
| Rate for Payer: The Alliance Commercial |
$4,084.00
|
| Rate for Payer: WEA Trust Commercial |
$561.55
|
| Rate for Payer: WPS Commercial |
$756.25
|
|
|
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 |
$500.29 |
| Max. Negotiated Rate |
$939.32 |
| Rate for Payer: Aetna Commercial |
$918.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$878.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$541.13
|
| Rate for Payer: Cash Price |
$306.30
|
| Rate for Payer: Cigna Commercial |
$939.32
|
| Rate for Payer: Health EOS Commercial |
$908.69
|
| Rate for Payer: HFN Commercial |
$939.32
|
| Rate for Payer: Multiplan Commercial |
$816.80
|
| Rate for Payer: NAPHCARE Commercial |
$612.60
|
| Rate for Payer: Preferred Network Access Commercial |
$939.32
|
| Rate for Payer: Quartz Beloit One Network |
$500.29
|
| Rate for Payer: Quartz Commercial |
$612.60
|
| Rate for Payer: WEA Trust Commercial |
$561.55
|
| Rate for Payer: WPS Commercial |
$756.25
|
|
|
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 |
$104.44 |
| Max. Negotiated Rate |
$1,492.00 |
| Rate for Payer: Aetna Commercial |
$335.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$320.78
|
| Rate for Payer: Aetna Managed Medicare |
$104.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$242.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$186.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$179.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$197.69
|
| Rate for Payer: Cash Price |
$111.90
|
| Rate for Payer: Cigna Commercial |
$343.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$208.73
|
| Rate for Payer: Health EOS Commercial |
$331.97
|
| Rate for Payer: HFN Commercial |
$343.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$279.75
|
| Rate for Payer: Multiplan Commercial |
$298.40
|
| Rate for Payer: NAPHCARE Commercial |
$223.80
|
| Rate for Payer: Preferred Network Access Commercial |
$343.16
|
| Rate for Payer: Quartz Beloit One Network |
$182.77
|
| Rate for Payer: Quartz Commercial |
$242.45
|
| Rate for Payer: Quartz Medicare Advantage |
$223.80
|
| Rate for Payer: The Alliance Commercial |
$1,492.00
|
| Rate for Payer: WEA Trust Commercial |
$205.15
|
| Rate for Payer: WPS Commercial |
$276.28
|
|
|
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 |
$182.77 |
| Max. Negotiated Rate |
$343.16 |
| Rate for Payer: Aetna Commercial |
$335.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$320.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$197.69
|
| Rate for Payer: Cash Price |
$111.90
|
| Rate for Payer: Cigna Commercial |
$343.16
|
| Rate for Payer: Health EOS Commercial |
$331.97
|
| Rate for Payer: HFN Commercial |
$343.16
|
| Rate for Payer: Multiplan Commercial |
$298.40
|
| Rate for Payer: NAPHCARE Commercial |
$223.80
|
| Rate for Payer: Preferred Network Access Commercial |
$343.16
|
| Rate for Payer: Quartz Beloit One Network |
$182.77
|
| Rate for Payer: Quartz Commercial |
$223.80
|
| Rate for Payer: WEA Trust Commercial |
$205.15
|
| Rate for Payer: WPS Commercial |
$276.28
|
|
|
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 |
$416.99 |
| Max. Negotiated Rate |
$782.92 |
| Rate for Payer: Aetna Commercial |
$765.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$731.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$451.03
|
| Rate for Payer: Cash Price |
$255.30
|
| Rate for Payer: Cigna Commercial |
$782.92
|
| Rate for Payer: Health EOS Commercial |
$757.39
|
| Rate for Payer: HFN Commercial |
$782.92
|
| Rate for Payer: Multiplan Commercial |
$680.80
|
| Rate for Payer: NAPHCARE Commercial |
$510.60
|
| Rate for Payer: Preferred Network Access Commercial |
$782.92
|
| Rate for Payer: Quartz Beloit One Network |
$416.99
|
| Rate for Payer: Quartz Commercial |
$510.60
|
| Rate for Payer: WEA Trust Commercial |
$468.05
|
| Rate for Payer: WPS Commercial |
$630.34
|
|
|
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 |
$238.28 |
| Max. Negotiated Rate |
$3,404.00 |
| Rate for Payer: Aetna Commercial |
$765.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$731.86
|
| Rate for Payer: Aetna Managed Medicare |
$238.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$553.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$425.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$408.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$451.03
|
| Rate for Payer: Cash Price |
$255.30
|
| Rate for Payer: Cigna Commercial |
$782.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$476.22
|
| Rate for Payer: Health EOS Commercial |
$757.39
|
| Rate for Payer: HFN Commercial |
$782.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$638.25
|
| Rate for Payer: Multiplan Commercial |
$680.80
|
| Rate for Payer: NAPHCARE Commercial |
$510.60
|
| Rate for Payer: Preferred Network Access Commercial |
$782.92
|
| Rate for Payer: Quartz Beloit One Network |
$416.99
|
| Rate for Payer: Quartz Commercial |
$553.15
|
| Rate for Payer: Quartz Medicare Advantage |
$510.60
|
| Rate for Payer: The Alliance Commercial |
$3,404.00
|
| Rate for Payer: WEA Trust Commercial |
$468.05
|
| Rate for Payer: WPS Commercial |
$630.34
|
|
|
PLATE 1/3 TUBULAR 4HL 241.34
|
Facility
|
IP
|
$991.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966647
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$485.59 |
| Max. Negotiated Rate |
$911.72 |
| Rate for Payer: Aetna Commercial |
$891.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$852.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$525.23
|
| Rate for Payer: Cash Price |
$297.30
|
| Rate for Payer: Cigna Commercial |
$911.72
|
| Rate for Payer: Health EOS Commercial |
$881.99
|
| Rate for Payer: HFN Commercial |
$911.72
|
| Rate for Payer: Multiplan Commercial |
$792.80
|
| Rate for Payer: NAPHCARE Commercial |
$594.60
|
| Rate for Payer: Preferred Network Access Commercial |
$911.72
|
| Rate for Payer: Quartz Beloit One Network |
$485.59
|
| Rate for Payer: Quartz Commercial |
$594.60
|
| Rate for Payer: WEA Trust Commercial |
$545.05
|
| Rate for Payer: WPS Commercial |
$734.03
|
|
