|
PLATE ANCHORAGE MTP V1 LONG LT 6HL PLP10341
|
Facility
|
IP
|
$9,271.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5617673
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,724.50 |
| Max. Negotiated Rate |
$8,870.49 |
| Rate for Payer: Aetna Commercial |
$8,677.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,291.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,110.18
|
| Rate for Payer: Cash Price |
$2,781.30
|
| Rate for Payer: Cigna Commercial |
$8,870.49
|
| Rate for Payer: Health EOS Commercial |
$8,581.24
|
| Rate for Payer: HFN Commercial |
$8,870.49
|
| Rate for Payer: Multiplan Commercial |
$7,713.47
|
| Rate for Payer: Preferred Network Access Commercial |
$8,870.49
|
| Rate for Payer: Quartz Beloit One Network |
$4,724.50
|
| Rate for Payer: Quartz Commercial |
$5,785.10
|
| Rate for Payer: WEA Trust Commercial |
$5,303.01
|
| Rate for Payer: WPS Commercial |
$7,141.45
|
|
|
PLATE ANCHORAGE MTP V1 LONG LT 8HL PLP10461
|
Facility
|
OP
|
$9,271.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5617695
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,699.72 |
| Max. Negotiated Rate |
$8,870.49 |
| Rate for Payer: Aetna Commercial |
$8,677.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,291.98
|
| Rate for Payer: Aetna Managed Medicare |
$2,699.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,267.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,820.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,628.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,110.18
|
| Rate for Payer: Cash Price |
$2,781.30
|
| Rate for Payer: Cigna Commercial |
$8,870.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,395.72
|
| Rate for Payer: Health EOS Commercial |
$8,581.24
|
| Rate for Payer: HFN Commercial |
$8,870.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,231.38
|
| Rate for Payer: Multiplan Commercial |
$7,713.47
|
| Rate for Payer: NAPHCARE Commercial |
$5,785.10
|
| Rate for Payer: Preferred Network Access Commercial |
$8,870.49
|
| Rate for Payer: Quartz Beloit One Network |
$4,724.50
|
| Rate for Payer: Quartz Commercial |
$6,267.20
|
| Rate for Payer: Quartz Medicare Advantage |
$5,785.10
|
| Rate for Payer: The Alliance Commercial |
$4,820.92
|
| Rate for Payer: WEA Trust Commercial |
$5,303.01
|
| Rate for Payer: WPS Commercial |
$7,141.45
|
|
|
PLATE ANCHORAGE MTP V1 LONG LT 8HL PLP10461
|
Facility
|
IP
|
$9,271.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5617695
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,724.50 |
| Max. Negotiated Rate |
$8,870.49 |
| Rate for Payer: Aetna Commercial |
$8,677.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,291.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,110.18
|
| Rate for Payer: Cash Price |
$2,781.30
|
| Rate for Payer: Cigna Commercial |
$8,870.49
|
| Rate for Payer: Health EOS Commercial |
$8,581.24
|
| Rate for Payer: HFN Commercial |
$8,870.49
|
| Rate for Payer: Multiplan Commercial |
$7,713.47
|
| Rate for Payer: Preferred Network Access Commercial |
$8,870.49
|
| Rate for Payer: Quartz Beloit One Network |
$4,724.50
|
| Rate for Payer: Quartz Commercial |
$5,785.10
|
| Rate for Payer: WEA Trust Commercial |
$5,303.01
|
| Rate for Payer: WPS Commercial |
$7,141.45
|
|
|
PLATE ANCHORAGE MTP V1 LONG RT 6HL PLP10342
|
Facility
|
OP
|
$10,116.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611633
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,945.78 |
| Max. Negotiated Rate |
$9,678.99 |
| Rate for Payer: Aetna Commercial |
$9,468.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,047.75
|
| Rate for Payer: Aetna Managed Medicare |
$2,945.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,838.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,260.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,049.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,575.94
|
| Rate for Payer: Cash Price |
$3,034.80
|
| Rate for Payer: Cigna Commercial |
$9,678.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,887.51
|
| Rate for Payer: Health EOS Commercial |
$9,363.37
|
| Rate for Payer: HFN Commercial |
$9,678.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,890.48
|
| Rate for Payer: Multiplan Commercial |
$8,416.51
|
| Rate for Payer: NAPHCARE Commercial |
$6,312.38
|
| Rate for Payer: Preferred Network Access Commercial |
$9,678.99
|
| Rate for Payer: Quartz Beloit One Network |
$5,155.11
|
| Rate for Payer: Quartz Commercial |
$6,838.42
|
| Rate for Payer: Quartz Medicare Advantage |
$6,312.38
|
| Rate for Payer: The Alliance Commercial |
$5,260.32
|
| Rate for Payer: WEA Trust Commercial |
$5,786.35
|
| Rate for Payer: WPS Commercial |
$7,792.35
|
|
|
PLATE ANCHORAGE MTP V1 LONG RT 6HL PLP10342
|
Facility
|
IP
|
$10,116.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611633
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,155.11 |
| Max. Negotiated Rate |
$9,678.99 |
| Rate for Payer: Aetna Commercial |
$9,468.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,047.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,575.94
|
| Rate for Payer: Cash Price |
$3,034.80
|
| Rate for Payer: Cigna Commercial |
$9,678.99
|
| Rate for Payer: Health EOS Commercial |
$9,363.37
|
| Rate for Payer: HFN Commercial |
$9,678.99
|
| Rate for Payer: Multiplan Commercial |
$8,416.51
|
| Rate for Payer: Preferred Network Access Commercial |
$9,678.99
|
| Rate for Payer: Quartz Beloit One Network |
$5,155.11
|
| Rate for Payer: Quartz Commercial |
$6,312.38
|
| Rate for Payer: WEA Trust Commercial |
$5,786.35
|
| Rate for Payer: WPS Commercial |
$7,792.35
|
|
|
PLATE ANKLE FUSION ANTERIOR TIBIOTALAR 4 HL RT AR-8970AR-04
|
Facility
|
IP
|
$15,159.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5603785
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,725.03 |
| Max. Negotiated Rate |
$14,504.13 |
| Rate for Payer: Aetna Commercial |
$14,188.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,558.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,355.64
|
| Rate for Payer: Cash Price |
$4,547.70
|
| Rate for Payer: Cigna Commercial |
$14,504.13
|
| Rate for Payer: Health EOS Commercial |
$14,031.17
|
| Rate for Payer: HFN Commercial |
$14,504.13
|
| Rate for Payer: Multiplan Commercial |
$12,612.29
|
| Rate for Payer: Preferred Network Access Commercial |
$14,504.13
|
| Rate for Payer: Quartz Beloit One Network |
$7,725.03
|
| Rate for Payer: Quartz Commercial |
$9,459.22
|
| Rate for Payer: WEA Trust Commercial |
$8,670.95
|
| Rate for Payer: WPS Commercial |
$11,676.98
|
|
|
PLATE ANKLE FUSION ANTERIOR TIBIOTALAR 4 HL RT AR-8970AR-04
|
Facility
|
OP
|
$15,159.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5603785
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,414.30 |
| Max. Negotiated Rate |
$14,504.13 |
| Rate for Payer: Aetna Commercial |
$14,188.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,558.21
|
| Rate for Payer: Aetna Managed Medicare |
$4,414.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,247.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,882.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,567.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,355.64
|
| Rate for Payer: Cash Price |
$4,547.70
|
| Rate for Payer: Cigna Commercial |
$14,504.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,822.54
|
| Rate for Payer: Health EOS Commercial |
$14,031.17
|
| Rate for Payer: HFN Commercial |
$14,504.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,824.02
|
| Rate for Payer: Multiplan Commercial |
$12,612.29
|
| Rate for Payer: NAPHCARE Commercial |
$9,459.22
|
| Rate for Payer: Preferred Network Access Commercial |
$14,504.13
|
| Rate for Payer: Quartz Beloit One Network |
$7,725.03
|
| Rate for Payer: Quartz Commercial |
$10,247.48
|
| Rate for Payer: Quartz Medicare Advantage |
$9,459.22
|
| Rate for Payer: The Alliance Commercial |
$7,882.68
|
| Rate for Payer: WEA Trust Commercial |
$8,670.95
|
| Rate for Payer: WPS Commercial |
$11,676.98
|
|
|
PLATE ANKLE FUSION ANTERIOR TIBIOTALAR SHORT 3HL RT AR-8970AS-03
|
Facility
|
OP
|
$10,612.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5803668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,090.21 |
| Max. Negotiated Rate |
$10,153.56 |
| Rate for Payer: Aetna Commercial |
$9,932.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,491.37
|
| Rate for Payer: Aetna Managed Medicare |
$3,090.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,173.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,518.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,297.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,849.33
|
| Rate for Payer: Cash Price |
$3,183.60
|
| Rate for Payer: Cigna Commercial |
$10,153.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,176.18
|
| Rate for Payer: Health EOS Commercial |
$9,822.47
|
| Rate for Payer: HFN Commercial |
$10,153.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,277.36
|
| Rate for Payer: Multiplan Commercial |
$8,829.18
|
| Rate for Payer: NAPHCARE Commercial |
$6,621.89
|
| Rate for Payer: Preferred Network Access Commercial |
$10,153.56
|
| Rate for Payer: Quartz Beloit One Network |
$5,407.88
|
| Rate for Payer: Quartz Commercial |
$7,173.71
|
| Rate for Payer: Quartz Medicare Advantage |
$6,621.89
|
| Rate for Payer: The Alliance Commercial |
$5,518.24
|
| Rate for Payer: WEA Trust Commercial |
$6,070.06
|
| Rate for Payer: WPS Commercial |
$8,174.42
|
|
|
PLATE ANKLE FUSION ANTERIOR TIBIOTALAR SHORT 3HL RT AR-8970AS-03
|
Facility
|
IP
|
$10,612.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5803668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,407.88 |
| Max. Negotiated Rate |
$10,153.56 |
| Rate for Payer: Aetna Commercial |
$9,932.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,491.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,849.33
|
| Rate for Payer: Cash Price |
$3,183.60
|
| Rate for Payer: Cigna Commercial |
$10,153.56
|
| Rate for Payer: Health EOS Commercial |
$9,822.47
|
| Rate for Payer: HFN Commercial |
$10,153.56
|
| Rate for Payer: Multiplan Commercial |
$8,829.18
|
| Rate for Payer: Preferred Network Access Commercial |
$10,153.56
|
| Rate for Payer: Quartz Beloit One Network |
$5,407.88
|
| Rate for Payer: Quartz Commercial |
$6,621.89
|
| Rate for Payer: WEA Trust Commercial |
$6,070.06
|
| Rate for Payer: WPS Commercial |
$8,174.42
|
|
|
PLATE ANKLE FUSION ANTERIOR TIBIOTALAR STD RT AR-8970AR
|
Facility
|
OP
|
$10,612.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611704
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,090.21 |
| Max. Negotiated Rate |
$10,153.56 |
| Rate for Payer: Aetna Commercial |
$9,932.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,491.37
|
| Rate for Payer: Aetna Managed Medicare |
$3,090.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,173.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,518.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,297.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,849.33
|
| Rate for Payer: Cash Price |
$3,183.60
|
| Rate for Payer: Cigna Commercial |
$10,153.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,176.18
|
| Rate for Payer: Health EOS Commercial |
$9,822.47
|
| Rate for Payer: HFN Commercial |
$10,153.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,277.36
|
| Rate for Payer: Multiplan Commercial |
$8,829.18
|
| Rate for Payer: NAPHCARE Commercial |
$6,621.89
|
| Rate for Payer: Preferred Network Access Commercial |
$10,153.56
|
| Rate for Payer: Quartz Beloit One Network |
$5,407.88
|
| Rate for Payer: Quartz Commercial |
$7,173.71
|
| Rate for Payer: Quartz Medicare Advantage |
$6,621.89
|
| Rate for Payer: The Alliance Commercial |
$5,518.24
|
| Rate for Payer: WEA Trust Commercial |
$6,070.06
|
| Rate for Payer: WPS Commercial |
$8,174.42
|
|
|
PLATE ANKLE FUSION ANTERIOR TIBIOTALAR STD RT AR-8970AR
|
Facility
|
IP
|
$10,612.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611704
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,407.88 |
| Max. Negotiated Rate |
$10,153.56 |
| Rate for Payer: Aetna Commercial |
$9,932.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,491.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,849.33
|
| Rate for Payer: Cash Price |
$3,183.60
|
| Rate for Payer: Cigna Commercial |
$10,153.56
|
| Rate for Payer: Health EOS Commercial |
$9,822.47
|
| Rate for Payer: HFN Commercial |
$10,153.56
|
| Rate for Payer: Multiplan Commercial |
$8,829.18
|
| Rate for Payer: Preferred Network Access Commercial |
$10,153.56
|
| Rate for Payer: Quartz Beloit One Network |
$5,407.88
|
| Rate for Payer: Quartz Commercial |
$6,621.89
|
| Rate for Payer: WEA Trust Commercial |
$6,070.06
|
| Rate for Payer: WPS Commercial |
$8,174.42
|
|
|
PLATE BROAD 10HL CRV 629560
|
Facility
|
OP
|
$4,572.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599755
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,331.37 |
| Max. Negotiated Rate |
$4,374.49 |
| Rate for Payer: Aetna Commercial |
$4,279.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,089.20
|
| Rate for Payer: Aetna Managed Medicare |
$1,331.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,090.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,377.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,282.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,520.09
|
| Rate for Payer: Cash Price |
$1,371.60
|
| Rate for Payer: Cigna Commercial |
$4,374.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,660.90
|
| Rate for Payer: Health EOS Commercial |
$4,231.84
|
| Rate for Payer: HFN Commercial |
$4,374.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,566.16
|
| Rate for Payer: Multiplan Commercial |
$3,803.90
|
| Rate for Payer: NAPHCARE Commercial |
$2,852.93
|
| Rate for Payer: Preferred Network Access Commercial |
$4,374.49
|
| Rate for Payer: Quartz Beloit One Network |
$2,329.89
|
| Rate for Payer: Quartz Commercial |
$3,090.67
|
| Rate for Payer: Quartz Medicare Advantage |
$2,852.93
|
| Rate for Payer: The Alliance Commercial |
$2,377.44
|
| Rate for Payer: WEA Trust Commercial |
$2,615.18
|
| Rate for Payer: WPS Commercial |
$3,521.81
|
|
|
PLATE BROAD 10HL CRV 629560
|
Facility
|
IP
|
$4,572.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599755
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,329.89 |
| Max. Negotiated Rate |
$4,374.49 |
| Rate for Payer: Aetna Commercial |
$4,279.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,089.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,520.09
|
| Rate for Payer: Cash Price |
$1,371.60
|
| Rate for Payer: Cigna Commercial |
$4,374.49
|
| Rate for Payer: Health EOS Commercial |
$4,231.84
|
| Rate for Payer: HFN Commercial |
$4,374.49
|
| Rate for Payer: Multiplan Commercial |
$3,803.90
|
| Rate for Payer: Preferred Network Access Commercial |
$4,374.49
|
| Rate for Payer: Quartz Beloit One Network |
$2,329.89
|
| Rate for Payer: Quartz Commercial |
$2,852.93
|
| Rate for Payer: WEA Trust Commercial |
$2,615.18
|
| Rate for Payer: WPS Commercial |
$3,521.81
|
|
|
PLATE BROAD LCP 10HL 226.601
|
Facility
|
IP
|
$9,066.00
|
|
| Hospital Charge Code |
2966750
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,620.03 |
| Max. Negotiated Rate |
$8,674.35 |
| Rate for Payer: Aetna Commercial |
$8,485.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,108.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,997.18
|
| Rate for Payer: Cash Price |
$2,719.80
|
| Rate for Payer: Cigna Commercial |
$8,674.35
|
| Rate for Payer: Health EOS Commercial |
$8,391.49
|
| Rate for Payer: HFN Commercial |
$8,674.35
|
| Rate for Payer: Multiplan Commercial |
$7,542.91
|
| Rate for Payer: Preferred Network Access Commercial |
$8,674.35
|
| Rate for Payer: Quartz Beloit One Network |
$4,620.03
|
| Rate for Payer: Quartz Commercial |
$5,657.18
|
| Rate for Payer: WEA Trust Commercial |
$5,185.75
|
| Rate for Payer: WPS Commercial |
$6,983.54
|
|
|
PLATE BROAD LCP 10HL 226.601
|
Facility
|
OP
|
$9,066.00
|
|
| Hospital Charge Code |
2966750
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,640.02 |
| Max. Negotiated Rate |
$8,674.35 |
| Rate for Payer: Aetna Commercial |
$8,485.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,108.63
|
| Rate for Payer: Aetna Managed Medicare |
$2,640.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,128.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,714.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,525.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,997.18
|
| Rate for Payer: Cash Price |
$2,719.80
|
| Rate for Payer: Cigna Commercial |
$8,674.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,276.41
|
| Rate for Payer: Health EOS Commercial |
$8,391.49
|
| Rate for Payer: HFN Commercial |
$8,674.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,071.48
|
| Rate for Payer: Multiplan Commercial |
$7,542.91
|
| Rate for Payer: NAPHCARE Commercial |
$5,657.18
|
| Rate for Payer: Preferred Network Access Commercial |
$8,674.35
|
| Rate for Payer: Quartz Beloit One Network |
$4,620.03
|
| Rate for Payer: Quartz Commercial |
$6,128.62
|
| Rate for Payer: Quartz Medicare Advantage |
$5,657.18
|
| Rate for Payer: The Alliance Commercial |
$4,714.32
|
| Rate for Payer: WEA Trust Commercial |
$5,185.75
|
| Rate for Payer: WPS Commercial |
$6,983.54
|
|
|
PLATE BROAD LCP 11HL 226.611
|
Facility
|
OP
|
$9,066.00
|
|
| Hospital Charge Code |
2966751
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,640.02 |
| Max. Negotiated Rate |
$8,674.35 |
| Rate for Payer: Aetna Commercial |
$8,485.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,108.63
|
| Rate for Payer: Aetna Managed Medicare |
$2,640.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,128.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,714.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,525.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,997.18
|
| Rate for Payer: Cash Price |
$2,719.80
|
| Rate for Payer: Cigna Commercial |
$8,674.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,276.41
|
| Rate for Payer: Health EOS Commercial |
$8,391.49
|
| Rate for Payer: HFN Commercial |
$8,674.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,071.48
|
| Rate for Payer: Multiplan Commercial |
$7,542.91
|
| Rate for Payer: NAPHCARE Commercial |
$5,657.18
|
| Rate for Payer: Preferred Network Access Commercial |
$8,674.35
|
| Rate for Payer: Quartz Beloit One Network |
$4,620.03
|
| Rate for Payer: Quartz Commercial |
$6,128.62
|
| Rate for Payer: Quartz Medicare Advantage |
$5,657.18
|
| Rate for Payer: The Alliance Commercial |
$4,714.32
|
| Rate for Payer: WEA Trust Commercial |
$5,185.75
|
| Rate for Payer: WPS Commercial |
$6,983.54
|
|
|
PLATE BROAD LCP 11HL 226.611
|
Facility
|
IP
|
$9,066.00
|
|
| Hospital Charge Code |
2966751
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,620.03 |
| Max. Negotiated Rate |
$8,674.35 |
| Rate for Payer: Aetna Commercial |
$8,485.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,108.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,997.18
|
| Rate for Payer: Cash Price |
$2,719.80
|
| Rate for Payer: Cigna Commercial |
$8,674.35
|
| Rate for Payer: Health EOS Commercial |
$8,391.49
|
| Rate for Payer: HFN Commercial |
$8,674.35
|
| Rate for Payer: Multiplan Commercial |
$7,542.91
|
| Rate for Payer: Preferred Network Access Commercial |
$8,674.35
|
| Rate for Payer: Quartz Beloit One Network |
$4,620.03
|
| Rate for Payer: Quartz Commercial |
$5,657.18
|
| Rate for Payer: WEA Trust Commercial |
$5,185.75
|
| Rate for Payer: WPS Commercial |
$6,983.54
|
|
|
PLATE BROAD LCP 12HL 226.621
|
Facility
|
OP
|
$9,066.00
|
|
| Hospital Charge Code |
2966752
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,640.02 |
| Max. Negotiated Rate |
$8,674.35 |
| Rate for Payer: Aetna Commercial |
$8,485.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,108.63
|
| Rate for Payer: Aetna Managed Medicare |
$2,640.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,128.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,714.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,525.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,997.18
|
| Rate for Payer: Cash Price |
$2,719.80
|
| Rate for Payer: Cigna Commercial |
$8,674.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,276.41
|
| Rate for Payer: Health EOS Commercial |
$8,391.49
|
| Rate for Payer: HFN Commercial |
$8,674.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,071.48
|
| Rate for Payer: Multiplan Commercial |
$7,542.91
|
| Rate for Payer: NAPHCARE Commercial |
$5,657.18
|
| Rate for Payer: Preferred Network Access Commercial |
$8,674.35
|
| Rate for Payer: Quartz Beloit One Network |
$4,620.03
|
| Rate for Payer: Quartz Commercial |
$6,128.62
|
| Rate for Payer: Quartz Medicare Advantage |
$5,657.18
|
| Rate for Payer: The Alliance Commercial |
$4,714.32
|
| Rate for Payer: WEA Trust Commercial |
$5,185.75
|
| Rate for Payer: WPS Commercial |
$6,983.54
|
|
|
PLATE BROAD LCP 12HL 226.621
|
Facility
|
IP
|
$9,066.00
|
|
| Hospital Charge Code |
2966752
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,620.03 |
| Max. Negotiated Rate |
$8,674.35 |
| Rate for Payer: Aetna Commercial |
$8,485.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,108.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,997.18
|
| Rate for Payer: Cash Price |
$2,719.80
|
| Rate for Payer: Cigna Commercial |
$8,674.35
|
| Rate for Payer: Health EOS Commercial |
$8,391.49
|
| Rate for Payer: HFN Commercial |
$8,674.35
|
| Rate for Payer: Multiplan Commercial |
$7,542.91
|
| Rate for Payer: Preferred Network Access Commercial |
$8,674.35
|
| Rate for Payer: Quartz Beloit One Network |
$4,620.03
|
| Rate for Payer: Quartz Commercial |
$5,657.18
|
| Rate for Payer: WEA Trust Commercial |
$5,185.75
|
| Rate for Payer: WPS Commercial |
$6,983.54
|
|
|
PLATE BROAD LCP 14HL 226.641
|
Facility
|
IP
|
$9,066.00
|
|
| Hospital Charge Code |
2966753
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,620.03 |
| Max. Negotiated Rate |
$8,674.35 |
| Rate for Payer: Aetna Commercial |
$8,485.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,108.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,997.18
|
| Rate for Payer: Cash Price |
$2,719.80
|
| Rate for Payer: Cigna Commercial |
$8,674.35
|
| Rate for Payer: Health EOS Commercial |
$8,391.49
|
| Rate for Payer: HFN Commercial |
$8,674.35
|
| Rate for Payer: Multiplan Commercial |
$7,542.91
|
| Rate for Payer: Preferred Network Access Commercial |
$8,674.35
|
| Rate for Payer: Quartz Beloit One Network |
$4,620.03
|
| Rate for Payer: Quartz Commercial |
$5,657.18
|
| Rate for Payer: WEA Trust Commercial |
$5,185.75
|
| Rate for Payer: WPS Commercial |
$6,983.54
|
|
|
PLATE BROAD LCP 14HL 226.641
|
Facility
|
OP
|
$9,066.00
|
|
| Hospital Charge Code |
2966753
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,640.02 |
| Max. Negotiated Rate |
$8,674.35 |
| Rate for Payer: Aetna Commercial |
$8,485.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,108.63
|
| Rate for Payer: Aetna Managed Medicare |
$2,640.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,128.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,714.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,525.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,997.18
|
| Rate for Payer: Cash Price |
$2,719.80
|
| Rate for Payer: Cigna Commercial |
$8,674.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,276.41
|
| Rate for Payer: Health EOS Commercial |
$8,391.49
|
| Rate for Payer: HFN Commercial |
$8,674.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,071.48
|
| Rate for Payer: Multiplan Commercial |
$7,542.91
|
| Rate for Payer: NAPHCARE Commercial |
$5,657.18
|
| Rate for Payer: Preferred Network Access Commercial |
$8,674.35
|
| Rate for Payer: Quartz Beloit One Network |
$4,620.03
|
| Rate for Payer: Quartz Commercial |
$6,128.62
|
| Rate for Payer: Quartz Medicare Advantage |
$5,657.18
|
| Rate for Payer: The Alliance Commercial |
$4,714.32
|
| Rate for Payer: WEA Trust Commercial |
$5,185.75
|
| Rate for Payer: WPS Commercial |
$6,983.54
|
|
|
PLATE BROAD LCP 16HL 226.661
|
Facility
|
OP
|
$9,066.00
|
|
| Hospital Charge Code |
2966754
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,640.02 |
| Max. Negotiated Rate |
$8,674.35 |
| Rate for Payer: Aetna Commercial |
$8,485.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,108.63
|
| Rate for Payer: Aetna Managed Medicare |
$2,640.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,128.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,714.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,525.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,997.18
|
| Rate for Payer: Cash Price |
$2,719.80
|
| Rate for Payer: Cigna Commercial |
$8,674.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,276.41
|
| Rate for Payer: Health EOS Commercial |
$8,391.49
|
| Rate for Payer: HFN Commercial |
$8,674.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,071.48
|
| Rate for Payer: Multiplan Commercial |
$7,542.91
|
| Rate for Payer: NAPHCARE Commercial |
$5,657.18
|
| Rate for Payer: Preferred Network Access Commercial |
$8,674.35
|
| Rate for Payer: Quartz Beloit One Network |
$4,620.03
|
| Rate for Payer: Quartz Commercial |
$6,128.62
|
| Rate for Payer: Quartz Medicare Advantage |
$5,657.18
|
| Rate for Payer: The Alliance Commercial |
$4,714.32
|
| Rate for Payer: WEA Trust Commercial |
$5,185.75
|
| Rate for Payer: WPS Commercial |
$6,983.54
|
|
|
PLATE BROAD LCP 16HL 226.661
|
Facility
|
IP
|
$9,066.00
|
|
| Hospital Charge Code |
2966754
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,620.03 |
| Max. Negotiated Rate |
$8,674.35 |
| Rate for Payer: Aetna Commercial |
$8,485.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,108.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,997.18
|
| Rate for Payer: Cash Price |
$2,719.80
|
| Rate for Payer: Cigna Commercial |
$8,674.35
|
| Rate for Payer: Health EOS Commercial |
$8,391.49
|
| Rate for Payer: HFN Commercial |
$8,674.35
|
| Rate for Payer: Multiplan Commercial |
$7,542.91
|
| Rate for Payer: Preferred Network Access Commercial |
$8,674.35
|
| Rate for Payer: Quartz Beloit One Network |
$4,620.03
|
| Rate for Payer: Quartz Commercial |
$5,657.18
|
| Rate for Payer: WEA Trust Commercial |
$5,185.75
|
| Rate for Payer: WPS Commercial |
$6,983.54
|
|
|
PLATE BROAD LCP 6HL 226.561
|
Facility
|
OP
|
$9,066.00
|
|
| Hospital Charge Code |
2966749
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,640.02 |
| Max. Negotiated Rate |
$8,674.35 |
| Rate for Payer: Aetna Commercial |
$8,485.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,108.63
|
| Rate for Payer: Aetna Managed Medicare |
$2,640.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,128.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,714.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,525.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,997.18
|
| Rate for Payer: Cash Price |
$2,719.80
|
| Rate for Payer: Cigna Commercial |
$8,674.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,276.41
|
| Rate for Payer: Health EOS Commercial |
$8,391.49
|
| Rate for Payer: HFN Commercial |
$8,674.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,071.48
|
| Rate for Payer: Multiplan Commercial |
$7,542.91
|
| Rate for Payer: NAPHCARE Commercial |
$5,657.18
|
| Rate for Payer: Preferred Network Access Commercial |
$8,674.35
|
| Rate for Payer: Quartz Beloit One Network |
$4,620.03
|
| Rate for Payer: Quartz Commercial |
$6,128.62
|
| Rate for Payer: Quartz Medicare Advantage |
$5,657.18
|
| Rate for Payer: The Alliance Commercial |
$4,714.32
|
| Rate for Payer: WEA Trust Commercial |
$5,185.75
|
| Rate for Payer: WPS Commercial |
$6,983.54
|
|
|
PLATE BROAD LCP 6HL 226.561
|
Facility
|
IP
|
$9,066.00
|
|
| Hospital Charge Code |
2966749
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,620.03 |
| Max. Negotiated Rate |
$8,674.35 |
| Rate for Payer: Aetna Commercial |
$8,485.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,108.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,997.18
|
| Rate for Payer: Cash Price |
$2,719.80
|
| Rate for Payer: Cigna Commercial |
$8,674.35
|
| Rate for Payer: Health EOS Commercial |
$8,391.49
|
| Rate for Payer: HFN Commercial |
$8,674.35
|
| Rate for Payer: Multiplan Commercial |
$7,542.91
|
| Rate for Payer: Preferred Network Access Commercial |
$8,674.35
|
| Rate for Payer: Quartz Beloit One Network |
$4,620.03
|
| Rate for Payer: Quartz Commercial |
$5,657.18
|
| Rate for Payer: WEA Trust Commercial |
$5,185.75
|
| Rate for Payer: WPS Commercial |
$6,983.54
|
|
