|
PLATE LATERAL DISTAL FIBULA 5HL LT 02.112.141
|
Facility
|
OP
|
$5,218.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4518955
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,519.48 |
| Max. Negotiated Rate |
$4,992.58 |
| Rate for Payer: Aetna Commercial |
$4,884.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,666.98
|
| Rate for Payer: Aetna Managed Medicare |
$1,519.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,527.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,713.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,604.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,876.16
|
| Rate for Payer: Cash Price |
$1,565.40
|
| Rate for Payer: Cigna Commercial |
$4,992.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,036.88
|
| Rate for Payer: Health EOS Commercial |
$4,829.78
|
| Rate for Payer: HFN Commercial |
$4,992.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,070.04
|
| Rate for Payer: Multiplan Commercial |
$4,341.38
|
| Rate for Payer: NAPHCARE Commercial |
$3,256.03
|
| Rate for Payer: Preferred Network Access Commercial |
$4,992.58
|
| Rate for Payer: Quartz Beloit One Network |
$2,659.09
|
| Rate for Payer: Quartz Commercial |
$3,527.37
|
| Rate for Payer: Quartz Medicare Advantage |
$3,256.03
|
| Rate for Payer: The Alliance Commercial |
$2,713.36
|
| Rate for Payer: WEA Trust Commercial |
$2,984.70
|
| Rate for Payer: WPS Commercial |
$4,019.43
|
|
|
PLATE LATERAL DISTAL FIBULA 5HL LT 02.112.141
|
Facility
|
IP
|
$5,218.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4518955
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,659.09 |
| Max. Negotiated Rate |
$4,992.58 |
| Rate for Payer: Aetna Commercial |
$4,884.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,666.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,876.16
|
| Rate for Payer: Cash Price |
$1,565.40
|
| Rate for Payer: Cigna Commercial |
$4,992.58
|
| Rate for Payer: Health EOS Commercial |
$4,829.78
|
| Rate for Payer: HFN Commercial |
$4,992.58
|
| Rate for Payer: Multiplan Commercial |
$4,341.38
|
| Rate for Payer: Preferred Network Access Commercial |
$4,992.58
|
| Rate for Payer: Quartz Beloit One Network |
$2,659.09
|
| Rate for Payer: Quartz Commercial |
$3,256.03
|
| Rate for Payer: WEA Trust Commercial |
$2,984.70
|
| Rate for Payer: WPS Commercial |
$4,019.43
|
|
|
PLATE LATERAL DISTAL FIBULA 7HL RT 02.112.144
|
Facility
|
OP
|
$6,235.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966370
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,815.63 |
| Max. Negotiated Rate |
$5,965.65 |
| Rate for Payer: Aetna Commercial |
$5,835.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,576.58
|
| Rate for Payer: Aetna Managed Medicare |
$1,815.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,214.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,242.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,112.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,436.73
|
| Rate for Payer: Cash Price |
$1,870.50
|
| Rate for Payer: Cigna Commercial |
$5,965.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,628.77
|
| Rate for Payer: Health EOS Commercial |
$5,771.12
|
| Rate for Payer: HFN Commercial |
$5,965.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,863.30
|
| Rate for Payer: Multiplan Commercial |
$5,187.52
|
| Rate for Payer: NAPHCARE Commercial |
$3,890.64
|
| Rate for Payer: Preferred Network Access Commercial |
$5,965.65
|
| Rate for Payer: Quartz Beloit One Network |
$3,177.36
|
| Rate for Payer: Quartz Commercial |
$4,214.86
|
| Rate for Payer: Quartz Medicare Advantage |
$3,890.64
|
| Rate for Payer: The Alliance Commercial |
$3,242.20
|
| Rate for Payer: WEA Trust Commercial |
$3,566.42
|
| Rate for Payer: WPS Commercial |
$4,802.82
|
|
|
PLATE LATERAL DISTAL FIBULA 7HL RT 02.112.144
|
Facility
|
IP
|
$6,235.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966370
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,177.36 |
| Max. Negotiated Rate |
$5,965.65 |
| Rate for Payer: Aetna Commercial |
$5,835.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,576.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,436.73
|
| Rate for Payer: Cash Price |
$1,870.50
|
| Rate for Payer: Cigna Commercial |
$5,965.65
|
| Rate for Payer: Health EOS Commercial |
$5,771.12
|
| Rate for Payer: HFN Commercial |
$5,965.65
|
| Rate for Payer: Multiplan Commercial |
$5,187.52
|
| Rate for Payer: Preferred Network Access Commercial |
$5,965.65
|
| Rate for Payer: Quartz Beloit One Network |
$3,177.36
|
| Rate for Payer: Quartz Commercial |
$3,890.64
|
| Rate for Payer: WEA Trust Commercial |
$3,566.42
|
| Rate for Payer: WPS Commercial |
$4,802.82
|
|
|
PLATE LATERAL FUSION TTC SM RT ORTHOLOC 5920301R
|
Facility
|
OP
|
$11,746.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6201058
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,420.44 |
| Max. Negotiated Rate |
$11,238.57 |
| Rate for Payer: Aetna Commercial |
$10,994.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,505.62
|
| Rate for Payer: Aetna Managed Medicare |
$3,420.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,940.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,107.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,863.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,474.40
|
| Rate for Payer: Cash Price |
$3,523.80
|
| Rate for Payer: Cigna Commercial |
$11,238.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,836.17
|
| Rate for Payer: Health EOS Commercial |
$10,872.10
|
| Rate for Payer: HFN Commercial |
$11,238.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,161.88
|
| Rate for Payer: Multiplan Commercial |
$9,772.67
|
| Rate for Payer: NAPHCARE Commercial |
$7,329.50
|
| Rate for Payer: Preferred Network Access Commercial |
$11,238.57
|
| Rate for Payer: Quartz Beloit One Network |
$5,985.76
|
| Rate for Payer: Quartz Commercial |
$7,940.30
|
| Rate for Payer: Quartz Medicare Advantage |
$7,329.50
|
| Rate for Payer: The Alliance Commercial |
$6,107.92
|
| Rate for Payer: WEA Trust Commercial |
$6,718.71
|
| Rate for Payer: WPS Commercial |
$9,047.94
|
|
|
PLATE LATERAL FUSION TTC SM RT ORTHOLOC 5920301R
|
Facility
|
IP
|
$11,746.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6201058
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,985.76 |
| Max. Negotiated Rate |
$11,238.57 |
| Rate for Payer: Aetna Commercial |
$10,994.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,505.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,474.40
|
| Rate for Payer: Cash Price |
$3,523.80
|
| Rate for Payer: Cigna Commercial |
$11,238.57
|
| Rate for Payer: Health EOS Commercial |
$10,872.10
|
| Rate for Payer: HFN Commercial |
$11,238.57
|
| Rate for Payer: Multiplan Commercial |
$9,772.67
|
| Rate for Payer: Preferred Network Access Commercial |
$11,238.57
|
| Rate for Payer: Quartz Beloit One Network |
$5,985.76
|
| Rate for Payer: Quartz Commercial |
$7,329.50
|
| Rate for Payer: WEA Trust Commercial |
$6,718.71
|
| Rate for Payer: WPS Commercial |
$9,047.94
|
|
|
PLATE L-BUTTRESS 4HL RT 240.44
|
Facility
|
IP
|
$1,588.00
|
|
| Hospital Charge Code |
2966759
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$809.24 |
| Max. Negotiated Rate |
$1,519.40 |
| Rate for Payer: Aetna Commercial |
$1,486.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,420.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$875.31
|
| Rate for Payer: Cash Price |
$476.40
|
| Rate for Payer: Cigna Commercial |
$1,519.40
|
| Rate for Payer: Health EOS Commercial |
$1,469.85
|
| Rate for Payer: HFN Commercial |
$1,519.40
|
| Rate for Payer: Multiplan Commercial |
$1,321.22
|
| Rate for Payer: Preferred Network Access Commercial |
$1,519.40
|
| Rate for Payer: Quartz Beloit One Network |
$809.24
|
| Rate for Payer: Quartz Commercial |
$990.91
|
| Rate for Payer: WEA Trust Commercial |
$908.34
|
| Rate for Payer: WPS Commercial |
$1,223.24
|
|
|
PLATE L-BUTTRESS 4HL RT 240.44
|
Facility
|
OP
|
$1,588.00
|
|
| Hospital Charge Code |
2966759
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$462.43 |
| Max. Negotiated Rate |
$1,519.40 |
| Rate for Payer: Aetna Commercial |
$1,486.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,420.31
|
| Rate for Payer: Aetna Managed Medicare |
$462.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,073.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$825.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$792.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$875.31
|
| Rate for Payer: Cash Price |
$476.40
|
| Rate for Payer: Cigna Commercial |
$1,519.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$924.22
|
| Rate for Payer: Health EOS Commercial |
$1,469.85
|
| Rate for Payer: HFN Commercial |
$1,519.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,238.64
|
| Rate for Payer: Multiplan Commercial |
$1,321.22
|
| Rate for Payer: NAPHCARE Commercial |
$990.91
|
| Rate for Payer: Preferred Network Access Commercial |
$1,519.40
|
| Rate for Payer: Quartz Beloit One Network |
$809.24
|
| Rate for Payer: Quartz Commercial |
$1,073.49
|
| Rate for Payer: Quartz Medicare Advantage |
$990.91
|
| Rate for Payer: The Alliance Commercial |
$825.76
|
| Rate for Payer: WEA Trust Commercial |
$908.34
|
| Rate for Payer: WPS Commercial |
$1,223.24
|
|
|
PLATE LC-DCP 2.0MM 6H/39MM 243.586
|
Facility
|
OP
|
$4,306.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508861
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,253.91 |
| Max. Negotiated Rate |
$4,119.98 |
| Rate for Payer: Aetna Commercial |
$4,030.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,851.29
|
| Rate for Payer: Aetna Managed Medicare |
$1,253.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,910.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,239.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,149.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,373.47
|
| Rate for Payer: Cash Price |
$1,291.80
|
| Rate for Payer: Cigna Commercial |
$4,119.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,506.09
|
| Rate for Payer: Health EOS Commercial |
$3,985.63
|
| Rate for Payer: HFN Commercial |
$4,119.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,358.68
|
| Rate for Payer: Multiplan Commercial |
$3,582.59
|
| Rate for Payer: NAPHCARE Commercial |
$2,686.94
|
| Rate for Payer: Preferred Network Access Commercial |
$4,119.98
|
| Rate for Payer: Quartz Beloit One Network |
$2,194.34
|
| Rate for Payer: Quartz Commercial |
$2,910.86
|
| Rate for Payer: Quartz Medicare Advantage |
$2,686.94
|
| Rate for Payer: The Alliance Commercial |
$2,239.12
|
| Rate for Payer: WEA Trust Commercial |
$2,463.03
|
| Rate for Payer: WPS Commercial |
$3,316.91
|
|
|
PLATE LC-DCP 2.0MM 6H/39MM 243.586
|
Facility
|
IP
|
$4,306.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508861
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,194.34 |
| Max. Negotiated Rate |
$4,119.98 |
| Rate for Payer: Aetna Commercial |
$4,030.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,851.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,373.47
|
| Rate for Payer: Cash Price |
$1,291.80
|
| Rate for Payer: Cigna Commercial |
$4,119.98
|
| Rate for Payer: Health EOS Commercial |
$3,985.63
|
| Rate for Payer: HFN Commercial |
$4,119.98
|
| Rate for Payer: Multiplan Commercial |
$3,582.59
|
| Rate for Payer: Preferred Network Access Commercial |
$4,119.98
|
| Rate for Payer: Quartz Beloit One Network |
$2,194.34
|
| Rate for Payer: Quartz Commercial |
$2,686.94
|
| Rate for Payer: WEA Trust Commercial |
$2,463.03
|
| Rate for Payer: WPS Commercial |
$3,316.91
|
|
|
PLATE LC-DCP 2.4MM 4HL 249.924
|
Facility
|
IP
|
$3,350.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508778
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,707.16 |
| Max. Negotiated Rate |
$3,205.28 |
| Rate for Payer: Aetna Commercial |
$3,135.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,996.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,846.52
|
| Rate for Payer: Cash Price |
$1,005.00
|
| Rate for Payer: Cigna Commercial |
$3,205.28
|
| Rate for Payer: Health EOS Commercial |
$3,100.76
|
| Rate for Payer: HFN Commercial |
$3,205.28
|
| Rate for Payer: Multiplan Commercial |
$2,787.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,205.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,707.16
|
| Rate for Payer: Quartz Commercial |
$2,090.40
|
| Rate for Payer: WEA Trust Commercial |
$1,916.20
|
| Rate for Payer: WPS Commercial |
$2,580.51
|
|
|
PLATE LC-DCP 2.4MM 4HL 249.924
|
Facility
|
OP
|
$3,350.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508778
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$975.52 |
| Max. Negotiated Rate |
$3,205.28 |
| Rate for Payer: Aetna Commercial |
$3,135.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,996.24
|
| Rate for Payer: Aetna Managed Medicare |
$975.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,264.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,742.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,672.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,846.52
|
| Rate for Payer: Cash Price |
$1,005.00
|
| Rate for Payer: Cigna Commercial |
$3,205.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,949.70
|
| Rate for Payer: Health EOS Commercial |
$3,100.76
|
| Rate for Payer: HFN Commercial |
$3,205.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,613.00
|
| Rate for Payer: Multiplan Commercial |
$2,787.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,090.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,205.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,707.16
|
| Rate for Payer: Quartz Commercial |
$2,264.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2,090.40
|
| Rate for Payer: The Alliance Commercial |
$1,742.00
|
| Rate for Payer: WEA Trust Commercial |
$1,916.20
|
| Rate for Payer: WPS Commercial |
$2,580.51
|
|
|
PLATE LC-DCP 2.4MM 6HL 249.926
|
Facility
|
IP
|
$5,537.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508779
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,821.66 |
| Max. Negotiated Rate |
$5,297.80 |
| Rate for Payer: Aetna Commercial |
$5,182.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,952.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,051.99
|
| Rate for Payer: Cash Price |
$1,661.10
|
| Rate for Payer: Cigna Commercial |
$5,297.80
|
| Rate for Payer: Health EOS Commercial |
$5,125.05
|
| Rate for Payer: HFN Commercial |
$5,297.80
|
| Rate for Payer: Multiplan Commercial |
$4,606.78
|
| Rate for Payer: Preferred Network Access Commercial |
$5,297.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,821.66
|
| Rate for Payer: Quartz Commercial |
$3,455.09
|
| Rate for Payer: WEA Trust Commercial |
$3,167.16
|
| Rate for Payer: WPS Commercial |
$4,265.15
|
|
|
PLATE LC-DCP 2.4MM 6HL 249.926
|
Facility
|
OP
|
$5,537.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508779
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,612.37 |
| Max. Negotiated Rate |
$5,297.80 |
| Rate for Payer: Aetna Commercial |
$5,182.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,952.29
|
| Rate for Payer: Aetna Managed Medicare |
$1,612.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,743.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,879.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,764.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,051.99
|
| Rate for Payer: Cash Price |
$1,661.10
|
| Rate for Payer: Cigna Commercial |
$5,297.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,222.53
|
| Rate for Payer: Health EOS Commercial |
$5,125.05
|
| Rate for Payer: HFN Commercial |
$5,297.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,318.86
|
| Rate for Payer: Multiplan Commercial |
$4,606.78
|
| Rate for Payer: NAPHCARE Commercial |
$3,455.09
|
| Rate for Payer: Preferred Network Access Commercial |
$5,297.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,821.66
|
| Rate for Payer: Quartz Commercial |
$3,743.01
|
| Rate for Payer: Quartz Medicare Advantage |
$3,455.09
|
| Rate for Payer: The Alliance Commercial |
$2,879.24
|
| Rate for Payer: WEA Trust Commercial |
$3,167.16
|
| Rate for Payer: WPS Commercial |
$4,265.15
|
|
|
PLATE LC-DCP 2.4MM 8HL 249.928
|
Facility
|
IP
|
$3,795.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508780
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,933.93 |
| Max. Negotiated Rate |
$3,631.06 |
| Rate for Payer: Aetna Commercial |
$3,552.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,394.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,091.80
|
| Rate for Payer: Cash Price |
$1,138.50
|
| Rate for Payer: Cigna Commercial |
$3,631.06
|
| Rate for Payer: Health EOS Commercial |
$3,512.65
|
| Rate for Payer: HFN Commercial |
$3,631.06
|
| Rate for Payer: Multiplan Commercial |
$3,157.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,631.06
|
| Rate for Payer: Quartz Beloit One Network |
$1,933.93
|
| Rate for Payer: Quartz Commercial |
$2,368.08
|
| Rate for Payer: WEA Trust Commercial |
$2,170.74
|
| Rate for Payer: WPS Commercial |
$2,923.29
|
|
|
PLATE LC-DCP 2.4MM 8HL 249.928
|
Facility
|
OP
|
$3,795.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508780
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,105.10 |
| Max. Negotiated Rate |
$3,631.06 |
| Rate for Payer: Aetna Commercial |
$3,552.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,394.25
|
| Rate for Payer: Aetna Managed Medicare |
$1,105.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,565.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,973.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,894.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,091.80
|
| Rate for Payer: Cash Price |
$1,138.50
|
| Rate for Payer: Cigna Commercial |
$3,631.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,208.69
|
| Rate for Payer: Health EOS Commercial |
$3,512.65
|
| Rate for Payer: HFN Commercial |
$3,631.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,960.10
|
| Rate for Payer: Multiplan Commercial |
$3,157.44
|
| Rate for Payer: NAPHCARE Commercial |
$2,368.08
|
| Rate for Payer: Preferred Network Access Commercial |
$3,631.06
|
| Rate for Payer: Quartz Beloit One Network |
$1,933.93
|
| Rate for Payer: Quartz Commercial |
$2,565.42
|
| Rate for Payer: Quartz Medicare Advantage |
$2,368.08
|
| Rate for Payer: The Alliance Commercial |
$1,973.40
|
| Rate for Payer: WEA Trust Commercial |
$2,170.74
|
| Rate for Payer: WPS Commercial |
$2,923.29
|
|
|
PLATE LCP 1.5MM 6HL WITH GUIDES 02.114.504S
|
Facility
|
IP
|
$3,694.00
|
|
| Hospital Charge Code |
2966316
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,882.46 |
| Max. Negotiated Rate |
$3,534.42 |
| Rate for Payer: Aetna Commercial |
$3,457.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,303.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,036.13
|
| Rate for Payer: Cash Price |
$1,108.20
|
| Rate for Payer: Cigna Commercial |
$3,534.42
|
| Rate for Payer: Health EOS Commercial |
$3,419.17
|
| Rate for Payer: HFN Commercial |
$3,534.42
|
| Rate for Payer: Multiplan Commercial |
$3,073.41
|
| Rate for Payer: Preferred Network Access Commercial |
$3,534.42
|
| Rate for Payer: Quartz Beloit One Network |
$1,882.46
|
| Rate for Payer: Quartz Commercial |
$2,305.06
|
| Rate for Payer: WEA Trust Commercial |
$2,112.97
|
| Rate for Payer: WPS Commercial |
$2,845.49
|
|
|
PLATE LCP 1.5MM 6HL WITH GUIDES 02.114.504S
|
Facility
|
OP
|
$3,694.00
|
|
| Hospital Charge Code |
2966316
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.69 |
| Max. Negotiated Rate |
$3,534.42 |
| Rate for Payer: Aetna Commercial |
$3,457.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,303.91
|
| Rate for Payer: Aetna Managed Medicare |
$1,075.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,497.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,920.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,844.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,036.13
|
| Rate for Payer: Cash Price |
$1,108.20
|
| Rate for Payer: Cigna Commercial |
$3,534.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,149.91
|
| Rate for Payer: Health EOS Commercial |
$3,419.17
|
| Rate for Payer: HFN Commercial |
$3,534.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,881.32
|
| Rate for Payer: Multiplan Commercial |
$3,073.41
|
| Rate for Payer: NAPHCARE Commercial |
$2,305.06
|
| Rate for Payer: Preferred Network Access Commercial |
$3,534.42
|
| Rate for Payer: Quartz Beloit One Network |
$1,882.46
|
| Rate for Payer: Quartz Commercial |
$2,497.14
|
| Rate for Payer: Quartz Medicare Advantage |
$2,305.06
|
| Rate for Payer: The Alliance Commercial |
$1,920.88
|
| Rate for Payer: WEA Trust Commercial |
$2,112.97
|
| Rate for Payer: WPS Commercial |
$2,845.49
|
|
|
PLATE LCP 2.0 10HL 247.360
|
Facility
|
OP
|
$2,227.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767797
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$648.50 |
| Max. Negotiated Rate |
$2,130.79 |
| Rate for Payer: Aetna Commercial |
$2,084.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,991.83
|
| Rate for Payer: Aetna Managed Medicare |
$648.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,505.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,158.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,111.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,227.52
|
| Rate for Payer: Cash Price |
$668.10
|
| Rate for Payer: Cigna Commercial |
$2,130.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,296.11
|
| Rate for Payer: Health EOS Commercial |
$2,061.31
|
| Rate for Payer: HFN Commercial |
$2,130.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,737.06
|
| Rate for Payer: Multiplan Commercial |
$1,852.86
|
| Rate for Payer: NAPHCARE Commercial |
$1,389.65
|
| Rate for Payer: Preferred Network Access Commercial |
$2,130.79
|
| Rate for Payer: Quartz Beloit One Network |
$1,134.88
|
| Rate for Payer: Quartz Commercial |
$1,505.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,389.65
|
| Rate for Payer: The Alliance Commercial |
$1,158.04
|
| Rate for Payer: WEA Trust Commercial |
$1,273.84
|
| Rate for Payer: WPS Commercial |
$1,715.46
|
|
|
PLATE LCP 2.0 10HL 247.360
|
Facility
|
IP
|
$2,227.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767797
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,134.88 |
| Max. Negotiated Rate |
$2,130.79 |
| Rate for Payer: Aetna Commercial |
$2,084.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,991.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,227.52
|
| Rate for Payer: Cash Price |
$668.10
|
| Rate for Payer: Cigna Commercial |
$2,130.79
|
| Rate for Payer: Health EOS Commercial |
$2,061.31
|
| Rate for Payer: HFN Commercial |
$2,130.79
|
| Rate for Payer: Multiplan Commercial |
$1,852.86
|
| Rate for Payer: Preferred Network Access Commercial |
$2,130.79
|
| Rate for Payer: Quartz Beloit One Network |
$1,134.88
|
| Rate for Payer: Quartz Commercial |
$1,389.65
|
| Rate for Payer: WEA Trust Commercial |
$1,273.84
|
| Rate for Payer: WPS Commercial |
$1,715.46
|
|
|
PLATE LCP 2.0 4HL 247.344
|
Facility
|
IP
|
$3,929.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966322
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,002.22 |
| Max. Negotiated Rate |
$3,759.27 |
| Rate for Payer: Aetna Commercial |
$3,677.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,514.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,165.66
|
| Rate for Payer: Cash Price |
$1,178.70
|
| Rate for Payer: Cigna Commercial |
$3,759.27
|
| Rate for Payer: Health EOS Commercial |
$3,636.68
|
| Rate for Payer: HFN Commercial |
$3,759.27
|
| Rate for Payer: Multiplan Commercial |
$3,268.93
|
| Rate for Payer: Preferred Network Access Commercial |
$3,759.27
|
| Rate for Payer: Quartz Beloit One Network |
$2,002.22
|
| Rate for Payer: Quartz Commercial |
$2,451.70
|
| Rate for Payer: WEA Trust Commercial |
$2,247.39
|
| Rate for Payer: WPS Commercial |
$3,026.51
|
|
|
PLATE LCP 2.0 4HL 247.344
|
Facility
|
OP
|
$3,929.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966322
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,144.12 |
| Max. Negotiated Rate |
$3,759.27 |
| Rate for Payer: Aetna Commercial |
$3,677.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,514.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,144.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,656.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,043.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,961.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,165.66
|
| Rate for Payer: Cash Price |
$1,178.70
|
| Rate for Payer: Cigna Commercial |
$3,759.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,286.68
|
| Rate for Payer: Health EOS Commercial |
$3,636.68
|
| Rate for Payer: HFN Commercial |
$3,759.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,064.62
|
| Rate for Payer: Multiplan Commercial |
$3,268.93
|
| Rate for Payer: NAPHCARE Commercial |
$2,451.70
|
| Rate for Payer: Preferred Network Access Commercial |
$3,759.27
|
| Rate for Payer: Quartz Beloit One Network |
$2,002.22
|
| Rate for Payer: Quartz Commercial |
$2,656.00
|
| Rate for Payer: Quartz Medicare Advantage |
$2,451.70
|
| Rate for Payer: The Alliance Commercial |
$2,043.08
|
| Rate for Payer: WEA Trust Commercial |
$2,247.39
|
| Rate for Payer: WPS Commercial |
$3,026.51
|
|
|
PLATE LCP 2.0 5HL 247.345
|
Facility
|
OP
|
$3,039.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966320
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$884.96 |
| Max. Negotiated Rate |
$2,907.72 |
| Rate for Payer: Aetna Commercial |
$2,844.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,718.08
|
| Rate for Payer: Aetna Managed Medicare |
$884.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,054.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,580.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,517.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,675.10
|
| Rate for Payer: Cash Price |
$911.70
|
| Rate for Payer: Cigna Commercial |
$2,907.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,768.70
|
| Rate for Payer: Health EOS Commercial |
$2,812.90
|
| Rate for Payer: HFN Commercial |
$2,907.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,370.42
|
| Rate for Payer: Multiplan Commercial |
$2,528.45
|
| Rate for Payer: NAPHCARE Commercial |
$1,896.34
|
| Rate for Payer: Preferred Network Access Commercial |
$2,907.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,548.67
|
| Rate for Payer: Quartz Commercial |
$2,054.36
|
| Rate for Payer: Quartz Medicare Advantage |
$1,896.34
|
| Rate for Payer: The Alliance Commercial |
$1,580.28
|
| Rate for Payer: WEA Trust Commercial |
$1,738.31
|
| Rate for Payer: WPS Commercial |
$2,340.94
|
|
|
PLATE LCP 2.0 5HL 247.345
|
Facility
|
IP
|
$3,039.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966320
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,548.67 |
| Max. Negotiated Rate |
$2,907.72 |
| Rate for Payer: Aetna Commercial |
$2,844.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,718.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,675.10
|
| Rate for Payer: Cash Price |
$911.70
|
| Rate for Payer: Cigna Commercial |
$2,907.72
|
| Rate for Payer: Health EOS Commercial |
$2,812.90
|
| Rate for Payer: HFN Commercial |
$2,907.72
|
| Rate for Payer: Multiplan Commercial |
$2,528.45
|
| Rate for Payer: Preferred Network Access Commercial |
$2,907.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,548.67
|
| Rate for Payer: Quartz Commercial |
$1,896.34
|
| Rate for Payer: WEA Trust Commercial |
$1,738.31
|
| Rate for Payer: WPS Commercial |
$2,340.94
|
|
|
PLATE LCP 2.0 6HL 247.346
|
Facility
|
OP
|
$2,227.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767794
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$648.50 |
| Max. Negotiated Rate |
$2,130.79 |
| Rate for Payer: Aetna Commercial |
$2,084.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,991.83
|
| Rate for Payer: Aetna Managed Medicare |
$648.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,505.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,158.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,111.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,227.52
|
| Rate for Payer: Cash Price |
$668.10
|
| Rate for Payer: Cigna Commercial |
$2,130.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,296.11
|
| Rate for Payer: Health EOS Commercial |
$2,061.31
|
| Rate for Payer: HFN Commercial |
$2,130.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,737.06
|
| Rate for Payer: Multiplan Commercial |
$1,852.86
|
| Rate for Payer: NAPHCARE Commercial |
$1,389.65
|
| Rate for Payer: Preferred Network Access Commercial |
$2,130.79
|
| Rate for Payer: Quartz Beloit One Network |
$1,134.88
|
| Rate for Payer: Quartz Commercial |
$1,505.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,389.65
|
| Rate for Payer: The Alliance Commercial |
$1,158.04
|
| Rate for Payer: WEA Trust Commercial |
$1,273.84
|
| Rate for Payer: WPS Commercial |
$1,715.46
|
|
