|
PLATE AMBI 135DEG 2HL 124121
|
Facility
|
IP
|
$7,922.00
|
|
| Hospital Charge Code |
4494005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,881.78 |
| Max. Negotiated Rate |
$7,288.24 |
| Rate for Payer: Aetna Commercial |
$7,129.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,812.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,198.66
|
| Rate for Payer: Cash Price |
$2,376.60
|
| Rate for Payer: Cigna Commercial |
$7,288.24
|
| Rate for Payer: Health EOS Commercial |
$7,050.58
|
| Rate for Payer: HFN Commercial |
$7,288.24
|
| Rate for Payer: Multiplan Commercial |
$6,337.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,753.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,288.24
|
| Rate for Payer: Quartz Beloit One Network |
$3,881.78
|
| Rate for Payer: Quartz Commercial |
$4,753.20
|
| Rate for Payer: WEA Trust Commercial |
$4,357.10
|
| Rate for Payer: WPS Commercial |
$5,867.83
|
|
|
PLATE AMBI 135DEG 2HL 124121
|
Facility
|
OP
|
$7,922.00
|
|
| Hospital Charge Code |
4494005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,218.16 |
| Max. Negotiated Rate |
$31,688.00 |
| Rate for Payer: Aetna Commercial |
$7,129.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,812.92
|
| Rate for Payer: Aetna Managed Medicare |
$2,218.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,149.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,961.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,802.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,198.66
|
| Rate for Payer: Cash Price |
$2,376.60
|
| Rate for Payer: Cigna Commercial |
$7,288.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,433.15
|
| Rate for Payer: Health EOS Commercial |
$7,050.58
|
| Rate for Payer: HFN Commercial |
$7,288.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,941.50
|
| Rate for Payer: Multiplan Commercial |
$6,337.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,753.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,288.24
|
| Rate for Payer: Quartz Beloit One Network |
$3,881.78
|
| Rate for Payer: Quartz Commercial |
$5,149.30
|
| Rate for Payer: Quartz Medicare Advantage |
$4,753.20
|
| Rate for Payer: The Alliance Commercial |
$31,688.00
|
| Rate for Payer: WEA Trust Commercial |
$4,357.10
|
| Rate for Payer: WPS Commercial |
$5,867.83
|
|
|
PLATE AMBI 135DEG 3HL 124126
|
Facility
|
IP
|
$3,707.00
|
|
| Hospital Charge Code |
2966021
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,816.43 |
| Max. Negotiated Rate |
$3,410.44 |
| Rate for Payer: Aetna Commercial |
$3,336.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,188.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,964.71
|
| Rate for Payer: Cash Price |
$1,112.10
|
| Rate for Payer: Cigna Commercial |
$3,410.44
|
| Rate for Payer: Health EOS Commercial |
$3,299.23
|
| Rate for Payer: HFN Commercial |
$3,410.44
|
| Rate for Payer: Multiplan Commercial |
$2,965.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,224.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,410.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,816.43
|
| Rate for Payer: Quartz Commercial |
$2,224.20
|
| Rate for Payer: WEA Trust Commercial |
$2,038.85
|
| Rate for Payer: WPS Commercial |
$2,745.77
|
|
|
PLATE AMBI 135DEG 3HL 124126
|
Facility
|
OP
|
$3,707.00
|
|
| Hospital Charge Code |
2966021
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,037.96 |
| Max. Negotiated Rate |
$14,828.00 |
| Rate for Payer: Aetna Commercial |
$3,336.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,188.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,037.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,409.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,853.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,779.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,964.71
|
| Rate for Payer: Cash Price |
$1,112.10
|
| Rate for Payer: Cigna Commercial |
$3,410.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,074.44
|
| Rate for Payer: Health EOS Commercial |
$3,299.23
|
| Rate for Payer: HFN Commercial |
$3,410.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,780.25
|
| Rate for Payer: Multiplan Commercial |
$2,965.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,224.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,410.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,816.43
|
| Rate for Payer: Quartz Commercial |
$2,409.55
|
| Rate for Payer: Quartz Medicare Advantage |
$2,224.20
|
| Rate for Payer: The Alliance Commercial |
$14,828.00
|
| Rate for Payer: WEA Trust Commercial |
$2,038.85
|
| Rate for Payer: WPS Commercial |
$2,745.77
|
|
|
PLATE AMBI 135DEG 4HL 124131
|
Facility
|
IP
|
$3,707.00
|
|
| Hospital Charge Code |
2966022
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,816.43 |
| Max. Negotiated Rate |
$3,410.44 |
| Rate for Payer: Aetna Commercial |
$3,336.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,188.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,964.71
|
| Rate for Payer: Cash Price |
$1,112.10
|
| Rate for Payer: Cigna Commercial |
$3,410.44
|
| Rate for Payer: Health EOS Commercial |
$3,299.23
|
| Rate for Payer: HFN Commercial |
$3,410.44
|
| Rate for Payer: Multiplan Commercial |
$2,965.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,224.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,410.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,816.43
|
| Rate for Payer: Quartz Commercial |
$2,224.20
|
| Rate for Payer: WEA Trust Commercial |
$2,038.85
|
| Rate for Payer: WPS Commercial |
$2,745.77
|
|
|
PLATE AMBI 135DEG 4HL 124131
|
Facility
|
OP
|
$3,707.00
|
|
| Hospital Charge Code |
2966022
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,037.96 |
| Max. Negotiated Rate |
$14,828.00 |
| Rate for Payer: Aetna Commercial |
$3,336.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,188.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,037.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,409.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,853.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,779.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,964.71
|
| Rate for Payer: Cash Price |
$1,112.10
|
| Rate for Payer: Cigna Commercial |
$3,410.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,074.44
|
| Rate for Payer: Health EOS Commercial |
$3,299.23
|
| Rate for Payer: HFN Commercial |
$3,410.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,780.25
|
| Rate for Payer: Multiplan Commercial |
$2,965.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,224.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,410.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,816.43
|
| Rate for Payer: Quartz Commercial |
$2,409.55
|
| Rate for Payer: Quartz Medicare Advantage |
$2,224.20
|
| Rate for Payer: The Alliance Commercial |
$14,828.00
|
| Rate for Payer: WEA Trust Commercial |
$2,038.85
|
| Rate for Payer: WPS Commercial |
$2,745.77
|
|
|
PLATE AMBI 135DEG 5HL 124136
|
Facility
|
OP
|
$3,967.00
|
|
| Hospital Charge Code |
2966023
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,110.76 |
| Max. Negotiated Rate |
$15,868.00 |
| Rate for Payer: Aetna Commercial |
$3,570.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,411.62
|
| Rate for Payer: Aetna Managed Medicare |
$1,110.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,578.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,983.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,904.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,102.51
|
| Rate for Payer: Cash Price |
$1,190.10
|
| Rate for Payer: Cigna Commercial |
$3,649.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,219.93
|
| Rate for Payer: Health EOS Commercial |
$3,530.63
|
| Rate for Payer: HFN Commercial |
$3,649.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,975.25
|
| Rate for Payer: Multiplan Commercial |
$3,173.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,380.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,649.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,943.83
|
| Rate for Payer: Quartz Commercial |
$2,578.55
|
| Rate for Payer: Quartz Medicare Advantage |
$2,380.20
|
| Rate for Payer: The Alliance Commercial |
$15,868.00
|
| Rate for Payer: WEA Trust Commercial |
$2,181.85
|
| Rate for Payer: WPS Commercial |
$2,938.36
|
|
|
PLATE AMBI 135DEG 5HL 124136
|
Facility
|
IP
|
$3,967.00
|
|
| Hospital Charge Code |
2966023
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,943.83 |
| Max. Negotiated Rate |
$3,649.64 |
| Rate for Payer: Aetna Commercial |
$3,570.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,411.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,102.51
|
| Rate for Payer: Cash Price |
$1,190.10
|
| Rate for Payer: Cigna Commercial |
$3,649.64
|
| Rate for Payer: Health EOS Commercial |
$3,530.63
|
| Rate for Payer: HFN Commercial |
$3,649.64
|
| Rate for Payer: Multiplan Commercial |
$3,173.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,380.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,649.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,943.83
|
| Rate for Payer: Quartz Commercial |
$2,380.20
|
| Rate for Payer: WEA Trust Commercial |
$2,181.85
|
| Rate for Payer: WPS Commercial |
$2,938.36
|
|
|
PLATE AMBI 135DEG 6HL 124141
|
Facility
|
OP
|
$4,103.00
|
|
| Hospital Charge Code |
2966024
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,148.84 |
| Max. Negotiated Rate |
$16,412.00 |
| Rate for Payer: Aetna Commercial |
$3,692.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,528.58
|
| Rate for Payer: Aetna Managed Medicare |
$1,148.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,666.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,051.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,969.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,174.59
|
| Rate for Payer: Cash Price |
$1,230.90
|
| Rate for Payer: Cigna Commercial |
$3,774.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,296.04
|
| Rate for Payer: Health EOS Commercial |
$3,651.67
|
| Rate for Payer: HFN Commercial |
$3,774.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,077.25
|
| Rate for Payer: Multiplan Commercial |
$3,282.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,461.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,774.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,010.47
|
| Rate for Payer: Quartz Commercial |
$2,666.95
|
| Rate for Payer: Quartz Medicare Advantage |
$2,461.80
|
| Rate for Payer: The Alliance Commercial |
$16,412.00
|
| Rate for Payer: WEA Trust Commercial |
$2,256.65
|
| Rate for Payer: WPS Commercial |
$3,039.09
|
|
|
PLATE AMBI 135DEG 6HL 124141
|
Facility
|
IP
|
$4,103.00
|
|
| Hospital Charge Code |
2966024
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,010.47 |
| Max. Negotiated Rate |
$3,774.76 |
| Rate for Payer: Aetna Commercial |
$3,692.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,528.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,174.59
|
| Rate for Payer: Cash Price |
$1,230.90
|
| Rate for Payer: Cigna Commercial |
$3,774.76
|
| Rate for Payer: Health EOS Commercial |
$3,651.67
|
| Rate for Payer: HFN Commercial |
$3,774.76
|
| Rate for Payer: Multiplan Commercial |
$3,282.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,461.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,774.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,010.47
|
| Rate for Payer: Quartz Commercial |
$2,461.80
|
| Rate for Payer: WEA Trust Commercial |
$2,256.65
|
| Rate for Payer: WPS Commercial |
$3,039.09
|
|
|
PLATE AMBI 135DEG 8HL 124146
|
Facility
|
IP
|
$3,747.00
|
|
| Hospital Charge Code |
2966032
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,836.03 |
| Max. Negotiated Rate |
$3,447.24 |
| Rate for Payer: Aetna Commercial |
$3,372.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,222.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,985.91
|
| Rate for Payer: Cash Price |
$1,124.10
|
| Rate for Payer: Cigna Commercial |
$3,447.24
|
| Rate for Payer: Health EOS Commercial |
$3,334.83
|
| Rate for Payer: HFN Commercial |
$3,447.24
|
| Rate for Payer: Multiplan Commercial |
$2,997.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,248.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,447.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,836.03
|
| Rate for Payer: Quartz Commercial |
$2,248.20
|
| Rate for Payer: WEA Trust Commercial |
$2,060.85
|
| Rate for Payer: WPS Commercial |
$2,775.40
|
|
|
PLATE AMBI 135DEG 8HL 124146
|
Facility
|
OP
|
$3,747.00
|
|
| Hospital Charge Code |
2966032
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,049.16 |
| Max. Negotiated Rate |
$14,988.00 |
| Rate for Payer: Aetna Commercial |
$3,372.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,222.42
|
| Rate for Payer: Aetna Managed Medicare |
$1,049.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,435.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,873.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,798.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,985.91
|
| Rate for Payer: Cash Price |
$1,124.10
|
| Rate for Payer: Cigna Commercial |
$3,447.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,096.82
|
| Rate for Payer: Health EOS Commercial |
$3,334.83
|
| Rate for Payer: HFN Commercial |
$3,447.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,810.25
|
| Rate for Payer: Multiplan Commercial |
$2,997.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,248.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,447.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,836.03
|
| Rate for Payer: Quartz Commercial |
$2,435.55
|
| Rate for Payer: Quartz Medicare Advantage |
$2,248.20
|
| Rate for Payer: The Alliance Commercial |
$14,988.00
|
| Rate for Payer: WEA Trust Commercial |
$2,060.85
|
| Rate for Payer: WPS Commercial |
$2,775.40
|
|
|
PLATE AMBI 140DEG 4HL 124132
|
Facility
|
OP
|
$3,580.00
|
|
| Hospital Charge Code |
2966025
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,002.40 |
| Max. Negotiated Rate |
$14,320.00 |
| Rate for Payer: Aetna Commercial |
$3,222.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,078.80
|
| Rate for Payer: Aetna Managed Medicare |
$1,002.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,327.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,790.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,718.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,897.40
|
| Rate for Payer: Cash Price |
$1,074.00
|
| Rate for Payer: Cigna Commercial |
$3,293.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,003.37
|
| Rate for Payer: Health EOS Commercial |
$3,186.20
|
| Rate for Payer: HFN Commercial |
$3,293.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,685.00
|
| Rate for Payer: Multiplan Commercial |
$2,864.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,148.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,293.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,754.20
|
| Rate for Payer: Quartz Commercial |
$2,327.00
|
| Rate for Payer: Quartz Medicare Advantage |
$2,148.00
|
| Rate for Payer: The Alliance Commercial |
$14,320.00
|
| Rate for Payer: WEA Trust Commercial |
$1,969.00
|
| Rate for Payer: WPS Commercial |
$2,651.71
|
|
|
PLATE AMBI 140DEG 4HL 124132
|
Facility
|
IP
|
$3,580.00
|
|
| Hospital Charge Code |
2966025
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,754.20 |
| Max. Negotiated Rate |
$3,293.60 |
| Rate for Payer: Aetna Commercial |
$3,222.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,078.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,897.40
|
| Rate for Payer: Cash Price |
$1,074.00
|
| Rate for Payer: Cigna Commercial |
$3,293.60
|
| Rate for Payer: Health EOS Commercial |
$3,186.20
|
| Rate for Payer: HFN Commercial |
$3,293.60
|
| Rate for Payer: Multiplan Commercial |
$2,864.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,148.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,293.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,754.20
|
| Rate for Payer: Quartz Commercial |
$2,148.00
|
| Rate for Payer: WEA Trust Commercial |
$1,969.00
|
| Rate for Payer: WPS Commercial |
$2,651.71
|
|
|
PLATE AMBI 140DEG 5HL 124137
|
Facility
|
IP
|
$3,447.00
|
|
| Hospital Charge Code |
2966026
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,689.03 |
| Max. Negotiated Rate |
$3,171.24 |
| Rate for Payer: Aetna Commercial |
$3,102.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,964.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,826.91
|
| Rate for Payer: Cash Price |
$1,034.10
|
| Rate for Payer: Cigna Commercial |
$3,171.24
|
| Rate for Payer: Health EOS Commercial |
$3,067.83
|
| Rate for Payer: HFN Commercial |
$3,171.24
|
| Rate for Payer: Multiplan Commercial |
$2,757.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,068.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,171.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,689.03
|
| Rate for Payer: Quartz Commercial |
$2,068.20
|
| Rate for Payer: WEA Trust Commercial |
$1,895.85
|
| Rate for Payer: WPS Commercial |
$2,553.19
|
|
|
PLATE AMBI 140DEG 5HL 124137
|
Facility
|
OP
|
$3,447.00
|
|
| Hospital Charge Code |
2966026
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$965.16 |
| Max. Negotiated Rate |
$13,788.00 |
| Rate for Payer: Aetna Commercial |
$3,102.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,964.42
|
| Rate for Payer: Aetna Managed Medicare |
$965.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,240.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,723.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,654.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,826.91
|
| Rate for Payer: Cash Price |
$1,034.10
|
| Rate for Payer: Cigna Commercial |
$3,171.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,928.94
|
| Rate for Payer: Health EOS Commercial |
$3,067.83
|
| Rate for Payer: HFN Commercial |
$3,171.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,585.25
|
| Rate for Payer: Multiplan Commercial |
$2,757.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,068.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,171.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,689.03
|
| Rate for Payer: Quartz Commercial |
$2,240.55
|
| Rate for Payer: Quartz Medicare Advantage |
$2,068.20
|
| Rate for Payer: The Alliance Commercial |
$13,788.00
|
| Rate for Payer: WEA Trust Commercial |
$1,895.85
|
| Rate for Payer: WPS Commercial |
$2,553.19
|
|
|
PLATE AMBI 145DEG 6HL 124143
|
Facility
|
IP
|
$3,447.00
|
|
| Hospital Charge Code |
2966027
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,689.03 |
| Max. Negotiated Rate |
$3,171.24 |
| Rate for Payer: Aetna Commercial |
$3,102.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,964.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,826.91
|
| Rate for Payer: Cash Price |
$1,034.10
|
| Rate for Payer: Cigna Commercial |
$3,171.24
|
| Rate for Payer: Health EOS Commercial |
$3,067.83
|
| Rate for Payer: HFN Commercial |
$3,171.24
|
| Rate for Payer: Multiplan Commercial |
$2,757.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,068.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,171.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,689.03
|
| Rate for Payer: Quartz Commercial |
$2,068.20
|
| Rate for Payer: WEA Trust Commercial |
$1,895.85
|
| Rate for Payer: WPS Commercial |
$2,553.19
|
|
|
PLATE AMBI 145DEG 6HL 124143
|
Facility
|
OP
|
$3,447.00
|
|
| Hospital Charge Code |
2966027
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$965.16 |
| Max. Negotiated Rate |
$13,788.00 |
| Rate for Payer: Aetna Commercial |
$3,102.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,964.42
|
| Rate for Payer: Aetna Managed Medicare |
$965.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,240.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,723.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,654.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,826.91
|
| Rate for Payer: Cash Price |
$1,034.10
|
| Rate for Payer: Cigna Commercial |
$3,171.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,928.94
|
| Rate for Payer: Health EOS Commercial |
$3,067.83
|
| Rate for Payer: HFN Commercial |
$3,171.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,585.25
|
| Rate for Payer: Multiplan Commercial |
$2,757.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,068.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,171.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,689.03
|
| Rate for Payer: Quartz Commercial |
$2,240.55
|
| Rate for Payer: Quartz Medicare Advantage |
$2,068.20
|
| Rate for Payer: The Alliance Commercial |
$13,788.00
|
| Rate for Payer: WEA Trust Commercial |
$1,895.85
|
| Rate for Payer: WPS Commercial |
$2,553.19
|
|
|
PLATE AMBI 150DEG 5HL 124139
|
Facility
|
IP
|
$3,072.00
|
|
| Hospital Charge Code |
2966028
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,505.28 |
| Max. Negotiated Rate |
$2,826.24 |
| Rate for Payer: Aetna Commercial |
$2,764.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,641.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,628.16
|
| Rate for Payer: Cash Price |
$921.60
|
| Rate for Payer: Cigna Commercial |
$2,826.24
|
| Rate for Payer: Health EOS Commercial |
$2,734.08
|
| Rate for Payer: HFN Commercial |
$2,826.24
|
| Rate for Payer: Multiplan Commercial |
$2,457.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,843.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,826.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,505.28
|
| Rate for Payer: Quartz Commercial |
$1,843.20
|
| Rate for Payer: WEA Trust Commercial |
$1,689.60
|
| Rate for Payer: WPS Commercial |
$2,275.43
|
|
|
PLATE AMBI 150DEG 5HL 124139
|
Facility
|
OP
|
$3,072.00
|
|
| Hospital Charge Code |
2966028
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$860.16 |
| Max. Negotiated Rate |
$12,288.00 |
| Rate for Payer: Aetna Commercial |
$2,764.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,641.92
|
| Rate for Payer: Aetna Managed Medicare |
$860.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,996.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,536.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,474.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,628.16
|
| Rate for Payer: Cash Price |
$921.60
|
| Rate for Payer: Cigna Commercial |
$2,826.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,719.09
|
| Rate for Payer: Health EOS Commercial |
$2,734.08
|
| Rate for Payer: HFN Commercial |
$2,826.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,304.00
|
| Rate for Payer: Multiplan Commercial |
$2,457.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,843.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,826.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,505.28
|
| Rate for Payer: Quartz Commercial |
$1,996.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,843.20
|
| Rate for Payer: The Alliance Commercial |
$12,288.00
|
| Rate for Payer: WEA Trust Commercial |
$1,689.60
|
| Rate for Payer: WPS Commercial |
$2,275.43
|
|
|
PLATE AMBI SUPRACON 90DEG 8HL 124170
|
Facility
|
OP
|
$3,119.00
|
|
| Hospital Charge Code |
2966033
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$873.32 |
| Max. Negotiated Rate |
$12,476.00 |
| Rate for Payer: Aetna Commercial |
$2,807.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,682.34
|
| Rate for Payer: Aetna Managed Medicare |
$873.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,027.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,559.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,497.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,653.07
|
| Rate for Payer: Cash Price |
$935.70
|
| Rate for Payer: Cigna Commercial |
$2,869.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,745.39
|
| Rate for Payer: Health EOS Commercial |
$2,775.91
|
| Rate for Payer: HFN Commercial |
$2,869.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,339.25
|
| Rate for Payer: Multiplan Commercial |
$2,495.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,871.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,869.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,528.31
|
| Rate for Payer: Quartz Commercial |
$2,027.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,871.40
|
| Rate for Payer: The Alliance Commercial |
$12,476.00
|
| Rate for Payer: WEA Trust Commercial |
$1,715.45
|
| Rate for Payer: WPS Commercial |
$2,310.24
|
|
|
PLATE AMBI SUPRACON 90DEG 8HL 124170
|
Facility
|
IP
|
$3,119.00
|
|
| Hospital Charge Code |
2966033
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,528.31 |
| Max. Negotiated Rate |
$2,869.48 |
| Rate for Payer: Aetna Commercial |
$2,807.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,682.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,653.07
|
| Rate for Payer: Cash Price |
$935.70
|
| Rate for Payer: Cigna Commercial |
$2,869.48
|
| Rate for Payer: Health EOS Commercial |
$2,775.91
|
| Rate for Payer: HFN Commercial |
$2,869.48
|
| Rate for Payer: Multiplan Commercial |
$2,495.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,871.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,869.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,528.31
|
| Rate for Payer: Quartz Commercial |
$1,871.40
|
| Rate for Payer: WEA Trust Commercial |
$1,715.45
|
| Rate for Payer: WPS Commercial |
$2,310.24
|
|
|
PLATE ANCHORAGE MTP CP LEFT PLP14341
|
Facility
|
OP
|
$7,316.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5265002
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,048.48 |
| Max. Negotiated Rate |
$29,264.00 |
| Rate for Payer: Aetna Commercial |
$6,584.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,291.76
|
| Rate for Payer: Aetna Managed Medicare |
$2,048.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,755.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,658.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,511.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,877.48
|
| Rate for Payer: Cash Price |
$2,194.80
|
| Rate for Payer: Cigna Commercial |
$6,730.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,094.03
|
| Rate for Payer: Health EOS Commercial |
$6,511.24
|
| Rate for Payer: HFN Commercial |
$6,730.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,487.00
|
| Rate for Payer: Multiplan Commercial |
$5,852.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,389.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,730.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,584.84
|
| Rate for Payer: Quartz Commercial |
$4,755.40
|
| Rate for Payer: Quartz Medicare Advantage |
$4,389.60
|
| Rate for Payer: The Alliance Commercial |
$29,264.00
|
| Rate for Payer: WEA Trust Commercial |
$4,023.80
|
| Rate for Payer: WPS Commercial |
$5,418.96
|
|
|
PLATE ANCHORAGE MTP CP LEFT PLP14341
|
Facility
|
IP
|
$7,316.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5265002
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,584.84 |
| Max. Negotiated Rate |
$6,730.72 |
| Rate for Payer: Aetna Commercial |
$6,584.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,291.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,877.48
|
| Rate for Payer: Cash Price |
$2,194.80
|
| Rate for Payer: Cigna Commercial |
$6,730.72
|
| Rate for Payer: Health EOS Commercial |
$6,511.24
|
| Rate for Payer: HFN Commercial |
$6,730.72
|
| Rate for Payer: Multiplan Commercial |
$5,852.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,389.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,730.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,584.84
|
| Rate for Payer: Quartz Commercial |
$4,389.60
|
| Rate for Payer: WEA Trust Commercial |
$4,023.80
|
| Rate for Payer: WPS Commercial |
$5,418.96
|
|
|
PLATE ANCHORAGE MTP V1 LONG LT 6HL PLP10341
|
Facility
|
OP
|
$9,271.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5617673
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,595.88 |
| Max. Negotiated Rate |
$37,084.00 |
| Rate for Payer: Aetna Commercial |
$8,343.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,973.06
|
| Rate for Payer: Aetna Managed Medicare |
$2,595.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,026.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,635.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,450.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,913.63
|
| Rate for Payer: Cash Price |
$2,781.30
|
| Rate for Payer: Cigna Commercial |
$8,529.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,188.05
|
| Rate for Payer: Health EOS Commercial |
$8,251.19
|
| Rate for Payer: HFN Commercial |
$8,529.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,953.25
|
| Rate for Payer: Multiplan Commercial |
$7,416.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,562.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,529.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,542.79
|
| Rate for Payer: Quartz Commercial |
$6,026.15
|
| Rate for Payer: Quartz Medicare Advantage |
$5,562.60
|
| Rate for Payer: The Alliance Commercial |
$37,084.00
|
| Rate for Payer: WEA Trust Commercial |
$5,099.05
|
| Rate for Payer: WPS Commercial |
$6,867.03
|
|
