|
PLATE MESH TITANIUM 01-7340
|
Facility
|
OP
|
$5,136.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3072512
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,495.60 |
| Max. Negotiated Rate |
$4,914.12 |
| Rate for Payer: Aetna Commercial |
$4,807.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,593.64
|
| Rate for Payer: Aetna Managed Medicare |
$1,495.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,471.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,670.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,563.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,830.96
|
| Rate for Payer: Cash Price |
$1,540.80
|
| Rate for Payer: Cigna Commercial |
$4,914.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,989.15
|
| Rate for Payer: Health EOS Commercial |
$4,753.88
|
| Rate for Payer: HFN Commercial |
$4,914.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,006.08
|
| Rate for Payer: Multiplan Commercial |
$4,273.15
|
| Rate for Payer: NAPHCARE Commercial |
$3,204.86
|
| Rate for Payer: Preferred Network Access Commercial |
$4,914.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,617.31
|
| Rate for Payer: Quartz Commercial |
$3,471.94
|
| Rate for Payer: Quartz Medicare Advantage |
$3,204.86
|
| Rate for Payer: The Alliance Commercial |
$2,670.72
|
| Rate for Payer: WEA Trust Commercial |
$2,937.79
|
| Rate for Payer: WPS Commercial |
$3,956.26
|
|
|
PLATE MESH TITANIUM 01-7340
|
Facility
|
IP
|
$5,136.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3072512
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,617.31 |
| Max. Negotiated Rate |
$4,914.12 |
| Rate for Payer: Aetna Commercial |
$4,807.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,593.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,830.96
|
| Rate for Payer: Cash Price |
$1,540.80
|
| Rate for Payer: Cigna Commercial |
$4,914.12
|
| Rate for Payer: Health EOS Commercial |
$4,753.88
|
| Rate for Payer: HFN Commercial |
$4,914.12
|
| Rate for Payer: Multiplan Commercial |
$4,273.15
|
| Rate for Payer: Preferred Network Access Commercial |
$4,914.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,617.31
|
| Rate for Payer: Quartz Commercial |
$3,204.86
|
| Rate for Payer: WEA Trust Commercial |
$2,937.79
|
| Rate for Payer: WPS Commercial |
$3,956.26
|
|
|
PLATE METAPHYSEAL 4.5/3.5 12HL
|
Facility
|
OP
|
$8,115.00
|
|
| Hospital Charge Code |
2966373
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,363.09 |
| Max. Negotiated Rate |
$7,764.43 |
| Rate for Payer: Aetna Commercial |
$7,595.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,258.06
|
| Rate for Payer: Aetna Managed Medicare |
$2,363.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,485.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,219.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,051.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,472.99
|
| Rate for Payer: Cash Price |
$2,434.50
|
| Rate for Payer: Cigna Commercial |
$7,764.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,722.93
|
| Rate for Payer: Health EOS Commercial |
$7,511.24
|
| Rate for Payer: HFN Commercial |
$7,764.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,329.70
|
| Rate for Payer: Multiplan Commercial |
$6,751.68
|
| Rate for Payer: NAPHCARE Commercial |
$5,063.76
|
| Rate for Payer: Preferred Network Access Commercial |
$7,764.43
|
| Rate for Payer: Quartz Beloit One Network |
$4,135.40
|
| Rate for Payer: Quartz Commercial |
$5,485.74
|
| Rate for Payer: Quartz Medicare Advantage |
$5,063.76
|
| Rate for Payer: The Alliance Commercial |
$4,219.80
|
| Rate for Payer: WEA Trust Commercial |
$4,641.78
|
| Rate for Payer: WPS Commercial |
$6,250.98
|
|
|
PLATE METAPHYSEAL 4.5/3.5 12HL
|
Facility
|
IP
|
$8,115.00
|
|
| Hospital Charge Code |
2966373
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,135.40 |
| Max. Negotiated Rate |
$7,764.43 |
| Rate for Payer: Aetna Commercial |
$7,595.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,258.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,472.99
|
| Rate for Payer: Cash Price |
$2,434.50
|
| Rate for Payer: Cigna Commercial |
$7,764.43
|
| Rate for Payer: Health EOS Commercial |
$7,511.24
|
| Rate for Payer: HFN Commercial |
$7,764.43
|
| Rate for Payer: Multiplan Commercial |
$6,751.68
|
| Rate for Payer: Preferred Network Access Commercial |
$7,764.43
|
| Rate for Payer: Quartz Beloit One Network |
$4,135.40
|
| Rate for Payer: Quartz Commercial |
$5,063.76
|
| Rate for Payer: WEA Trust Commercial |
$4,641.78
|
| Rate for Payer: WPS Commercial |
$6,250.98
|
|
|
PLATE MIB LT 300-70-002
|
Facility
|
OP
|
$9,494.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5456742
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,764.65 |
| Max. Negotiated Rate |
$9,083.86 |
| Rate for Payer: Aetna Commercial |
$8,886.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,491.43
|
| Rate for Payer: Aetna Managed Medicare |
$2,764.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,417.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,936.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,739.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,233.09
|
| Rate for Payer: Cash Price |
$2,848.20
|
| Rate for Payer: Cigna Commercial |
$9,083.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,525.51
|
| Rate for Payer: Health EOS Commercial |
$8,787.65
|
| Rate for Payer: HFN Commercial |
$9,083.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,405.32
|
| Rate for Payer: Multiplan Commercial |
$7,899.01
|
| Rate for Payer: NAPHCARE Commercial |
$5,924.26
|
| Rate for Payer: Preferred Network Access Commercial |
$9,083.86
|
| Rate for Payer: Quartz Beloit One Network |
$4,838.14
|
| Rate for Payer: Quartz Commercial |
$6,417.94
|
| Rate for Payer: Quartz Medicare Advantage |
$5,924.26
|
| Rate for Payer: The Alliance Commercial |
$4,936.88
|
| Rate for Payer: WEA Trust Commercial |
$5,430.57
|
| Rate for Payer: WPS Commercial |
$7,313.23
|
|
|
PLATE MIB LT 300-70-002
|
Facility
|
IP
|
$9,494.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5456742
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,838.14 |
| Max. Negotiated Rate |
$9,083.86 |
| Rate for Payer: Aetna Commercial |
$8,886.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,491.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,233.09
|
| Rate for Payer: Cash Price |
$2,848.20
|
| Rate for Payer: Cigna Commercial |
$9,083.86
|
| Rate for Payer: Health EOS Commercial |
$8,787.65
|
| Rate for Payer: HFN Commercial |
$9,083.86
|
| Rate for Payer: Multiplan Commercial |
$7,899.01
|
| Rate for Payer: Preferred Network Access Commercial |
$9,083.86
|
| Rate for Payer: Quartz Beloit One Network |
$4,838.14
|
| Rate for Payer: Quartz Commercial |
$5,924.26
|
| Rate for Payer: WEA Trust Commercial |
$5,430.57
|
| Rate for Payer: WPS Commercial |
$7,313.23
|
|
|
PLATE MIB RT 300-70-001
|
Facility
|
IP
|
$9,874.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415997
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,031.79 |
| Max. Negotiated Rate |
$9,447.44 |
| Rate for Payer: Aetna Commercial |
$9,242.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,831.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,442.55
|
| Rate for Payer: Cash Price |
$2,962.20
|
| Rate for Payer: Cigna Commercial |
$9,447.44
|
| Rate for Payer: Health EOS Commercial |
$9,139.37
|
| Rate for Payer: HFN Commercial |
$9,447.44
|
| Rate for Payer: Multiplan Commercial |
$8,215.17
|
| Rate for Payer: Preferred Network Access Commercial |
$9,447.44
|
| Rate for Payer: Quartz Beloit One Network |
$5,031.79
|
| Rate for Payer: Quartz Commercial |
$6,161.38
|
| Rate for Payer: WEA Trust Commercial |
$5,647.93
|
| Rate for Payer: WPS Commercial |
$7,605.94
|
|
|
PLATE MIB RT 300-70-001
|
Facility
|
OP
|
$9,874.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415997
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,875.31 |
| Max. Negotiated Rate |
$9,447.44 |
| Rate for Payer: Aetna Commercial |
$9,242.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,831.31
|
| Rate for Payer: Aetna Managed Medicare |
$2,875.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,674.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,134.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,929.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,442.55
|
| Rate for Payer: Cash Price |
$2,962.20
|
| Rate for Payer: Cigna Commercial |
$9,447.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,746.67
|
| Rate for Payer: Health EOS Commercial |
$9,139.37
|
| Rate for Payer: HFN Commercial |
$9,447.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,701.72
|
| Rate for Payer: Multiplan Commercial |
$8,215.17
|
| Rate for Payer: NAPHCARE Commercial |
$6,161.38
|
| Rate for Payer: Preferred Network Access Commercial |
$9,447.44
|
| Rate for Payer: Quartz Beloit One Network |
$5,031.79
|
| Rate for Payer: Quartz Commercial |
$6,674.82
|
| Rate for Payer: Quartz Medicare Advantage |
$6,161.38
|
| Rate for Payer: The Alliance Commercial |
$5,134.48
|
| Rate for Payer: WEA Trust Commercial |
$5,647.93
|
| Rate for Payer: WPS Commercial |
$7,605.94
|
|
|
PLATE MINI 3HL 243.13
|
Facility
|
OP
|
$370.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966761
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$107.74 |
| Max. Negotiated Rate |
$354.02 |
| Rate for Payer: Aetna Commercial |
$346.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$330.93
|
| Rate for Payer: Aetna Managed Medicare |
$107.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$250.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$192.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$184.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$203.94
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cigna Commercial |
$354.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$215.34
|
| Rate for Payer: Health EOS Commercial |
$342.47
|
| Rate for Payer: HFN Commercial |
$354.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$288.60
|
| Rate for Payer: Multiplan Commercial |
$307.84
|
| Rate for Payer: NAPHCARE Commercial |
$230.88
|
| Rate for Payer: Preferred Network Access Commercial |
$354.02
|
| Rate for Payer: Quartz Beloit One Network |
$188.55
|
| Rate for Payer: Quartz Commercial |
$250.12
|
| Rate for Payer: Quartz Medicare Advantage |
$230.88
|
| Rate for Payer: The Alliance Commercial |
$192.40
|
| Rate for Payer: WEA Trust Commercial |
$211.64
|
| Rate for Payer: WPS Commercial |
$285.01
|
|
|
PLATE MINI 3HL 243.13
|
Facility
|
IP
|
$370.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966761
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$188.55 |
| Max. Negotiated Rate |
$354.02 |
| Rate for Payer: Aetna Commercial |
$346.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$330.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$203.94
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cigna Commercial |
$354.02
|
| Rate for Payer: Health EOS Commercial |
$342.47
|
| Rate for Payer: HFN Commercial |
$354.02
|
| Rate for Payer: Multiplan Commercial |
$307.84
|
| Rate for Payer: Preferred Network Access Commercial |
$354.02
|
| Rate for Payer: Quartz Beloit One Network |
$188.55
|
| Rate for Payer: Quartz Commercial |
$230.88
|
| Rate for Payer: WEA Trust Commercial |
$211.64
|
| Rate for Payer: WPS Commercial |
$285.01
|
|
|
PLATE MINI 4HL 243.14
|
Facility
|
IP
|
$404.00
|
|
| Hospital Charge Code |
2975069
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$205.88 |
| Max. Negotiated Rate |
$386.55 |
| Rate for Payer: Aetna Commercial |
$378.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$361.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$222.68
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cigna Commercial |
$386.55
|
| Rate for Payer: Health EOS Commercial |
$373.94
|
| Rate for Payer: HFN Commercial |
$386.55
|
| Rate for Payer: Multiplan Commercial |
$336.13
|
| Rate for Payer: Preferred Network Access Commercial |
$386.55
|
| Rate for Payer: Quartz Beloit One Network |
$205.88
|
| Rate for Payer: Quartz Commercial |
$252.10
|
| Rate for Payer: WEA Trust Commercial |
$231.09
|
| Rate for Payer: WPS Commercial |
$311.20
|
|
|
PLATE MINI 4HL 243.14
|
Facility
|
OP
|
$404.00
|
|
| Hospital Charge Code |
2975069
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$117.64 |
| Max. Negotiated Rate |
$386.55 |
| Rate for Payer: Aetna Commercial |
$378.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$361.34
|
| Rate for Payer: Aetna Managed Medicare |
$117.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$273.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$210.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$201.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$222.68
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cigna Commercial |
$386.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$235.13
|
| Rate for Payer: Health EOS Commercial |
$373.94
|
| Rate for Payer: HFN Commercial |
$386.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$315.12
|
| Rate for Payer: Multiplan Commercial |
$336.13
|
| Rate for Payer: NAPHCARE Commercial |
$252.10
|
| Rate for Payer: Preferred Network Access Commercial |
$386.55
|
| Rate for Payer: Quartz Beloit One Network |
$205.88
|
| Rate for Payer: Quartz Commercial |
$273.10
|
| Rate for Payer: Quartz Medicare Advantage |
$252.10
|
| Rate for Payer: The Alliance Commercial |
$210.08
|
| Rate for Payer: WEA Trust Commercial |
$231.09
|
| Rate for Payer: WPS Commercial |
$311.20
|
|
|
PLATE MINI 5HL 243.15
|
Facility
|
OP
|
$161.00
|
|
| Hospital Charge Code |
2966762
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$46.88 |
| Max. Negotiated Rate |
$154.04 |
| Rate for Payer: Aetna Commercial |
$150.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$144.00
|
| Rate for Payer: Aetna Managed Medicare |
$46.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$108.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$83.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$80.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$88.74
|
| Rate for Payer: Cash Price |
$48.30
|
| Rate for Payer: Cigna Commercial |
$154.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$93.70
|
| Rate for Payer: Health EOS Commercial |
$149.02
|
| Rate for Payer: HFN Commercial |
$154.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$125.58
|
| Rate for Payer: Multiplan Commercial |
$133.95
|
| Rate for Payer: NAPHCARE Commercial |
$100.46
|
| Rate for Payer: Preferred Network Access Commercial |
$154.04
|
| Rate for Payer: Quartz Beloit One Network |
$82.05
|
| Rate for Payer: Quartz Commercial |
$108.84
|
| Rate for Payer: Quartz Medicare Advantage |
$100.46
|
| Rate for Payer: The Alliance Commercial |
$83.72
|
| Rate for Payer: WEA Trust Commercial |
$92.09
|
| Rate for Payer: WPS Commercial |
$124.02
|
|
|
PLATE MINI 5HL 243.15
|
Facility
|
IP
|
$161.00
|
|
| Hospital Charge Code |
2966762
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$82.05 |
| Max. Negotiated Rate |
$154.04 |
| Rate for Payer: Aetna Commercial |
$150.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$144.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$88.74
|
| Rate for Payer: Cash Price |
$48.30
|
| Rate for Payer: Cigna Commercial |
$154.04
|
| Rate for Payer: Health EOS Commercial |
$149.02
|
| Rate for Payer: HFN Commercial |
$154.04
|
| Rate for Payer: Multiplan Commercial |
$133.95
|
| Rate for Payer: Preferred Network Access Commercial |
$154.04
|
| Rate for Payer: Quartz Beloit One Network |
$82.05
|
| Rate for Payer: Quartz Commercial |
$100.46
|
| Rate for Payer: WEA Trust Commercial |
$92.09
|
| Rate for Payer: WPS Commercial |
$124.02
|
|
|
PLATE MINI LT 242.33
|
Facility
|
IP
|
$402.00
|
|
| Hospital Charge Code |
2966763
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$204.86 |
| Max. Negotiated Rate |
$384.63 |
| Rate for Payer: Aetna Commercial |
$376.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$359.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$221.58
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cigna Commercial |
$384.63
|
| Rate for Payer: Health EOS Commercial |
$372.09
|
| Rate for Payer: HFN Commercial |
$384.63
|
| Rate for Payer: Multiplan Commercial |
$334.46
|
| Rate for Payer: Preferred Network Access Commercial |
$384.63
|
| Rate for Payer: Quartz Beloit One Network |
$204.86
|
| Rate for Payer: Quartz Commercial |
$250.85
|
| Rate for Payer: WEA Trust Commercial |
$229.94
|
| Rate for Payer: WPS Commercial |
$309.66
|
|
|
PLATE MINI LT 242.33
|
Facility
|
OP
|
$402.00
|
|
| Hospital Charge Code |
2966763
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$117.06 |
| Max. Negotiated Rate |
$384.63 |
| Rate for Payer: Aetna Commercial |
$376.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$359.55
|
| Rate for Payer: Aetna Managed Medicare |
$117.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$271.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$209.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$200.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$221.58
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cigna Commercial |
$384.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$233.96
|
| Rate for Payer: Health EOS Commercial |
$372.09
|
| Rate for Payer: HFN Commercial |
$384.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$313.56
|
| Rate for Payer: Multiplan Commercial |
$334.46
|
| Rate for Payer: NAPHCARE Commercial |
$250.85
|
| Rate for Payer: Preferred Network Access Commercial |
$384.63
|
| Rate for Payer: Quartz Beloit One Network |
$204.86
|
| Rate for Payer: Quartz Commercial |
$271.75
|
| Rate for Payer: Quartz Medicare Advantage |
$250.85
|
| Rate for Payer: The Alliance Commercial |
$209.04
|
| Rate for Payer: WEA Trust Commercial |
$229.94
|
| Rate for Payer: WPS Commercial |
$309.66
|
|
|
PLATE MINI RT 242.34
|
Facility
|
OP
|
$461.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599596
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.24 |
| Max. Negotiated Rate |
$441.08 |
| Rate for Payer: Aetna Commercial |
$431.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$412.32
|
| Rate for Payer: Aetna Managed Medicare |
$134.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$311.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$239.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$230.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$254.10
|
| Rate for Payer: Cash Price |
$138.30
|
| Rate for Payer: Cigna Commercial |
$441.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$268.30
|
| Rate for Payer: Health EOS Commercial |
$426.70
|
| Rate for Payer: HFN Commercial |
$441.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$359.58
|
| Rate for Payer: Multiplan Commercial |
$383.55
|
| Rate for Payer: NAPHCARE Commercial |
$287.66
|
| Rate for Payer: Preferred Network Access Commercial |
$441.08
|
| Rate for Payer: Quartz Beloit One Network |
$234.93
|
| Rate for Payer: Quartz Commercial |
$311.64
|
| Rate for Payer: Quartz Medicare Advantage |
$287.66
|
| Rate for Payer: The Alliance Commercial |
$239.72
|
| Rate for Payer: WEA Trust Commercial |
$263.69
|
| Rate for Payer: WPS Commercial |
$355.11
|
|
|
PLATE MINI RT 242.34
|
Facility
|
IP
|
$461.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5599596
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$234.93 |
| Max. Negotiated Rate |
$441.08 |
| Rate for Payer: Aetna Commercial |
$431.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$412.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$254.10
|
| Rate for Payer: Cash Price |
$138.30
|
| Rate for Payer: Cigna Commercial |
$441.08
|
| Rate for Payer: Health EOS Commercial |
$426.70
|
| Rate for Payer: HFN Commercial |
$441.08
|
| Rate for Payer: Multiplan Commercial |
$383.55
|
| Rate for Payer: Preferred Network Access Commercial |
$441.08
|
| Rate for Payer: Quartz Beloit One Network |
$234.93
|
| Rate for Payer: Quartz Commercial |
$287.66
|
| Rate for Payer: WEA Trust Commercial |
$263.69
|
| Rate for Payer: WPS Commercial |
$355.11
|
|
|
PLATE MTP LEFT ORTHOLOC 3Di CROSSCHECK 5820MPX1L
|
Facility
|
IP
|
$13,390.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6099635
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,823.54 |
| Max. Negotiated Rate |
$12,811.55 |
| Rate for Payer: Aetna Commercial |
$12,533.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,976.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,380.57
|
| Rate for Payer: Cash Price |
$4,017.00
|
| Rate for Payer: Cigna Commercial |
$12,811.55
|
| Rate for Payer: Health EOS Commercial |
$12,393.78
|
| Rate for Payer: HFN Commercial |
$12,811.55
|
| Rate for Payer: Multiplan Commercial |
$11,140.48
|
| Rate for Payer: Preferred Network Access Commercial |
$12,811.55
|
| Rate for Payer: Quartz Beloit One Network |
$6,823.54
|
| Rate for Payer: Quartz Commercial |
$8,355.36
|
| Rate for Payer: WEA Trust Commercial |
$7,659.08
|
| Rate for Payer: WPS Commercial |
$10,314.32
|
|
|
PLATE MTP LEFT ORTHOLOC 3Di CROSSCHECK 5820MPX1L
|
Facility
|
OP
|
$13,390.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6099635
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,899.17 |
| Max. Negotiated Rate |
$12,811.55 |
| Rate for Payer: Aetna Commercial |
$12,533.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,976.02
|
| Rate for Payer: Aetna Managed Medicare |
$3,899.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,051.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,962.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,684.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,380.57
|
| Rate for Payer: Cash Price |
$4,017.00
|
| Rate for Payer: Cigna Commercial |
$12,811.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,792.98
|
| Rate for Payer: Health EOS Commercial |
$12,393.78
|
| Rate for Payer: HFN Commercial |
$12,811.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,444.20
|
| Rate for Payer: Multiplan Commercial |
$11,140.48
|
| Rate for Payer: NAPHCARE Commercial |
$8,355.36
|
| Rate for Payer: Preferred Network Access Commercial |
$12,811.55
|
| Rate for Payer: Quartz Beloit One Network |
$6,823.54
|
| Rate for Payer: Quartz Commercial |
$9,051.64
|
| Rate for Payer: Quartz Medicare Advantage |
$8,355.36
|
| Rate for Payer: The Alliance Commercial |
$6,962.80
|
| Rate for Payer: WEA Trust Commercial |
$7,659.08
|
| Rate for Payer: WPS Commercial |
$10,314.32
|
|
|
PLATE MTP LO-PRO CONTOURED TI SHORT RT AR-8944CR-P
|
Facility
|
OP
|
$7,141.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459662
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,079.46 |
| Max. Negotiated Rate |
$6,832.51 |
| Rate for Payer: Aetna Commercial |
$6,683.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,386.91
|
| Rate for Payer: Aetna Managed Medicare |
$2,079.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,827.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,713.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,564.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,936.12
|
| Rate for Payer: Cash Price |
$2,142.30
|
| Rate for Payer: Cigna Commercial |
$6,832.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,156.06
|
| Rate for Payer: Health EOS Commercial |
$6,609.71
|
| Rate for Payer: HFN Commercial |
$6,832.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,569.98
|
| Rate for Payer: Multiplan Commercial |
$5,941.31
|
| Rate for Payer: NAPHCARE Commercial |
$4,455.98
|
| Rate for Payer: Preferred Network Access Commercial |
$6,832.51
|
| Rate for Payer: Quartz Beloit One Network |
$3,639.05
|
| Rate for Payer: Quartz Commercial |
$4,827.32
|
| Rate for Payer: Quartz Medicare Advantage |
$4,455.98
|
| Rate for Payer: The Alliance Commercial |
$3,713.32
|
| Rate for Payer: WEA Trust Commercial |
$4,084.65
|
| Rate for Payer: WPS Commercial |
$5,500.71
|
|
|
PLATE MTP LO-PRO CONTOURED TI SHORT RT AR-8944CR-P
|
Facility
|
IP
|
$7,141.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5459662
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,639.05 |
| Max. Negotiated Rate |
$6,832.51 |
| Rate for Payer: Aetna Commercial |
$6,683.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,386.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,936.12
|
| Rate for Payer: Cash Price |
$2,142.30
|
| Rate for Payer: Cigna Commercial |
$6,832.51
|
| Rate for Payer: Health EOS Commercial |
$6,609.71
|
| Rate for Payer: HFN Commercial |
$6,832.51
|
| Rate for Payer: Multiplan Commercial |
$5,941.31
|
| Rate for Payer: Preferred Network Access Commercial |
$6,832.51
|
| Rate for Payer: Quartz Beloit One Network |
$3,639.05
|
| Rate for Payer: Quartz Commercial |
$4,455.98
|
| Rate for Payer: WEA Trust Commercial |
$4,084.65
|
| Rate for Payer: WPS Commercial |
$5,500.71
|
|
|
PLATE MTP LO-PRO CONTOURED TI STD LT AR-8944CL-S
|
Facility
|
IP
|
$7,141.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5603770
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,639.05 |
| Max. Negotiated Rate |
$6,832.51 |
| Rate for Payer: Aetna Commercial |
$6,683.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,386.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,936.12
|
| Rate for Payer: Cash Price |
$2,142.30
|
| Rate for Payer: Cigna Commercial |
$6,832.51
|
| Rate for Payer: Health EOS Commercial |
$6,609.71
|
| Rate for Payer: HFN Commercial |
$6,832.51
|
| Rate for Payer: Multiplan Commercial |
$5,941.31
|
| Rate for Payer: Preferred Network Access Commercial |
$6,832.51
|
| Rate for Payer: Quartz Beloit One Network |
$3,639.05
|
| Rate for Payer: Quartz Commercial |
$4,455.98
|
| Rate for Payer: WEA Trust Commercial |
$4,084.65
|
| Rate for Payer: WPS Commercial |
$5,500.71
|
|
|
PLATE MTP LO-PRO CONTOURED TI STD LT AR-8944CL-S
|
Facility
|
OP
|
$7,141.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5603770
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,079.46 |
| Max. Negotiated Rate |
$6,832.51 |
| Rate for Payer: Aetna Commercial |
$6,683.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,386.91
|
| Rate for Payer: Aetna Managed Medicare |
$2,079.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,827.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,713.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,564.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,936.12
|
| Rate for Payer: Cash Price |
$2,142.30
|
| Rate for Payer: Cigna Commercial |
$6,832.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,156.06
|
| Rate for Payer: Health EOS Commercial |
$6,609.71
|
| Rate for Payer: HFN Commercial |
$6,832.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,569.98
|
| Rate for Payer: Multiplan Commercial |
$5,941.31
|
| Rate for Payer: NAPHCARE Commercial |
$4,455.98
|
| Rate for Payer: Preferred Network Access Commercial |
$6,832.51
|
| Rate for Payer: Quartz Beloit One Network |
$3,639.05
|
| Rate for Payer: Quartz Commercial |
$4,827.32
|
| Rate for Payer: Quartz Medicare Advantage |
$4,455.98
|
| Rate for Payer: The Alliance Commercial |
$3,713.32
|
| Rate for Payer: WEA Trust Commercial |
$4,084.65
|
| Rate for Payer: WPS Commercial |
$5,500.71
|
|
|
PLATE MTP RIGHT ORTHOLOC 3Di CROSSCHECK 5820MPX1R
|
Facility
|
OP
|
$14,184.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5458985
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,130.38 |
| Max. Negotiated Rate |
$13,571.25 |
| Rate for Payer: Aetna Commercial |
$13,276.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,686.17
|
| Rate for Payer: Aetna Managed Medicare |
$4,130.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,588.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,375.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,080.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,818.22
|
| Rate for Payer: Cash Price |
$4,255.20
|
| Rate for Payer: Cigna Commercial |
$13,571.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,255.09
|
| Rate for Payer: Health EOS Commercial |
$13,128.71
|
| Rate for Payer: HFN Commercial |
$13,571.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,063.52
|
| Rate for Payer: Multiplan Commercial |
$11,801.09
|
| Rate for Payer: NAPHCARE Commercial |
$8,850.82
|
| Rate for Payer: Preferred Network Access Commercial |
$13,571.25
|
| Rate for Payer: Quartz Beloit One Network |
$7,228.17
|
| Rate for Payer: Quartz Commercial |
$9,588.38
|
| Rate for Payer: Quartz Medicare Advantage |
$8,850.82
|
| Rate for Payer: The Alliance Commercial |
$7,375.68
|
| Rate for Payer: WEA Trust Commercial |
$8,113.25
|
| Rate for Payer: WPS Commercial |
$10,925.94
|
|
