|
PLATE SEMI TUBULAR 7HL 222.07
|
Facility
|
OP
|
$478.00
|
|
| Hospital Charge Code |
2966782
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.19 |
| Max. Negotiated Rate |
$457.35 |
| Rate for Payer: Aetna Commercial |
$447.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$427.52
|
| Rate for Payer: Aetna Managed Medicare |
$139.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$323.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$248.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$238.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$263.47
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cigna Commercial |
$457.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$278.20
|
| Rate for Payer: Health EOS Commercial |
$442.44
|
| Rate for Payer: HFN Commercial |
$457.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$372.84
|
| Rate for Payer: Multiplan Commercial |
$397.70
|
| Rate for Payer: NAPHCARE Commercial |
$298.27
|
| Rate for Payer: Preferred Network Access Commercial |
$457.35
|
| Rate for Payer: Quartz Beloit One Network |
$243.59
|
| Rate for Payer: Quartz Commercial |
$323.13
|
| Rate for Payer: Quartz Medicare Advantage |
$298.27
|
| Rate for Payer: The Alliance Commercial |
$248.56
|
| Rate for Payer: WEA Trust Commercial |
$273.42
|
| Rate for Payer: WPS Commercial |
$368.20
|
|
|
PLATE SEMI TUBULAR 8HL 222.08
|
Facility
|
OP
|
$445.00
|
|
| Hospital Charge Code |
2966783
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$129.58 |
| Max. Negotiated Rate |
$425.78 |
| Rate for Payer: Aetna Commercial |
$416.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$398.01
|
| Rate for Payer: Aetna Managed Medicare |
$129.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$300.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$231.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$222.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$245.28
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cigna Commercial |
$425.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$258.99
|
| Rate for Payer: Health EOS Commercial |
$411.89
|
| Rate for Payer: HFN Commercial |
$425.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$347.10
|
| Rate for Payer: Multiplan Commercial |
$370.24
|
| Rate for Payer: NAPHCARE Commercial |
$277.68
|
| Rate for Payer: Preferred Network Access Commercial |
$425.78
|
| Rate for Payer: Quartz Beloit One Network |
$226.77
|
| Rate for Payer: Quartz Commercial |
$300.82
|
| Rate for Payer: Quartz Medicare Advantage |
$277.68
|
| Rate for Payer: The Alliance Commercial |
$231.40
|
| Rate for Payer: WEA Trust Commercial |
$254.54
|
| Rate for Payer: WPS Commercial |
$342.78
|
|
|
PLATE SEMI TUBULAR 8HL 222.08
|
Facility
|
IP
|
$445.00
|
|
| Hospital Charge Code |
2966783
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$226.77 |
| Max. Negotiated Rate |
$425.78 |
| Rate for Payer: Aetna Commercial |
$416.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$398.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$245.28
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cigna Commercial |
$425.78
|
| Rate for Payer: Health EOS Commercial |
$411.89
|
| Rate for Payer: HFN Commercial |
$425.78
|
| Rate for Payer: Multiplan Commercial |
$370.24
|
| Rate for Payer: Preferred Network Access Commercial |
$425.78
|
| Rate for Payer: Quartz Beloit One Network |
$226.77
|
| Rate for Payer: Quartz Commercial |
$277.68
|
| Rate for Payer: WEA Trust Commercial |
$254.54
|
| Rate for Payer: WPS Commercial |
$342.78
|
|
|
PLATE SLIM STRAIGHT 3 HOLE 626963
|
Facility
|
IP
|
$5,026.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6173720
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,561.25 |
| Max. Negotiated Rate |
$4,808.88 |
| Rate for Payer: Aetna Commercial |
$4,704.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,495.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,770.33
|
| Rate for Payer: Cash Price |
$1,507.80
|
| Rate for Payer: Cigna Commercial |
$4,808.88
|
| Rate for Payer: Health EOS Commercial |
$4,652.07
|
| Rate for Payer: HFN Commercial |
$4,808.88
|
| Rate for Payer: Multiplan Commercial |
$4,181.63
|
| Rate for Payer: Preferred Network Access Commercial |
$4,808.88
|
| Rate for Payer: Quartz Beloit One Network |
$2,561.25
|
| Rate for Payer: Quartz Commercial |
$3,136.22
|
| Rate for Payer: WEA Trust Commercial |
$2,874.87
|
| Rate for Payer: WPS Commercial |
$3,871.53
|
|
|
PLATE SLIM STRAIGHT 3 HOLE 626963
|
Facility
|
OP
|
$5,026.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6173720
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,463.57 |
| Max. Negotiated Rate |
$4,808.88 |
| Rate for Payer: Aetna Commercial |
$4,704.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,495.25
|
| Rate for Payer: Aetna Managed Medicare |
$1,463.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,397.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,613.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,508.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,770.33
|
| Rate for Payer: Cash Price |
$1,507.80
|
| Rate for Payer: Cigna Commercial |
$4,808.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,925.13
|
| Rate for Payer: Health EOS Commercial |
$4,652.07
|
| Rate for Payer: HFN Commercial |
$4,808.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,920.28
|
| Rate for Payer: Multiplan Commercial |
$4,181.63
|
| Rate for Payer: NAPHCARE Commercial |
$3,136.22
|
| Rate for Payer: Preferred Network Access Commercial |
$4,808.88
|
| Rate for Payer: Quartz Beloit One Network |
$2,561.25
|
| Rate for Payer: Quartz Commercial |
$3,397.58
|
| Rate for Payer: Quartz Medicare Advantage |
$3,136.22
|
| Rate for Payer: The Alliance Commercial |
$2,613.52
|
| Rate for Payer: WEA Trust Commercial |
$2,874.87
|
| Rate for Payer: WPS Commercial |
$3,871.53
|
|
|
PLATE SLIM STRAIGHT 5 HOLE 626965
|
Facility
|
OP
|
$7,469.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5563673
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,174.97 |
| Max. Negotiated Rate |
$7,146.34 |
| Rate for Payer: Aetna Commercial |
$6,990.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,680.27
|
| Rate for Payer: Aetna Managed Medicare |
$2,174.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,049.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,883.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,728.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,116.91
|
| Rate for Payer: Cash Price |
$2,240.70
|
| Rate for Payer: Cigna Commercial |
$7,146.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,346.96
|
| Rate for Payer: Health EOS Commercial |
$6,913.31
|
| Rate for Payer: HFN Commercial |
$7,146.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,825.82
|
| Rate for Payer: Multiplan Commercial |
$6,214.21
|
| Rate for Payer: NAPHCARE Commercial |
$4,660.66
|
| Rate for Payer: Preferred Network Access Commercial |
$7,146.34
|
| Rate for Payer: Quartz Beloit One Network |
$3,806.20
|
| Rate for Payer: Quartz Commercial |
$5,049.04
|
| Rate for Payer: Quartz Medicare Advantage |
$4,660.66
|
| Rate for Payer: The Alliance Commercial |
$3,883.88
|
| Rate for Payer: WEA Trust Commercial |
$4,272.27
|
| Rate for Payer: WPS Commercial |
$5,753.37
|
|
|
PLATE SLIM STRAIGHT 5 HOLE 626965
|
Facility
|
IP
|
$7,469.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5563673
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,806.20 |
| Max. Negotiated Rate |
$7,146.34 |
| Rate for Payer: Aetna Commercial |
$6,990.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,680.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,116.91
|
| Rate for Payer: Cash Price |
$2,240.70
|
| Rate for Payer: Cigna Commercial |
$7,146.34
|
| Rate for Payer: Health EOS Commercial |
$6,913.31
|
| Rate for Payer: HFN Commercial |
$7,146.34
|
| Rate for Payer: Multiplan Commercial |
$6,214.21
|
| Rate for Payer: Preferred Network Access Commercial |
$7,146.34
|
| Rate for Payer: Quartz Beloit One Network |
$3,806.20
|
| Rate for Payer: Quartz Commercial |
$4,660.66
|
| Rate for Payer: WEA Trust Commercial |
$4,272.27
|
| Rate for Payer: WPS Commercial |
$5,753.37
|
|
|
PLATE SLIM STRAIGHT 6 HOLE 626966
|
Facility
|
OP
|
$5,026.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6171787
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,463.57 |
| Max. Negotiated Rate |
$4,808.88 |
| Rate for Payer: Aetna Commercial |
$4,704.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,495.25
|
| Rate for Payer: Aetna Managed Medicare |
$1,463.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,397.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,613.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,508.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,770.33
|
| Rate for Payer: Cash Price |
$1,507.80
|
| Rate for Payer: Cigna Commercial |
$4,808.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,925.13
|
| Rate for Payer: Health EOS Commercial |
$4,652.07
|
| Rate for Payer: HFN Commercial |
$4,808.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,920.28
|
| Rate for Payer: Multiplan Commercial |
$4,181.63
|
| Rate for Payer: NAPHCARE Commercial |
$3,136.22
|
| Rate for Payer: Preferred Network Access Commercial |
$4,808.88
|
| Rate for Payer: Quartz Beloit One Network |
$2,561.25
|
| Rate for Payer: Quartz Commercial |
$3,397.58
|
| Rate for Payer: Quartz Medicare Advantage |
$3,136.22
|
| Rate for Payer: The Alliance Commercial |
$2,613.52
|
| Rate for Payer: WEA Trust Commercial |
$2,874.87
|
| Rate for Payer: WPS Commercial |
$3,871.53
|
|
|
PLATE SLIM STRAIGHT 6 HOLE 626966
|
Facility
|
IP
|
$5,026.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6171787
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,561.25 |
| Max. Negotiated Rate |
$4,808.88 |
| Rate for Payer: Aetna Commercial |
$4,704.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,495.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,770.33
|
| Rate for Payer: Cash Price |
$1,507.80
|
| Rate for Payer: Cigna Commercial |
$4,808.88
|
| Rate for Payer: Health EOS Commercial |
$4,652.07
|
| Rate for Payer: HFN Commercial |
$4,808.88
|
| Rate for Payer: Multiplan Commercial |
$4,181.63
|
| Rate for Payer: Preferred Network Access Commercial |
$4,808.88
|
| Rate for Payer: Quartz Beloit One Network |
$2,561.25
|
| Rate for Payer: Quartz Commercial |
$3,136.22
|
| Rate for Payer: WEA Trust Commercial |
$2,874.87
|
| Rate for Payer: WPS Commercial |
$3,871.53
|
|
|
PLATE SLIM STRAIGHT 7 HOLE 626967
|
Facility
|
OP
|
$7,469.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767632
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,174.97 |
| Max. Negotiated Rate |
$7,146.34 |
| Rate for Payer: Aetna Commercial |
$6,990.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,680.27
|
| Rate for Payer: Aetna Managed Medicare |
$2,174.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,049.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,883.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,728.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,116.91
|
| Rate for Payer: Cash Price |
$2,240.70
|
| Rate for Payer: Cigna Commercial |
$7,146.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,346.96
|
| Rate for Payer: Health EOS Commercial |
$6,913.31
|
| Rate for Payer: HFN Commercial |
$7,146.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,825.82
|
| Rate for Payer: Multiplan Commercial |
$6,214.21
|
| Rate for Payer: NAPHCARE Commercial |
$4,660.66
|
| Rate for Payer: Preferred Network Access Commercial |
$7,146.34
|
| Rate for Payer: Quartz Beloit One Network |
$3,806.20
|
| Rate for Payer: Quartz Commercial |
$5,049.04
|
| Rate for Payer: Quartz Medicare Advantage |
$4,660.66
|
| Rate for Payer: The Alliance Commercial |
$3,883.88
|
| Rate for Payer: WEA Trust Commercial |
$4,272.27
|
| Rate for Payer: WPS Commercial |
$5,753.37
|
|
|
PLATE SLIM STRAIGHT 7 HOLE 626967
|
Facility
|
IP
|
$7,469.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767632
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,806.20 |
| Max. Negotiated Rate |
$7,146.34 |
| Rate for Payer: Aetna Commercial |
$6,990.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,680.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,116.91
|
| Rate for Payer: Cash Price |
$2,240.70
|
| Rate for Payer: Cigna Commercial |
$7,146.34
|
| Rate for Payer: Health EOS Commercial |
$6,913.31
|
| Rate for Payer: HFN Commercial |
$7,146.34
|
| Rate for Payer: Multiplan Commercial |
$6,214.21
|
| Rate for Payer: Preferred Network Access Commercial |
$7,146.34
|
| Rate for Payer: Quartz Beloit One Network |
$3,806.20
|
| Rate for Payer: Quartz Commercial |
$4,660.66
|
| Rate for Payer: WEA Trust Commercial |
$4,272.27
|
| Rate for Payer: WPS Commercial |
$5,753.37
|
|
|
PLATE SLIM Y 2 SHAFT HOLE 626982
|
Facility
|
IP
|
$5,456.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5563677
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,780.38 |
| Max. Negotiated Rate |
$5,220.30 |
| Rate for Payer: Aetna Commercial |
$5,106.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,879.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,007.35
|
| Rate for Payer: Cash Price |
$1,636.80
|
| Rate for Payer: Cigna Commercial |
$5,220.30
|
| Rate for Payer: Health EOS Commercial |
$5,050.07
|
| Rate for Payer: HFN Commercial |
$5,220.30
|
| Rate for Payer: Multiplan Commercial |
$4,539.39
|
| Rate for Payer: Preferred Network Access Commercial |
$5,220.30
|
| Rate for Payer: Quartz Beloit One Network |
$2,780.38
|
| Rate for Payer: Quartz Commercial |
$3,404.54
|
| Rate for Payer: WEA Trust Commercial |
$3,120.83
|
| Rate for Payer: WPS Commercial |
$4,202.76
|
|
|
PLATE SLIM Y 2 SHAFT HOLE 626982
|
Facility
|
OP
|
$5,456.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5563677
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,588.79 |
| Max. Negotiated Rate |
$5,220.30 |
| Rate for Payer: Aetna Commercial |
$5,106.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,879.85
|
| Rate for Payer: Aetna Managed Medicare |
$1,588.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,688.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,837.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,723.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,007.35
|
| Rate for Payer: Cash Price |
$1,636.80
|
| Rate for Payer: Cigna Commercial |
$5,220.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,175.39
|
| Rate for Payer: Health EOS Commercial |
$5,050.07
|
| Rate for Payer: HFN Commercial |
$5,220.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,255.68
|
| Rate for Payer: Multiplan Commercial |
$4,539.39
|
| Rate for Payer: NAPHCARE Commercial |
$3,404.54
|
| Rate for Payer: Preferred Network Access Commercial |
$5,220.30
|
| Rate for Payer: Quartz Beloit One Network |
$2,780.38
|
| Rate for Payer: Quartz Commercial |
$3,688.26
|
| Rate for Payer: Quartz Medicare Advantage |
$3,404.54
|
| Rate for Payer: The Alliance Commercial |
$2,837.12
|
| Rate for Payer: WEA Trust Commercial |
$3,120.83
|
| Rate for Payer: WPS Commercial |
$4,202.76
|
|
|
PLATE SLIM Y 4 SHAFT HOLE 626984
|
Facility
|
IP
|
$5,456.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685845
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,780.38 |
| Max. Negotiated Rate |
$5,220.30 |
| Rate for Payer: Aetna Commercial |
$5,106.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,879.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,007.35
|
| Rate for Payer: Cash Price |
$1,636.80
|
| Rate for Payer: Cigna Commercial |
$5,220.30
|
| Rate for Payer: Health EOS Commercial |
$5,050.07
|
| Rate for Payer: HFN Commercial |
$5,220.30
|
| Rate for Payer: Multiplan Commercial |
$4,539.39
|
| Rate for Payer: Preferred Network Access Commercial |
$5,220.30
|
| Rate for Payer: Quartz Beloit One Network |
$2,780.38
|
| Rate for Payer: Quartz Commercial |
$3,404.54
|
| Rate for Payer: WEA Trust Commercial |
$3,120.83
|
| Rate for Payer: WPS Commercial |
$4,202.76
|
|
|
PLATE SLIM Y 4 SHAFT HOLE 626984
|
Facility
|
OP
|
$5,456.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685845
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,588.79 |
| Max. Negotiated Rate |
$5,220.30 |
| Rate for Payer: Aetna Commercial |
$5,106.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,879.85
|
| Rate for Payer: Aetna Managed Medicare |
$1,588.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,688.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,837.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,723.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,007.35
|
| Rate for Payer: Cash Price |
$1,636.80
|
| Rate for Payer: Cigna Commercial |
$5,220.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,175.39
|
| Rate for Payer: Health EOS Commercial |
$5,050.07
|
| Rate for Payer: HFN Commercial |
$5,220.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,255.68
|
| Rate for Payer: Multiplan Commercial |
$4,539.39
|
| Rate for Payer: NAPHCARE Commercial |
$3,404.54
|
| Rate for Payer: Preferred Network Access Commercial |
$5,220.30
|
| Rate for Payer: Quartz Beloit One Network |
$2,780.38
|
| Rate for Payer: Quartz Commercial |
$3,688.26
|
| Rate for Payer: Quartz Medicare Advantage |
$3,404.54
|
| Rate for Payer: The Alliance Commercial |
$2,837.12
|
| Rate for Payer: WEA Trust Commercial |
$3,120.83
|
| Rate for Payer: WPS Commercial |
$4,202.76
|
|
|
PLATE SPIDER 20MM SMALL 814100003
|
Facility
|
OP
|
$726.00
|
|
| Hospital Charge Code |
2965014
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$211.41 |
| Max. Negotiated Rate |
$694.64 |
| Rate for Payer: Aetna Commercial |
$679.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$649.33
|
| Rate for Payer: Aetna Managed Medicare |
$211.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$490.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$377.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$362.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$400.17
|
| Rate for Payer: Cash Price |
$217.80
|
| Rate for Payer: Cigna Commercial |
$694.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$422.53
|
| Rate for Payer: Health EOS Commercial |
$671.99
|
| Rate for Payer: HFN Commercial |
$694.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$566.28
|
| Rate for Payer: Multiplan Commercial |
$604.03
|
| Rate for Payer: NAPHCARE Commercial |
$453.02
|
| Rate for Payer: Preferred Network Access Commercial |
$694.64
|
| Rate for Payer: Quartz Beloit One Network |
$369.97
|
| Rate for Payer: Quartz Commercial |
$490.78
|
| Rate for Payer: Quartz Medicare Advantage |
$453.02
|
| Rate for Payer: The Alliance Commercial |
$377.52
|
| Rate for Payer: WEA Trust Commercial |
$415.27
|
| Rate for Payer: WPS Commercial |
$559.24
|
|
|
PLATE SPIDER 20MM SMALL 814100003
|
Facility
|
IP
|
$726.00
|
|
| Hospital Charge Code |
2965014
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$369.97 |
| Max. Negotiated Rate |
$694.64 |
| Rate for Payer: Aetna Commercial |
$679.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$649.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$400.17
|
| Rate for Payer: Cash Price |
$217.80
|
| Rate for Payer: Cigna Commercial |
$694.64
|
| Rate for Payer: Health EOS Commercial |
$671.99
|
| Rate for Payer: HFN Commercial |
$694.64
|
| Rate for Payer: Multiplan Commercial |
$604.03
|
| Rate for Payer: Preferred Network Access Commercial |
$694.64
|
| Rate for Payer: Quartz Beloit One Network |
$369.97
|
| Rate for Payer: Quartz Commercial |
$453.02
|
| Rate for Payer: WEA Trust Commercial |
$415.27
|
| Rate for Payer: WPS Commercial |
$559.24
|
|
|
PLATE SQUARE 4 HOLE BIOMET 73-2622
|
Facility
|
IP
|
$4,320.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4205985
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,201.47 |
| Max. Negotiated Rate |
$4,133.38 |
| Rate for Payer: Aetna Commercial |
$4,043.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,863.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,381.18
|
| Rate for Payer: Cash Price |
$1,296.00
|
| Rate for Payer: Cigna Commercial |
$4,133.38
|
| Rate for Payer: Health EOS Commercial |
$3,998.59
|
| Rate for Payer: HFN Commercial |
$4,133.38
|
| Rate for Payer: Multiplan Commercial |
$3,594.24
|
| Rate for Payer: Preferred Network Access Commercial |
$4,133.38
|
| Rate for Payer: Quartz Beloit One Network |
$2,201.47
|
| Rate for Payer: Quartz Commercial |
$2,695.68
|
| Rate for Payer: WEA Trust Commercial |
$2,471.04
|
| Rate for Payer: WPS Commercial |
$3,327.70
|
|
|
PLATE SQUARE 4 HOLE BIOMET 73-2622
|
Facility
|
OP
|
$4,320.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4205985
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,257.98 |
| Max. Negotiated Rate |
$4,133.38 |
| Rate for Payer: Aetna Commercial |
$4,043.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,863.81
|
| Rate for Payer: Aetna Managed Medicare |
$1,257.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,920.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,246.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,156.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,381.18
|
| Rate for Payer: Cash Price |
$1,296.00
|
| Rate for Payer: Cigna Commercial |
$4,133.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,514.24
|
| Rate for Payer: Health EOS Commercial |
$3,998.59
|
| Rate for Payer: HFN Commercial |
$4,133.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,369.60
|
| Rate for Payer: Multiplan Commercial |
$3,594.24
|
| Rate for Payer: NAPHCARE Commercial |
$2,695.68
|
| Rate for Payer: Preferred Network Access Commercial |
$4,133.38
|
| Rate for Payer: Quartz Beloit One Network |
$2,201.47
|
| Rate for Payer: Quartz Commercial |
$2,920.32
|
| Rate for Payer: Quartz Medicare Advantage |
$2,695.68
|
| Rate for Payer: The Alliance Commercial |
$2,246.40
|
| Rate for Payer: WEA Trust Commercial |
$2,471.04
|
| Rate for Payer: WPS Commercial |
$3,327.70
|
|
|
PLATE STERNALOCK 8HL STRAIGHT 73-1952
|
Facility
|
IP
|
$4,440.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5447129
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,262.62 |
| Max. Negotiated Rate |
$4,248.19 |
| Rate for Payer: Aetna Commercial |
$4,155.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,971.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,447.33
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cigna Commercial |
$4,248.19
|
| Rate for Payer: Health EOS Commercial |
$4,109.66
|
| Rate for Payer: HFN Commercial |
$4,248.19
|
| Rate for Payer: Multiplan Commercial |
$3,694.08
|
| Rate for Payer: Preferred Network Access Commercial |
$4,248.19
|
| Rate for Payer: Quartz Beloit One Network |
$2,262.62
|
| Rate for Payer: Quartz Commercial |
$2,770.56
|
| Rate for Payer: WEA Trust Commercial |
$2,539.68
|
| Rate for Payer: WPS Commercial |
$3,420.13
|
|
|
PLATE STERNALOCK 8HL STRAIGHT 73-1952
|
Facility
|
OP
|
$4,440.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5447129
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,292.93 |
| Max. Negotiated Rate |
$4,248.19 |
| Rate for Payer: Aetna Commercial |
$4,155.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,971.14
|
| Rate for Payer: Aetna Managed Medicare |
$1,292.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,001.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,308.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,216.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,447.33
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cigna Commercial |
$4,248.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,584.08
|
| Rate for Payer: Health EOS Commercial |
$4,109.66
|
| Rate for Payer: HFN Commercial |
$4,248.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,463.20
|
| Rate for Payer: Multiplan Commercial |
$3,694.08
|
| Rate for Payer: NAPHCARE Commercial |
$2,770.56
|
| Rate for Payer: Preferred Network Access Commercial |
$4,248.19
|
| Rate for Payer: Quartz Beloit One Network |
$2,262.62
|
| Rate for Payer: Quartz Commercial |
$3,001.44
|
| Rate for Payer: Quartz Medicare Advantage |
$2,770.56
|
| Rate for Payer: The Alliance Commercial |
$2,308.80
|
| Rate for Payer: WEA Trust Commercial |
$2,539.68
|
| Rate for Payer: WPS Commercial |
$3,420.13
|
|
|
PLATE STRAIGHT 1.3MM 12HL 221.312
|
Facility
|
OP
|
$3,488.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508590
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,015.71 |
| Max. Negotiated Rate |
$3,337.32 |
| Rate for Payer: Aetna Commercial |
$3,264.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,119.67
|
| Rate for Payer: Aetna Managed Medicare |
$1,015.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,357.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,813.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,741.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,922.59
|
| Rate for Payer: Cash Price |
$1,046.40
|
| Rate for Payer: Cigna Commercial |
$3,337.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,030.02
|
| Rate for Payer: Health EOS Commercial |
$3,228.49
|
| Rate for Payer: HFN Commercial |
$3,337.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,720.64
|
| Rate for Payer: Multiplan Commercial |
$2,902.02
|
| Rate for Payer: NAPHCARE Commercial |
$2,176.51
|
| Rate for Payer: Preferred Network Access Commercial |
$3,337.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,777.48
|
| Rate for Payer: Quartz Commercial |
$2,357.89
|
| Rate for Payer: Quartz Medicare Advantage |
$2,176.51
|
| Rate for Payer: The Alliance Commercial |
$1,813.76
|
| Rate for Payer: WEA Trust Commercial |
$1,995.14
|
| Rate for Payer: WPS Commercial |
$2,686.81
|
|
|
PLATE STRAIGHT 1.3MM 12HL 221.312
|
Facility
|
IP
|
$3,488.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508590
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,777.48 |
| Max. Negotiated Rate |
$3,337.32 |
| Rate for Payer: Aetna Commercial |
$3,264.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,119.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,922.59
|
| Rate for Payer: Cash Price |
$1,046.40
|
| Rate for Payer: Cigna Commercial |
$3,337.32
|
| Rate for Payer: Health EOS Commercial |
$3,228.49
|
| Rate for Payer: HFN Commercial |
$3,337.32
|
| Rate for Payer: Multiplan Commercial |
$2,902.02
|
| Rate for Payer: Preferred Network Access Commercial |
$3,337.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,777.48
|
| Rate for Payer: Quartz Commercial |
$2,176.51
|
| Rate for Payer: WEA Trust Commercial |
$1,995.14
|
| Rate for Payer: WPS Commercial |
$2,686.81
|
|
|
PLATE STRAIGHT 1.3MM 6HL 221.306
|
Facility
|
IP
|
$2,793.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508588
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,423.31 |
| Max. Negotiated Rate |
$2,672.34 |
| Rate for Payer: Aetna Commercial |
$2,614.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,498.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,539.50
|
| Rate for Payer: Cash Price |
$837.90
|
| Rate for Payer: Cigna Commercial |
$2,672.34
|
| Rate for Payer: Health EOS Commercial |
$2,585.20
|
| Rate for Payer: HFN Commercial |
$2,672.34
|
| Rate for Payer: Multiplan Commercial |
$2,323.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,672.34
|
| Rate for Payer: Quartz Beloit One Network |
$1,423.31
|
| Rate for Payer: Quartz Commercial |
$1,742.83
|
| Rate for Payer: WEA Trust Commercial |
$1,597.60
|
| Rate for Payer: WPS Commercial |
$2,151.45
|
|
|
PLATE STRAIGHT 1.3MM 6HL 221.306
|
Facility
|
OP
|
$2,793.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508588
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$813.32 |
| Max. Negotiated Rate |
$2,672.34 |
| Rate for Payer: Aetna Commercial |
$2,614.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,498.06
|
| Rate for Payer: Aetna Managed Medicare |
$813.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,888.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,452.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,394.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,539.50
|
| Rate for Payer: Cash Price |
$837.90
|
| Rate for Payer: Cigna Commercial |
$2,672.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,625.53
|
| Rate for Payer: Health EOS Commercial |
$2,585.20
|
| Rate for Payer: HFN Commercial |
$2,672.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,178.54
|
| Rate for Payer: Multiplan Commercial |
$2,323.78
|
| Rate for Payer: NAPHCARE Commercial |
$1,742.83
|
| Rate for Payer: Preferred Network Access Commercial |
$2,672.34
|
| Rate for Payer: Quartz Beloit One Network |
$1,423.31
|
| Rate for Payer: Quartz Commercial |
$1,888.07
|
| Rate for Payer: Quartz Medicare Advantage |
$1,742.83
|
| Rate for Payer: The Alliance Commercial |
$1,452.36
|
| Rate for Payer: WEA Trust Commercial |
$1,597.60
|
| Rate for Payer: WPS Commercial |
$2,151.45
|
|
