|
T-PLATE 3HL HEAD/7HL SHAFT 2.0
|
Facility
|
OP
|
$5,608.00
|
|
| Hospital Charge Code |
2966589
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,570.24 |
| Max. Negotiated Rate |
$22,432.00 |
| Rate for Payer: Aetna Commercial |
$5,047.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,822.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,570.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,645.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,804.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,691.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,972.24
|
| Rate for Payer: Cash Price |
$1,682.40
|
| Rate for Payer: Cigna Commercial |
$5,159.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,138.24
|
| Rate for Payer: Health EOS Commercial |
$4,991.12
|
| Rate for Payer: HFN Commercial |
$5,159.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,206.00
|
| Rate for Payer: Multiplan Commercial |
$4,486.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,364.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,159.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,747.92
|
| Rate for Payer: Quartz Commercial |
$3,645.20
|
| Rate for Payer: Quartz Medicare Advantage |
$3,364.80
|
| Rate for Payer: The Alliance Commercial |
$22,432.00
|
| Rate for Payer: WEA Trust Commercial |
$3,084.40
|
| Rate for Payer: WPS Commercial |
$4,153.85
|
|
|
T-PLATE 3HL HEAD/7HL SHAFT 2.0
|
Facility
|
IP
|
$5,608.00
|
|
| Hospital Charge Code |
2966589
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,747.92 |
| Max. Negotiated Rate |
$5,159.36 |
| Rate for Payer: Aetna Commercial |
$5,047.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,822.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,972.24
|
| Rate for Payer: Cash Price |
$1,682.40
|
| Rate for Payer: Cigna Commercial |
$5,159.36
|
| Rate for Payer: Health EOS Commercial |
$4,991.12
|
| Rate for Payer: HFN Commercial |
$5,159.36
|
| Rate for Payer: Multiplan Commercial |
$4,486.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,364.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,159.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,747.92
|
| Rate for Payer: Quartz Commercial |
$3,364.80
|
| Rate for Payer: WEA Trust Commercial |
$3,084.40
|
| Rate for Payer: WPS Commercial |
$4,153.85
|
|
|
T-PLATE 3HL SMALL 241.13
|
Facility
|
OP
|
$778.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2969339
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$217.84 |
| Max. Negotiated Rate |
$3,112.00 |
| Rate for Payer: Aetna Commercial |
$700.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$669.08
|
| Rate for Payer: Aetna Managed Medicare |
$217.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$505.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$389.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$373.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$412.34
|
| Rate for Payer: Cash Price |
$233.40
|
| Rate for Payer: Cigna Commercial |
$715.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$435.37
|
| Rate for Payer: Health EOS Commercial |
$692.42
|
| Rate for Payer: HFN Commercial |
$715.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$583.50
|
| Rate for Payer: Multiplan Commercial |
$622.40
|
| Rate for Payer: NAPHCARE Commercial |
$466.80
|
| Rate for Payer: Preferred Network Access Commercial |
$715.76
|
| Rate for Payer: Quartz Beloit One Network |
$381.22
|
| Rate for Payer: Quartz Commercial |
$505.70
|
| Rate for Payer: Quartz Medicare Advantage |
$466.80
|
| Rate for Payer: The Alliance Commercial |
$3,112.00
|
| Rate for Payer: WEA Trust Commercial |
$427.90
|
| Rate for Payer: WPS Commercial |
$576.26
|
|
|
T-PLATE 3HL SMALL 241.13
|
Facility
|
IP
|
$778.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2969339
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$381.22 |
| Max. Negotiated Rate |
$715.76 |
| Rate for Payer: Aetna Commercial |
$700.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$669.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$412.34
|
| Rate for Payer: Cash Price |
$233.40
|
| Rate for Payer: Cigna Commercial |
$715.76
|
| Rate for Payer: Health EOS Commercial |
$692.42
|
| Rate for Payer: HFN Commercial |
$715.76
|
| Rate for Payer: Multiplan Commercial |
$622.40
|
| Rate for Payer: NAPHCARE Commercial |
$466.80
|
| Rate for Payer: Preferred Network Access Commercial |
$715.76
|
| Rate for Payer: Quartz Beloit One Network |
$381.22
|
| Rate for Payer: Quartz Commercial |
$466.80
|
| Rate for Payer: WEA Trust Commercial |
$427.90
|
| Rate for Payer: WPS Commercial |
$576.26
|
|
|
T-PLATE 4HL SMALL 241.14
|
Facility
|
IP
|
$806.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2969340
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$394.94 |
| Max. Negotiated Rate |
$741.52 |
| Rate for Payer: Aetna Commercial |
$725.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$693.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$427.18
|
| Rate for Payer: Cash Price |
$241.80
|
| Rate for Payer: Cigna Commercial |
$741.52
|
| Rate for Payer: Health EOS Commercial |
$717.34
|
| Rate for Payer: HFN Commercial |
$741.52
|
| Rate for Payer: Multiplan Commercial |
$644.80
|
| Rate for Payer: NAPHCARE Commercial |
$483.60
|
| Rate for Payer: Preferred Network Access Commercial |
$741.52
|
| Rate for Payer: Quartz Beloit One Network |
$394.94
|
| Rate for Payer: Quartz Commercial |
$483.60
|
| Rate for Payer: WEA Trust Commercial |
$443.30
|
| Rate for Payer: WPS Commercial |
$597.00
|
|
|
T-PLATE 4HL SMALL 241.14
|
Facility
|
OP
|
$806.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2969340
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$225.68 |
| Max. Negotiated Rate |
$3,224.00 |
| Rate for Payer: Aetna Commercial |
$725.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$693.16
|
| Rate for Payer: Aetna Managed Medicare |
$225.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$523.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$403.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$386.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$427.18
|
| Rate for Payer: Cash Price |
$241.80
|
| Rate for Payer: Cigna Commercial |
$741.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$451.04
|
| Rate for Payer: Health EOS Commercial |
$717.34
|
| Rate for Payer: HFN Commercial |
$741.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$604.50
|
| Rate for Payer: Multiplan Commercial |
$644.80
|
| Rate for Payer: NAPHCARE Commercial |
$483.60
|
| Rate for Payer: Preferred Network Access Commercial |
$741.52
|
| Rate for Payer: Quartz Beloit One Network |
$394.94
|
| Rate for Payer: Quartz Commercial |
$523.90
|
| Rate for Payer: Quartz Medicare Advantage |
$483.60
|
| Rate for Payer: The Alliance Commercial |
$3,224.00
|
| Rate for Payer: WEA Trust Commercial |
$443.30
|
| Rate for Payer: WPS Commercial |
$597.00
|
|
|
T-PLATE DISTAL TIBIA 3.5 3 HL 02.112.203S
|
Facility
|
OP
|
$4,879.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5384723
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,366.12 |
| Max. Negotiated Rate |
$19,516.00 |
| Rate for Payer: Aetna Commercial |
$4,391.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,195.94
|
| Rate for Payer: Aetna Managed Medicare |
$1,366.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,171.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,439.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,341.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,585.87
|
| Rate for Payer: Cash Price |
$1,463.70
|
| Rate for Payer: Cigna Commercial |
$4,488.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,730.29
|
| Rate for Payer: Health EOS Commercial |
$4,342.31
|
| Rate for Payer: HFN Commercial |
$4,488.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,659.25
|
| Rate for Payer: Multiplan Commercial |
$3,903.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,927.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,488.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,390.71
|
| Rate for Payer: Quartz Commercial |
$3,171.35
|
| Rate for Payer: Quartz Medicare Advantage |
$2,927.40
|
| Rate for Payer: The Alliance Commercial |
$19,516.00
|
| Rate for Payer: WEA Trust Commercial |
$2,683.45
|
| Rate for Payer: WPS Commercial |
$3,613.88
|
|
|
T-PLATE DISTAL TIBIA 3.5 3 HL 02.112.203S
|
Facility
|
IP
|
$4,879.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5384723
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,390.71 |
| Max. Negotiated Rate |
$4,488.68 |
| Rate for Payer: Aetna Commercial |
$4,391.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,195.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,585.87
|
| Rate for Payer: Cash Price |
$1,463.70
|
| Rate for Payer: Cigna Commercial |
$4,488.68
|
| Rate for Payer: Health EOS Commercial |
$4,342.31
|
| Rate for Payer: HFN Commercial |
$4,488.68
|
| Rate for Payer: Multiplan Commercial |
$3,903.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,927.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,488.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,390.71
|
| Rate for Payer: Quartz Commercial |
$2,927.40
|
| Rate for Payer: WEA Trust Commercial |
$2,683.45
|
| Rate for Payer: WPS Commercial |
$3,613.88
|
|
|
T-PLATE DISTAL TIBIA 3.5 5 HL 02.112.205S
|
Facility
|
IP
|
$7,265.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966378
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,559.85 |
| Max. Negotiated Rate |
$6,683.80 |
| Rate for Payer: Aetna Commercial |
$6,538.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,247.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,850.45
|
| Rate for Payer: Cash Price |
$2,179.50
|
| Rate for Payer: Cigna Commercial |
$6,683.80
|
| Rate for Payer: Health EOS Commercial |
$6,465.85
|
| Rate for Payer: HFN Commercial |
$6,683.80
|
| Rate for Payer: Multiplan Commercial |
$5,812.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,359.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,683.80
|
| Rate for Payer: Quartz Beloit One Network |
$3,559.85
|
| Rate for Payer: Quartz Commercial |
$4,359.00
|
| Rate for Payer: WEA Trust Commercial |
$3,995.75
|
| Rate for Payer: WPS Commercial |
$5,381.19
|
|
|
T-PLATE DISTAL TIBIA 3.5 5 HL 02.112.205S
|
Facility
|
OP
|
$7,265.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966378
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,034.20 |
| Max. Negotiated Rate |
$29,060.00 |
| Rate for Payer: Aetna Commercial |
$6,538.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,247.90
|
| Rate for Payer: Aetna Managed Medicare |
$2,034.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,722.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,632.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,487.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,850.45
|
| Rate for Payer: Cash Price |
$2,179.50
|
| Rate for Payer: Cigna Commercial |
$6,683.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,065.49
|
| Rate for Payer: Health EOS Commercial |
$6,465.85
|
| Rate for Payer: HFN Commercial |
$6,683.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,448.75
|
| Rate for Payer: Multiplan Commercial |
$5,812.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,359.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,683.80
|
| Rate for Payer: Quartz Beloit One Network |
$3,559.85
|
| Rate for Payer: Quartz Commercial |
$4,722.25
|
| Rate for Payer: Quartz Medicare Advantage |
$4,359.00
|
| Rate for Payer: The Alliance Commercial |
$29,060.00
|
| Rate for Payer: WEA Trust Commercial |
$3,995.75
|
| Rate for Payer: WPS Commercial |
$5,381.19
|
|
|
T-PLATE LCP 4.5 4HL 240.141
|
Facility
|
IP
|
$7,509.00
|
|
| Hospital Charge Code |
2967328
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,679.41 |
| Max. Negotiated Rate |
$6,908.28 |
| Rate for Payer: Aetna Commercial |
$6,758.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,457.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,979.77
|
| Rate for Payer: Cash Price |
$2,252.70
|
| Rate for Payer: Cigna Commercial |
$6,908.28
|
| Rate for Payer: Health EOS Commercial |
$6,683.01
|
| Rate for Payer: HFN Commercial |
$6,908.28
|
| Rate for Payer: Multiplan Commercial |
$6,007.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,505.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,908.28
|
| Rate for Payer: Quartz Beloit One Network |
$3,679.41
|
| Rate for Payer: Quartz Commercial |
$4,505.40
|
| Rate for Payer: WEA Trust Commercial |
$4,129.95
|
| Rate for Payer: WPS Commercial |
$5,561.92
|
|
|
T-PLATE LCP 4.5 4HL 240.141
|
Facility
|
OP
|
$7,509.00
|
|
| Hospital Charge Code |
2967328
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.52 |
| Max. Negotiated Rate |
$30,036.00 |
| Rate for Payer: Aetna Commercial |
$6,758.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,457.74
|
| Rate for Payer: Aetna Managed Medicare |
$2,102.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,880.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,754.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,604.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,979.77
|
| Rate for Payer: Cash Price |
$2,252.70
|
| Rate for Payer: Cigna Commercial |
$6,908.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,202.04
|
| Rate for Payer: Health EOS Commercial |
$6,683.01
|
| Rate for Payer: HFN Commercial |
$6,908.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,631.75
|
| Rate for Payer: Multiplan Commercial |
$6,007.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,505.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,908.28
|
| Rate for Payer: Quartz Beloit One Network |
$3,679.41
|
| Rate for Payer: Quartz Commercial |
$4,880.85
|
| Rate for Payer: Quartz Medicare Advantage |
$4,505.40
|
| Rate for Payer: The Alliance Commercial |
$30,036.00
|
| Rate for Payer: WEA Trust Commercial |
$4,129.95
|
| Rate for Payer: WPS Commercial |
$5,561.92
|
|
|
T-PLATE LCP 4.5 6HL 240.161
|
Facility
|
OP
|
$7,509.00
|
|
| Hospital Charge Code |
2967329
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.52 |
| Max. Negotiated Rate |
$30,036.00 |
| Rate for Payer: Aetna Commercial |
$6,758.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,457.74
|
| Rate for Payer: Aetna Managed Medicare |
$2,102.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,880.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,754.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,604.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,979.77
|
| Rate for Payer: Cash Price |
$2,252.70
|
| Rate for Payer: Cigna Commercial |
$6,908.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,202.04
|
| Rate for Payer: Health EOS Commercial |
$6,683.01
|
| Rate for Payer: HFN Commercial |
$6,908.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,631.75
|
| Rate for Payer: Multiplan Commercial |
$6,007.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,505.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,908.28
|
| Rate for Payer: Quartz Beloit One Network |
$3,679.41
|
| Rate for Payer: Quartz Commercial |
$4,880.85
|
| Rate for Payer: Quartz Medicare Advantage |
$4,505.40
|
| Rate for Payer: The Alliance Commercial |
$30,036.00
|
| Rate for Payer: WEA Trust Commercial |
$4,129.95
|
| Rate for Payer: WPS Commercial |
$5,561.92
|
|
|
T-PLATE LCP 4.5 6HL 240.161
|
Facility
|
IP
|
$7,509.00
|
|
| Hospital Charge Code |
2967329
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,679.41 |
| Max. Negotiated Rate |
$6,908.28 |
| Rate for Payer: Aetna Commercial |
$6,758.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,457.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,979.77
|
| Rate for Payer: Cash Price |
$2,252.70
|
| Rate for Payer: Cigna Commercial |
$6,908.28
|
| Rate for Payer: Health EOS Commercial |
$6,683.01
|
| Rate for Payer: HFN Commercial |
$6,908.28
|
| Rate for Payer: Multiplan Commercial |
$6,007.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,505.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,908.28
|
| Rate for Payer: Quartz Beloit One Network |
$3,679.41
|
| Rate for Payer: Quartz Commercial |
$4,505.40
|
| Rate for Payer: WEA Trust Commercial |
$4,129.95
|
| Rate for Payer: WPS Commercial |
$5,561.92
|
|
|
T-PLATE LCP 4.5 8HL 240.181
|
Facility
|
IP
|
$7,509.00
|
|
| Hospital Charge Code |
2967330
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,679.41 |
| Max. Negotiated Rate |
$6,908.28 |
| Rate for Payer: Aetna Commercial |
$6,758.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,457.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,979.77
|
| Rate for Payer: Cash Price |
$2,252.70
|
| Rate for Payer: Cigna Commercial |
$6,908.28
|
| Rate for Payer: Health EOS Commercial |
$6,683.01
|
| Rate for Payer: HFN Commercial |
$6,908.28
|
| Rate for Payer: Multiplan Commercial |
$6,007.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,505.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,908.28
|
| Rate for Payer: Quartz Beloit One Network |
$3,679.41
|
| Rate for Payer: Quartz Commercial |
$4,505.40
|
| Rate for Payer: WEA Trust Commercial |
$4,129.95
|
| Rate for Payer: WPS Commercial |
$5,561.92
|
|
|
T-PLATE LCP 4.5 8HL 240.181
|
Facility
|
OP
|
$7,509.00
|
|
| Hospital Charge Code |
2967330
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.52 |
| Max. Negotiated Rate |
$30,036.00 |
| Rate for Payer: Aetna Commercial |
$6,758.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,457.74
|
| Rate for Payer: Aetna Managed Medicare |
$2,102.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,880.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,754.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,604.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,979.77
|
| Rate for Payer: Cash Price |
$2,252.70
|
| Rate for Payer: Cigna Commercial |
$6,908.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,202.04
|
| Rate for Payer: Health EOS Commercial |
$6,683.01
|
| Rate for Payer: HFN Commercial |
$6,908.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,631.75
|
| Rate for Payer: Multiplan Commercial |
$6,007.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,505.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,908.28
|
| Rate for Payer: Quartz Beloit One Network |
$3,679.41
|
| Rate for Payer: Quartz Commercial |
$4,880.85
|
| Rate for Payer: Quartz Medicare Advantage |
$4,505.40
|
| Rate for Payer: The Alliance Commercial |
$30,036.00
|
| Rate for Payer: WEA Trust Commercial |
$4,129.95
|
| Rate for Payer: WPS Commercial |
$5,561.92
|
|
|
T-PLATE NARROW LOCK 2.7MM 2 X 5 HOLE 629782
|
Facility
|
OP
|
$5,064.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6185014
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,417.92 |
| Max. Negotiated Rate |
$20,256.00 |
| Rate for Payer: Aetna Commercial |
$4,557.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,355.04
|
| Rate for Payer: Aetna Managed Medicare |
$1,417.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,291.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,532.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,430.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,683.92
|
| Rate for Payer: Cash Price |
$1,519.20
|
| Rate for Payer: Cigna Commercial |
$4,658.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,833.81
|
| Rate for Payer: Health EOS Commercial |
$4,506.96
|
| Rate for Payer: HFN Commercial |
$4,658.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,798.00
|
| Rate for Payer: Multiplan Commercial |
$4,051.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,038.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,658.88
|
| Rate for Payer: Quartz Beloit One Network |
$2,481.36
|
| Rate for Payer: Quartz Commercial |
$3,291.60
|
| Rate for Payer: Quartz Medicare Advantage |
$3,038.40
|
| Rate for Payer: The Alliance Commercial |
$20,256.00
|
| Rate for Payer: WEA Trust Commercial |
$2,785.20
|
| Rate for Payer: WPS Commercial |
$3,750.90
|
|
|
T-PLATE NARROW LOCK 2.7MM 2 X 5 HOLE 629782
|
Facility
|
IP
|
$5,064.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6185014
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,481.36 |
| Max. Negotiated Rate |
$4,658.88 |
| Rate for Payer: Aetna Commercial |
$4,557.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,355.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,683.92
|
| Rate for Payer: Cash Price |
$1,519.20
|
| Rate for Payer: Cigna Commercial |
$4,658.88
|
| Rate for Payer: Health EOS Commercial |
$4,506.96
|
| Rate for Payer: HFN Commercial |
$4,658.88
|
| Rate for Payer: Multiplan Commercial |
$4,051.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,038.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,658.88
|
| Rate for Payer: Quartz Beloit One Network |
$2,481.36
|
| Rate for Payer: Quartz Commercial |
$3,038.40
|
| Rate for Payer: WEA Trust Commercial |
$2,785.20
|
| Rate for Payer: WPS Commercial |
$3,750.90
|
|
|
T-PLATE NARROW LOCK 2.7MM 3 X 10 HOLE 629785
|
Facility
|
IP
|
$5,657.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685716
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,771.93 |
| Max. Negotiated Rate |
$5,204.44 |
| Rate for Payer: Aetna Commercial |
$5,091.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,865.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,998.21
|
| Rate for Payer: Cash Price |
$1,697.10
|
| Rate for Payer: Cigna Commercial |
$5,204.44
|
| Rate for Payer: Health EOS Commercial |
$5,034.73
|
| Rate for Payer: HFN Commercial |
$5,204.44
|
| Rate for Payer: Multiplan Commercial |
$4,525.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,394.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,204.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,771.93
|
| Rate for Payer: Quartz Commercial |
$3,394.20
|
| Rate for Payer: WEA Trust Commercial |
$3,111.35
|
| Rate for Payer: WPS Commercial |
$4,190.14
|
|
|
T-PLATE NARROW LOCK 2.7MM 3 X 10 HOLE 629785
|
Facility
|
OP
|
$5,657.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685716
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,583.96 |
| Max. Negotiated Rate |
$22,628.00 |
| Rate for Payer: Aetna Commercial |
$5,091.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,865.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,583.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,677.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,828.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,715.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,998.21
|
| Rate for Payer: Cash Price |
$1,697.10
|
| Rate for Payer: Cigna Commercial |
$5,204.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,165.66
|
| Rate for Payer: Health EOS Commercial |
$5,034.73
|
| Rate for Payer: HFN Commercial |
$5,204.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,242.75
|
| Rate for Payer: Multiplan Commercial |
$4,525.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,394.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,204.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,771.93
|
| Rate for Payer: Quartz Commercial |
$3,677.05
|
| Rate for Payer: Quartz Medicare Advantage |
$3,394.20
|
| Rate for Payer: The Alliance Commercial |
$22,628.00
|
| Rate for Payer: WEA Trust Commercial |
$3,111.35
|
| Rate for Payer: WPS Commercial |
$4,190.14
|
|
|
T-PLATE OBLIQUE 3HL 241.23
|
Facility
|
OP
|
$799.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967331
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$223.72 |
| Max. Negotiated Rate |
$3,196.00 |
| Rate for Payer: Aetna Commercial |
$719.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$687.14
|
| Rate for Payer: Aetna Managed Medicare |
$223.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$519.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$399.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$383.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$423.47
|
| Rate for Payer: Cash Price |
$239.70
|
| Rate for Payer: Cigna Commercial |
$735.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$447.12
|
| Rate for Payer: Health EOS Commercial |
$711.11
|
| Rate for Payer: HFN Commercial |
$735.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$599.25
|
| Rate for Payer: Multiplan Commercial |
$639.20
|
| Rate for Payer: NAPHCARE Commercial |
$479.40
|
| Rate for Payer: Preferred Network Access Commercial |
$735.08
|
| Rate for Payer: Quartz Beloit One Network |
$391.51
|
| Rate for Payer: Quartz Commercial |
$519.35
|
| Rate for Payer: Quartz Medicare Advantage |
$479.40
|
| Rate for Payer: The Alliance Commercial |
$3,196.00
|
| Rate for Payer: WEA Trust Commercial |
$439.45
|
| Rate for Payer: WPS Commercial |
$591.82
|
|
|
T-PLATE OBLIQUE 3HL 241.23
|
Facility
|
IP
|
$799.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967331
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$391.51 |
| Max. Negotiated Rate |
$735.08 |
| Rate for Payer: Aetna Commercial |
$719.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$687.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$423.47
|
| Rate for Payer: Cash Price |
$239.70
|
| Rate for Payer: Cigna Commercial |
$735.08
|
| Rate for Payer: Health EOS Commercial |
$711.11
|
| Rate for Payer: HFN Commercial |
$735.08
|
| Rate for Payer: Multiplan Commercial |
$639.20
|
| Rate for Payer: NAPHCARE Commercial |
$479.40
|
| Rate for Payer: Preferred Network Access Commercial |
$735.08
|
| Rate for Payer: Quartz Beloit One Network |
$391.51
|
| Rate for Payer: Quartz Commercial |
$479.40
|
| Rate for Payer: WEA Trust Commercial |
$439.45
|
| Rate for Payer: WPS Commercial |
$591.82
|
|
|
T-PLATE OBLIQUE 5HL 241.25
|
Facility
|
IP
|
$730.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967332
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$357.70 |
| Max. Negotiated Rate |
$671.60 |
| Rate for Payer: Aetna Commercial |
$657.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$627.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$386.90
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cigna Commercial |
$671.60
|
| Rate for Payer: Health EOS Commercial |
$649.70
|
| Rate for Payer: HFN Commercial |
$671.60
|
| Rate for Payer: Multiplan Commercial |
$584.00
|
| Rate for Payer: NAPHCARE Commercial |
$438.00
|
| Rate for Payer: Preferred Network Access Commercial |
$671.60
|
| Rate for Payer: Quartz Beloit One Network |
$357.70
|
| Rate for Payer: Quartz Commercial |
$438.00
|
| Rate for Payer: WEA Trust Commercial |
$401.50
|
| Rate for Payer: WPS Commercial |
$540.71
|
|
|
T-PLATE OBLIQUE 5HL 241.25
|
Facility
|
OP
|
$730.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967332
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$204.40 |
| Max. Negotiated Rate |
$2,920.00 |
| Rate for Payer: Aetna Commercial |
$657.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$627.80
|
| Rate for Payer: Aetna Managed Medicare |
$204.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$474.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$365.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$350.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$386.90
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cigna Commercial |
$671.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$408.51
|
| Rate for Payer: Health EOS Commercial |
$649.70
|
| Rate for Payer: HFN Commercial |
$671.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$547.50
|
| Rate for Payer: Multiplan Commercial |
$584.00
|
| Rate for Payer: NAPHCARE Commercial |
$438.00
|
| Rate for Payer: Preferred Network Access Commercial |
$671.60
|
| Rate for Payer: Quartz Beloit One Network |
$357.70
|
| Rate for Payer: Quartz Commercial |
$474.50
|
| Rate for Payer: Quartz Medicare Advantage |
$438.00
|
| Rate for Payer: The Alliance Commercial |
$2,920.00
|
| Rate for Payer: WEA Trust Commercial |
$401.50
|
| Rate for Payer: WPS Commercial |
$540.71
|
|
|
TPMT Activity
|
Facility
|
OP
|
$564.00
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
5438799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.17 |
| Max. Negotiated Rate |
$518.88 |
| Rate for Payer: Aetna Commercial |
$507.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$485.04
|
| Rate for Payer: Aetna Managed Medicare |
$22.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$83.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$38.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$36.80
|
| Rate for Payer: Anthem Medicaid |
$22.91
|
| Rate for Payer: Anthem Medicare Advantage |
$22.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$298.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22.17
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Cigna Commercial |
$518.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$22.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$22.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$315.61
|
| Rate for Payer: Dean Health Medicaid |
$22.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$22.17
|
| Rate for Payer: Health EOS Commercial |
$501.96
|
| Rate for Payer: HFN Commercial |
$518.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$82.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22.17
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$22.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22.17
|
| Rate for Payer: Managed Health Services Medicaid |
$23.83
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$22.17
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$22.17
|
| Rate for Payer: Multiplan Commercial |
$451.20
|
| Rate for Payer: NAPHCARE Commercial |
$33.26
|
| Rate for Payer: Preferred Network Access Commercial |
$518.88
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$22.91
|
| Rate for Payer: Quartz Beloit One Network |
$276.36
|
| Rate for Payer: Quartz Commercial |
$366.60
|
| Rate for Payer: Quartz Medicare Advantage |
$22.17
|
| Rate for Payer: The Alliance Commercial |
$88.68
|
| Rate for Payer: United Healthcare Medicaid |
$22.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.17
|
| Rate for Payer: United Healthcare PPO |
$423.00
|
| Rate for Payer: WEA Trust Commercial |
$310.20
|
| Rate for Payer: Wellcare Medicare |
$22.17
|
| Rate for Payer: WMAP Medicaid |
$22.91
|
| Rate for Payer: WPS Commercial |
$417.75
|
|
