|
Tox Scr Serum
|
Professional
|
$594.00
|
|
|
Service Code
|
CPT 80329
|
| Hospital Charge Code |
979884
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.06 |
| Max. Negotiated Rate |
$564.30 |
| Rate for Payer: Aetna Commercial |
$564.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$510.84
|
| Rate for Payer: Cash Price |
$178.20
|
| Rate for Payer: Cash Price |
$178.20
|
| Rate for Payer: Cigna Commercial |
$564.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$297.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$356.40
|
| Rate for Payer: Health EOS Commercial |
$540.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$80.06
|
| Rate for Payer: Multiplan Commercial |
$475.20
|
| Rate for Payer: Preferred Network Access Commercial |
$564.30
|
| Rate for Payer: Quartz Beloit One Network |
$261.36
|
| Rate for Payer: Quartz Commercial |
$338.58
|
| Rate for Payer: The Alliance Commercial |
$297.00
|
| Rate for Payer: WEA Trust Commercial |
$326.70
|
| Rate for Payer: WPS Commercial |
$439.98
|
|
|
T-PLATE 1.3MM 3H HEAD/8H SHAFT 221.333
|
Facility
IP
|
$3,201.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508594
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,568.49 |
| Max. Negotiated Rate |
$2,944.92 |
| Rate for Payer: Aetna Commercial |
$2,880.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,696.53
|
| Rate for Payer: Cash Price |
$960.30
|
| Rate for Payer: Cigna Commercial |
$2,944.92
|
| Rate for Payer: Health EOS Commercial |
$2,848.89
|
| Rate for Payer: HFN Commercial |
$2,944.92
|
| Rate for Payer: Multiplan Commercial |
$2,560.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,920.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,944.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,568.49
|
| Rate for Payer: Quartz Commercial |
$1,920.60
|
| Rate for Payer: WEA Trust Commercial |
$1,760.55
|
| Rate for Payer: WPS Commercial |
$2,370.98
|
|
|
T-PLATE 1.3MM 3H HEAD/8H SHAFT 221.333
|
Facility
OP
|
$3,201.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508594
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$896.28 |
| Max. Negotiated Rate |
$2,944.92 |
| Rate for Payer: Aetna Commercial |
$2,880.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,752.86
|
| Rate for Payer: Aetna Managed Medicare |
$896.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,080.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,600.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,536.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,696.53
|
| Rate for Payer: Cash Price |
$960.30
|
| Rate for Payer: Cigna Commercial |
$2,944.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,791.28
|
| Rate for Payer: Health EOS Commercial |
$2,848.89
|
| Rate for Payer: HFN Commercial |
$2,944.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,400.75
|
| Rate for Payer: Multiplan Commercial |
$2,560.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,920.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,944.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,568.49
|
| Rate for Payer: Quartz Commercial |
$2,080.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,920.60
|
| Rate for Payer: WEA Trust Commercial |
$1,760.55
|
| Rate for Payer: WPS Commercial |
$2,370.98
|
|
|
T-PLATE 2.0 2HEAD 7HL 247.351
|
Facility
OP
|
$3,944.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767801
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,104.32 |
| Max. Negotiated Rate |
$3,628.48 |
| Rate for Payer: Aetna Commercial |
$3,549.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,391.84
|
| Rate for Payer: Aetna Managed Medicare |
$1,104.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,563.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,972.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,893.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,090.32
|
| Rate for Payer: Cash Price |
$1,183.20
|
| Rate for Payer: Cigna Commercial |
$3,628.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,207.06
|
| Rate for Payer: Health EOS Commercial |
$3,510.16
|
| Rate for Payer: HFN Commercial |
$3,628.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,958.00
|
| Rate for Payer: Multiplan Commercial |
$3,155.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,366.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,628.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,932.56
|
| Rate for Payer: Quartz Commercial |
$2,563.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2,366.40
|
| Rate for Payer: WEA Trust Commercial |
$2,169.20
|
| Rate for Payer: WPS Commercial |
$2,921.32
|
|
|
T-PLATE 2.0 2HEAD 7HL 247.351
|
Facility
IP
|
$3,944.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767801
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,932.56 |
| Max. Negotiated Rate |
$3,628.48 |
| Rate for Payer: Aetna Commercial |
$3,549.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,090.32
|
| Rate for Payer: Cash Price |
$1,183.20
|
| Rate for Payer: Cigna Commercial |
$3,628.48
|
| Rate for Payer: Health EOS Commercial |
$3,510.16
|
| Rate for Payer: HFN Commercial |
$3,628.48
|
| Rate for Payer: Multiplan Commercial |
$3,155.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,366.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,628.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,932.56
|
| Rate for Payer: Quartz Commercial |
$2,366.40
|
| Rate for Payer: WEA Trust Commercial |
$2,169.20
|
| Rate for Payer: WPS Commercial |
$2,921.32
|
|
|
T-PLATE 2.4MM 2HL HEAD/8LH SHAFT 249.913
|
Facility
OP
|
$4,354.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508773
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,219.12 |
| Max. Negotiated Rate |
$4,005.68 |
| Rate for Payer: Aetna Commercial |
$3,918.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,744.44
|
| Rate for Payer: Aetna Managed Medicare |
$1,219.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,830.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,177.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,089.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,307.62
|
| Rate for Payer: Cash Price |
$1,306.20
|
| Rate for Payer: Cigna Commercial |
$4,005.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,436.50
|
| Rate for Payer: Health EOS Commercial |
$3,875.06
|
| Rate for Payer: HFN Commercial |
$4,005.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,265.50
|
| Rate for Payer: Multiplan Commercial |
$3,483.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,612.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,005.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,133.46
|
| Rate for Payer: Quartz Commercial |
$2,830.10
|
| Rate for Payer: Quartz Medicare Advantage |
$2,612.40
|
| Rate for Payer: WEA Trust Commercial |
$2,394.70
|
| Rate for Payer: WPS Commercial |
$3,225.01
|
|
|
T-PLATE 2.4MM 2HL HEAD/8LH SHAFT 249.913
|
Facility
IP
|
$4,354.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508773
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,133.46 |
| Max. Negotiated Rate |
$4,005.68 |
| Rate for Payer: Aetna Commercial |
$3,918.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,307.62
|
| Rate for Payer: Cash Price |
$1,306.20
|
| Rate for Payer: Cigna Commercial |
$4,005.68
|
| Rate for Payer: Health EOS Commercial |
$3,875.06
|
| Rate for Payer: HFN Commercial |
$4,005.68
|
| Rate for Payer: Multiplan Commercial |
$3,483.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,612.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,005.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,133.46
|
| Rate for Payer: Quartz Commercial |
$2,612.40
|
| Rate for Payer: WEA Trust Commercial |
$2,394.70
|
| Rate for Payer: WPS Commercial |
$3,225.01
|
|
|
T-PLATE 2.4MM 3HL HEAD/8HL SHAFT 249.914
|
Facility
IP
|
$4,633.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508774
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,270.17 |
| Max. Negotiated Rate |
$4,262.36 |
| Rate for Payer: Aetna Commercial |
$4,169.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,455.49
|
| Rate for Payer: Cash Price |
$1,389.90
|
| Rate for Payer: Cigna Commercial |
$4,262.36
|
| Rate for Payer: Health EOS Commercial |
$4,123.37
|
| Rate for Payer: HFN Commercial |
$4,262.36
|
| Rate for Payer: Multiplan Commercial |
$3,706.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,779.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,262.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,270.17
|
| Rate for Payer: Quartz Commercial |
$2,779.80
|
| Rate for Payer: WEA Trust Commercial |
$2,548.15
|
| Rate for Payer: WPS Commercial |
$3,431.66
|
|
|
T-PLATE 2.4MM 3HL HEAD/8HL SHAFT 249.914
|
Facility
OP
|
$4,633.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508774
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,297.24 |
| Max. Negotiated Rate |
$4,262.36 |
| Rate for Payer: Aetna Commercial |
$4,169.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,984.38
|
| Rate for Payer: Aetna Managed Medicare |
$1,297.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,011.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,316.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,223.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,455.49
|
| Rate for Payer: Cash Price |
$1,389.90
|
| Rate for Payer: Cigna Commercial |
$4,262.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,592.63
|
| Rate for Payer: Health EOS Commercial |
$4,123.37
|
| Rate for Payer: HFN Commercial |
$4,262.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,474.75
|
| Rate for Payer: Multiplan Commercial |
$3,706.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,779.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,262.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,270.17
|
| Rate for Payer: Quartz Commercial |
$3,011.45
|
| Rate for Payer: Quartz Medicare Advantage |
$2,779.80
|
| Rate for Payer: WEA Trust Commercial |
$2,548.15
|
| Rate for Payer: WPS Commercial |
$3,431.66
|
|
|
T-PLATE 2.7 3HL SMALL 242.41
|
Facility
IP
|
$828.00
|
|
| Hospital Charge Code |
2967327
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$405.72 |
| Max. Negotiated Rate |
$761.76 |
| Rate for Payer: Aetna Commercial |
$745.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$438.84
|
| Rate for Payer: Cash Price |
$248.40
|
| Rate for Payer: Cigna Commercial |
$761.76
|
| Rate for Payer: Health EOS Commercial |
$736.92
|
| Rate for Payer: HFN Commercial |
$761.76
|
| Rate for Payer: Multiplan Commercial |
$662.40
|
| Rate for Payer: NAPHCARE Commercial |
$496.80
|
| Rate for Payer: Preferred Network Access Commercial |
$761.76
|
| Rate for Payer: Quartz Beloit One Network |
$405.72
|
| Rate for Payer: Quartz Commercial |
$496.80
|
| Rate for Payer: WEA Trust Commercial |
$455.40
|
| Rate for Payer: WPS Commercial |
$613.30
|
|
|
T-PLATE 2.7 3HL SMALL 242.41
|
Facility
OP
|
$828.00
|
|
| Hospital Charge Code |
2967327
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.84 |
| Max. Negotiated Rate |
$3,312.00 |
| Rate for Payer: Aetna Commercial |
$745.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$712.08
|
| Rate for Payer: Aetna Managed Medicare |
$231.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$538.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$414.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$397.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$438.84
|
| Rate for Payer: Cash Price |
$248.40
|
| Rate for Payer: Cigna Commercial |
$761.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$463.35
|
| Rate for Payer: Health EOS Commercial |
$736.92
|
| Rate for Payer: HFN Commercial |
$761.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$621.00
|
| Rate for Payer: Multiplan Commercial |
$662.40
|
| Rate for Payer: NAPHCARE Commercial |
$496.80
|
| Rate for Payer: Preferred Network Access Commercial |
$761.76
|
| Rate for Payer: Quartz Beloit One Network |
$405.72
|
| Rate for Payer: Quartz Commercial |
$538.20
|
| Rate for Payer: Quartz Medicare Advantage |
$496.80
|
| Rate for Payer: The Alliance Commercial |
$3,312.00
|
| Rate for Payer: WEA Trust Commercial |
$455.40
|
| Rate for Payer: WPS Commercial |
$613.30
|
|
|
T-PLATE 2.7 LCP 2HL HEAD/3HL SHAFT 249.685
|
Facility
OP
|
$4,923.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767804
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,378.44 |
| Max. Negotiated Rate |
$4,529.16 |
| Rate for Payer: Aetna Commercial |
$4,430.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,233.78
|
| Rate for Payer: Aetna Managed Medicare |
$1,378.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,199.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,461.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,363.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,609.19
|
| Rate for Payer: Cash Price |
$1,476.90
|
| Rate for Payer: Cigna Commercial |
$4,529.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,754.91
|
| Rate for Payer: Health EOS Commercial |
$4,381.47
|
| Rate for Payer: HFN Commercial |
$4,529.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,692.25
|
| Rate for Payer: Multiplan Commercial |
$3,938.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,953.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,529.16
|
| Rate for Payer: Quartz Beloit One Network |
$2,412.27
|
| Rate for Payer: Quartz Commercial |
$3,199.95
|
| Rate for Payer: Quartz Medicare Advantage |
$2,953.80
|
| Rate for Payer: WEA Trust Commercial |
$2,707.65
|
| Rate for Payer: WPS Commercial |
$3,646.47
|
|
|
T-PLATE 2.7 LCP 2HL HEAD/3HL SHAFT 249.685
|
Facility
IP
|
$4,923.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767804
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,412.27 |
| Max. Negotiated Rate |
$4,529.16 |
| Rate for Payer: Aetna Commercial |
$4,430.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,609.19
|
| Rate for Payer: Cash Price |
$1,476.90
|
| Rate for Payer: Cigna Commercial |
$4,529.16
|
| Rate for Payer: Health EOS Commercial |
$4,381.47
|
| Rate for Payer: HFN Commercial |
$4,529.16
|
| Rate for Payer: Multiplan Commercial |
$3,938.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,953.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,529.16
|
| Rate for Payer: Quartz Beloit One Network |
$2,412.27
|
| Rate for Payer: Quartz Commercial |
$2,953.80
|
| Rate for Payer: WEA Trust Commercial |
$2,707.65
|
| Rate for Payer: WPS Commercial |
$3,646.47
|
|
|
T-PLATE 2.7 LCP 2HL HEAD/4HL SHAFT 249.697
|
Facility
OP
|
$4,923.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767805
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,378.44 |
| Max. Negotiated Rate |
$4,529.16 |
| Rate for Payer: Aetna Commercial |
$4,430.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,233.78
|
| Rate for Payer: Aetna Managed Medicare |
$1,378.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,199.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,461.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,363.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,609.19
|
| Rate for Payer: Cash Price |
$1,476.90
|
| Rate for Payer: Cigna Commercial |
$4,529.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,754.91
|
| Rate for Payer: Health EOS Commercial |
$4,381.47
|
| Rate for Payer: HFN Commercial |
$4,529.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,692.25
|
| Rate for Payer: Multiplan Commercial |
$3,938.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,953.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,529.16
|
| Rate for Payer: Quartz Beloit One Network |
$2,412.27
|
| Rate for Payer: Quartz Commercial |
$3,199.95
|
| Rate for Payer: Quartz Medicare Advantage |
$2,953.80
|
| Rate for Payer: WEA Trust Commercial |
$2,707.65
|
| Rate for Payer: WPS Commercial |
$3,646.47
|
|
|
T-PLATE 2.7 LCP 2HL HEAD/4HL SHAFT 249.697
|
Facility
IP
|
$4,923.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767805
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,412.27 |
| Max. Negotiated Rate |
$4,529.16 |
| Rate for Payer: Aetna Commercial |
$4,430.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,609.19
|
| Rate for Payer: Cash Price |
$1,476.90
|
| Rate for Payer: Cigna Commercial |
$4,529.16
|
| Rate for Payer: Health EOS Commercial |
$4,381.47
|
| Rate for Payer: HFN Commercial |
$4,529.16
|
| Rate for Payer: Multiplan Commercial |
$3,938.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,953.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,529.16
|
| Rate for Payer: Quartz Beloit One Network |
$2,412.27
|
| Rate for Payer: Quartz Commercial |
$2,953.80
|
| Rate for Payer: WEA Trust Commercial |
$2,707.65
|
| Rate for Payer: WPS Commercial |
$3,646.47
|
|
|
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: 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 |
$715.76 |
| 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: 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: 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: 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 |
$741.52 |
| 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: 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 |
$4,488.68 |
| 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: 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: 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: 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 |
$6,683.80 |
| 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: WEA Trust Commercial |
$3,995.75
|
| Rate for Payer: WPS Commercial |
$5,381.19
|
|
